Klaske van Sluis

General introduction 9 Figure 1.2: Schematic drawing of tracheoesophageal speech. With manual occlusion of the stoma, air from the lungs passes through the voice prosthesis to allow the pharyngo-esophageal segment to vibrate and generate voice. to the introduction of tracheoesophageal speech in the early 1980s, esophageal speech played a prominent role in speech rehabilitation after total laryngec- tomy. Esophageal speech does offer advantages over tracheoesophageal speech and artificial larynx speech: it does not require a mechanical or prosthetic device and the hands are not occupied during voicing. Disadvantages of esophageal speech are the short phonation time, reduced loudness, and lower success rate, and it has the longest training time of all of the speech rehabilitation options. Esophageal speech is produced by injection of air into the esophagus. The esophagus serves as the air reservoir; the PE-segment is set into vibration. The reported volume of this esophageal reservoir is approximately 40 to 80cc [20]. There are two main ways to get air into the esophagus for voicing purposes which are classified as a positive pressure approach and a negative pressure approach. In the positive pressure approach, air is injected into the esophagus on a consonant or with a tongue pumping method. In the negative pressure approach an inhalation technique is used to create a negative air pressure into the upper esophagus. When the air is released, the PE-segment vibrates which creates voicing. Both methods require oral, motor and cognitive skills of the patient. Both approaches to get the air into the esophagus can disrupt artic- ulatory movements and reduce fluency of speech. Therefore, longer training periods are required, often up to months [21]. Since tracheoesophageal speech is considered as the preferred method, nowadays, fewer speech and language pathologists (SLP’s) are proficient at teaching esophageal speech. In Figure 1.3