All patients with a tracheostomy or laryngectomy will have some problems with communication at some stage in their care. This can be compounded by being unwell, especially in critical illness, where a patient may be extremely weak or dependent on a mechanical ventilator to help with breathing.
A laryngectomy is a surgical treatment for cancer of the larynx and involves complete removal of the larynx, which is the ‘voice box’ that allows speech. Partial laryngectomies are possible in some circumstances, but the treatment priority is to address any underlying cancer. Radiotherapy is also an option but this too can damage the larynx and lead to speaking problems.
With a tracheostomy tube in place, there may still be a connection to the upper airways, so that gas can pass upwards and out past the vocal cords, allowing speech. This requires a high degree of coordination of the muscles of the throat and larynx, the mouth and tongue, and enough breathing reserve to exhale gas out via the upper airways. This can be difficult following a severe illness or stroke for example, certain neurological conditions, or if a patient needs on going help with their breathing from a ventilator.
Techniques are available to help patients communicate to staff and to their families during these difficult and stressful times. Non-verbal communication aids can be used by staff and families, but usually require some dexterity and strength from the patient. There are also a number of techniques that can be used to promote airflow through the larynx and lead to speech. Techniques and success will vary from patient to patient and over time, depending on the underlying problem and other medical needs.
The gift of speech is priceless for patients, but also for families and staff. Patient anxiety and stress levels have been shown to be reduced through effective communication, and engagement and cooperation with treatment can be similarly improved, with clear benefits for patients and staff.
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