Voice reacquisition after total laryngectomy via tracheoesophageal speech in patients with head and neck cancer: A qualitative study

Abstract

Abstract Purpose: Speech rehabilitation contributes to improved quality of life for patients who have undergone laryngectomy for head and neck cancer. Tracheoesophageal speech (TES) provides better speech quality when rehabilitation is initiated early. However, patients must work on rebuilding their self-identity and develop the habit of cleaning and replacing their voice prostheses regularly. We aimed to attain a deeper theoretical understanding of the process involved in the transition from selection to adaptation to TES in patients with head and neck cancer. Methods: Using grounded theory methodology, we interviewed 13 TES speakers (3 women) across peer support groups in Japan who had undergone laryngectomy for head and neck cancer. Semi-structured interviews were used to investigate what TES speakers thought of their voices, their preferred means of alternative communication, and how they have adapted. Results: Participants emphasized the importance of communicating with their own voices, the adaptation process for which was influenced by anxiety related to losing one’s natural voice, confronting the reality of living without a voice, and coping with one’s new voice. Through this process, participants eventually learned to recognize the changed voice as one's own. However, despite voice restoration through TES, feelings of hopelessness persisted for many patients. Conclusion: The value assigned “communicating with one’s own voice” is integral to the adaptation process for patients with head and neck cancer who undergo laryngectomies and use TES. However, some aspects of TES can easily lead to feelings of hopelessness, suggesting the importance of enhancing multifaceted support for speech rehabilitation.