Following a laryngectomy, some patients can have further surgical procedures to enable speech. Some centres may perform a Tracheo-oesophageal puncture (TEP) as part of the original surgery.

Oesophageal speech is now achieved by forcing exhaled air into the oesophagus in expiration through a one-way tracheo-oesophageal prosthetic (TEP) valve (Fig 1).

A small, one-way valve is inserted into the hole, known as a voice prosthesis. Different types are available, and these can be changed relatively easily, depending on what type of valve is fitted. By occluding the stoma with a finger, gas is forced out via the oesophagus, allowing one-way oesophageal speech (Fig 2).

A variety of stoma 'buttons' may also be inserted into the stoma (Fig 3). These can act as HMEs and contribute to the passage of gas to the oesophagus. Some of these systems are 'hands free'. The valves are always open during inhalation, but they may close during exhalation (like a one-way speech and swallow valve that is used with a tracheostomy tube). Whether they close or not is controlled by adjustable magnets, depending on the force at which a patient exhales. Some versions allow you to switch between 'speech' and 'breathe' modes by twisting the external part of the stoma cover.