If you have had some, or all, of your larynx removed (laryngectomy), it's likely that you'll need to spend one or two days in an intensive care unit (ICU) until your body has recovered from the effects of the surgery.
You won't be able to eat until your throat has healed, which for most people is between 7 and 14 days. During this time, you'll need to be fed with a tube that's placed down your nose and into your stomach. However, in a small number of people, recovery can take several months.
If you've had all of your larynx removed, you won't be able to speak normally because you will no longer have any vocal cords (the tissue that's used to generate sound). A number of techniques can be used to replicate the functions of your vocal cords (see below), although they can take several weeks or months to learn.
Therefore, it's likely that you'll need to use alternative methods of communicating during the first few weeks or months after surgery. For example, using a pen and paper or lip reading. This can be a frustrating experience and the loss of an ability that you've previously taken for granted can be difficult to cope with.
Prepare yourself for people who you don't know reacting to you in unpredictable or sometimes upsetting ways. For example, many people who have had a laryngectomy have reported that people sometimes assume that they're deaf or have a learning difficulty due to their inability to speak.
Emotional impact
The emotional impact of living with a laryngectomy can be significant. Many people report experiencing a kind of roller-coaster effect.
For example, you may feel down when laryngeal cancer is diagnosed, then feel up after the cancer has been removed, then feel down again as you try to come to terms with the practicalities of living with a laryngectomy. This type of emotional disruption can sometimes trigger feelings of depression. You may be depressed if:
- you have felt very down during the past month
- you no longer take pleasure in doing the things that you enjoy
Contact your GP for advice if you think that you may be depressed. There are a range of effective treatments for depression, such as antidepressant medication and talking therapies, such as cognitive behavioural therapy.
The National Association of Laryngectomee Clubs (NALC) is another useful resource for people who are trying to come to terms with living with a laryngectomy. NALC is a patient support group that provides support and advice about all aspects of living with a laryngectomy.
Stoma care
If you've had all of your larynx removed (total laryngectomy) the surgeon will need to create a permanent hole in your throat through which you will breathe (a stoma). During the first few months after surgery, it's likely that your stoma will produce a lot of mucus, particularly if you've had radiotherapy.
Excessive mucus can cause breathing difficulties, so a tube may be attached to your stoma to help you breathe more easily. Once the production of mucus has settled down the tube can be removed.
It's important to clean your stoma at least once a day otherwise it can become crusty and may become vulnerable to infection. This can be done using a cotton bud and freshly boiled water that's then cooled.
Alternatively, the ear nose and throat (ENT) department of your local hospital will be able to give you cleaning solutions. An ENT nurse will be able to train you in how to keep your stoma clean. Your ENT department also has filters that can help to keep your stoma moist and free of germs.
It's important to remember that you'll need to cover your stoma with a tissue when you cough or sneeze, rather than covering your mouth or nose. This is because mucus or saliva will come out of your stoma.
Vocal restoration
If your larynx has been completely removed as part of your treatment for laryngeal cancer, you'll need additional treatment to help restore your voice. This is because you will no longer have any vocal cords, so you won't be able to produce sound in the normal way.
Before your laryngectomy, you may meet a speech and language therapist (SLT) to discuss possible treatment options for restoring your voice. A SLT is a healthcare professional who specialises in helping people who have difficulties speaking and using language.
There are several different treatment options, which are briefly outlined below.
Voice prosthesis
A voice prosthesis is an artificial valve that can be implanted into your neck when you have a laryngectomy. When you want to speak, you cover the stoma and breathe out through the valve.
The valve produces a noise which you can use to make words by moving your lips and mouth in the usual way. The voice that's produced by the valve sounds natural although it may be lower pitched than your previous voice.
Oesophageal speech
Oesophageal speech is a technique for speaking that your SLT can teach you. It involves learning to push through your oesophagus (gullet). As the air moves through your oesophagus it vibrates and makes a noise. You can produce words by moving your lips and mouth.
Some people find it quite easy to learn oesophageal speech, whereas others find it difficult. Regular practice by yourself and with your SLT can help you to improve.
Electropharynx
An electropharynx is a small electrical device that vibrates and produces sound. You hold the device under your chin, and as you move your mouth and lips the vibrations translate into spoken words. Your SLT can train you to use an electropharynx.
