Merck Manual

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Speech Without Vocal Cords

Speech Without Vocal Cords

Speech requires a source of sound waves (vibrations) and a means of shaping those vibrations into words. The vocal cords normally provide the vibrations, which are then shaped into words by the tongue, palate, and lips. People whose vocal cords have been removed can regain their voice if a new source of sound vibrations can be provided because their tongue, palate, and lips remain able to shape these new vibrations into words.

There are three ways that people with no larynx can produce sound vibrations. In all three techniques, sound changes into speech through the throat (pharynx), palate, tongue, teeth, and lips.

Esophageal speech

  • No surgery or mechanical accessories required

  • Person taught to swallow air into the esophagus (pathway from the throat to the stomach) and expel the air (as in a belch) to produce a sound

  • Difficult to learn and may be hard for other people to understand

Tracheoesophageal puncture

  • One-way valve inserted in surgically created hole between the windpipe (trachea) and the esophagus

  • Air enters the windpipe (trachea) through an opening in the front of the neck (stoma)

  • Speech produced with air diverted into the esophagus through the valve while the person exhales

  • Requires significant practice and training

  • Often eventually produces easy and fluent speech

  • Valve requires daily cleaning and needs to be replaced after many months

  • With some valves, person must block the opening in the windpipe with a finger to speak

  • Risk of fluids or food accidentally entering the windpipe if the valve malfunctions


  • Battery-powered vibrating device that acts as a sound source when held against the neck

  • Produces an artificial, mechanical sound

  • Easier to use and understand than esophageal speech

  • Requires batteries and must be carried with the person

  • Requires little or no training

  • Can carry a great deal of social stigma for many people