A 60-year-old man underwent total laryngectomy for advanced glottic carcinoma. At follow-up he wants the best chance of fluent hands-free speech. Which method of voice restoration is associated with the highest success rate and most natural voice quality?

• A Oesophageal speech using injected air and pharyngoesophageal segment vibration
• B Buccinator-assisted whispering technique
• C Electronic artificial larynx held against the neck
• D Tracheoesophageal puncture with a one-way valved voice prosthesis ✓

Explanation

Tracheoesophageal puncture with a silicone one-way valve (such as a Blom-Singer or Provox prosthesis) diverts pulmonary air into the pharyngoesophageal segment, giving the most natural voice with the highest fluency success rate, exceeding 90 percent in selected patients. Oesophageal speech takes months to learn and succeeds in fewer than half of patients, while the electronic larynx produces a robotic monotone. The valve prevents aspiration by remaining closed until the patient occludes the stoma to speak.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.