See videos: 

• Esophageal Speech without TEP (tracheoesophageal puncture) compared to with TEP (Videos)
• Tracheoesophageal Puncture (TEP) Technique with Voice Training

Definitions

Alaryngeal Speech: voicing without using the larynx as a sound source - most commonly after total laryngectomy - (Ng 2021)

• 4 most common speaking methods
  • Internal
    • ES = esophageal speech
    • TE = tracheoeosphageal speech
  • External
    • EL = electrolarynx speech
    • PA = pnematic articial laryngeal speech (pneumatic laryngeal device)

Background

An alternative approach to voicing after total laryngectomy - common in China and Taiwan but not in common in the United States - includes use of the Pneumatic Laryngeal Device (PLD) also known as the Pneumatic Artificial Larynx  (Lu 2021). 

These devices connect lung-powered breath to the mouth through a tube that has a widened flange at one end to seal against the stoma and a reed or vibrating device either within the barrel (as depicted in image above) or at the other end placed intraorally (Goode 1975) . Lu et al reported that “in Taiwan, most patients use PLDs” [Lu et akl 2021]. These investigators identified an advantage to PLDs to be the absence of need for an external power supply. This device additionally provides adaptations to intonation through variable modification in amount of breath support used. This approach to voicing is reported to permit modulations more closely approaching normal speech – thought to be more important in languages such as Mandarin, Taiwanese and Cantonese. Disadvantages include difficulties with clogging with saliva and the awkward handling of an external device.

Wang (2023) citing Tsai (2003) reported a survey of 108 laryngectomy pateints in Taiwan who communicated most commonly with the Pneumatic Artificial Larynx (58.8%) compared to Esophageal Speech (24.7%) and Electrolarynx (10.3%). 

References

Lu YA, Pei YC, Chuang HF, Lin LY, Hsin LJ, Kang CJ, Huang SF, Chiang HC, Tsao CK, Fang TJ. Speech Performance after Anterolateral Thigh Phonatory Tube Reconstruction for Total Laryngectomy. Laryngoscope. 2021 Jun;131(6):1349-1357. doi: 10.1002/lary.29005. Epub 2020 Sep 10. PMID:

Goode RL. Artificial laryngeal devices in post-laryngectomy rehabilitation.Laryngoscope1975;85:677–689

Wang CC, Liao JS, Lai HC, Lo YH. Voice-Related Quality of Life Outcomes from Pneumatic Artificial Laryngeal and Esophageal Speakers. J Voice. 2023 Nov;37(6):970.e19-970.e27. doi: 10.1016/j.jvoice.2021.05.011. Epub 2021 Jul 3. PMID: 34226090.

          citing  T-L Tsai, S-Y Chang, Y-C Guo, et al. Voice rehabilitation in laryngectomees: comparison of daily-life performance of 4 types of alaryngeal speech J Chin Med Assoc, 66 (2003), pp. 360-363
Ng ML. The use of the Lombard Effect in Improving Alaryngeal Speech. J Voice. 2021 Jan;35(1):18-28. doi: 10.1016/j.jvoice.2019.07.007. Epub 2019 Jul 23. PMID: 31350113.