Unless you have lived through it, it is hard to imagine what it feels like to wake up one day and find your voice gone. After surgery that removes the entire larynx, the vocal cords themselves are gone, so the old road to making sound is closed off. Many people recall the helplessness of standing in front of a mirror for the first time, mouthing words with no sound coming out. But there is one thing I want to make clear here. The ability to speak has not vanished forever — only the passage that creates the sound has changed. You can learn it again.
Broadly speaking, there are three roads back to speaking. The first is esophageal speech: you swallow air into the esophagus and then bring it back up almost like a burp, using that vibration to produce sound. The big advantage is that you can speak using only your own body, with no device at all — but it takes a fair amount of time to master. Sometimes it takes weeks just to string two or three syllables together. The second is tracheoesophageal puncture, where a small valve is fitted to send air from the lungs toward the esophagus to make sound. The third is what people usually call the artificial larynx — the electrolarynx.
An electrolarynx works by holding a device about the size of your palm against the underside of the chin or the cheek and sending vibration in; that vibration is then shaped into speech inside the mouth. The first time you use it, the robotic, metallic sound startles you more than anyone. But it is a device you grow used to, and once you find your own spot — the place where the sound comes out clearest — you start taking phone calls and ordering at shops. People say the trick is to move your lips clearly and a little more slowly than usual. The habit of keeping a battery on hand, and of having two or three devices to rotate, turns out to matter more than you would expect.
What surprisingly trips people up in rehab is not the speaking technique but the heart. If you are too embarrassed to hold the device up in a crowd and just shut your mouth, the very chance to practice disappears. Before long you end up speaking only briefly with family at home and replacing speech with writing or a phone screen when you are out — and if that drags on, the loneliness deepens. I would encourage you to attend, at least once, a group of people who have walked this same road before you. Nothing is as encouraging as hearing someone say to your face, "At first I could not get out a single word either."
Knowing the small daily changes in advance makes them less startling. Because a separate airway opening (a stoma) is created at the front of the neck, it becomes hard to smell through the nose, and you have to be careful that water does not get in while bathing. When cold winter air brings on more coughing, humidifiers or protective devices help, and managing phlegm becomes a new part of your routine that you have to learn. The fastest way to handle all of this is to write your questions on paper before discharge and ask the medical staff or speech therapist one by one. There is no such thing as an embarrassing question.
Recovery speed really does vary from person to person, so there is no need to grow anxious by comparing yourself to the person next to you. A word that would not come out yesterday comes out clearly once today — and those small successes pile up until they become conversation. What is written here is a reference to help you grasp the big picture; please be sure to decide on the rehabilitation method and timing that suit your own condition by talking directly with your attending medical team and speech therapist.