It’s easy to forget how much the distinctive sound of our speech contributes to the character of even the most ordinary conversations. The vibrations of the vocal cords determine whether an exchange feels intimate or boisterous. These vocal cords, set into motion by airflow, are located in the larynx. Unfortunately, some people lose this organ, for example as a result of cancer. Laryngeal cancer is the most common malignant tumor of the head and neck region. Does removal of the larynx mean losing the ability to speak or express oneself?
The surgical removal of the larynx – often a necessary part of treating laryngeal cancer – is called a laryngectomy. After surgery, speaking is usually still possible, although the voice sounds different than it did before. What challenges do patients face when using their new voice? And how can these challenges be addressed?
Who speaks – and how – without a larynx?
Even after complete removal of the larynx (including the vocal cords), most patients can learn to speak again. There are several methods.
Esophageal speech, the most common method in Poland, is also the most difficult to master but requires no device. It involves generating vibrations by forcing air through the esophagus, somewhat like a controlled burping motion.
An electrolarynx (or electronic larynx) is a handheld device typically placed against the cheek or under the chin. It produces a buzzing sound that resonates in the mouth; movements of the tongue and lips shape this sound into speech.
A tracheoesophageal prosthesis uses a small silicone valve connecting the trachea to the esophagus. Air from the lungs passes through the prosthesis, enabling speech when the user temporarily covers the stoma (a surgically created opening in the throat), either with a finger or with a heat- and moisture-exchange device.
“In Poland alone, about 1,500 to 2,000 people undergo laryngectomy every year. Worldwide, estimates range from 200,000 to 500,000,” says Konrad Zieliński from the University of Warsaw. “Previously, most patients were older men, largely due to smoking and heavy alcohol use. Today, that profile is changing: more women and younger people are affected, due to a range of environmental factors. It’s important to remember that people with atypical speech are not only laryngectomy patients – they also include stroke survivors, individuals with cerebral palsy, and people with Parkinson’s disease.”
The special needs of people with atypical speech
Regardless of the method used, speech after laryngectomy does not sound the same as it did before. For many patients, this can be uncomfortable and challenging. Voice amplifiers can help them be heard and understood more clearly, but speaking naturally across a range of situations remains difficult.
Researchers at the Faculty of Psychology at the University of Warsaw – Konrad Zieliński and Prof. Joanna Rączaszek-Leonardi – analyze the communication needs of laryngectomy patients using behavior setting theory, which focuses on the situations people encounter and the demands those situations create.
People may want to speak softly and delicately, firmly and seriously, or assertively. They want their voice to blend naturally into the surrounding sound environment, with dynamic modulation suited to the context. Whether on a phone call, reading a story to a child, or navigating public transportation, they want their voice to adapt appropriately. They may also want to make a good impression, sing around a campfire, or tell jokes with expressive variation.
“We are developing a set of practical guidelines – a tool for studying people with atypical speech not only in terms of voice, but also in the context of interaction. We focus on situations that are important, frequent, or particularly challenging. Then we adapt the device to the individual’s needs – unlike current approaches, where devices are designed for the entire population. That’s ineffective, because any given speech method only works for a specific person in a specific situation. At home, I might whisper; on the phone, I use an electrolarynx. At a conference, I use one type of microphone, and another for everyday use. Our goal is to develop a methodology that allows technology to meet a wide range of communication needs,” explains Zieliński, drawing on personal experience.
Theory and technology in action
Careful analysis of real-life situations – and the specific communication demands they create – allows researchers to propose technological solutions tailored to different contexts. Singing around a campfire or taking part in social activities may require speaking while eating or keeping one’s hands free – a challenge if speech requires covering the stoma. Each situation presents its own technological constraints.
Researchers at the University of Warsaw are involved not only in analyzing the needs of people with atypical speech, but also in developing practical solutions. The startup Uhura Bionics has created the Voxflow voice amplifier and is working on an electronic larynx with individually customizable voice characteristics. In the near future, people with atypical speech may have access to technologies that allow them to participate fully, expressively, and flexibly in everyday interactions.
The text was originally published in Polish on the Serwis Naukowy UW website on March 20, 2025
