We reviewed the present status of our understanding of the various methods of vocal rehabilitation after total laryngectomy with respect to the vibrating portion.
In a pneumolarynx with a rubber membrane, the vocal intensity and the phonating duration can be controlled easily, but it is difficult, although not impossible, to control the vocal pitch. An electrolarynx produces monotonous and noisy sound during phonation, and its vocal control ability is poor at present.
In tracheoesophageal shunt speech and injected esophageal speech, the mucosal membrane vibrates to produce sound at the so called “neoglottis” level. Many authors have stressed the importance of a proper tonicity of the pharyngo-esophageal segment for good voice production. However, there is no conclusive evidence that the vibrating status correlates with speech skill. Voice quality in both speaking methods is a little poorer than in tracheopharyngeal speech, and injected esophageal speech has the added disadvantage of the short duration of phonation.
From the viewpoints of voice quality, vocal control and articulation, tracheopharyngeal shunt speech is considered to be the best method at present, even though it is difficult to control the vocal pitch.
We suppose that the ability to control the vocal pitch would provide one of the most important improvements for vocal rehabilitation following total laryngectomy.