Internet Laryngectomee Support
December 1999

Date Set for IAL Convention

The dates have been confirmed for the 2000 International Association of Laryngectomees Voice Institute and Annual Meeting in Nashville, Tennessee. The Voice Institute begins on Tuesday, August 15th, and the Annual Meeting begins on Thursday, August 17th. Both end on Saturday, August 19, 2000. Additional information is available on the member website. A vacation guide (with map and lists of useful addresses) and coupon book for Nashville can be ordered at this website: Nashville Convention and Visitor's Bureau Online.  The headquarters hotel is the Sheraton which can be contacted through  SHERATON MUSIC CITY - Overview.

Improving Your AL/EL Technique

Whether you call it an artificial larynx (AL), electronic larynx (EL), artificial laryngeal device (ALD), or perhaps refer to it by a brand name (such as Servox or Cooper-Rand), most users of these devices can make significant improvements in their use through correct practice and improved technique. While some of the suggestions may apply to any type of AL, the emphasis here is on the devices which are used by holding them against the neck.

If you have spent much time with other laryngectomees you have certainly noticed differences in the quality of speech produced by AL users. We notice that some are louder, clearer and easier to understand than others. Part of the problem is that many appear to be self-taught and would have benefited from good instruction at the outset from a speech-language pathologist (SLP) or other qualified therapist. Of course some of the differences we hear are the consequence of radiation, scar tissue, wearing of dentures, and physical or other problems which interfere with speech. In some cases these circumstances may not be correctable, or significantly improved. Nevertheless, most laryngectomees CAN improve their AL use through proper initial instruction, experimentation, and practicing good technique.

    Most ALs are made to be used by holding them against the outside of the neck, such as the Servox, TruTone, Romet, Optivox, Nu-Vois, Denrick, Solatone, etc.) Some important tips on using them well include:

    1. Find that “Sweet Spot"!  A sweet spot is a location where sound and vibration is most efficiently transmitted into the esophagus and mouth for speech. There may be more than one sweet spot, and it can change over time with additional ones coming into existence as the healing process progresses. There will often be two, three, or even more places on the neck which produce a loud and clear sound. A simple way to find the sweet spot is to open your mouth and keep it in one position as you place the AL in different locations on your neck. Say the neutral “ahhhh” sound. 

    It is important that you maintain a uniform pressure of the AL head against your neck at each location you try. If you have not experimented with looking for new sweet spots, you may discover that you have developed a better one, or additional ones you can use as an alternate to the primary spot. In addition to experimenting with different locations, try different amounts of pressure to get a good compromise between too tight, which can be painful (and muffle the sound in some ALs); and too loose, which will produce the loud buzzing sound which interferes with intelligible speech. 

    The laryngectomy operation can produce lots of scar tissue and swelling from the accumulation of lymph fluid in the neck area (edema). This typically muffles the sound when using the AL against the neck right after the operation, and for weeks and even months afterwards. This problem and post-operative pain can cause many laryngectomees to initially use an AL intra-orally with the “straw” adapter which puts the sound into the mouth instead of through the neck. 

Neck tissue which has been treated with radiation can also become thickened, tender, and more resistant to the use of the device held against the neck. Those who have had to use an AL intra-orally because of these problems should remain open to trying an AL against the neck as healing progresses since the volume and quality of sound are often superior to the device used inter-orally.

    The location of one or more good “sweet spots” is essential. And once you have found one, continue to experiment over time as a better or additional one or more may develop.

    2. If you are able to do so, learn to hold and operate the AL with your non-dominant hand. Doing so frees your dominant hand to write, shake hands, etc. It is also better for many of us to use our index finger to push the button rather than the thumb since most people have better fine motor control with it. This is especially important for a device like the TruTone where varying the pressure in small steps causes the change in pitch. The first and second fingers work well together in operating the dual tone change buttons of the Servox and similar larynges.

3. Coordinate pressing the button on and off with your phrases and sentences. Certainly let go of the button at the end of a sentence. But you may discover that letting go of the button between phrases within a sentence is also helpful to your listener, although pushing the button off and on with each word should definitely be avoided. Work towards being fluid with your phrasing. These pauses will also make it easier for people to understand you. Pauses are important. 

    4. Vary your speech rate (how fast you talk.) A variety in your rate along with pauses can help substitute for the pitch variations in your pre-laryngectomy voice. 

    5. Over-articulate and slightly exaggerate your mouth movements. Open your mouth wider and give more emphasis to the final consonant sounds in words (such as the "d" sound in the word "cold", the "t" sound in "pleasant", the "ch" sound in "speech," the "p" sound in "tape", etc.)

    6. Talking too fast is a problem for many laryngectomees. Try and speak more slowly than you did with your pre-laryngectomy voice. Some people have a more difficult time separating the buzzing sound the AL makes from the words you are saying. Many speech-language pathologists consider the speech rate as affecting intelligibility more than any other single speech factor. Combined with #4 above, it is possible to vary the speed of your speech to provide variety and emphasis, but also not speak so fast that it becomes a problem for your listener.

    7. The “h” sound is virtually impossible for laryngectomees to say. But an approximation can be made by prolonging the vowel sound which follows the “h”. An example is “heat” and “eat.” Prolong the “e” sound in front of the word “eat”, and it is more likely to be perceived as the “h” sound. Other pairs of words you can practice “at - hat, it - hit, am - ham, all - hall, eye - high, ill - hill, is - his, as - has, add - had.” Another solution for the missing “h” sound is to begin to substitute the “k” sound. But stop short of fully inserting the “k” sound where the “h” should be. 

    8. Avoid expelling air out of your stoma as you speak, or making noise as you breathe. It calls attention to us in undesirable ways. This is called, among other things, "stoma blast." This noisiness is a remnant of your pre-laryngectomy speaking when you had to use exhaled breath to speak, or the result of unnecessary strain to force esophageal or TEP speech. Most of us initially produced some unwanted stoma sounds, but audible breathing and air expulsions while talking can become a habit. It is one we want to avoid, or break if we already have. 

    9. If your AL has a pitch and/or volume control, practice using them to change the pitch to provide variety, and adjust that volume to different situations. 

    And remember that maintaining eye contact and using facial expression and gestures can also help your listener understand you. 

    Most laryngectomees can make substantial improvement in their ability to use the AL. The name of the game is to be understood, and practice and good technique can make a big difference.

(Thanks to Herb Simon, Elizabeth Finchem, Harriet Thurston, Pat Sanders, SLPs Kathy Welsh, Brian Shute, Dan Kelly, and Carla Gress who contributed ideas or editing suggestions)

Son in Trouble and Mom is Proud

Did you catch this email?:

"A few weeks ago, Dakota made me the happiest mom in the world. He got in trouble in school for "talking!" Most parents would not be as thrilled as we were, but this was a funny thing for us. Since Dakota can't actually talk because of his defective larynx, this was something special for us. He was actually being a NORMAL little boy! Dakota has discovered Buccal speech and loves to talk now. We are in the process of changing therapists so we can introduce him to esophageal speech. But until then, he loves using Buccal speech. I knew everyone in the group could understand why talking at school was good and not bad in this case. I have found that I even have to tell him to be quiet sometimes when he is talking because he will get too loud or talk nonstop." - Kelly Killough 

Dakota has a rare genetic condition called Smith and Bain Type1 Laryngeal Atresia. His trachea was incompletely formed at birth and air could not reach his lungs. A tracheostomy had to be performed within a few days of his birth as he temporarily breathed through a fistula. He had additional defects in his heart and lower digestive system. Progressing from no ability to speak, through clicking sounds, and now self-taught Buccal speech, he is a candidate for esophageal speech.

   Note: Buccal speech has been described as sounding like Donald Duck and uses air from the cheeks to speak. SLPs try to steer patients who have taught themselves Buccal speech towards esophageal or TEP speech.  Additional information about Dakota and other children who have similar or related problems can be found at: Kids with Tracheostomies.

Beginning Medical Research
By Pat Wertz Sanders

For newcomers to the Internet, this is a step-by-step guide to an easy to navigate medical information site where you can educate yourself about the basics of any medical condition or treatment for it. These are simple instructions, so try it. You may get addicted to research!

    1. In the location strip (a white strip near the top of your computer browser), type in this address http://medicinenet.com, and tap Enter on the keyboard (or if this address is in a color and underlined, just click on it right where it is - it is a LINK to that site).

This takes you to MedicineNet Smart Medicine.

2. Click on Diseases and Conditions and it will take you to a page where you select the first letter of the disease or condition you are researching.

   3. Since all of us are interested in laryngeal cancer, let's look for that. So, choose "L" and click to get to the page that has the "L" words.

    4. Scroll to reach Laryngeal Cancer and click on that to reach the Laryngeal Cancer Forum

5. Click on the Main Article and it will take you to three pages of information on Laryngeal Cancer, from “What is the Larynx?” to “Treatment Options” and “Voice Rehabilitation.”

    You can get a good basic education on this site and you can find explanations on medications or medical terms, as well as diseases and conditions. Just go back to the main page of Medicine Net and click on whatever subject you are interested in and go through the same process. Become your family's medical expert!

Hints Pages Revised

Major revisions have been made in the WebWhispers Hints Section thanks to Pat Sanders and her committee. Enjoy them at:  Hints Index.

Words to the Wise

Share your knowledge, it is a way to achieve immortality

Reminder:  Our Treasurer is now accepting donations from those who wish to contribute to the Club and become Voting Members for Calendar Year 2000 (a $5.00 minimum donation).  All checks should be made out to the "WebWhispers Nu-Voice Club" and be mailed to our Treasurer, Mr. Terry Duga, 6115 North Park Ave., Indianapolis, IN 46220.

Welcome New Members! 

We welcome new WebWhispers members who joined us in November:

Ben Armato
Hartsdale, NY
Bill Brown
Crossville, TN 
Cheryl Campbell, SLP
Anchorage, Alaska
Charles E. Crawford
Austin, TX
Steve and Sandy Doherty 
Hutchinson, KS 
Janice Hayes
Atlanta, GA
Bob Hodge
Cary, NC
Pamela L. Husa
Mount Pleasant, MI
Al Keneda
Medina, OH
John and Joan Kittrell 
Coconut Creek, FL 
Fred A. Markowitz
Emporia, KS. 
Robert O. Mathieu 
Somerset, MA. 
JoAnne Paradis, SLP 
Ottawa, Ontario, Canada. 
Reuben H. Pruitte, Jr
Dawson Springs, Kentucky. 
Mike Rosenkranz
Plantation, FL
Sara Rothenberger, Caregiver
Batesville, VA. 
Frederick Roughedge
Deerfield Beach, FL
James Shannon
Brandywine, MD. 
Jay H. Shunk
Baltimore, MD
Richard J. Stommel
Orlando, FL 
Linda Stonebarger
Columbia, TX