Who we build for
Most people never think about their larynx until they lose it. Every year several thousand Americans have a total laryngectomy, the removal of the voice box, usually as part of treatment for throat cancer. The surgery works. What comes after is learning to talk again, and no two people do that the same way.
Some do very well with a voice prosthesis. Some learn esophageal speech. A lot of people use an electrolarynx. And some find that none of those fit, for reasons that have to do with their health, their anatomy, or simply what they want. We’ve spent about thirty years building for that last group, and this post is about why.
The economics of a small market
Medical devices are expensive to bring to market. Engineering, testing, FDA clearance, tooling, clinician training, and years of service after the sale cost roughly the same whether a product ends up with fifty million users or fifty thousand. A company making glucose monitors spreads those costs over millions of customers. A company making an artificial voice box for laryngectomees has, by most estimates, a few thousand potential users in the U.S.
So the big manufacturers mostly stay away, and the companies that remain can’t spread their costs very far. Designs don’t change much. Prices stay high. Insurers see few claims and have little reason to revisit coverage. None of that makes the need any smaller. It just means fewer people are working on it.
What UltraVoice does
UltraVoice is an engineering and manufacturing company, and laryngectomees are the only people we build for. David Baraff founded the company, and in 1995 we released the first UltraVoice: a small sound source built into a custom-fitted denture or retainer, so the voice comes out of the mouth instead of through the neck.
Because each device was fitted to one person’s mouth, personalization was built in from day one, and it’s still how we work. We work with each user, and usually their speech-language pathologist, and set the device up around them. That might mean a custom voice, with pitch and tone adjusted to sound more like their own. It might mean a louder amplifier for someone who works in a loud environment or has a big, noisy family. For people with limited hand strength, or who just want their hands free, there’s our hands-free switch. We design and build the hardware and software ourselves, so when users tell us something isn’t working, we can change it.
When the usual options don’t fit
The voice prosthesis, placed through a tracheoesophageal puncture (TEP), is a good choice for a lot of people. It isn’t for everyone. Some people aren’t good candidates for the procedure, and some would rather not have another one. Some have dealt with ongoing leakage or trouble with their prostheses. For people at higher risk of infection, pneumonia, or aspiration, a care team may prefer an option that doesn’t involve an opening between the airway and the esophagus.
Esophageal speech has its own limits. It takes practice, breath support, and stamina, which can be hard to come by for someone who is also managing heart or lung disease.
And many people simply want to know that the company making their device will be around for years and is still working to improve it. We hear that one often.
How the options compare
A little voice box anatomy helps here. The voice box medical term is the larynx. It sits at the top of the windpipe and holds the vocal folds, which vibrate to make sound. [Insert voice box diagram: larynx, vocal folds, trachea, and esophagus, before and after surgery.] After the voice box is taken out, breathing happens through a stoma in the neck. The tongue, lips, and mouth still shape words. What’s missing is something to make the sound, and every laryngectomy speaking device is a different answer to that problem.
People often ask us how an electrolarynx works. A handheld electrolarynx device, sometimes called an electronic voice box or electric voice box, makes a buzz that travels into the throat through the neck or through a small tube in the mouth, and the user shapes it into words. Electrolarynx speech is quick to learn. It does take a free hand, and radiation changes or scar tissue in the neck can make it harder for the sound to get through.
When people search for an artificial voice box implant, they usually mean a voice prosthesis: a small one-way valve in the TEP that lets air from the lungs make sound. Many users speak very well with one. It requires a procedure, periodic valve changes, and ongoing care.
Esophageal speech uses swallowed air and no device at all.
The UltraVoice speaking device sits in the mouth like a retainer or denture, so the sound starts where speech is shaped and neck tissue doesn’t get in the way. It’s worn through the day, meals included. Most people speak intelligibly as soon as it’s fitted, and a few sessions with a speech-language pathologist help them get the most from it. The main reason it won’t suit someone is if they can’t tolerate something in their mouth.
We also get asked what the best electrolarynx device is, or which voice box device or voice box machine to buy. Whatever you call it, the honest answer is that it depends on the person, which is why having more than one choice matters.
What’s been hard
Our first device had a real drawback. The custom denture and dental visit made it cost more than a standard electrolarynx, and insurers didn’t always cover the difference. Some people who wanted one couldn’t get one.
The business is still hard. Engineering and manufacturing specialized devices carries high overhead, and a company our size doesn’t have much leverage with insurers. Reimbursements keep going down while manufacturing costs and the cost of doing business keep going up.
We’ve stayed anyway, mostly because of what our users keep telling us. Nearly every improvement we’ve made started as a customer’s request. They’ve taught us that better speech takes more than hardware: sound quality, fit, training, and software all matter. And many of them chose us because they wanted someone who would still be there after the sale. We take that seriously. We fit, adjust, repair, and keep improving the devices our customers rely on, for as long as they need them.
Other places to look
This is a small field, and we’d rather people know about every option, including the ones we don’t make.
Atos Medical is one of the largest suppliers of laryngectomy supplies. Its products include voice prostheses, the Provox Life stoma care line, and the Provox TruTone Emote electrolarynx. For the Atos Medical phone number or Atos ordering, use the official Atos Medical website. Griffin Laboratories is known for its TruTone electrolarynx line. InHealth Technologies makes the Blom-Singer voice prosthesis, and InHealth medical supplies also cover stoma and airway care. Lingraphica is one of the better-known AAC device manufacturers, and its assistive devices for speech impaired users are aimed mostly at people with aphasia and similar conditions.
If you have a tracheostomy rather than a laryngectomy, you still have your voice box, and a tracheostomy speaking device such as a speaking valve is usually what you need. A speech-language pathologist can help you sort out which voice boxes, valves, and supplies make sense for you.
For an electrolarynx purchase or an UltraVoice evaluation, reach us at www.ultravoice2.com/contact.
Why we keep at it
On paper, this is a market to skip. We’ve never seen it that way. Every laryngectomee’s situation is different, and when a device actually fits someone’s health and routine, talking with family, at work, and everywhere else gets easier.
If you know someone in the laryngectomy community, please pass this along. If you’re wondering whether UltraVoice could work for you, ask your speech-language pathologist. And if you have a story or an idea for us, we’d like to hear it at www.ultravoice2.com/contact.