The SLP Laryngectomy Speech Restoration Toolkit

Laryngectomy speech restoration is not a single pathway. It is a toolkit. Two patients can share the same diagnosis and still have very different capabilities based on the surgery performed, reconstruction choices, healing outcomes, anatomy, and dexterity. That variability is exactly why SLPs play such a central role in guiding patients through the available speech options and optimizing speech quality over time. The work is not about selecting a universally “best” device, but about matching tools to the patient in front of you, knowing that needs evolve over time and that no single option fits every anatomy or lifestyle.

One of the most important sources of variability is what was removed in addition to the larynx. Tongue resections, in particular, can significantly alter speech potential. Reduced lingual strength, range of motion, or coordination can make it difficult for patients to shape sound into clear, intelligible speech, even when an effective sound source is available. Consonant precision, vowel shaping, and overall clarity may require advanced therapy. In these cases, dentists who specialize in custom oral prosthetics can be an important and sometimes underutilized resource. Prosthetic designs that improve tongue reach, stabilize oral structures, or enhance contact surfaces can meaningfully influence intelligibility and ease of communication. Experienced SLP’s can help identify when these options are appropriate.

Artificial Larynx vs TEP

Artificial larynx devices work well in general and can produce clear, functional speech for many patients. Their primary tradeoff is practical. Most require the device to be held against a specific “sweet spot” on the neck to generate sound. This can be challenging for patients with limited dexterity, fatigue, sensory changes, or neck anatomy that makes consistent placement difficult. There is also a sound-quality consideration. Because traditional artificial larynxes offer limited variation in pitch, frequency, and prosody, the resulting voice is often perceived as robotic. Intelligibility may be good, but expressiveness and naturalness can be harder to achieve.

Another challenge SLPs frequently help patients manage with artificial larynx use is what many patients refer to as stoma blasting. Heavy or forceful breathing while speaking, especially during exertion, anxiety, or respiratory irritation, can result in audible airflow escaping from the stoma. This can be uncomfortable for the patient, distracting for the listener, and can reduce overall intelligibility by competing with the speech signal. Even when articulation is strong, excessive breathing noise can interfere with communication and increase self-consciousness in social settings.

TEP speech and voice prostheses often sound excellent. When functioning well, they can provide natural-sounding voice quality with good prosody and conversational flow. The tradeoff is the ongoing commitment required to maintain the system. Voice prostheses need regular monitoring and replacement, and valve failures can happen unexpectedly. A blown valve can immediately disrupt communication, which is why many experienced patients carry backup supplies such as adhesive valves or other accessories. For some patients, this maintenance burden is manageable. For others, it becomes a reason to seek an additional or alternative option.

UltraVoice as the Third Option in the Toolkit

UltraVoice is a third option SLPs may consider as patients move through the toolkit. UltraVoice is a non-invasive oral appliance, similar in form to a denture, with a computer-operated speaker built directly into the appliance. Instead of generating sound at the neck, UltraVoice produces sound inside the oral cavity, allowing patients to shape speech using familiar articulation patterns.

The system includes an oral appliance with an embedded speaker, a small wearable microphone that captures the patient’s speech input, and a control unit that processes the signal in real time. The control unit can modify pitch and frequency, offering different voice profiles such as male, female, and whisper-like settings, while also allowing the patient to adjust volume to match their environment. By adding variation in pitch and frequency before projecting sound through the oral speaker, the system can improve perceived naturalness compared to traditional monotone devices.

UltraVoice is not intended to replace speech therapy or displace TEP as a gold-standard option when it is working well. Instead, it expands the menu, particularly for patients who struggle with neck-based devices, experience discomfort or intelligibility issues related to stoma blasting, want a non-invasive solution, or need an alternative when maintenance burden or device failures make other options unreliable. If laryngectomy care is a toolkit, UltraVoice is another tool SLPs can reach for when anatomy, dexterity, and day-to-day realities call for something different.