It’s not a myth or science fiction that you can speak without a throat, it’s a fact.
Everyone has a throat, so why do some people lose it? How can a “laryngectomees” speak?
The culprit of larynxlessness is tumor.
”Professor Su, why do they have no throats?” I asked, pointing to the crowd in the hall who were talking in various tones.
”It is the need of the condition. Normally, advanced malignant tumors of the larynx and hypopharynx must be removed completely. Malignant tumors of the larynx account for about 1-5% of malignant tumors in the whole body, among which laryngeal cancer is the most common. Of course, total laryngectomy is not necessary for early stage laryngeal cancer.”
”Since total laryngectomy is not necessary for early stage laryngeal cancer, how can laryngeal cancer be detected early?” I think this should also be a concern of the readers.
”The question you raised is very meaningful. Although our technology can make it possible for people without larynx to speak, total laryngectomy, which can be avoided, is what we are looking for. The detection of early laryngeal cancer requires the cooperation of the patient, i.e., vigilance. Vocal hilar type laryngeal cancer, because the lesion is in the vocal cords, early laryngeal cancer will have voice changes, such as hoarseness that is not easily cured, easy to pronounce tiredness, and occasional bloody sputum. Therefore, those who are over 40 years old, especially those who are addicted to smoking and alcohol, and have hoarseness for more than 3 weeks without improvement after treatment, must be carefully examined by laryngoscopy. However, if the tumor grows in the supraglottis or infraglottis, the symptoms of hoarseness are not obvious. It is more difficult to detect these types of larynx at an early stage, and patients often come to the clinic with symptoms such as dyspnea and coughing up blood, when laryngeal cancer is often at an advanced stage. Late stage laryngeal cancer requires total laryngectomy in order to completely remove the tumor.”
Professor Su continued, “For patients who undergo total laryngectomy, improving their post-operative quality of life is a very real clinical problem because, the ‘speechless’ ending is very painful and the patient’s quality of life will be drastically reduced as a result. Early diagnosis and correct first treatment are extremely important to improve survival.”
With his own clinical experience, Prof. Su cites individual cases 10, 15 or even more years after surgery who are now living normal lives, and some are still good in business or active in leadership positions.
Wonderful hands for laryngeal reconstruction.
”Since not every laryngeal cancer patient needs a total laryngectomy, what are the specific ways to treat laryngeal cancer?” I asked.
”The treatment of laryngeal cancer includes surgery, radiotherapy, chemotherapy and immunotherapy,” Prof. Su talked about the treatment of laryngeal cancer as if he were a doctor, “The treatment plan is determined from various aspects, such as the primary part of the tumor, the extension, the biological characteristics of the tumor, the patient’s age, the patient’s general condition, the body’s immunity, the The treatment plan is determined from various aspects, such as the primary part of the tumor, the extent of expansion, the biological characteristics of the tumor, the patient’s age, the patient’s general condition, the immune system, the presence of lymph node metastasis and the requirement of voice. Surgery is the main treatment for laryngeal cancer, and we choose different surgical procedures according to the specific situation, such as partial laryngectomy, subtotal laryngectomy and near-total laryngectomy. The basic requirement of these surgeries is to preserve the laryngeal articulation, breathing and anti-misopharyngeal functions while removing the tumor as much as possible, in order to maintain the patient’s quality of life.
”In China, laryngeal surgeons have considerable clinical experience and high surgical standards in this area. For example, in partial laryngectomy, although the patient loses one or both vocal cords, if the surgeon applies the surgical technique well and uses the ‘vocal cords’ formed by the tissues in the larynx to reconstruct the new vocal folds, the quality of his or her postoperative articulation can be improved. Before and after the surgery, radiotherapy, chemotherapy or immunotherapy are often supplemented according to the specific situation, which is often referred to as comprehensive treatment. For early stage vocal cord cancer, radical radiotherapy alone has good effect, and the effect on pronunciation after radiotherapy is less. Clinical experience shows that there is no significant difference between radiotherapy and surgery, and the 5-year survival rate is about 90%.
”Speaking without larynx, each one shows its own strengths.
”If a laryngeal cancer patient has a total laryngectomy and loses their entire throat, how do they speak?”
Professor Su walked me around the meeting room and said with a smile, “These are all laryngectomized people, look, aren’t they speaking well? In fact, the general belief that laryngectomized people cannot speak is completely understandable. There are also many clinical cases of advanced laryngeal cancer who would rather die than ‘cut’ for fear of losing their speech, that is, they refuse to have surgery. However, the inability of laryngectomees to speak has become history, and with medical staff teaching esophageal language, articulation tubes, electronic larynxes and trumpet transmitters, language recovery is only a matter of speed as long as one has confidence.”
I looked around the venue and noticed that the various tones of speech originated from different methods of pronunciation. “It seems that the laryngeal-free pronunciation is actually made by several methods mentioned above to make the mucous membrane and air in the pharyngeal cavity vibrate, and then processed by the nasal, pharyngeal, tongue, lips and other constructive speech organs tissues. Do you think so?” Professor Su nodded his head and said, “Basically,” and he said with great interest.
He said with great interest: “In order to rehabilitate the speech of people without a larynx, the choice of method is also important. This is one of the most convenient methods of articulation, which does not require reoperation or the use of a vocal device, and can be spoken with an open mouth and a good tone. However, patients who pronounce esophageal language must be trained systematically, have certain perseverance and endurance, and take a long time to master it gradually. In order to master the pronunciation of esophageal language, the consistency of language is poor at the beginning, and cannot speak longer sentences, and many factors will affect the pronunciation effect, such as too much damage to the laryngopharyngeal soft tissue, extensive scar formation, old age, weakness, lack of strength and poor cultural quality, etc. However, with experience, there is no shortage of people who use esophageal language to make cell phone calls, talk and even sing karaoke!
Professor Su pointed to an old man and said, “He is more suitable to use electronic larynx, although the sound is more monotonous mechanical, full of metallic taste, but convenient, simple and labor-saving, can talk for a long time, without special training can be used, almost every person without larynx can be applied. Look again, that well-dressed person is a manager, now running business all over the country, but rarely found to be a laryngeal person, he often puts his hand into the collar, in order to press the tracheal fistula in the neck, and press the gas in the trachea into the esophagus and hypopharynx through the articulatory tube. This kind of pronunciation maintains the original tone and coherent language, but the pronunciation tube must be kept clean and unobstructed, and the tube needs to be replaced again every 1~2 years, which is more expensive, and a few patients will also drool from the tube.”
In another corner of the venue, an old man, holding the thin end of the small tube in his mouth and pressing the thick end against the anterior cervical tracheal fistula, made a very special sound, attracting many curious onlookers. Professor Su told me that this is the “trumpet” loudspeaker, its structure is simple, inexpensive, speak when breathing smoothly, can talk for a long time, sound quality is still possible, the disadvantage is that the use of inconvenient, like holding a pipe needs to be fixed by hand, and because the tube through the side of the mouth into the pharynx, some must also remove a molar.
Professor Su concluded slightly: “There are many ways to make people without a larynx speak. Theoretically, they are applicable to all laryngectomized patients, but the choice of speech rehabilitation should be based on each individual’s age, physical condition, occupational characteristics, pharyngoesophageal surgery options and economic conditions. In the future, it is necessary for doctors to include the type and implementation of postoperative language rehabilitation within the medical plan before performing total laryngectomy for patients, that is, the medical model of diagnosis-surgery-language rehabilitation for laryngeal cancer”.
Self-improvement and mutual assistance, return to the community.
One person in the venue wearing a white patient costume caught my attention. He was thin and looked less than 20 years old. He wandered around the meeting with melancholy eyes, paying attention to the speech of the throatless man, and from his focused look, he seemed to want to learn something. Professor Su said to me, “This young man has been diagnosed with a malignant tumor of the larynx and will be the youngest of our patients to have a total laryngectomy – 19 years old and still a high school student, so I really feel a bit uncomfortable! Today, I made special arrangements for him to visit a laryngeal-free person to speak before surgery, hoping to strengthen his confidence in overcoming the disease.”
Readers, at this point, you may already feel that the speech of the “laryngectomees” is no longer a secret. However, the speech of the “laryngectomees” is only an improvement of their physiological functions, but the social functions are restored, and the social acceptance of them is not yet large. Therefore, Professor Su emphasized that the laryngectomees must increase their self-confidence to better participate in society. Medical professionals should also help them to rehabilitate their speech in an organized manner after treatment. The New Voice Club of Hong Kong is a private organization for the laryngectomees, sponsored by charitable organizations in the community, which holds regular activities and has friendly exchanges with corresponding organizations in China and abroad.
Professor Su concluded, “This event has been well received by the laryngectomees. We hope that the whole society will come to care about the language rehabilitation of laryngectomees and the self-improvement of laryngectomees to help each other and reintegrate into society.”
By the way, I would like to tell our readers that the 19-year-old boy introduced above has successfully completed the medical program of “diagnosis – total laryngectomy – post-operative radiotherapy – speech rehabilitation (esophageal language)”, and he may be included in the team of esophageal language specialists in the future.