Do most laryngectomees talk again?  You bet we do!  The more ways you can communicate, the better off you will be in your post laryngectomy life.  Your medical team may have good reasons for recommending a particular type of speech to be learned, so listen to them.  Many people learn the electrolarynx first and another type of speech later.  They have an advantage after they have learned the second speech because, if needed, they have the first type of speech to fall back on.  Others are given a TE puncture during their surgery and a prosthesis shortly thereafter.  In the days before the artificial larynx (AL) and the tracheoesophageal prosthesis (TE or TEP), there was esophageal speech (ES). You didn’t have to buy speech aids to use or remember to carry anything around with you but it was difficult or even impossible for many to learn.

You will find descriptions and comments on many ways of speaking again.  Listen, read, practice and learn well.  This is the new way of communication for you.  Welcome it and consider yourself lucky that it was discovered or invented before you became a laryngectomee so you would have choices.

For those of you who mentioned you are “undecided” about which method of post op voice you may end up with, here are a few suggestions. The first is try an electro larynx. It may be a neck type with an intra oral adaptor at first, or a design that is built to be intra oral only. There are several brands, and each unit … no matter the brand, will probably sound different.
The difference may be the unit, or more likely you physical differences, and that will change as the swelling goes down. As your neck heals the EL can be considered the first step, as you might graduate from wheel chair to walker to cane. The voice you end up with after healing enough to pass the swallow test you can consider the next step; which may be esophageal speech (ES). You can go to the WW homepage and select “Talking Again” on the topics menu, and then choose from samples of laryngectomees speaking.

The next step is one you can become acquainted with while your healing if you visit the Face Book group called “Esophageal Speech Support”. There you will find almost 500 people who have chosen to become members. (490 as of this morning.) There are so many who are told that ES is “burp talk that’s too hard to learn and takes too long”. Standard Esophgeal Speech isn’t burp talk, nor is it assisted by the use of a TEP. ES means no puncture or prosthesis is required. ES only uses the air that is already in your mouth at all times. You have always used many of the same techniques pre op and didn’t know it. You may, like so many do, think that exhaling lung air to speak is the ONLY way to talk, and it isn’t. That assumption leaves too many “without a voice”, and it is not true for all. I hope you will take the time to visit the Facebook site, read the posts and listen to the variety of videos that revolve around this topic.

Again, Welcome.
Elizabeth A. Finchem
DOS: 10/2/78
Tucson, AZ

The following link is a YouTube video that has a basic explanation of the methods of speech that are available to a laryngectomee.

More reading material information is available in the General Information Section under recommended reading.

Electolarynx

Your state may have a program but only a few states do. Check the Suppliers Section for more information. You should also check for that information here:
https://tedpa.org/

We at WW have a program for a loaner that a member can borrow for up to 90 days and sometimes extended arrangements can be made and ELs left to us for that purpose. The smart thing to do is have the patient join WW which will give him time to find out the rest.

He will need an email address to join us (or someone in the family can join for him using something like a gmail.com address. Most libraries have computers for public use so you don’t even have to own one.

Please check their insurance. Most will have some help.

He also would learn from our members as we are a full fledged active volunteer support group with communication between our members who wish it.

Also, look here for other methods: (Leading them to this page)

If he has a smart phone, he can likely get a free app…text to speech.

Electrolarynx Speech Samples

Electrolarynx

ElectroLarynx – (abbreviated EL or AL for Artificial Larynx) There are several such devices on the market – of basically two types. They are all battery powered, but with one type of unit, you place it against your throat, push a button, and the machine transmits a vibration noise to your throat which you then form into words and sounds with your lips, teeth, and tongue. With the second type, the vibration sound is transmitted directly into your mouth via a small tube – words and sounds are made in a similar manner. Practice is the key to producing a good voice along with how your device is adjusted.

You can adjust the device to your preference. Keep in mind that as we age the first thing lost in hearing is the higher frequencies. Low frequencies also penetrate the dense scar tissue and swelling better than higher frequencies.

(Permission to re-print provided by InHealth Technologies, Carpinteria, CA.)

Assorted Electro-Larynx Devices

You may think that you can get along with pencil and paper, but this is really a time consuming ordeal. One of the things that you will quickly discover is that when there are two or more people besides yourself trying to carry on a conversation, they are off on a different topic while you are still writing a comment on something mentioned earlier. An electrolarynx is the first “voice” most of us have after laryngectomy, sometimes the only voice we have and is a spare or back-up voice even if you learn another method of speech.

ATOS videos to help your speech

When Atos sent the address of a video relating to the use of an electrolarynx, I went to the site and watched a well done video explaining using an oral adapter on the electrolarynx.  Then I noticed there were 60 of these videos. You can put them on autoplay or just have them in numerical order and chose the one you wish to see.  They are varying lengths from 1 minute to double digits. Some are made for clinicians, instructional videos with professionals demonstrating how they solve problems. Many others, titled “Life as a Laryngectomy” simply tell who they are and a bit of their story. All are interesting and informative.

These links take you to information relating to the Electrolarynx:

#7 is Placement of an oral adaptor with SolaTone Electrolarynx – Video
http://www.youtube.com/watch?v=3TelA5HJrR0&list=UUtTiTi3t55jJ4Dr-zNLjBYg&index=7

#13 is Speaking with an Electrolarynx – Albert Brooks

#21 is Life as a Laryngectomee – John Aguilar – Video
http://www.youtube.com/watch?v=kuJe85xdRj8&list=UUtTiTi3t55jJ4Dr-zNLjBYg&index=21

You will come through this being knowledgeable about all types of voices.

Griffin labs videos

Instructions: how to use an electrolarynx

This video details how to make adjustments to the trutone and solatone

Differences in the TruTone

Lauder Enterprises – SERVOX GURU

“How to adjust the Digital Servox”

Many of you may find the video clip beneficial and educational. For those of you who might use a digital Servox and have difficulty in understanding how to make adjustments to the pitch and volume settings for this device, this video clip would be of great benefit to you.

(Editor’s note: The instruction provided by the “Servox Guru” in the video clip is clearly illustrated and very simple to understand)

“How to Waterproof Your SERVOX Digital Speech Aid”

Do you use your SERVOX device in a wet or dirty environment? You can protect the device by using a commonly found party balloon. Another helpful tip from the Servox Guru.

(Editor’s note: When I would be working in the kitchen doing something like cutting up a chicken…I always had my Servox nearby in a thin plastic sandwich sized plastic bag and the telephone nearby so I could punch the speaker button with my knuckle!)

“Oral Adapter Moisture Barrier”

You can add a moisture barrier to protect your SERVOX device when using the oral adapter. Water can damage the internal electronics and this tip will prevent that.

“SERVOX Battery Cap Bumper”

The battery cap bumper is used to protect the back of your SERVOX speech aid device.

Hints for use – oral adapters

ORAL ADAPTERS

My husband, Bill, has to use the oral adapter with his Servox. He is lucky to have a daughter that cleans teeth and uses the adapters in her business, so she keeps him supplied with them. Thought maybe there are others that could ask friends and relatives in the business to help them out or maybe your dentist will give you a couple for spares. Just something else we don’t have to buy. (Grace and Bill Wegman)

ORAL SPEECH “TUBE”, NOT “STRAW”!

In response to those who have been wondering what, “Talking with a straw” is, it is a method of speech where the sound is put into the mouth through a plastic tube connected to the EL rather than by pressing the EL to the neck.

This is useful to people who cannot get enough sound through the neck tissues or who find it painful to press an EL to the neck. These problems are most often because of hardened neck tissue from radiation, irregular tissue contours, scar tissue or a lot of fat tissue any of which may prevent good contact or good transmission of sound. Also, a very short neck so that the EL bumps the jaw bone or causes a pain or cough reaction from the pressure on the neck may cause the need for an oral speech tube.

To get the sound into the mouth with the tube, there are two possibilities. There is the Cooper-Rand Intra-Oral artificial larynx which is solely an oral
device. The tube attaches to a small silver cylinder called a Tone Generator
that has a button on the side and connects with a cord to the battery/circuitry box. The user holds the Tone Generator up to the side of the face and inserts the tube into the side of the mouth and pushes the TG button to stop and start the sound.

The other method uses one of the neck-held ELs. A silicone or plastic tube is inserted into a small hole on the mostly closed end of a round rubber,
silicone or plastic device that looks like a crutch tip. The large open end
then is put and pressed over the end of the EL. The user holds the EL up and inserts the tube into the side of the mouth and pushes the EL button to start and stop the sound.

Either way, oral use can be very helpful to people who just cannot use an EL on the neck. The problem is that the tube interferes somewhat with the proper pronunciation of some sounds such as g’s, k’s, t’s and d’s that are made by putting the tongue to the back the teeth or the roof of the mouth just behind the teeth. That is probably the main reason that people using intra-oral devices have more trouble being understood, especially when talking on the phone so that people don’t have visual clues to their speech.

Many people, with some practice, can learn to pronounce almost all of the
sounds quite well. Some people just can’t quite get past those 4 difficult sounds, but still can achieve quite understandable speech by substituting
words. For instance, “Mow the lawn” is much easier to say than “Cut the
grass.”

Including, and beyond those 4 sounds, A LOT of the problem with pronunciation of many sounds using a mouth tube is the positioning of the tube. It should be put in from the side back of the mouth, about an inch or inch and a half beyond the teeth, with the open part of the tube aimed at the clear area in the roof of the mouth above the tongue, leaving the tip of tongue as free as possible to do its best with proper pronunciation.

BUT, HERE IS WHERE EVERYONE NEEDS TO HELP!!! HOW??? PLEASE DON’T REFER TO THE TUBE AS A “STRAW!!!.” WHY?? BECAUSE WHEN ANYONE THINKS OF A STRAW, THE IMMEDIATE INSTINCT IS TO PUT IT RIGHT IN THE FRONT MIDDLE OF THE TONGUE (where it is placed to sip), BUT THAT IS THE WORST PLACEMENT FOR AN ORAL SPEECH TUBE!!!

Everyone helping with the use of an oral adapter needs to make it clear right from the beginning that the tube is different from a straw!! You don’t just stick it in, you learn to place it carefully in the best position in your
mouth, just as people using a neck placement experiment to find their best
position on the neck.

PLEASE HELP TO GET THE RIGHT IDEA OF ORAL TUBE PLACEMENT ACROSS TO ANYONE INVOLVED.

Thanks,
Dorothy Lennox
Vendor Member
Luminaud, Inc.

ORAL ADAPTERS ON TELEPHONE

For those who have trouble with an EL/oral adapter on the phone, here are several things to try. We hope one or more may help:

1. If your pitch is set fairly high, try setting it a little lower. Phones often
pick-up and distort higher pitches.

2. Keep the mouth piece a couple of inches away from the mouth – not right up almost touching your lips. Phones will often amplify and distort speech and other sounds more than you realize when they are very close.

3. Keep the EL itself and the phone mouthpiece as far separated as possible to prevent the phone from picking up the extraneous electronic sound that most ELs have. That buzzing could compete with or drown out your voice. Sometimes that may be a major part of the problem when the listener isn’t sure if there is actually a person on the line.

4. Talk more slowly and carefully when you are on the phone. People you speak to in person have visual clues from watching your lips, facial expressions and body language.. On the phone to a new person, consider say slowly something like, “Hello. I am using an artificial voice. I will talk very slowly so you can understand me.”

In any case, don’t give your name right away. The people listening have no
clues as to what you are saying. Instead, start with a couple of sentences
with words that are very easy for you to pronounce and for most people to
understand so they can “sync into” your speech before you say anything vital.

5. Consider what it sounds like to you when you listen to someone with a heavy accent on the TV. At first you can understand very little, but after a few sentences it becomes much easier. It often works the same way listening to someone using an EL.

6. Phone two or three friends or relatives and ask them to honestly let you know what problems they hear when speaking to you on the phone. Maybe they’ll have some good ideas that they just didn’t think about mentioning before because they knew your speech well enough not to be bothered much by those problems when talking to you on the phone.

7. Make arrangements with a friend or relative who has an answering machine for you to phone and have the answering machine pick up. Say several of the kinds of sentences that you might normally use when calling to place an order or for any other common call. Then visit the friend and listen to how you sound on the answering machine. That should give you some good clues. Since answering machines differ considerably, it might help to try it with more than one phone/answering machine system.

8. Don’t be insulted by this one – but when you are talking on the phone be sure that you don’t have a radio or TV playing loudly in the background and don’t stand next to a dishwasher, microwave, washing machine or a barking dog. It may seem obvious, but a lot of people do make phone calls without having any idea how much the phone is picking up other noise around them.

If you would like, you can e-mail us at info@luminaud.com and arrange a time to phone us. Since we have been working primarily with intra-oral (mouth tube) artificial larynges for over 35 years, we have had a lot of experience with this sort of thing and if we listen to you, we might have a good idea what the problem is. We would need to prearrange a time so that Tom or I would be here since we would be the most logical ones here to be able to help you.

Good luck and best wishes,
Dorothy Lennox
Vendor Member, Luminaud, Inc.
800-255-3408

USING THE NECK TYPE ELECTROLARYNX

Most artificial or electrolarynges (called either AL or EL) are made to be used by holding them against the outside of the neck, but some have oral adapters, particularly useful when the throat is swollen or sensitive. Some of these brand names are Servox, TruTone, Romet, IVox, Optivox, Nu-Vois, Denrick and Solatone . Important tips on using them include:

Find the “sweet spot”. There will be one, two, or even more places on the neck which produce a louder, clearer, sound. A simple way to find the sweet spot is to open your mouth and keep it in one position as you place the electrolarynx in different locations on your neck and push the button on the device. Try and maintain a uniform pressure of the EL head against your neck at each location. The laryngectomy operation produces lots of scar tissue and swelling which will initially muffle the sound (that’s when you use the oral adapter). Neck tissue which has been treated with radiation can be difficult. Also, the sweet spot can change over time as healing progresses, so you should periodically try other locations. In addition to trying different locations, experiment with different amounts of pressure to get a good compromise between too tight, which can be very uncomfortable, and too loose, which will produce an unpleasant clatter and unintelligible speech.

If possible, learn to hold and operate the EL in your non-dominant hand since it frees up your other hand so that you can write. Press the button on and off to coordinate with your phrases and sentences. It will make it easier for people to understand you, as well as make it a more pleasant and natural sound for the listener. Pauses are important. A variety in your speech rate (how fast you talk), and pauses can help substitute for the pitch variations in your pre-laryngectomy voice. Over-articulate, or slightly exaggerate your pronunciation of words. 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”, and the “p” sound in “tape”. Try and speak more slowly than you did with your pre-laryngectomy voice. If your EL has a pitch and/or volume control, practice using them to vary the pitch to provide variety, and adjust your volume to different situations.


WHAT DO THE VARIOUS EL DEVICES SOUND LIKE?

While it is difficult to reproduce the EXACT sounds via the Internet, the following are various “example” recordings (.wav and .aiff files) made of individuals using the indicated device. (Note: Your personal “sound” could vary greatly from one device to another. Everyone is different and success is dependent upon the right combination of equipment, training, and practice.) It also depends on how the device is adjusted, especially for the tone it produces. Some of the larger files take a minute or two to upload completely, but they are worth the wait. Make sure the file is fully loaded before you play it.

1. TruTone – “Hello, how are you?” (.wav – 28 KB)

2. SolaTone – “I’m doing great!” (.wav – 16 KB)

3. Nu-Vois – “I’m doing great!” (.wav – 49 KB)

4. OptiVox – “I’m doing great!” (.wav – 19 KB)

5. Servox – “I’m doing great!” (.wav – 18 KB) *

6.UltraVoice Plus – (Provided by UltraVoice) (.wav – 376 KB)

7. Cooper-Rand – “The rainbow is a division of white light into many beautiful colors.” (.aiff – 260 KB) *

(*Samples provided courtesy of Dr. Philip C. Doyle, Voice Production and Perception Laboratory, University of Western Ontario)

Also, “BBC Tyne” in the UK has made two “videos” showing a gentleman using an electrolarynx. You will need “RealPlayer” or the AOL Media Player to view them. Links to these are as follows:
http://www.bbc.co.uk/tyne/videonation/stories/man_from_mars.shtml
http://www.bbc.co.uk/tyne/videonation/stories/cat.shtml

BETTER COMMUNICATION

1] Look at the person to whom you are speaking, and have them look at you. A lot of our communication is visual. Understanding is enhanced from seeing your head nod in agreement or the expression on your face as something pleases or displeases you. Don’t try to talk from one room to another and lose the benefits of face to face conversation.

2] As a Realtor/general contractor I spend 30-40% of my day on the phone.After a bad phone experience with a customer I found a solution that works great for me. When I answer or call someone for the first time, I start my call by say… “First let me explain my voice, I speak with an electronic speech device due to the loss of my voice to cancer, so it may take a moment for your ears to tune in.”

Seems to work every time… amazing how everyone answers back that they can understand me just fine.You also become an excellent judge on who is or is not a good listener, plus I no longer have to introduce myself to anyone on the phone after first call since as soon as they hear my Servox voice they know who it is!
Randy Wienke, WI

Repairs and maintenance

BATTERIES FOR ELECTROLARYNX

1. If your batteries are not charging well, the charging port may not be making a good contact. Try cleaning off the surface of the Servox with alcohol, and rub the little contact point in the charging port with a clean pencil eraser. Also make sure the contact point on the bottom of the Servox battery cap is clean. You can use the pencil eraser on this as well.
Jack Nolin

2. After having problems with batteries not charging, I found the culprit. The batteries are good, it was the charger malfunctioning and shutting off long before battery was charged. Be sure your charger is working.
Jerry Lowe

3. About 9.6v NuVois II or III batteries – I am a little frugal and, consequently, hate to throw away batteries when they start to weaken. I charge them to the max and use them in garage door openers and they do very well.
John AR – 0208

(Comment: Most clocks and other household items use little power but our fireman warns us, smoke protectors are important to our lives.)

4. Jim Lauder advised to NOT refrigerate your batteries. On the other hand, don’t leave them in a hot car. They shouldn’t be exposed to extremes in temperature.


5. Jim Lauder advised keeping our extra batteries in those little film canisters as loose batteries can make contact with change or keys in your pocket and can short circuit and either get very hot or in some cases explode.

I said that I put my charged batteries in the canister so I can see the “+” on the top of the battery. If I change my battery during the day, then I put the dying or dead battery back in the canister with the “+” side on the BOTTOM. That way, for my short term memory, when I get home, I will know for sure that this battery needs charging.
Vicki Metz

PROTECTING THE SERVOX?

1. In the kitchen while doing chores such as peeling onions or cutting up chicken, you can protect your electrolarynx by sticking it in a sandwich size thin plastic bag (the cheapest kind).
Pat Sanders


2. At the garage, I found that greasy hands were messing up my Servox. A baggie was the answer to keep the Servox clean and you can talk just as well through the plastic.
Steve Verngren

3. My laryngectomee husband, Jay, works at construction sites. He uses a Servox EL. He was having a lot of problems with it because of dust and grime and was having to send it off on a regular basis to Siemens for costly repairs. They recommended he try to protect it from dust. We pondered this for quite some time and he was trying a baggie wrapped around the end. He was explaining to one of the construction workers why he does this and the guy whipped a condom out of his wallet and said to Jay, “Here, try this.” It was the perfect solution! The last repair was almost a year ago and since he’s gone to this type of “protection”, the Servox has worked fine.
Sara Rothenberger


4. Another tip from Jim Lauder, instead of the condom, one could use a party balloon (cheaper than a condom) to cover the head of the EL to protect it from rain or dust. Remove it when not needed to prevent condensation from forming.

5. If using the oral adapter, to prevent moisture, cover the head of the EL with saran wrap, then put on the oral adapter. Remove it occasionally to prevent condensation.

OTHER MAINTENANCE OF EL’S

Ideas from Jim Lauder’s maintenance demonstration

1. If EL ever gets really wet and/or dirty, take apart as much as possible, remove battery, clean as well as possible, and let it all air dry before inserting battery and using again.

2. If you tend to screw head of EL on too tight, you can get a thicker or new O-ring from the hardware store–this is just used as a spacer.

3. Use an old toothbrush to clean threads on EL where parts screw together.

4. If you need to clean parts, use isopropyl alcohol–NOT rubbing alcohol. The rubbing alcohol leaves a residue.

5. Jim gave us “bumpers” to put on the lower end of our EL’s–to help protect them if dropped. These are the things he applies to BOTH ends when shipping them back to us after repairs.

An Emergency Fix That Might Keep You Going

After watching a helicopter pilot on TV , demonstrate a fast permanent repair of the worn tips of his helicopter blade tips, using only Crazy glue
and baking Soda to fill in the voids at the end tips of helicopter blades.
observing the Crazy glue in liquid state he sprinkles ordinary Baking Soda
on top, in a Nano second or less, the chemical reaction of the two , Crazy Glue and Baking soda bounds to a rock hard permanent fusion .

So what does this have to do with a Cheap Repair?

My battery end cap on my Servox cracked , So I tried to Crazy Glue and
Baking Soda. to my amazement in less than a blink of a eye. My battery end
cap was rock solid and functional again. No waiting instant results.
Smiles all around. I have since see other reports using Crazy glue on broken plastic car parts.
Thanks for reading
Jack 2008

Spare Batteries

Thought I would share this with you!

buying wrangler men’s denim blue jeans, and discovering the fifth 5th watch pocket has been deleted, a cost saving for the manufacturer .

As I use a Servox to voice with, I had used the fifth pocket A.K.A. watch pocket to carry two 2 Servox spare batteries. as a back up., and miss the convenience of the small watch pocket gladly not all jean manufacturer’s have omitted the watch pocket. yet!

Solution found , Finding a small Velcro military’s  cloth fabric pouch with belt loop at a flea market, perfect size that holds up to 3 three Servox batteries at a time it is hardly noticeable , light weight, 5 five inches long x 2 two inches wide

I am not sure what it was made to hold, perhaps a very small pocket knife, light weight can be used left or right side of for left handed people. very secure belt loop with Velcro flap, keep spare batteries safely  quietly in place, lift flap and squeeze clothe pouch and dispense battery.so light weight I forget I have it on my belt waist, all this to say, might find some thing like what I found a sporting good store small knife shelf.
Jack
Feb 8 2008
Posted 10/2019

An added note of caution is that if your EL uses 9 volt batteries, be very careful that no metal can come in contact with both the battery connectors. Fires have been known to happen but at the very least they can get extremely hot. I had it happen to me when I had a 9 volt battery in my pants pocket and my pocket knife shorted the terminals. It almost burnt my leg before I could get it out.
Ron Seattle 2010
Posted 10/2019

USING AN ELECTROLARYNX AS A “BACK-UP” FOR YOUR TEP OR ESOPHAGEAL SPEECH

TEP Prosthesis

Sample of TEP Speech

Tracheoesophageal Puncture and Prosthesis:

In this case, a doctor makes a small hole in the rear of your stoma leading to the esophagus. Once this puncture heals, a prosthesis is fitted and inserted into the opening. To speak, you occlude (cover) the stoma with your thumb or finger and simply force air through the prosthesis into the esophagus. This air movement vibrates the walls of the esophagus and you can create sounds and words normally with your lips, teeth, and tongue, etc. The prosthesis has a one-way valve in it to prevent swallowed food and liquids from entering your stoma. Additionally, your stoma can be covered with a special valve,  called a Hands-Free) that closes when you wish to speak, thus forcing air into the prosthesis. With this valve in place, you no longer need to occlude the stoma with your thumb/finger … your hands are free.

(Permission to re-print provided by InHealth Technologies, Carpinteria, CA.)

Assorted TEP Prostheses



WHAT IS A TEP?

A TEP (tracheoesophageal puncture) is a same-day, simple, surgery, where the doctor makes a small puncture in the wall between the trachea and esophagus. This puncture will hold a prosthesis, with a valve on the esophageal end, so that lung air can again be directed through the mouth by closing off the stoma during exhalation. Closing the stoma can be done with finger, thumb or hands free valve (see illustration above). This redirected column of air will pick up vibrations as it passes through a narrowed section of the esophagus, so talking is again possible for most people.

What is the TEP Plug or Dilator?

The dilator is if the prosthesis comes out or leaks. The SLP uses that when she changes the prosthesis. It is inserted into the puncture after she takes the “old” leaking prosthesis out. That keeps the puncture from closing while she prepares the new prosthesis. The plug is used to stop leaking of the TEP while it is still in place. If something should happen to the plug it would be needed to used in order to place a new plug. This is something you might ask your doctor about. 

If you had a problem with your plug you would need to see the otolaryngologist. The problem would be that you could aspirate which can cause aspiration pneumonia.

Rita
Posted 02/2020

Anyone with a TEP should have a dilator (or red rubber catheter) and a plug on hand in case of problems.

Ron
Posted 02/2020

Videos available for viewing to help your voice

When ATOS sent the address of a video to check out for our website, I went to the site and watched a well done video explaining the use of an oral adapter on the electrolarynx. Then I noticed there were 60 of these videos. You can put them on auto play or just have them in numerical order and chose the one you wish to see. They are varying lengths from 1 minute to double digits. Some are made for clinicians, instructional videos with professionals demonstrating how they solve problems. Many others, titled “Life as a Laryngectomy” simply tell who they are and a bit of their story. All are interesting and informative.

This link takes you to #1 of 60, from which you can play them straight through.  This one relates to body posture to counter hypotonicity (air coming through, little sound) with the patient using a TE prosthesis:

Another sample, showing #14 of 60 is Bobby Noe, demonstating use of :

Provox® Vega™ and XtraHME™

www.youtube.com/watch?v=R1Gtk0FD76E&list=UUtTiTi3t55jJ4Dr-zNLjBYg&index=14

#21 is a part of the ‘Life as a Laryngectomee’ series, an interview with John Aquilar:
http://www.youtube.com/watch?v=kuJe85xdRj8&list=UUtTiTi3t55jJ4Dr-zNLjBYg&index=21

LEARNING TO TALK

Work on getting your breathing rhythmic and practice, practice. Read out loud. Let the air flow be soft, don’t blow it. Don’t strain. It takes very little air to speak, so concentrate on speaking clearly and quietly. Don’t worry about volume.

If you have difficulty getting air to come through, check the trouble shooting article at the bottom of this page.

TRAINING YOURSELF TO IMPROVE YOUR VOICE

When I was a boy, in the early 50s, I took voice lessons from an old maid named Elizabeth Otwell. my parents did not want me to grow up talking like a redneck sharecropper, so I went to voice lessons once a week for a couple of years. I thought it was a real waste of time. However, after my laryngectomy, and when I started with the TEP, I realized how beneficial all that training was. It is somewhat the same way with regard to the many football coaches I had from the time I was 12 until I was 21, and finally retired thanks to a bad knee. I never really understood the concept of “paying the price”, and “overachieving” until I had a laryngectomy.

I have spent quite a bit of time standing in front of a mirror and talking to myself. I have done it in English, Spanish, French, some German, and a little bit of Thai. I have done it using the hands-free valve, various fingers to occlude with, and using esophageal speech. I did a limited amount of time with it on the one time I had a Cooper-Rand device, and once when I had a Servox. I did not have either one of the electronic devices long enough to get very proficient.

When I practice, I speak slowly. I try to enunciate each syllable. I use my tongue and my lips. I watch myself to see how I form the words. I try different sounds. I speak from my diaphragm, as opposed to my mouth. I work to control my breathing. I want to project my voice even when I speak softly, which is one of the things I learned I should do from Jim Shanks and Dan Kelly. The bane of the hands-free valve is to lose the seal. The length of time one can maintain a seal is directly related to the amount of back pressure placed on the seal. If you put on the valve, never talk, never sweat, and never get any mucus on the glue, then the seal should last forever. The less back pressure used in talking, the longer the seal will last.

It would be very good, for you to speak into a recorder, then play it back. Then do it again, and see if you’re improving. I have watched videos of myself, and used them for what to do and to “not” do. When you speak, speak from the bottom of your stomach, project your voice, speak softly, enunciate each syllable, speak distinctly and precisely. (Philip Clemmons)

WAYS TO OCCLUDE LARGE STOMA

1. I occlude my stoma to speak (or to swim..see Keep Active) with a hand exercise ball manufactured by Theraband. The company manufactures these balls in three different colors but I recommend the yellow which is the softest and molds around the stoma. I have been using these balls to occlude the stoma for speech as I have a very large stoma and there is no way I can use a stoma adhesive and HME or a freehand valve. I have been using the Provox 2 prostheses for the last four years. Call The Hygenic Corporation for a Dealer near you. In the U.S. or Canada, call: (800) 321-2135 (Jose Cruz)

2. Use ping-pong ball (which can be washed).

3. A rubber thumb. The office supply covering that is worn on the thumb when you are sorting through files and papers. That would make the thumb larger.

4. Look at the grocery or drug store for a bottle, maybe shampoo, that has a large round top on it. I took one of those and glued it onto a dowel so I could hold it in my fist when I talk a lot. Helps when arthritis sets in the fingers.

I brought home some sample size bottles of shampoo and conditioner from a hotel. The little plastic bottle is very light and the round top is about an inch in diameter. Works great for a small stoma and, maybe, for a large one…but I have seen several in the Dollar store with a larger top. (Pat Sanders)

5. Try making a fist and using the big knuckle at the top of the forefinger. 

6. Almost any of these can work quite well if you don’t try to push the air out. Unless you exhale in an easy manner, the air wil often escape around whatever you are using to occlude

Maintenance

CLEANING A PROSTHESIS IN PLACE

1. There are little brushes, 2 or 3 to a package, found where you would buy toothbrushes and floss. The brushes are straight or tapered and are the perfect size to insert “gently” into the prosthesis to clean out any mucous that might have it stopped up. Take care and don’t push the brush in far enough to hit the esophagus. I store or clean my brush in a medicine cup of peroxide.
Pat Sanders

2. I use the Provox brush, which is expensive but well worth it. I bought a dozen for $54.00. Each will last about six months, but I like to keep one in each bathroom, both vehicles, and in my Dopp kit so that I will not forget it if I go on a trip on short notice. I keep the new curved tube irrigation bulbs in the same places. along with a pair of blunt, straight tip tweezers, the kind with finger holes in the handle. That way, I’m always prepared to clean anywhere. I also carry a flashlight that looks like a ball point pen. Big help in poorly lit bathrooms—and that’s nearly all of them.
Roger Jordan

3. I found one of the small t-handle insertion tools for a TEP prosthesis works real well for a quick cleaning. It even has a built in stop, I carry one in my wallet for those times I suddenly can’t talk. If you have one in a size that matches your prosthesis, give a try.
Bill Parks

ATOS CareTips

ATOS had care tip pages for many subjects. The following is the link to the tips for maintaining your TEP.
https://www.atosmedical.us/wp-content/uploads/2018/07/mc0685_caretip_01_provox_vp_care_brush_flush_201807_web.pdf

Advanced Head and Neck cancer Rehabilitation of Texas

The following link is information on cleaning and maintaining your TEP from the Advanced Head and Neck Cancer Rehabilitation of Texas.
https://www.practicalslpinfo.com/cleaning-your-voice-prosthesis.html

When to replace Indwelling prosthesis

It is not possible to be specific as to when an indwelling prosthesis should be changed. For most people, I suspect the determinant is when leakage becomes a problem. But one should always try to make certain that the leakage is not just a temporary occurrence caused by insufficient or careless brushing before taking the more drastic step of replacing the TEP.

This advice is especially important for those who are still in the early months (or years) after surgery. It is very important too to make sure you are measured from time to time for the correct size of prostheses as the puncture can (and frequently does) change over time. Even a completely new TEP will leak if it is not a proper fit. In my own case I have had very different intervals between changes – ranging from just two months (in one case) to a more satisfactory nine to twelve months which is my norm in more recent times.

The state of health of the individual, issues relating to diet and medication are other factors that come into play.
Michael Mac Mahon

TEP TAB

I wear the Blom-Singer patient-changeable and have the same issue with the tab. Because of the way the Blom-Singer is installed, there is a very small hole in the tab itself that is used for the installation tool. Prior to installing the prosthetic, I tie a piece of nylon thread into a loop that passes through the installation hole. When I put on a base plate, I hold the thread and tab up at the 12 o’clock position and then put on the base plate as usual. The thread is thin enough not to interfere with the seal of the base plate. The string is trapped in position between skin and base plate which holds the tab in the right position, plus the adhesive of the base plate helps secure the string and tab as well.

A little experimentation will show the proper length of string for you. I like to keep a half-inch or so sticking beyond the edge of the base plate in order to pull the tab up should it wiggle down during the course of the working day.

I do not know if the Provox prosthetic has a similar hole in the tab, so this may not work for that brand. (But I would guess a sewing needle should be able to punch a hole in the soft plastic, if needed. The hole only needs to be large enough to pass one width of the thread, so it isn’t a large hole.)

Just my way of dealing with the tab – your mileage may vary 🙂
Loyd Enoch December 2009
Huntsville, AL (work)
Evansville, IN (home)

Leaks

IF THERE IS A LEAK

1. If you swallow and a drop or two leaks through the prosthesis, first you cough, than try this! Occasionally, food gets at the edge of the valve of the prosthesis and holds it open just enough that taking a drink will allow liquid to run into the trachea. This can cause spasms of coughing so you want to get it fixed as soon as possible. To check to see if this is the problem, I lean over so the water doesn’t run down my trachea, use a light and mirror and sip a little water. Then I watch to see if it is dripping through the middle of the prosthesis. If it is, then a good flushing or cleaning should remove the food that has it blocked. I would clean with a brush (see hint above) and flush with the syringe/pipet. Drink some water and check it again. That should correct it, but, if you still have a leak, repeat the cleaning and flushing.

2. I had continuous central leakage of my TEP which would not last more than 1-2 weeks. This frustrating problem stopped once I began to flush my TEP with very warm or hot water and not use room temperature water. I heat water and make sure it is not too hot by sipping. If I can drink it, I can use it for flushing with a bulb. The warm water is probably more effective because it flushes away mucus, debris and perhaps even fungus to keep the inner canal open. One potential advantage is that the heat may be deleterious to the viability of Candida and therefore impede its growth inside the TEP. My prosthesis will last now for a month or more rather than days. It is so simple that it is worth while for anyone to try.
Dribrook, Washington DC

3. If you can’t stop a leak coming through the prosthesis when you eat or drink, there are now plugs to use to stop up the passage through the prosthesis on a temporary basis until you can get to your SLP for a change. 

Some laryngectomees who did not have a plug available have used a cotton swab while they eat or drink to temporarily block leakage but do not use the type where the cotton may be loose and could fall into the trachea or a cut off one, or even the short handled Q-tip.  The only safe one would be the long handled one that you can hold onto.

For those who insert their own prosthesis, the original insertion tool can make a temporary stop to the drip.  It is the right size and has a lip on it so you can’t insert it too far into the prosthesis and it has a handle so it can’t be dropped down the trachea.

LEAK – NEWLY INSTALLED PROSTHESIS

1.  I have been using indwelling prostheses for just over a year now. Every one that my SLP has inserted has leaked liquid thru the middle when I do the swallow test. I live about an hour from the SLP and I just leave the TEP in and go home. By the time I get home the prosthesis has stopped leaking and I have no further problems. I am of the opinion that the process of folding the flange, inserting it in a gel cap, etc.. causes the TEP to be warped out of shape a little. It also takes some time for all of the gel cap to dissolve and disappear and also any KY jelly or other lubricant that was used during insertion.

My point is that both patients and SLPs should be patient and give the prosthesis some time to settle in. I always have the SLP leave the insertion/safety tab on my TEP just in case I would have to return and have it taken out/re-inserted. I’ve had 4 indwelling TEPs inserted and every one of them has had this “temporary” leakage problem. So just because it leaks when you take that first drink or two after the SLP puts it in, DOES NOT mean it is a faulty TEP. Give it some time to settle in, and see what happens.
Cheers, C. Bruce “Buck” Martin

2.  I use the patient changeable prosthesis and I will often have a small leak that doesn’t last long. I find sipping a hot liquid or using very warm water in a flusher to warm the prosthesis helps.  It may very well be the flange that has not settled into place or it can be the flap that is not opening and closing properly.  In either case, it usually adjusts.

I also make sure the flap works before insertion.
Pat Sanders

BULB TYPE IRRIGATION SYRINGE

From Wal-Mart or your local drug store, buy a bulb type irrigation syringe and an eye dropper (the kind with the black bulb on the end.) Take the little bulb off the dropper and insert syringe tip into glass tube…Voila!!!…if you press the bulb in, using a lubricant like KY jelly, it will slip on, lodge securely, and when the carrier (water) evaporates the bulb will never come out… well not without a LOT of pulling and pushing and twisting. No cutting or taping or gluing…great if you’re traveling and forgot to bring one. And, because the end of the tube is tapered, it fits perfectly into any prosthesis.

To fill: simply immerse in tepid water, squeeze the bulb, then let go. It really cleans well because it has the volume or pressure to do the job. You can vary the nozzle pressure by squeezing harder or lighter. To clean it all you have to do is simply flush the unit with hydrogen peroxide and then warm water. Total cost not much more than $3 — even less if you steal the parts. Note: this is a little bit of YANKEE know-how.
Paul Galioni

Note: The manufactures of each TEP make specific brushes and flush devices for their TEPs. They are the correct size and application for the device. Contact the manufacture for more information from the Suppliers Section.

“SOME COMMENTS ON THE ESCALATION OF TRACHEOESOPHAGEAL VOICE PROSTHESIS DIMENSIONS”

Dr. Eric D. Blom, PhD, of Head and Neck Surgery Associates in Indianapolis, IN, had a Letter to the Editor published in Otolaryngology – Head & Neck Surgery on the above subject. The original letter from Volume 129 April 2003 is in the archives of the Journal of American Medical Association. An Adobe Acrobat (.pdf) format copy of a reprint is available for those who would care to read it in its entirety (to include its charts). Dr. Blom notes in his conclusion, based upon numerous independent clinical observations, that, “Although it is not irrefutably established that leakage around a tracheoesophageal voice prosthesis is predictably related to increased dimensional characteristics or the dilating effects of insertion, an awareness of a possible relationship seems warranted.” One of the studies cited by Dr. Blom in his letter was “Downsizing of Voice Prosthesis Diameter in Patients with Laryngectomy”, by Drs. Eerenstein, Grolman, & Schouwenburg, 2002. An Adobe Acrobat (.pdf) format copy of an AMA reprint of this study is also available, should you be interested in reading it.

Hints from members

TWO WAYS TO CUT TUBES FOR WEARING WITH PROSTHESIS

1. I use a modified trach tube to hold the Provox HME filter. Other brands of tubes could be modified this way also. I cut it off to an inserted length of about 3/8″, then cut a U at the back of the stem to clear my prosthesis. I use silicon adhesive on the front and sides of the tapered flange. I let it dry for 15 minutes before inserting in my stoma. This prevents the transfer of the adhesive to my skin. It remains tacky and sticks to the skin around my stoma, but when I remove it (to cough or whatever) it pulls away gently. I pop it back in and it stays in place. It sort of acts like Velcro.

Update note: many vendors make tube for TEP speakers so they do not need to be modified.

During the day, if I get mucus on it, which can ruin the adhesion, I rinse thoroughly in hot water, dry and pop it back into place. Each night before going to bed I give it the hot water rinse, so it will stay in through the night. The next morning, hot water rinse, add another coat of silicon adhesive. After about a week the adhesive build-up gets too thick so I remove the build-up with silicon adhesive thinner, using a 2×2 gauze pad, wash with soap and water and start another weeks cycle.

I hated the adhesive patch HME holders. Unless you are using a hands-free valve the procedure, the above works great and is much less expensive. (Kent Smith)

2. I use a trach button for holding my stoma open and to make it easier to occlude (This was the Bivona-Colorado template that they started selling to use as a button. Bivona has been bought out by Portex). The button is light weight, will fold and roll for easy insertion and comes with a small hole in it. By enlarging that hole to uncover the area where my prosthesis is, I am able to have the air flow into the button and into the prosthesis when I occlude. The small ridge at the back holds it in for me.
Pat Wertz Sanders

TEP TRAVELERS

While I have an Indwelling TEP that is changed by the SLP, I always have a couple of the low pressure prostheses at home and carry a couple with me when traveling. I have been using the Indwelling for about 8 years, and once accidentally pulled it out with my tweezers when cleaning it. I replaced it with a low pressure that held fine until I got a new Indwelling installed the next day. I believe in being prepared. All of us should.
Roger Jordan

Those little mustard or Jelly jars in the Hickory Farms type gifts? They make real good containers for soaking the prosthesis in and they don’t leak so can be used in a travel kit. They are thick enough so it would take a lot of banging around to break one.
Par Stratton

A LESSON FOR TEP USERS

I have been using TEP speech for approximately 12 years and have never had occur what happened to me today. I exchanged my prosthesis this morning for one that was ready to be reinserted and shortly thereafter mucous started coming from the stoma in copious amounts. I thought that somehow I had caught a severe cold. After putting up with this stream of mucous for about 20-30 minutes, I decided to investigate. The suddenness and the constant output puzzled me. It turned out the mucous wasn’t coming from the inner stoma, but leaking out of the middle of the prosthesis. After inserting a brand new prosthesis everything magically cleared up. Lesson: A prosthesis doesn’t last forever – sometimes you should change to a new prosthesis and discard the old one!
Irwin Title

PROSTHESIS SIZING & FITTING  – troubleshooting

GETTING VOICE (No Air coming through)

Here is the way we problem-solve, step by step:

Step 1. Determine whether the problem with getting voice is a problem with the prosthesis, or with the patient’s anatomy & physiology. To do this, we usually remove the prosthesis from the puncture and have the pt try to voice “open tract” on a prolonged ‘ahhhhhh’. Don’t swallow when there is nothing in the puncture or you will get saliva leaking through the puncture into your trachea. If the voice is good, the problem is with the prosthesis and you go to Step 2. If the voice is not improved, the problem is with the pt. Skip Step 2, and Go to Step 3.

Step 2. If the problem is with the prosthesis (voice is good open tract), the puncture should be dilated a sufficient length of time, and then the puncture tract length is carefully measured (not just a guess!). The prosthesis is inserted. Wait a few minutes if a gel cap insertion is used, so the capsule will completely dissolve. If the prosthesis is the correct length and properly inserted, it should rotate freely in the tract while it is still attached to the insertion tool. And if it is correctly inserted, you should feel resistance to gently trying to pull it back out while still attached to the inserter, because the esophageal flange is fully deployed in the esophagus. In many laryngectomees, you can see the esophageal flange of the prosthesis by passing a flexible endoscope through the nose and down into the upper esophagus. If the prosthesis is seen, you know that you have the correct size and that it is fully inserted into the puncture. It can be hard to see it sometimes because of secretions, the way healing occurs after surgery, and the absence of the usual landmarks that are there before surgery. Some tricks to get a good view: the scope is advanced slightly below the prosthesis. The examiner can tell where the scope is because the light of the scope will shine through the tissue allowing you to see it on the outside of the neck. You should occlude the stoma and try to voice on a long ‘ahhhh’ or ‘eeeee’ as the examiner very slowly removes the scope, and usually the prosthesis will be seen for a brief instant. It helps to record the exam and play it back because sometimes you think that you see the prosthesis but aren’t sure. If the prosthesis isn’t visualized with the scope, it may still be correctly inserted, just not easily visible. If the voice is worse with the prosthesis inserted in the puncture compared to open tract voicing, the prosthesis may be the wrong length or not correctly inserted, or you may need a prosthesis that has a lower resistance to the flow of air. The different types of prostheses have different levels of resistance.

Step 3. If the problem is with the anatomy/physiology (voice isn’t good even with an open tract), first check that the puncture is still completely open all the way through to the esophagus. You should be able to insert adilator/stent/catheter, lubricated with water-soluable lubricant like K-Y jelly, into the puncture. If you can’t get it in, the puncture may have closed on the esophageal side — think of the puncture like a tunnel, and the back end of the tunnel has collapsed. Verify whether it is closed by taking a small, very small sip of water and looking at the puncture with a bright light. If the water doesn’t seep through the puncture, it is closed and you need a repuncture. If you see water seeping through, the puncture is still open. Go to Step 4.

Step 4. The puncture needs to be fully open to a diameter that is slightly larger in diameter than the prosthesis (eg, 22 French for a 20 French prosthesis) to have an easy insertion. Start with a dilator/stent/catheter that is slightly smaller in diameter than the puncture – it should slide easily in and out of the puncture with a lubricant. Move to successively larger diameter stents/catheters until the dilator that is slightly larger than the diameter of the prosthesis (eg, 22 French for a 20 French prosthesis) slides easily in and out of the puncture tract. That can take hours sometimes, even overnight, but don’t rush it. Once it is fully dilated, check that the open tract voicing is good. If it is, the puncture tract length is measured and the correct prosthesis is inserted. If the open tract voice is still not good after you know that the puncture is fully dilated, go to Step 5.

Step 5. Check that the stoma occlusion isn’t interfering with the flow of air or the vibration of the pharyngoesophagus when trying to voice open tract. (you may need to periodically replace the dilator so that you can swallow saliva, and so that the puncture stays fully dilated.) If using finger occlusion, do not exert inward pressure which might “pinch” the esophagus. Gently but completely cover the stoma with the finger. As you start to voice, the stoma usually will move forward to meet your finger. Also make sure that your finger doesn’t block the prosthesis. If that doesn’t solve the problem, go to Step 6.

Step 6. Make certain that you aren’t tensing up when you try to voice open tract. The jaw should drop freely when you prolong ‘ahhhhh’, and the shoulders should be low and relaxed. Take some slow deep breaths to make certain that all is relaxed, and then try to voice without
tightening up. If the open tract voice still isn’t better, go to Step 7.

Step 7. The clinician can try to do an air insufflation test by placing a red rubber catheter a small distance into the puncture so that the fenestration is inside the esophagus. The other end of the catheter is connected to an air supply, and a very low ‘flow rate’ introduced into the esophagus as you try to say ‘ahhhhhh’ – don’t need to occlude the stoma since the air isn’t
coming from your lungs. If you get good sound, then the problem is either with your respiratory support or the way you are occluding the stoma. If you still don’t get good voicing, go to Step 8.

Step 8. The physician can perform a “lidocaine block” which is an injection of a topical anesthetic into the neck. If the muscles of the throat have too much tone, or are going into spasm, the block will release them temporarily and free the voice. It can take a good 20-30 minutes after the injection for the voice to loosen up, and it will wear off after ~ an hour. If the voice is good during the block, it might suggest that Botox would be helpful.

When I worked with Mark Singer, MD, who developed the TEP method with Eric Blom, SLP, he always reminded me that the TEP method is simple, but that doesn’t mean it is always easy. When a person fails to develop TE speech, it requires careful problem-solving to determine the cause of the problem, and that can be time consuming. Too often, we clinicians are in a hurry and don’t think it through. Instead we try this and try that, without fully understanding what might be the real issue.

I’ve seen too many patients where a surgeon reached for the Botox right off the bat, which didn’t work, because the real problem was the way the stoma was occluded, or an improperly fit prosthesis, or the patient’s excess tension. If a clinician is stumped by a pt, they can always contact some of the “master clinicians” who are willing to offer suggestions. Both InHealth and ATOS have knowledgeable SLPs on staff who can also assist with problem-solving.
Carla DeLassus Gress, ScD, CCC-SLPCharlottesville, VA .

Removing the TEP and allowing  puncture to heal

If it doesn’t work for you?

Some people have difficulty with keeping a TEP from leaking, staying in or working the way it should (and does for most.)  For some of those, the simplest way is for the doctor or SLP to be aware and help you plan for just simply removing the prosthesis, check it over … and let the puncture close.  For some, there will be further problems.

Question: I have asked for advice from those who know about this process to tell us something of what to expect. I put this question in the list for feedback.

I was just in the WW Facebook Group and someone was asking how long it takes a puncture to heal. I never had to do that and I wonder, too. I also wonder if it takes longer for the 20fr size puncture to close than it does the 16fr?

There is more to it than that but if you have had the wrong size prosthesis and it pistons in place, I think it make a wound longer to heal…  it could be like scar tissue. Please help me to get together some ideas for the Information Library.

Answers:

1. A puncture healing is dependent on the overall health of the person. As we always say, “we are all different.” Our medical issues, age, nutrition, etc. will cause the differences in length of time for the puncture to heal. If the puncture is in tissue which was used in reconstruction of the area, it might require a different solution. I had to have mine surgically closed; it wouldn’t heal because it was skin from my forearm.  Rita B.

2. This is an issue that will be different for everyone. I have known of people that have taken out the prosthesis and the puncture site closed in 8 hours. I have also known people that it never closes on it’s own. A lot depends on how much radiation the patient has had and how healthy the tissue around the puncture site is. As to the size of the puncture site I would think that it may take a little longer for a 20fr site to close than a 16fr site.
Richard Crum

3. It happens pretty quick depending on the person, your antibodies, health etc.. In just a matter of a couple days, it can heal to the point of not being usable to hold a prosthesis.
David W lary 2014

4. When the tissue was not good enough to start with, the puncture is more likely to fail… and more likely to not regain health and close if you remove the prosthesis.
Pat W S lary 1995

WHISPERS ON THE WEB READING FOR TEP advice

Hands Free Devices

WHAT IS HANDS FREE?

The Tracheostoma Valve, when used in conjunction with a voice prosthesis, enables hands-free, conversational speech. After proper fitting, the diaphragm portion of the valve rests in an open position and may be adjusted by rotating the diaphragm/baseplate for relaxed, quiet breathing, or routine physical activity. During speech, a slight increase in exhalation causes the diaphragm to close and divert air through the prosthesis. At the completion of speech, the diaphragm automatically reopens as exhalation decreases.
InHealth Technologies

USING THE BLOM-SINGER HANDS-FREE VALVE & VALVE HOLDER

I have found that the edges of the valve holder for the Blom-Singer valve assembly often cut into the skin of my throat. This is particularly true because my reconstruction included placing a flap in place of skin and muscle taken from the throat. (O.K. the fact that I am overweight doesn’t help either.). The skin above the valve holder pushes down on the holder. As the holder material ages, it gets harder and eventually irritates the skin. I have found that if I rotate among two or three holders, using a different one each day, I have less irritation because the different holders stiffen at a different rate and at different places. Therefore, the pressure areas change each day with each different holder. This doesn’t completely eliminate the problem, but it eases it significantly (or, I believe it does, which is much the same thing for me).
Terry G. Duga

Video showing an installation

A lot of members have written about having trouble installing their handsfree, so I put a video on youtube demonstrating how I install.

I’m probably the only person to make a video in the bathroom. This is a demonstration of how I do it. I know that it is not recommended to take off the insertion tab, but many do remove it. That’s where I got the idea. The maker recommends against taking it off in any circumstance.

This is the link http://www.youtube.com/watch?v=5Wo1z5_n1j8
Hope it helps.
Steve Staton

Atos Videos

ATOS has some videos about their hands-free devices at the following link:
https://www.atosmedical.com/laryngectomy/free-your-voice/

Atos handsfree device works basically the same but uses different units for different pressures instead of being adjustable.

USE CLIP TO HOLD LARY BUTTON from a Member

Alligator clip is used to hold the Lary button and is great for hands free.
When I cough the cap sometimes goes flying so I anchor it with a clip to attach it to my clothing.
Paul Frehner 2009

SHOWER GUARD TO GO WITH THE HANDS-FREE DEVICE

Imagine my chagrin when I nearly drowned while taking that long awaited first post-laryngectomy shower. I had failed to take into account that my breathing hole was now oriented in the wrong direction relative to the shower stream and the high concentration of soap reduced the water surface tension allowing it to go places it was never intended to go. This was extremely disagreeable and I would suspect that many of you might have experienced a similar event. There are a number of products on the market designed to provide relief, but unfortunately some simply just don’t work very well. For those of us that utilize a tracheoesophageal prosthetic device to produce speech, there is a very effective little gadget available for our use. It is merely a small, upside down snorkel and all you have to do is remove your filter or “hands-free” device from the plastic collar and snap this thing in while you shower. I’ve been using one for two years and have yet to suffer the first leak. It works so well that you don’t even have to take any special precautions and may shower just as you did prior to the surgery.

I use the one designed and produced by ATOS (the blue one) and distributed by Bivona Medical Technologies. It has a clever little internal baffle that may make it slightly more effective. INHEALTH also markets a similar device (the clear one) that should work equally well. These things only cost a couple of bucks and should last forever so you really ought to give one a tryout. (Marvin Whitley)

MUCUS REMOVAL HINT

For you “hands-free” and HME TEP users, this is a tip that you will want to try. The collar that attaches your hands-free or HME device also makes it difficult to remove mucus from the margin of your stoma and the inside edge of the collar. To the best of my knowledge, nobody makes a product for that purpose and if you don’t keep that area clean, the mucus will eventually cause the collar adhesive to loosen resulting in a leak or loss of seal defeating the purpose of both devices. Indiscriminately poking around in there exposes you to the possibility of injury or accidental aspiration. Fear not – There is an extremely inexpensive, safe, readily available product that will do a great job of cleaning that area. Try using a small (one-inch) disposable foam paintbrush. That’s right – Paintbrush! The thing is made of mucus grabbing, open-cell foam (just like HMEs) so you can actually breathe right through it. Most importantly, it’s sized and shaped exactly right to get in there and do the job. You can buy a package of them for about a buck at most hardware or craft stores – fifty cents is the most I’ve every seen a single one sell for. The technique is extraordinarily simple. Just go to a sink with a mirror, moisten the foam slightly, remove your “hands-free or HME, cover your stoma with the foam brush, cough right into it, rinse the mucus from the brush (recommend you get a black one to make that task easier), and then while exhaling slightly to maintain positive air pressure just insert the clean, moist (not wet) brush into the collar and rotate it with light pressure so as to scrub the pesky remaining mucus free from your stoma area. There are other foam brushes available which are apparently designed for special purposes such as stenciling, but I would recommend that you stay with a paintbrush as they have an internal plastic stiffener that will afford some degree of support while scrubbing. (Marvin Whitley)

Instructions for installing base plate

KEEPING A SEAL

There has been a lot of talk on the list about how to keep a seal and the correct use of base plates. I have been a laryngectomee for 25 years and have used a hands free valve with a base plate most every day. I almost never have an air leek. I have found that keeping the base plate from leaking air is a three fold process. The skin must be prepared properly using the right materials and the amount of back pressure must be limited to using just enough pressure to produce speech and not to much pressure to break a seal.

It is very important to put the base plate on correctly. I first clean my skin with a warm wet wash cloth. I then dry my skin and use an alcohol pad to clean any oil that is on my skin. I then apply a Skin Prep pad. I think of this as putting a layer of plastic wrap on my skin to protect it. After applying the Skin Prep it must dry. I use a short cut and dry it with my hair dryer. After the Skin Prep is dry I use a Skin Tac pad. I have found that Skin Tac is much better for my skin than Silicone adhesive. I take one of the Skin Tac pads and using one side I coat my skin. I then turn it over and coat the area around my stoma again. I then use my hair dryer to make sure that the Skin Tac is completely dry

I then very carefully take a base plate and remove it from it’s paper backing. Holding the base plate in my right hand I spread my skin around my stoma with my left hand so it is as smooth as possible. I then place the base plate on my skin so the hole of the base plate lines up with my stoma. I then press around to make sure that the base plate is firmly in place. I am set to go for the day.

I have found that it is best for me to remove the base plate in the evening. This gives my skin the chance to breath. I NEVER use an adhesive remover. The way an adhesive remover works is to break down the adhesive. If this remover is not fully cleaned off your skin it will continue to break down the adhesive. After I remove the base plate I wash my skin with a warm wash cloth.

If you have put on the base place correctly the next problem you need to address is the amount of back pressure. I like to think of this process as when you learned to ride a bike. You will remember that you would get on the bike and fall off. After doing this several times you would learn to keep your balance and you could ride the bike without thinking about how you were doing it. Learning to keep a seal is a lot like this. You must learn to use enough force or pressure to be able to speak and not so much pressure that you force the base plate off your skin and you get an air leak.

This whole process has a long time learning curve. I have had people tell me that they cannot keep a seal. I ask them have they tried using a base plate. They reply that they have tried using it several times. My reply to them is that I have put the base plate on over 8,000 times. I must admit that it took me about 6 months before I was truly successful.

In summation use the correct materials to put the base plate on, do it correctly, and control the amount of back pressure. When you have mastered these basics it will become as natural as shaving or putting on your make up every morning. I hope this may be helpful for those who chose to use a hands free valve or an HME.
Richard Crum

ROUTINE FOR INSTALLING HOUSING

I use the Tru-Seal disposable housings with adhesive (Skin-Tac “H”) and here’s how they work for me. First, I gently clean the area around the stoma with plain soap and water, followed by alcohol. After that dries, I use a protective barrier wipe, either Shield Skin or Skin-Prep. This gives the adhesive a good base and protects the skin from irritation. I then apply a thin coat of adhesive to the area where the baseplate will go and wait about 4-5 minutes. (I use this time to do other grooming things which help the time go faster) I apply a 2nd thin coat and wait another 4-5 minutes. Now, I carefully place the baseplate around the stoma, making sure there are no wrinkles. At this point, I gently but firmly keep pressing the whole baseplate to work the glue in thoroughly. I then pop the hands-free valve in (with HME filter) and it’s done. I’ve also found that waiting about 15 minutes before speaking gives the bonding a better chance. When it’s time to change again, I use adhesive tape remover pads which I pick up at a local medical supply store and that’s that. It should work. Good Luck! (Libby Fitzgerald)

SECURING HOUSING FOR VALVE

When I was introduced to the Hands-Free device, I was given a bottle of glue and some disks. This was messy and unreliable as the glue did not keep the housing secure. I finally found Hy Tape, which is waterproof and has a zinc oxide base and created my own method of securing the housing for my tracheostoma valve, which I use on a daily basis. It has worked very well for me during the past 4 years..

These are the products I use, including the brand names:
Hy Tape – available at Bruce Medical or from Hy Tape.
Smith Nephew “Skin Prep” and “Remove”- most health supply stores (in Canada)

My method is as follows:
Place the valve or housing on the tape disk and use a scissor handle to get a good seal.
Apply Skin Prep “only” around the area that will require tape.
Apply the housing over the stoma using fingers to seal.
Cut a 3 inch strip of Hy Tape and apply to the top of the housing under the chin.
Cut another strip a little longer and apply to the bottom .
The sides seem to take the most pressure so I use two strips on each side overlapping each other.

The housing should be secure. Normally it last several hours depending on use. If it breaks the seal, I simply pull it off, clean the area with “Remove” and put a new housing on with a new disk. I normally have three housings or valves, and remove the tape and disk each night. They can be cleaned with “remove” and washed with water to be used until they become brittle.

I find it quite reliable, easy to apply, and have used it successfully.
Robert Smith

TAPE THAT HOLDS

After many problems with tape that came loose while holding the strap of my Blom-Singer prosthesis against my neck, I have found two 3/4″ tapes that I can recommend. They both come in rolls that are probably available in every drugstore.
(1) 3M Nexcare Soft Cloth Premium Tape – Advanced Holding Power (White Tape)
(2) 3M Nexcare Foam Premium Tape – Absolute Waterproof (Flesh-colored Tape)
The Foam Tape seems to work the best for me .. although the cloth tape works almost as well.
Dutch Helms

PREPARING SKIN TO HOLD TAPE

I’ve used 3M’s Transpore tape to hold the strap on my prosthesis with good success for sixteen years. I suggest that you change the tape once or twice daily, and clean off the residual glue with a little alcohol on a Q-tip. You might leave the tape off for an hour now and then to let the skin breathe. Some people might find a thinner strip of tape (3/8″ or so) placed alternately high then low on the strap is sufficient to hold the strap, and will give the skin more chance to breathe.
Ron Langseth

GLUE ON YOUR CLOTHING?

When I first started wearing the hands-free valve and seal, it seemed I was having to re-glue all day long. Unfortunately, when using the glue to repair my seal, I ruined a lot of clothing because of the glue drips. I have finally found an adhesive remover that works really well and have removed the glue from the clothing. It is called “Citrus Magic” – Natural Citrus Stain & Adhesive Remover. I buy mine at a Meijer Store but you could probably find it at Target or Walmart. Also I have found an additional product it is made by Carbona. It is called Stain Devils Spot Remover for removing chewing gum and glue especially from fabrics. You can find this usually in any grocery store.
Kay Allison

Esophageal Speech

Click on the Links below to hear samples of esophageal speech:

Sample of Esophageal Speech *

(*Sample provided courtesy of Dr. Philip C. Doyle, Voice Production and Perception Laboratory, University of Western Ontario)

(Permission to re-print provided by InHealth Technologies, Carpinteria, CA.)

Comments From Rita Burfitt and Elizabeth Finchem on Esophageal Speech:

“The following is from a thread that appeared 10/27/17 on WebWhispers, last weekend. It may be a repeat for WW members, but new info for some members. This was my contribution on the subject: Forms of speech; EL, ES. TEP or ULTRA VOICE.This is a response to Rita Burfitt’s long, but well done explanation of our usual post op voice choices today. With the advent of the TEP surgical protocol had shifted to primary puncture at the time of surgery, but more recently the pendulum has begun to swing back to secondary puncture to give the patient time to heal and inform themselves about the choices that may best suit their particular needs.Learning to use the electro larynx (EL) as soon as possible is a wise move for immediate communication if an intra oral tube is attached to the EL in some fashion it can be used without concern for the neck incision and swelling. Some people refer to this tube as a “straw”; which seems to suggest the tube should be placed in the center of the lower lip as a straw would be. The tube will produce much improved speech when it is placed inside the mouth, but to the side of the mouth and pointed up toward the roof of the mouth. The EL seems to remain a favored back up no matter which choice ends up as your primary means of speech. One more advantage to becoming proficient with an EL is learning to speak without using lung air if you plan to keep using the EL, or learn to use esophageal speech (ES) also. For EL & ES the stoma is for breathing, not speaking.It is really regrettable that pre op counseling is not provided across the board before laryngectomy as it once was. I had two sessions pre op with my SLP with time to listen and ask all my questions. That was a time, not so long ago, when we had time before surgery to view video tapes with really good ES speakers who had returned to work as teachers (3rd grade and high school French). When I saw this video I thought if they can do this…so can I with an SLP to help me. Sure they were accomplished at ES; it looked easy. I had no clue what I’d have to learn to duplicate their level of achievement. In a nutshell, now I tell my ES students to think of ES as counter-intuitive to everything they assume they did to speak with a larynx. We know the body is capable of reversing the peristalsis (like fingers moving downward to milk a cow) because we know our body already knows how to burp and vomit. Because both of those moves are much bigger that ES the body also stands by avoiding these behaviors. The trick is to give the body permission to do something similar with less air as we begin to use this means to produce a new voice … quite easily. The ease of it is always a surprise for the ES student. So, as Rita states “ES is hard to learn”, that may be the first hurdle to get over. This is not something most SLPs can relate to beyond the “swallow air and burp” example. Too bad this demonstration isn’t presented as a “one time only” example because it delivers too much air all at once and a set up further difficulties as the therapy session progresses… or not. ES at its best is relaxed, effortless and fluid. (A “burped” conversation is soon painfully full of air in the stomach; that is also “hard” and a cause for giving up on ES for some.)I encourage you to be as curious as you can be and investigate every possibility as you go along with your healing and rehabilitation. The perpetual student wins the day because things do change.Elizabeth A. Finchem DOS: 10/2/78 Tucson, AZ

Books and videos follow:

Esophageal speech, A manual for teachers(DoeHLER)

Book to Video –  furnished by Lauder Enterprises

This is one of the best esophageal voices I have ever heard. Mrs Doehler reads the book including the exercises and Jim Lauder has copied the book to read along.
PWS

EDMUND LAUDER AUDIO ON ESOPHAGEAL SPEECH

The following is a link to the audio that was created by Edmund Lauder and is available on the WebWhispers youtube site. http://youtu.be/rtRetlucFeA

Edmund was a laryngectomee, a speech pathologist, and the author publisher of the book “Self Help for the Laryngectomee”. This tape was produced to help laryngectomees produce esophageal speech. It is a vocal extension of his book, which is available from Jim Lauder’s business, Lauder Enterprises. Information on Lauder Enterprises is located in our Supplier’s section.

Recent video of new esophageal speaker

Dave Aitchison has been working on learning ES and just sent this video of his highly successful studies.  Congratulations, Dave.

“I put together a short video of me in my role as park greeter at the mobile park in South Texas where we spend our winters. This year the park greeter didn’t come back so I offered to help. Ended up doing whole thing – I meet all new arrivals and tell them what is going on in area and then stand up at our weekly social and introduce them.I am hoping that others may see it and try ES. I have had good success with ES and like the trouble free part. We are Canadians and could not afford help in Texas if I were using a TEP. I am hopeful that people that are going to have a laryngectomy would see video and consider ES as a speech option. I appreciate it is not for everyone but it certainly has worked out well for me.”

FACEBOOK SITE – open to the public

Esophageal Speech Support is a Facebook group that is “Open to the Public”. It began on July 22, 2015 with the goal of a group dedicated to just esophageal speech for laryngectomees and SLPs. As the Administrator I started writing the basic steps to learning/teaching how the three methods of air intake work, the difference between the roles consonants and vowels play in producing ES voice, and how to link multiple syllables into phrases. It is a little different approach to teaching ES than relying on word lists that will eventually produce an ES word, and it gets quick results. Understanding the mechanics of how ES works is as important for “self monitoring and self correcting” to maintain fluent reliable esophageal speech.
Elizabeth
https://www.facebook.com/groups/elizabethfinchem/

If you are already on the WebWhispers group site, there is a direct link to the ES support site.

SPEAKING ESOPHAGEALLY    by Jim Shanks, Ph.D.

This was written for and published in Whispers on the Web, March 2005

This message is intended for a limited audience: 1) the individual laryngectomee who does not have access to a qualified teacher of post-laryngectomy speech, and 2) the individual speech-language pathologist (SLP) who has not had special instruction in all three voice options for speech after laryngectomy. The message focuses on esophageal speech (ES). Although you can learn to ride a bike without knowing how it was built or works, the following explanation is offered to all ‘bike riders’.

We know that laryngectomy surgery means: no voice box – no voice. Historically, ES was the primary or only choice for many decades after laryngectomy surgery became successful in saving lives. To the quantity of life should be added quality of life. To be without voice or speech is a tragic circumstance. One has to be haunted by the tale of a man from western Indiana who had his operation in St. Louis. At his post-op visit, the patient was told by his surgeon that although he (the doctor) did not know what was involved, he understood that there was a way of learning to speak again. After the Hoosier came home, every day he silently tried to form words. After 6 months, as a burp came up, the man said a word, then toiled to imitate his chance sound. When he was able to count to ten out loud, he went to bed to have the best sleep he’d had in half a year!

Getting Air In!

For those who have the good fortune of not undergoing laryngectomy, to talk involves using air power to drive vocal cords in the voice box, or larynx. This cord action is like the sound of the ‘Bronx cheer’ (raspberry). Lung air can be pushed out from the mouth between lips half together with some tension. This sound is voiced, has pitch and loudness.

Whereas the lungs can hold 4,000-6,000 cc of air, the food tube (esophagus), holds only 100 cc. This dinky tube, running up and down behind the wind pipe (trachea), can serve as a substitute storage tank for air. Usually the tank has only a small bubble of air (taken in while swallowing food or from gas-producing food). In order to serve as a new lung, it is necessary to move air down from the throat into the esophagus. At the top of the esophagus is a ring of muscle that is usually closed tight. This muscle ring serves as a cap on the gas tank that is the esophagus. Gas getting into a car’s tank goes only 1 way: down. Likewise, food going through the esophagus into the stomach goes only down. Getting air into the esophagus is not so simple. Getting air into the esophageal tank may be by either of two ways: inhaling or injecting. You can even think of it as kissing or spitting at the lips. We think there are more spitters, but many of us prefer kisses. It’s hard to do both at the same time! Esophageal speakers may be divided into inhalers or injectors. The key: where is the pressure to fill the tank. Inhalers have negative pressure below to pull air in. Injectors have positive pressure above to push air into the esophagus.

Bringing air up and out from the esophagus actually generates esophageal voice. But the real problem is getting air in first. To help a person feel air being sucked in (as the inhalers do), we may consider parallel actions. To hiccup is one example. To sniff is another. To yawn is yet another. To gasp is another. Breathing air into the lungs may parallel breathing (i.e., inhaling) air into the esophagus. This is facilitated by first exhaling lung air, then raising the head and chin while inhaling. A smoker may imitate getting a ‘drag’ on a cigarette/pipe/cigar. Achieving esophageal inhalation involves two different acts: (1) reducing the tension of the muscle ring at the top of the esophagus, and (2) further lowering the pressure within the esophagus. Pressure within the esophagus is negative at rest and varies with pulmonary respiration, becoming more negative when the lungs inhale air. This greater negative pressure literally sucks air from the throat down into the esophagus – assuming one can get the muscle ring at the top of the esophagus to open up!

The injector uses a different scheme to force air from the throat down into the esophagus using the lips and/or tongue. An obvious action that one might think is parallel is swallowing. In the old days a ‘new’ laryngectomee might have a glass of water to sip. Water is a fine product – for bathing, wetting one’s mouth, getting food to move south. However, swallowing is not the same as injecting air into the esophagus for speech purposes. For one thing swallowing involves much greater pressures along the length of the vocal tract from the tongue tip to the bottom of the throat. Additionally, when one swallows food, the esophagus is quite intent on moving the material all the way down its length and into the stomach, usually a ‘point of no return’. If the intent is to get air into the esophagus, one might think about swallowing carbonated liquid (beer, soda pop) or eating gas-generating foods (cabbage, beans). There are similar problems with this approach. To create air in the stomach from carbonated drinks or gas-generating foods is not the same as injecting air just part-way down the esophagus. We want air to enter the esophagus, but not proceed to the stomach. While a savvy esophageal speaker can take advantage of air that inadvertently made it to the stomach and plans its own return, one is better able to control the return of air if it never descends further than, say, the upper to middle part of the esophagus (Also, we won’t go into other horror stories involving carbonated beverages, beans, and cabbage: having beer for breakfast, feeding beer to a recovered alcoholic!)

Raising pressure in the throat may be facilitated by: puffing out the checks, whistling, whispering, blowing out a match, trying to blow up a balloon or manometer, blowing the nose, swallowing while holding the nose (a Valsalva), ‘starting’ to swallow, or saying speech sounds (p, t, k, f, s, sh, ch) which are voiceless consonants involving increased air pressure from the mouth. Some people learn to ‘burp’ as children or to relieve excess stomach air. Seldom do we find people trying to pump air into the mouth/throat, as with a tire pump or an inflated balloon. Inhaling is apt to be accompanied by raising, injecting by lowering, the head.

Getting Air Out!

Having gotten air into the esophagus, one might assume that it is a simple matter to release the cap on the gas tank for voice. Not so. Mother Nature doesn’t like to be fooled. She tells the body to push down on contents from the esophagus into the stomach, like milking a cow. Putting milk up into the udder is not so easy (vomiting is the exception!)

The diaphragm is a muscle for inhalation – breathing air into the lungs. Opposing it in exhalation are abdominal muscles (running up and down in front of the belly) which squeeze in from below to force air out of the lungs. For esophageal speakers, abdomen also is responsible for pushing speech air up and out – but this time out of the esophagus. In fact, good esophageal speakers use less vocal volume and muscle effort than a none laryngectomee using the diaphragm. Some laryngectomees think that they can talk while ‘holding their breath’ but it can’t be done!

Esophageal voice can be identified/described in three ways: pitch/frequency, loudness/intensity, and rate/time. The first letter of the second term makes a word. ‘FIT’. This acronym has been discussed elsewhere.* Perhaps the concern of getting a voice causes us to think that once a voice is acquired, nothing more is needed. Not so! Speech must be understood as well as heard! Good esophageal speakers are able to manipulate the ‘F’ (frequency), ‘I’ (intensity), and ‘T’ (time they are able to produce esophageal sound).

To change voice into speech involves letting the ‘Bronx cheer’ from the top of the esophagus vibrate (or resonate) through three cavities: throat, mouth and/or nose. Lips and tongue are then moved to articulate individual sounds. Without getting technical about every speech sound, we should agree on how to judge speech. Vowel sounds (15-25) outnumber vowel letters (a, e, i, o, u and sometimes y). In esophageal speech, vowel sounds usually are understood, even as accents. Only when significant damage has been done (i.e., to the tongue) will there be errors.

However, boo-boos occur too often on consonants in esophageal speech. Here we address only the main errors to be expected. If we are not careful, we may lose some hiss in sounds like ‘s’ and ‘sh’. The ‘hiss’ or noise is what gives these consonants their characteristic sound – without it, a listener may detect a sound other than the one intended by the esophageal speaker. Some consonants are voiceless (p, t, k, f, s, sh, ch, h, and th as in thumb). However, the very voice we sought can be over-done, thus distorting the voiceless into a voiced consonant (p, t, k, f, s, and sh become b, d, g, v, z, and zh). For those with a larynx, the difference between a voiced or voiceless consonant can be felt by placing a finger on the side of the larynx/voice box while saying the sound. (See previous articles noted below) There’s a vibration that can be felt for the voiced, but not the voiceless sounds. When everything becomes voiced (as often happens in esophageal speech), the resulting faulty sound pattern can resemble pseudo bulbar palsy or inebriated speech. Correcting it lies not in dropping voice, but in adding more pressure to the sound emerging from the lips when making the voiceless sounds. When learning esophageal speech, a moist finger, strip of Kleenex or whistle placed at the lips may help the laryngectomee speaker monitor the extent to which pressure is exploded from the mouth when talking. Voiceless consonants have more air power! One nasty voiceless consonant is the ‘h’ which baffles all laryngectomees. To avoid sounding like a Cockney from England, we borrow from another country. ‘I’ (‘ich’ in German) uses a prolonged kiss of the back of tongue against the roof of the mouth. The same sound is in Scotland (loch/lake). We get the same result by saying ‘k’ as a non-stop prolonged consonant: for the good esophageal speaker, saying the word ‘hair’ lies between ‘air’ and ‘care’. Finally, three sounds are supposed to go through the nose: ‘m, n, ng’ as in the word ‘morning’. The back part of the mouth (palate) must lower, letting sound and air into the nose to get the nasal tone. Some esophageal speakers don’t let the palate down when making ‘m, n, ng.’ This common error makes the word ‘morning’ sound like ‘bordig.’ Again we may invoke a wet finger, this time placed just underneath the nose to feel whether air escapes nasally on these sounds.

What’s In Store

The outlook for the continued use of esophageal speech is grim, at least in the United States, but also in many other parts of the world. Esophageal speech is the least utilized form of alaryngeal speech. Although the ES Speaker is less dependent on things – no device to carry, no prosthesis to insert, clean or replace – it takes longer to learn, has limitations of rate (fewer words per minute), takes more time to re-load air for speech, and has fewer physicians and SLP’s who recommend it and even fewer who can teach it and trouble shoot problem cases. Although artificial larynx and tracheoesophageal speech (TEP) may cost more, these days, those costs are more apt to be covered by insurance or physician fees than SLP therapy sessions to teach esophageal speech. In addition, the preponderance of TEP success has lead to less teaching of esophageal speech in IAL clubs. Fewer IAL clubs and fewer IAL members portend a shift from peer support to highly specialized intervention. Support for the continuance or existence of IAL Voice Institutes is eroding. Historically, the IAL Voice Institute has been a primary vehicle for training clinicians and laryngectomees how to train others in esophageal voice use. Few university programs in speech pathology include ES in the curriculum, at least not to the extent needed to prepare clinicians who are both confident and competent in offering this voice option.

Surgical specialization in voice restoration after laryngectomy is becoming a sub-specialty, even within the specialized field of ENT physicians. The role of ES can be expected to diminish more and more, at least in most parts of the world. Perhaps esophageal speech will continue to have a place in certain areas, although even this is not a guarantee.

Although we began with a focus on voices after total laryngectomy, we conclude by stressing speech and communication. This reinforces our goal of helping individuals cope with an unusual problem in living fully. Each of the three primary alaryngeal speech options ‘ AL, TEP, and ES’ has advantages and disadvantages over the others. Although it has become rare given the current direction of alaryngeal voice rehabilitation, there will always be those for whom esophageal speech remains not only a viable option, but perhaps the best option. The question will be whether anyone can teach it to them. Or will they stumble upon it on their own as our Indiana Hoosier did several years ago.

Esophageal speech

Esophageal Speech – probably the most difficult to master. You will need a speech therapist to help you learn how to force air into to the top of your esophagus and expel it out again through your mouth. This air movement will vibrate the walls of the esophagus and create the “sound” of your voice. There are advantages to this method of speech – you are not battery-dependent and both of your hands are free for other things.

(Permission to re-print provided by InHealth Technologies, Carpinteria, CA.)

A. Tongue press to inject air into esophagus.
B. Air enters esophagus.
C. Air released from esophagus to produce sound.
D. Sound shaped into speech.
E. Location of tissue vibration for sound.

TRICKS TO ESOPHAGEAL SPEECH

I will provide my comments regarding the tricks to esophageal speech and I am sure the others will have comments as well. After five months if your husband is getting whispers then he is on his way to speaking again. After my operation, I would say it took me a good eight months or more to produce sound loud enough to be heard by more than one. The secret is practice and more practice and you must relax to speak. After several months the muscles in the throat become strong and the whisper turns to sounds that you will clearly understand. The use of the tongue and lips to trap air is important, you must insure that you have enough air to speak multiple words. Relax while pumping in the air and forcing it back out. Trying too hard to speak will make it more difficult, whereas relaxing is the key, along with using the tongue and lips to trap the air. Frustrations and getting upset with yourself while learning is normal so please tell your husband not to get upset with that. When it happens just quit and relax before starting again. (Bob Hoover)

 READING AND LEARNING

Our monthly newsletter, Whispers on the Web

Our VoicePoints column is written by and for SLPs as well as Laryngectomees. Many are relating to ES.

Elizabeth Finchem wrote many columns relating to ES called “Practically Speaking” from Aug 2006 through 2010.

711 Phone Assistance

Telecommunications Relay Services permit persons with a hearing or speech disability to use the telephone system via a text telephone (TTY) or other device to call persons with or without such disabilities.

To make using TRS as simple as possible, you can dial 711 to be automatically connected to a TRS operator. It’s fast, functional and free. Dialing 711, both voice and TRS users can initiate a call from any telephone, anywhere in the United States, without having to remember and dial a ten-digit access number.
https://www.fcc.gov/consumers/guides/711-telecommunications-relay-service

Text to Speech Apps

Text to speech apps  for Phones and Pads

1. Signs of the times.  We have just received our first application from someone who gives this as the main method of speech: Using iPad & iPhone for communication. Feb 2011

2. Turning into 2014 next week and there are so many programs, it is impossible to keep up.

Speak it! Text to Speech

1. In addition to Locabulary Lite, another great text-to-speech program available for the iPhone/iPod and the iPad is “Speak it! Text to Speech”. The speech quality is far better than that of Locabulary Lite in my humble opinion.

One nice feature of this program is the ability to copy and paste pretty much any length of text into the program for it to say aloud. Some
of my patients loved that they could type out their most used phrases on a full size keyboard that they wanted to “carry” with them and email it to themselves. They would then copy and paste the messages into the program and save them for later use. Sometimes pecking away on those little screens can be a chore. The other nice little feature is the ability to create an audio file of your message and email it, so the person can actually just listen to what you have written instead of read it.

For $1.99 app you certainly get a lot of functionality. Technology is certainly increasing our options for communication at a rapid pace.
Todd Coleman, MS, CCC-SLP

2. I totally second what Todd is saying about “Speak it!” When I had my surgery last year, my husband downloaded this app for our iPad and I would type up a report for my doctors as the day went by, so when they stopped to check in on my I’d just replay it and it was very easy to communicate. I also had lots of pre-loaded phrases like: “thank you”, “suction, please”, “can you adjust my humidifier, please” etc. etc. I could just run at any time.

AND the quality of the voice is fantastic! You can chose from several
feminine or masculine voices and accents. I keep thinking some smart
engineering types must be looking at ways where all this speech synthesis
can be applied to devices so our ELs sound like human voices rather than the buzz. Or something along those lines. I bet something will come up along these lines, as technology keeps evolving.
Joss

iPad and iPhone

1. IPad has a great text to speech one for 2 dollars called “Speak it” at Apple store or go to iTunes and download.
Peter Powell

2. Natural Reader online text-to-speech application. I have this on my iPad and it will read anything. ……This application works with most commonly-used documents, such as Word docs, PDF files and webpages. Also, it provides over 30 natural-sounding voices in seven languages. You can switch voices and adjust the speaking speed. You can not only access your documents from any device, but also convert the documents into mp3 files

Free download to Computer
NaturalReaders.com
Pat Sanders

3. Verbally – Uses text to speech plus prepared words and phrases.  I downloaded the free one and it works great for my purposes on my iPad.  They do have a Premium one for sale. This is simple to use and is ready as soon as you touch the icon, keyboard and all.
http://verballyapp.com
Pat Sanders

I recommend the app. Talk for Me.  It is easy to use and has a number of self designed phrases that the individual user can program or just use it to covert a text comment/conversation to speech.  I used to use Speech Magnet but it was not upgraded to IOS 11  and no longer works.
Bob Mason Class of ‘15

IPhones now have the capability to run Alex which will do text to speech. The instructions can be found at the following link: https://support.apple.com/en-us/HT203077
Thanks to Bruce Medical for pointing this out.


Saypad

A fairly simple application at https://sites.google.com/site/saypadapp/
Ian Johnson – Brisbane, Australia

Applications for Android Devices

There are many Text-to-Voice applications available from Google (and others) but I’ve settled on two. Note that I am a new Android user and am still getting used to it.

Talk – Text to Voice FREE
This is free application and is good way for you to get the hang of the basics. It may be all you want.


SVOX

The basic application is free but you need to buy “voices” from the store (around $3 each). There is quite a wide range covering various languages and English accents (but no Aussie male!).
It is very adaptable (look at the App Gallery accessible in SVOX) and I particularly like the Pronunciation Correction function – try and get a silicon brain to say an Aussie G’day like reality (so far I gave settled on Gidday).
Ian Johnson – Brisbane, Australia

Sticky Notes that Speak

1. I have been using a program for years on my Windows machines and I just recently found a new use for it. It lets you create post it type notes on your desktop and will allow you to maintain a library of notes that you find useful: recipes, phone numbers, etc. What I just found is that on the left top of each note is a speaker icon…so I clicked on it and it read what ever I had typed into that note (in a very clear woman’s voice).

This got me thinking that for those of us with holes in our necks and for some with holes in their heads that this would be a great way of storing notes for different purposes such as making an emergency 911 call for us. One note with your name, complete address, including main cross streets, your home phone number, and emergency contact person’s info. Then should you ever need to call 911 just dial the # and play the note for the operator…and replay it as needed. By doing this ahead of time while your thinking is clear you will give accurate info instead of fumbling for your EL or trying to get your breathing working right.

You will also find this to be a great little desktop accessory for jotting down just about anything you want to be reminded of. (It will even let you set alarms for certain notes to go off at certain times). So far this is a Windows only product…but any version of windows will work.
The program is available free of charge from http://www.sticky-notes.org/
Happy Noting!
Frank in NJ

2. I knew I had sticky notes on my Mac but had to look for who made them. Apple. They are called Stickies and are handy for making notes to refer to for any purpose. Mine are reminder notes usually.

There is no voice on the notes… however for those who have an Apple Computer, you have Speech. So I wrote out a note, went to Edit up top…slid down to Speech in the drop down menu. Then over to Start Speaking. It read my note. As I am writing this, I am trying to be sure the instructions are right so I reached up and chose Start Speaking. I need to quickly find the Stop Speaking (the same way) as yelling Shut Up doesn’t work. It is reading this entire message! I just made up a note to be used to reach 911 like Frank suggested.

Mine shows 6 voice choices and you can slow it down or speed it up. To me, Alex is the clearest.
Pat Sanders

Some apps that have been discussed recently on the Email list is “Type and Speak” and “@Voice Aloud Reader”. Another one is “Large Text” which make text easier to read. Some phones now come with a text to speech application already installed. I have not used them but you they may be worth checking out.
Ron M – Seattle

PC based text to speech software.

E-TRILOQUIST Ver. 6.3 –

A free PC based text to speech software.

The first section below is the description which is taken directly from the E-triloquist web site located at http://www.etriloquist.com/. You would need to go to the web site to get the links below to work. The second section is my opinion of the pros and cons that I have observed. The last section is a summary of the value of this software for the non-speaking laryngectomee, of which I am one.

DESCRIPTION
E-Triloquist – a PC-based communication aid for a speech impaired person. It serves as an electronic voice for those who can’t speak on their own.
E-triloquist, the personal computer augmentative communication aid software formerly known as “SpeakEasy”, developed as a family project. Dad had amyotrophic lateral sclerosis (ALS) and lost his ability to speak in the course of the disease. Son is particularly versatile in personal computers. Our first version (named “SpeakEasy” at the time) was made available on the Internet in early 1995. We are now on Version 6.3 with even more new features suggested by current users of the program, and with full support for Windows-XP, Vista, and Windows-7 operating systems. See the News page for full details on the enhancements in V6.1. Go to the Downloads page to install or upgrade to the latest version of E-triloquist.

Most users of the program can still use a keyboard, albeit slowly. For those who can no longer type, E-triloquist can easily be teamed-up with on-screen keyboards, scanners, word-predictors, single-switch input, or other assistive input devices such as Click-N-Type virtual keyboard from Lake Software,SofType from Origin Instruments,WiViK® on-screen keyboard (virtual keyboard) software, Virtual On-Screen Keyboard by MiloSoft,My-T-Mouse from IMG, and a variety of input devices and augmentative communication products from Prentke Romich Company. A longer list of devices can be viewed on the ALS Resources page. These tools can also be added on at a later time if the need arises. Note: when looking for assistive input devices, be sure to get one that will work with ALL of your Windows programs, (e.g. E-triloquist, word processor, e-mail, web browser, …) not just one specific software program.
The early versions of the program were focused on text phrases that are keyed and converted to speech using the computer’s sound card and a standard text to speech program. A while back we added the capability of handling audio phrases as well. Our use of the term “phrase” is quite liberal. For text it ranges from one word to a novel. For audio it ranges from a single spoken word to a song.

Our thought in including audio is that as soon as speech begins to be affected by the disease, patients can record commonly used expressions in their own voice. The pre-recorded expressions in the patient’s own voice can later be intermixed with phrases that are keyed and “spoken” in the computer’s synthetic voice. One pre-recorded expression might be an explanation of why your voice sounds different from one statement to the next.

Audio phrases need not be the patient’s own voice. They can be the voice of a family member or of a friend. Indeed, they need not be spoken. One possibility is a rendition of Happy Birthday or something of that ilk. Or a musical treat, or just plain noise, to announce that you have something profound and/or provocative to say. Hey, we had to include something for people who have already become anarthric, the fancy word for people who can’t speak. Dad found that his trumpet fanfares and assorted noises were quite valuable for getting the attention of a group.

Instructions for creating and for adding recorded audio phrases hide in the E-triloquist manual under the Audio Phrases topic. The manual is included in the download and can be accessed from the “Help” menu within the program. Or, you can view the manual now.

REVIEW

PROS AND CONS

Pros
1. The E-triloquist software is free.
2. It is easily downloaded from the site and uploaded on the PC. Each function was done in seconds.
3. A free voice is provided with the software, Microsoft Anna, for Windows Vista or 7.0. If you are using Windows XP, you can choose between Microsoft Mike or Mary.
4. It even comes with a 20 page manual.
5. The software is easy to use. You can load it and use it immediately without even opening the manual.
6. It has ongoing support and routine upgrades.

Cons
1. This software is for PCs only. If you are using a Mac, this won’t work.
2. If you are using Windows Vista or 7.0, you will only have Microsoft Anna’s voice. This may be a little awkward for the men out there. Other voices can be purchased from other sites on line. They cost about $30.00 per voice.
3. The voice is very mechanical, which is a problem with most computer voices. It has either no voice inflection or incorrect voice inflection. This makes it difficult to understand.
4. PC speakers are not very loud. To be heard, you may have to invest in external speakers.
5. It has no mobility. You would have to carry your laptop with you if you wanted to use it on the go.

SUMMARY

The limited applicability of the software to PCs only and the limit of only one voice, which is female, that comes with the software certainly limits who would comfortably use E-triloquist. Also, the lack of mobility is a hindrance.
However, it is a free software and may be of some use to some of us larys. Speakers may be necessary to amplify the voice.
The above comments are my opinion only and do not represent the opinion of the WebWhispers organization.
Best wishes to all,
Hank Henry Luniewski
Charlottesville, VA
Submitted 4/11/2012

DEVICE ADDS PRIVACY FOR TEXT TO VOICE PROGRAM

An additional program to use with E-triloquist for using telephone.

A little background. I had my laryngectomy, a little over two months ago. Over the past two months I have made a few adjustments. I am almost half through with radiation treatments, which will continue for 3 more weeks. After, a hopefully brief convalescence period, I will return to work. As a systems administrator for a large computer-engineering group, my need to communicate on a technical level is important. From what I am told, I will be able to speak again, for that I am grateful. At best, that is 6 months or more down the road, it has been two and counting. Even then, telephone conversations will be more difficult for the recipient to understand. Over the years, I have had many deaf clients, and have set up TTY devices for their use. These have their drawbacks. I have always been a very independent person and have been frustrated with my new dependence on family and friends, for simple everyday things. Which brings me to why I am writing this. I spent hours searching the web, first looking for a text to speech program. I found several free ones. The one I selected is called E-triloquist. I found it on the WebWhispers home page. It allows 48 pre-programmable hot keys, plus plenty of options for pre-typed questions and responses. It is a good program! Having the ability to type and spell are a big plus. Unfortunately I can do neither, but with practice I am getting there. I type into a spell checker program, then cut and paste into the text to speech program. One draw back is the voices that come for free, are terrible. They sound very robotic. I bought 2 additional voices, one male, and one female (they come as a package) from AT&T for $35.00. These voices are better than the free ones, but still leave something to be desired.

Next, I needed a way to interface the output of E-triloquist to the telephone. At first I put the speakerphone near the computer speakers that worked, kind of. There was a problem with background noise, and clarity was lacking. My biggest issue was the lack of privacy. This method would never work in an office environment. I send out inquiries, as to how others cope with this issue. I received several responses, ranging from TTY devices to web services for people with speech difficulties. Although these may work for some people, the limitations of a TTY device, or paying a monthly service charge to make phone calls, spurred me to continue my web search. The point is, I found a hardware device that does what I need, and more. The device allows me to output the text to speech program or anything from the computer speakers, directly to the phone with privacy and clarity. The hardware set up is very simple. It comes with step-by-step instructions and a CD containing an installation video. The use of the text to voice program is also very simple, but takes some practice to make a conversation flow and sound semi normal. (Roger and John are very helpful).

The E-triloquist text to voice program can be obtained from:
http://www.etriloquist.com/

In closing, even if I am able to use the phone again, with out difficulty, the combination of E-triloquist and the eZSharePro device has been an inexpensive way for me to communicate over the phone until my voice returns.I also think you should know, that I do not work for, nor profit in anyway, from the sales of the eZSharePro device. In my opinion it is a good product, at a fair price. It has helped me. I am just sharing this information in hopes that others in my situation may benefit.
John Nicols

ESpeak

eSpeak is a compact, multi-language, open source text-to-speech synthesizer.

This version is a SAPI5 compatible Windows speech engine which should work with screen readers such as Jaws, NVDA, and Window-Eyes.

There is also a version of eSpeak which can be run as a command-line program. This is in eSpeak\command-line. Read docs\commands.html for details.

License
This software is licensed under the GNU General Public License version3. See the file: License.txt.

Voices and Languages
The available Voices can be seen as files in the directory espeak-edit/voices. To change which eSpeak Voices are available through Windows, re-run the installer and specify the Voice files which you want to use.

The tone of a Voice can be modified by adding a variant name after the Voice name, eg: pt+f3

The available variants are:
Male: +m1 +m2 +m3 +m4 +m5 +m6 +m7
Female: +f1 +f2 +f3 +f4 +f5
Other effects: +croak +whisper
A different synthesizer method: klatt klatt2 klatt3

These variants are defined by text files in espeak-edit/voices/!v

TTSApp Application


This is a test program provided by Microsoft which can be
used to speak text using SAPI5 voices. The eSpeak voices
which were specified during installation should appear in
its voice menu. Select its “22050Hz 16-bit mono” option for speaking.

Updates

The eSpeak project homepage is at:
http://espeak.sourceforge.net/

Comments, corrections, and other feedback and assistance is sought from native speakers of the various languages because I’ve no idea how they are supposed to sound 🙂

To make changes to pronunciation rules and exceptions, or to change the sounds of phonemes, or just to experiment with speech synthesis, download the “espeakedit” program.
Ian Johnson – Brisbane, Australia

Locabulary Lite

1. New Product to Watch (HeadLines, 3rd Qtr, 2009)
In the morning paper recently, a product so new you can barely find it on Google, a design firm here in the Birmingham area has created a tool for the speech impaired that will be used on Apple’s iPhone. Designed for speech impaired children, it will be wonderful for laryngectomees who can’t speak because it speaks for you with a base of words that lets you rapidly form a sentence….or order from McDonalds or Starbucks. It uses the GPS to even offer you that menu as you walk in the store. Words like “Cool” and “Dude”, are already programmed. I haven’t seen the part yet that lets you write new words but I do have the beta version on my iPhone.
This is being released, likely this month, July, as a free app for the iPhone.

From the B’ham News article:
“Locabulary” grew out of discussions the team at PUSH Product Design had with Drew Davis, a pediatric rehabilitation physician who is an assistant professor at UAB. Davis and another doctor treat about 4,000 patients in their practice, specializing in children and teens who have physical or cognitive disabilities, such as muscular dystrophy, cystic fibrosis or traumatic brain injuries.

Davis was interested in PUSH’s work in design, believing the firm could make affordable technology for the disabled. PUSH, a firm of Auburn-educated engineers and designers, has designed everything from spinal implants to video gaming equipment.”
“The result was Locabulary, an application, or software tool for Apple’s iPhone. Locabulary allows an iPhone user to manipulate the phone’s touch screen to call up a menu of words and phrases, with the phone speaking the words. The application is designed so that users can assemble sentences using a minimum number of finger taps and also provides an option for sending completed sentences as text messages. The program was funded by a grant of about $24,000 from the Alabama Council for Developmental Disabilities, a division of the state’s Department of Mental Health.”
I remember the days with no voice and the struggle to write the questions or tell them what was happening. Now, if you have an iPhone, you will be able to answer with a touch screen to the extent of what is programmed into the app. This is the start of something exciting for us. I has been for me, already.
You see, I wrote to them to tell them I was excited about what they are doing, and to talk about laryngectomees and WebWhispers. I made a couple of suggestions….. and they liked them. The very next day, they invited me to become an iPhone developer and to join the team. I am enjoying using my knowledge and experience with laryngectomees to make suggestions for methods of making menus work together or separately, and suggesting, for the future, things like a menu to be used to talk with your health professional. They tell me they like my ideas and I certainly like theirs. The app that will be released first will get a lot of feedback and they are leaving plenty of room for growth of vocabulary on Locabulary.
Pat Sanders

2. By far the newest goes with you everywhere on your phone. I have one of them, on my iPhone and iPad called Locabulary Lite… again FREE. It has a full text to speech with choice of male or female voice. You type,
click to speak. The latest on this is the ability to type a message and
save it under a category… for instance Greetings, Explanations, Questions, Goodbyes, Medical, etc. Make up your own categories. Then you choose a quick explanation that you have written in advance to tell someone what is wrong. You can carry on a conversation with someone by typing your question or answer if they will wait for you to be able to type it.
Pat Sanders (from the WW list, Nov 2010)

3. Be sure to read some of the hints in the library. Ideas for what to take with you to the hospital.. Lots of folks take a laptop now. If I went right now, I would take my iPhone and iPad with Locabulary App loaded on them so they could talk for me. Everyone reaches for a pad and pen…. or those toys that have a screen you can write on. InHealth gives away free the Laryngectomee Needs Charts so you can just point. They are under Free for the Asking in General Information section.
(From the List Dec 2010)

Alternative Communications

WHO NEEDS ALTERNATIVES?

Anyone who can shape words will almost certainly be better served by a speech method that allows him to shape words and speak as he wishes – and anyone who can shape words but not be heard loudly enough will almost certainly be better served by using a voice amplifier to bring his voice up to a louder level. But what about the person whose words are a little difficult to understand or the person who has intermittent problems with tongue coordination (laryngectomees can also have stokes and aphasia and other speech disorders). Some of these devices, in smaller versions, are good for backup or for phone emergency messages. They definitely should be thought of in a positive light for those who cannot speak any other way. People needing/using these devices should be considered equal citizens in the lary community just as AL users have been for the last few years.
Dorothy Lennox

GoTalk

GoTalks provide fantastic sound with volume control, easy sequential recording, quick level erase, built-in overlay storage, record lock, level lock and 2-year warranty. It’s a GoTalk so it’s easy to use and affordably priced! Use GoTalks to initiate conversations, support daily activities, talk on the telephone, tell personal anecdotes, practice speaking and articulation, give instructions, participate in small group instruction and more. 

Easily make printed overlays using GoTalk Overlay Software , sold separately.

TELEPHONE RELAY SERVICES

I live in Pennsylvania and use the telephone relay system that is available here; it may be somewhat different in other locations, but the principles involved are most likely the same. The basic idea behind the relay system is that the laryngectomee, who can’t speak, uses a typewriter keyboard unit with a display on it to type a message. The message is then transmitted over the telephone lines to a relay operator, provided by the telephone company. The relay operator then repeats the message that you typed to your party. When the other party responds, the relay operator types the response back to you, which appears on your display. The relay operator in effect acts like an interpreter between you, the laryngectomee, and the speaking person with whom you wish to communicate. For an incoming call, the person calling you dials the relay operator, the operator then dials your number and your phone rings (mine also has a flashing light.). When you answer your phone, you and your party then communicate through the operator. The equipment that you need is a teletype-like device, with a keyboard and a display that plugs into your telephone line (both the teletype device and your telephone can share the same line.) I got mine through a local Pennsylvania agency that provides them free of charge, if you can establish need; otherwise they are commercially available if you can’t meet the minimum income requirements. The relay service (the relay line and the operator) are provided by the telephone company. The relay number is listed in the beginning section of the telephone directory, under “Relay”.

We have all heard of the text telephone system for the deaf called the TTY, the system is usable in reverse for the voice impaired. If I could not talk at all, I would use it this way to call anyone who is able to talk. I would call the number for the Communications Assistant (CA) and request “hearing carryover (HCO)”, using the keyboard to let them know what number I wanted to call. They would call the number for me and tell the person who answered that they were with the relay service and who the calling party was on the line. I would type what I wanted to say, and the CA would speak it. Then the person would answer and I would be able to hear them because of the HCO, so I could immediately start to type in my answer. It is a good product for some of us who can’t speak clearly or not at all. In my state the relay service is free, but you must buy the instrument.

I use the TTY phone and it really helps for any business I need to conduct.
I dial 711 and am assisted by an operator that handles the communication.
The TTY phone came with speakers so that I can hear the conversation. When I dial up the 711, I wait until the system asks for the number I am dialing. I type in the number and add HCO PLS GA which means hearing carry over please go ahead. That keys the operator that you can hear versus a phone call from a deaf person. I type whatever I want to say, the 711 operator reads it and the person I am dealing with responds.

The 711 service is free in my state of Virginia and I believe exists as a free service in most states. The phone and speakers were made available to me for half price through the local non-profit deaf and hard of hearing organization. If my income was smaller, they would have provided it for free
An option to using TTY is texting. I text my children all the time. My wife
and I text if I am out running errands and she is home.
I hope this helps.
Hank Luniewski
Charlottesville, VA

AT&T RELAY SERVICES

AT&T has announced that starting December 18, 2000, Speech-to-Speech Relay Service, and 900 Pay-Per-Call Relay Services will be available in all AT&T states and nationally, for state to state relay calls. They have refreshed their relay website with new information about Speech to Speech and 900-number calling.
* Speech-to-Speech Relay Service: This service allows a person whose speech may be difficult to understand to communicate over the telephone with the help of a specially trained Communications Assistant. No special telephone is needed for this calling option.
* 900 Pay-Per-Call Relay Service: Now TTY/TDD relay customers can access any 900-service provider by dialing AT&T’s 900 Pay-Per-Call Relay.l
* Spanish Relay Service: Now Spanish Relay users can access Speech-to-Speech, and 900 Pay-Per-Call services through a dedicated toll-free number specifically for Spanish-speaking relay users!

OTHER WEB SITES FOR RELAY INFORMATION

California: http://www.ddtp.org

Another help is WWW.GetHuman.com . You enter the company that you need to talk to and they will help you.

ATT – INFORMATION PLEASE?

With all the new voice prompted answering systems, these days, it can get frustrating for us Larys. I have a fairly good voice, but if I call 800 information the computer does not understand me.

I have discovered if one calls 1-800-CALL-ATT (1-800-225-5288), punch 0 (zero) when the computer answers and you get a live operator. Tell the operator that you need a “Special Needs” operator. They will assist you themselves or transfer you to a supervisor who will dial the number for you and use their voice to give the instructions to the computer. This is all done while you are listening so that you can speak with the “Special Needs” operator if there is any clarification needed. This works 24/7.
Kent Smith

The three digit number 711 can be used as a shortcut to access Telecommunications Relay Services (TRS) anywhere in the U.S. TRS facilitates telephone conversations by one or more people who have speech and hearing disabilities. All telecommunications carriers in the United States, including wireline, wireless and pay phone providers must provide 711 service.

Sprint IP Relay Service

I use Sprint IP Relay as well. It is GREAT! It’s helped me with all sorts of communication and they are so friendly, confidential, patient, and really good natured and helpful. They help YOU attain what you could have done if you had a voice. Exceptional service and customer service is awesome. All that is needed is some kind of Internet connection. I use my laptop – or you can use both laptop/computer and/or cell. There is an initial set up with providing your #, form of identification, etc. to verify your identity and that you who are you say you are…and the rest is a piece of pie from the sky of grace and gratitude for me. Here’s a link to get you on the page and site to get you started if you determine that this is for you. Best wishes everyone! (And yes, it is free without any special equipment needed except an Internet connection of some sorts and they work with you to get all your p’s and q’s and EVEN y’s in order to get you on your feet.
https://www.sprintrelay.com/sprintiprelay
Lisa O Chgo – August 2017

COMPUTER ACCESS – SPECIAL SOLUTIONS

There are 3 cell phone apps that you may want to look at. These can be found by searching the app store on your phone.

1) There is an app titled ICE (in case of emergency) that is free to add to your phone. It allows emergency personnel to see all your medications, allergies, doctors, emergency contacts.

2) TrachTools app has several functions but the one that I think is most useful is a button speech capability, If you want to say Yes you only need to press the “Yes” button. This would be especially useful for those in the hospital.

3)The Tracheostoma app has a lot of information. The however is comes from Netherlands so it is not in English. I has buttons that will convert it to English or span ish, but this has to be done every time you enter the app. The other issue is that it has a emergency help button but it dials 112 instead of 911. I found no way to change this. You still might find the in from at ion useful.
Ron Mattoon 2010 Seattle

Amplification

Need more volume? Use An Amplifier

You have to play with it to get the most out of it. They don’t clear up the voice but make it louder. If your voice is very clear and distinct in a quiet mode, it will likely work very well using an amplifier.

I find one useful in a crowd or where there is background noise. I use it to give a speech. For daily use, you could have it handy at home, but wearing one all the time and being ready to talk louder, well, it could get in the way at the dinner table. I use mine with a head set and place the mouthpiece about level with the bottom of the nose. The speaker goes on a waist belt. If you are sitting at a dining table or a desk, you will get feedback and need to sit the speaker on top of the table…

They are well worth it for the purpose of increasing the volume when all the kids or neighbors are over or at a meeting…in a car or to call your wife from another room!! Almost all of our main vendors carry them. Look under suppliers section and check their websites. 
Pat Sanders lary 1995

Note: the following is written by Dorothy Lennox, downloadable from the Luminaud.com site.  It is the most comprehensive explanation of personal voice amplification that I have found and I am putting in our site for your convenience. There are slight edits because of minor changes when downloading to a different format. (editor)

PERSONAL VOICE AMPLIFICATION – by Luminaud, Inc.

ADVANTAGES TO USERS & LISTENERS, TO CONSIDER WHEN CHOOSING A VOICE

AMPLIFIER, AMPLIFIER & MICROPHONE POSITIONING, INFORMATION ON USE & CARE

KEY WORDS for Internet search: Voice amplifier, amplification, microphone, weak voice, whisper, communication, any brand names or manufacturer’s names

Personal voice amplifiers are usually wearable or carryable devices used to increase the loudness level of the user’s voice. They are commonly made up of two parts – a circuitry/battery/speaker package and a microphone on a cord. Batteries, often rechargeable, are the usual power source, but a few medium size, portable amplifiers are line powered.

Voice amplification is helpful to those who can shape words understandably but have a voice volume too soft to be heard easily. If speaking is fatiguing, requires frequent repetition and/or the listener must be only a few inches away to hear what is said, a voice amplifier is likely to be very beneficial. Voice amplifiers are also valuable to people with no voice problems who speak to large groups or in noisy or wide-spread areas. They eliminate shouting, protect the throat and allow the speaker to reach a larger audience more effectively.

Voice amplifiers are useful to esophageal & TEP speakers and anyone with a weak voice or throat problem such as: vocal nodules, Parkinson’s, PSP, ALS, MS, Guillan Barre, damaged or partially paralyzed vocal cords, impairment of throat or chest muscles, diminished lung capacity. They also can be used to amplify artificial larynx speech in large or noisy areas.

They are useful in almost any setting – home, office, factory, hospital, school, nursing home, church, retreat, park, camp, meeting, restaurant, party, ballgame, on the street, any place or event – for one to one conversation or for group activity. Personal amplifiers are ideal for people who have difficulty being heard above engine or other noises in a car, bus, plane or train.

People with no voice problems will also benefit from using an amplifier when talking to groups or in a large or noisy area. Amplification will eliminate shouting and voice strain and provide better listener understanding. Amplifiers are a major asset to tour guides, teachers, coaches, clergy, lawyers, morticians, business and organization leaders, entertainers, public officials, public safety officers, politicians, and public speakers of all kinds, whether or not they have difficulty with voice volume.

VOICE AMPLIFICATION OFFERS EASIER, LESS FRUSTRATING COMMUNICATION AND HAS MANY RELATED ADVANTAGES FOR BOTH USERS AND LISTENERS:

• > Minimizes overall strain and fatigue when physical condition makes talking a tiring effort.

• > Rests the throat to allow healing or to avoid damage or further damage.

• > Reduces misunderstandings & need for repetition.

• > Makes life generally more pleasant and less frustrating both for people who want to be heard and for the family, friends, care givers and teachers who want to be able to hear them easily.

• > Promotes independence and self-assurance in those who otherwise could not “speak up” and take charge of their own lives and care.

• > Assists conversation between someone with a voice volume problem and someone with a hearing problem – a great relief to both.

• > Lets those with hearing impairment hear themselves better during speech practice – after laryngectomee, stroke or injury, etc.

• > Allows longer phrasing for esophageal & TEP speakers.

• > Provides easier, more accurate communication in a noisy workplace.

• > Helps develop poise and self-confidence in those not accustomed to public speaking.

• > Enhances enjoyment for both participants and audience at special events.

• > Increases effectiveness of classes, lectures, meetings, sales presentations.

• > Furnishes a means of easier, non-aggressive crowd control in a variety of public settings.

“HOW CAN WE TELL WHETHER VOICE AMPLIFICATION IS LIKELY TO BE SUCCESSFUL?”

Choose a quiet room and a listener with average hearing. Position the listener so that the speaker’s mouth is about 12″ from the listener’s ears. (Listener should close eyes or turn head to avoid lip reading.) If the amplifier user can shape words properly and the listener can understand most of what the users say – 70% or more – then there is a probably enough voicing to make good use of a variety of amplifiers. If only about 10% to 30% can be understood, then it is still possible that a somewhat larger, though still portable, amplifier might bring the voice volume up to a usable level.

A successful amplifier user must be able to shape words fairly well – amplifiers improve only volume, not articulation. However, speech therapists often report that once a patient is freed of worry about volume, proper articulation is easier. Also, people with spastic dysphonia and others whose volume is variable and unpredictable sometimes find that the use of an amplifier allows them to produce more consistent voicing. And, amplifying the voice, even though not technically clarifying it, may bring words, weak consonants and speech nuances up to a level that allows the listener’s brain to process them more easily, thus improving apparent intelligibility. These advantages cannot be promised to all amplifier users, but have been reported often enough to indicate that they definitely will happen with some individuals..

“BUT I CAN”T WEAR THAT!!! EVERYONE WOULD LOOK AT ME !!”

There is sometimes objection to voice amplification on the grounds that it is too noticeable and makes the user feel too conspicuous. This is similar to the resistance people have traditionally had to wearing hearing aids and eyeglasses. People of any age may have this response, but it is particularly frequent among teenagers. However, consider that, as well as the obvious advantages of voice amplification to both speaker and listeners, a voice amplifier actually allows the user to be LESS conspicuous. Voice amplification is no longer an oddity – entertainers and many others use it all the time. After a very short initial adjustment, both the user and the listeners will forget about the amplifier and give no more attention to it than they would to glasses on someone’s face. Then everyone is free to carry on natural conversations without any undue attention to the person with the voice problem.

Of course, as with any equipment, the use of a voice amplifier will probably seem awkward at first, but it will become routine with a little practice. Often the amplifier becomes so helpful that the user will wonder how he/she ever got along without it.

“OK – IT SEEMS LIKELY THAT A VOICE AMPLIFIER WOULD HELP – SO WHAT’S THE BEST ONE???”

Really – there isn’t any one best! The ideal voice amplifier, of course, would be the size of a common pin, worn on the lapel!! Unfortunately, that kind of StarTrek technology is not yet available. In order to get good amplification for a weak voice – with reasonable sound quality and minimal feedback problem – at a reasonable price – the speaker/circuitry must have size, weight and bulk and there must be a microphone close to the lips. So choices must be made from what is available.

“Trade-offs” are often necessary. Some people may want or need more amplification even if it means dealing with a heaver instrument. Others want a smaller amplifier even if it limits their easy-conversation area to just a few feet away. Some may want very good voice quality for singing. Others just want reasonable amplification at as small a size and/or as economic a price as possible. Some want or need a “hands-free” mic. We feel, certainly, that some brands are generally preferable, but overall, the best amplifier is the one has the most helpful combination of features for each specific individual user.

WHEN CHOOSING A VOICE AMPLIFIER0 THE USER, SPEECH PATHOLOGIST AND SUPPLIER MUST CONSIDER INDIVIDUAL NEEDS, PREFERENCES AND ABILITIES AS WELL AS THE FEATURES OF VARIOUS AMPLIFIERS AND MICROPHONES. This may seem to be a rather long list, but it will all become second nature to someone who does a reasonable amount of work with voice amplification.

Type of Vocal Sound to be Amplified

Whispy or breathy
Soft normal
Rough or gravelly
Uncontrolled volume changes
Deterioration of volume or voice quality after a period of use or when tiring Esophageal or TEP

Electronic Artificial Larynx

Communication board output Amplification Needs –

To be heard one-to-one or by just a few close people in a quiet area
To be heard in a large group or in a large or noisy area
To be heard by someone in the next room
To be amplified during specific hours of the day or occasionally, when in special situations

– or is 24 hour a day amplification needed?
To have vocal rest to lessen damage or help prevent further damage to throat To carry on a conversation without using as much energy

Individual Preferences

Wants equipment to be very inconspicuous
– or is willing to use whatever is required to get the amplification needed
– or wants to be heard loud and clear or even call attention to him/herself.

Wants or needs to have hands free
Is willing to wear something on the head and over the hair

– or refuses to consider it.
Positioning and Mobility – whether the individual:
Is strong and completely mobile Is mobile but weak
Has balance problems
Uses a cane or walker

Uses a wheelchair or sits in the same chair most of the time

Is in bed much or all the time. Sitting up or lying down? Head control – whether he/she:

Can keep head up
Can move head forward and backward Can turn head side to side
Has uncontrolled head movements Has a brace to keep head in position

Hand and arm capabilities. Is s/he able to handle and position and adjust equipment? Cognitive ability – Is s/he able to understand and remember how to:

Use off/on and volume controls?
Turn mouth to mic when speaking?
Charge or change batteries as required?
Use device with reasonable care (will not throw it, sit on it, put things in openings, etc.)?

Assistance available – if user is unable to operate and care for device completely on his/her own, is there a family member, friend or caregiver available to assist?

3 AMPLIFIER/SPEAKER FEATURES

Amplification Potential – is the maximum workable volume sufficient for current and future needs?

Sound Quality – Clarity and Fidelity. In general, the larger the speaker, the louder and clearer the sound. Many people will prefer a smaller amplifier with reasonable sound quality to a larger device with excellent sound quality. Note that high fidelity is not always desirable. Some good amplifiers for people with voice problems have a “controlled bandwidth”—they are tailored to emphasize the frequencies in the voice that are most helpful to communication and to dampen unwanted highs and lows. Good music amplifiers are often not the best choice for people with voice problems.

Handling requirements – Location of controls, knobs, switches. Can the volume level can be left preset or is combined with the on/off switch? How much dexterity is required to put the amplifier on/take it off and for changing or recharging batteries. Can controls be extended or modified for special needs?

Weight, size, shape, arrangements for carrying – Is there a shoulder strap, belt mount, carrying case? Does the amp fit in a pocket? Can the user manage the size and weight of the device if walking? (Some advertised weights are WITHOUT batteries – but the carrying or wearing weight will be WITH batteries.) If on a belt, is the user willing to wear a belt. (Some people, women especially, are not comfortable with the feel or appearance of a belt.) Is there a good location to set or hang or place the amplifier on a wheelchair, at bedside, etc.

Power source, battery usage and/or recharge requirements -Battery powered amps have no line power cord to limit movement and no danger of electric shock in wet areas, but the batteries must be replaced or recharged. People who move around will want battery power, but people who will be in one indoor place most of the time may want to consider an amplifier that plugs in to line power. How and how often must batteries be recharged or replaced? Is there a proper power source available for the amp or the charger? Will it be going to another country with different voltage?

Compatibility with preferred microphone. Will the amp work only with a supplied mic or are there other choices of mic available?

Wireless capability (mic not attached by cord to speaker) if desired. Does unit have a wireless receiver built in or can one easily be added? Will an added receiver require a separate power supply?

Durability – expected longevity and resistance to breakage of the brand of instrument. If the need will be short term, then a less expensive instrument with a shorter warranty may be a reasonable choice.

Price, Warranty, Return policy, Repair Service on any particular instrument. Some warranties are only 3 months, some are as long as 6 years. Note that the warranty on the batteries and the mics is very often shorter than the warranty on the amplifier. Is repair service available after warranty has expired?

MUCH ADO ABOUT WATTS

Many amplifiers advertise output wattage – the power delivered to the speaker from the amplifier. In general, the higher the wattage the louder the amplifier may seem. When using small, personal amplifiers, the types and characteristics of the mic and the loudspeaker and the weaknesses and distortions of the voice will all effect what the listener hears. Wattage listing alone is not the best guide to anticipated effectiveness. A better measurement is the overall dB gain from the microphone to a specified distance in front of the loudspeaker. (Usually 10 cm is the distance used.) This measurement represents the capability of any particular mic/amp system and these numbers tend to relate better to the logarithmic response of the human ear.

The wattage listed for amplifiers usually assumes a high fidelity output from very low to very high frequencies. With many portable amplifier systems made specifically for people with voice problems, this range has been narrowed to apply only to useful speech frequencies. The full wattage of the device can then be concentrated in this narrow band and the listener’s ear will hear that range as apparently louder, with less distractions from non-communication sounds in the voice such as air noises when breathing, heavy resonant vowels, and air injection of esophageal speakers.

4 BASIC TYPES/SIZES OF AMPLIFIER SPEAKERS

POCKET SIZE – OR ALMOST: The smallest, generally pocket size amplifiers, are attractive because of minimum size and weight and bulk – often weigh only about 6 to 12 oz. – sometimes a very important feature for someone trying to remain mobile. Because they have a smaller speaker, the sound quality and/or volume may be somewhat limited, but many people find them convenient and helpful, especially when talking to a few people in a small to medium size room or in a vehicle. High-gain, uni-directional, noise canceling mics often work well with these units to make them useful even for someone with a very weak, whispy voice, but if the mic is too powerful and/or someone speaks into it at a loudness level above a weak voice or whisper, the sound may sometimes “overdrive” the speaker and become tinny or distorted. Some small amps can be worn in a pocket or on a belt. Some are a little too big for a pocket and go on the belt or on a strap around the neck. Note that a layer or two of cloth in a breast pocket or pants pocket will not interfere with the volume. The cloth might even help a bit in avoiding feedback.

WAISTBAND OR FANNYPACK:

These tend to put out a lot of sound for their size, especially directly in front of the speaker. They are compact and fairly light weight (typically about 1 lb. to 11⁄4 lb) and can be very convenient for those who are comfortable wearing a belt. (If you wear an over blouse, sweater or shirt, the amplifier can be worn under it. The sound should come through with no trouble as long as the cloth is not extremely thick or dense). These amplifiers can be worn to the side or back if preferred – and also can be unbuckled and set on a table, hung on a chair back, etc., which might be needed to avoid feedback when sitting at a table if the chair has a back and arms. It is important to consider the size, weight and positioning and hand/arm capabilities of the wearer compared to the exact shape of the amplifier and the position and design of off/on switches and controls. This type of amplifier may vary a little in length and depth, may have knobs that stick up, may be difficult to position comfortably for larger people. Users must have reasonable dexterity to unbuckle and place it on a table or hang it over a chair. If hung, the speaker will point toward the floor. It will probably have the volume control and off/on switch in one knob or dial, so that turning it on will require adjusting the volume – you will not be able to leave it set at a pre-adjusted level that you know you prefer – but you can mark the unit with a bit of nail polish or felt tip pen so you can quickly turn to your most common setting.

SHOULDER STRAP PURSE TYPE:

Typically about 2 -6 lbs, they are quick and easy to put on and take off – or can be set or hung somewhere. If hung, the speaker will point out into the room, not toward the floor. When worn, they will swing and move a bit unless otherwise secured, so they may be more difficult than the pocket and waistband types for the person struggling with balance and mobility. However, this type of amplifier is often ideal for use with a wheelchair where it can be set, hung or mounted in various positions – and the user may be able to use a microphone held onto the chair by a goose neck or clamp to avoid wearing a mic on the head or hand-holding it. The amp may have a volume control separate from the off/on switch so the volume can be left set and it will come right back to the preferred volume as the switch is turned on. The larger ones may be bigger and more powerful than most people need for personal conversation unless the voice is barely perceptible, but tend to have really good sound quality because the speaker is larger, so they can be a great asset to people who need to speak to larger groups or at a distance or where there is a high noise level. Some of the amplifiers in this category are also available in a wireless version (transmitter between the mic and the amplifier/receiver) so that the user and mic can be as much as 150 ft to 200 ft. away from the speaker without a mic cord to trail around – a good feature for active people like gym teachers and coaches, for instance.

TABLE TOP OR STAND ALONE:

About 6 lbs. up. The smallest of these can be dropped into a canvas bag and easily transported anywhere. Out of the Personal Voice Amplifier category, but of interest to many people for various work or group activities, these units can go up to about 40 lbs. and reach up to 5,000 people, still using battery power. Many are available with line power capability for those who are in the same room(s) most of the time and do not require “out and about” use. This will eliminate battery replacement or recharging schedules. Many will have wireless versions available. Many will also amplify other equipment – radio, tape or CD player, computer, musical instruments.

5 MICROPHONES TYPES

HAND-HELD MICS

Are convenient to pick up and use as needed, quick and easy to position.
Do not require “wiring” of head.
Do not interfere with hair or clothing.
Are quick and easy to pass from person to person for group use (such as laryngectomee club) Often are the most satisfactory and least expensive choice.

Are subject to creating extraneous static noises if user rubs hands on mic or cord Usually require that the user have reasonable control and movement of hands and arms,

But can often be “goose necked” into position for hands free use by someone who is in the same place a lot of the time. (See section farther on)

Or can easily be held for the user, when needed, by a therapist, family member, friend or caregiver. HANDS-FREE MICS for those who cannot use hands or arms or need hands free for work or activities.

Headset and headband type mics

Stay with the mouth at all times unless deliberately moved – useful for those without good head control, those who must turn their heads constantly (for instance: special needs teachers), or who must bend over or jump around (doing craft demonstrations, bending over small children’s desks, leading jazzercize classes).

Require user’s or someone else’s “hands-on” to get away from the mic – to eat, drink, or, if desired, to avoid amplification when coughing, sneezing, clearing the throat, etc.

Require a cord to the head and may interfere with hair style.
Some, especially heavier ones or those with rigid parts, are not comfortable to wear for long periods

of time and are better suited to occasional short periods of use rather than all day, every day.. May require special adjustments for child or small heads or extra large heads.
Note: Some headband mics are versatile and can be worn two or three ways around the back of the head, over the top of the head, around the neck with the mic sticking up in front of the mouth.

Collar Microphones – like long, bendable pencils – they curl around the neck and the mic end bends up toward the mouth.

Do not move with head – require head control and the cognition and memory of the user to turn to the mic when speaking.

Do not usually give as much of a feeling of being “wired.”
Do not interfere with hair style or put any pressure on the head.
May be useful for someone who has head support brackets or any other hardware on the head that would interfere with use of a headband mic.
Need to be pinned under the collar or fastened down for an active user – otherwise may bounce around as user moves and will probably bump the user in the nose if he/she bends over.
Some brands do not adjust small enough to stay in place well on children and people of small stature. Others work very well for very small people. Some may not go far enough around very large necks. Check neck size before purchase and ask supplier to confirm that the mic being supplied will be satisfactory for the size of the particular individual. Some brands will hold their position better than others.

Hand-held mics on goose necks

Often an ideal arrangement for people using wheel chairs or sitting or lying at the same place for long periods of time.

Do not require that any cords or wires be placed or draped on the head or body. Allow complete freedom of head and mouth.
Often work well for people lying in bed since other mics may be knocked out of place when turning head or be uncomfortable to lie on.

Are convenient if user must transfer or be lifted from the bed or chair – can easily be pushed out of the way without snagging and pulling cords as a mike worn on the head or body might do.

Some handheld mics require that a button be held down when talking, but goose neck clamp may serve this purpose.

Require control of head movement, the cognition to turn to the mic when speaking.

Lapel or Lavaliere mics

Are very seldom suitable for people with weak voices. (Those television announcers have strong voices, are not being amplified in the same room so the gain can be turned up with no feedback problems – and the station can spend big $$$$$ on their sound systems!)

Are primarily useful for people with good voices using wireless amplifiers, with mic and amplifier speaker separated by at least several feet.

Have been used clipped to a ring or watch while the user at a table rested chin on uplifted fist. Can be useful mounted next to a suck/puff motorized chair switch for someone with multiple needs.

Bone conduction and throat mics

Pick-up varies – in general they have difficulty in picking up sound energy from a weak voice through the throat tissue or structure of the neck, so are likely to provide very limited amplification.

Scar tissue, irregular neck tissue, excessive fat tissue may decrease pick-up significantly
Even those that do a reasonable job of sound pick-up will not have the voice quality of other mics – voice may have “static” sounds, due to pick-up of body noises and mic rubbing on skin, hair and beards – swallowing is usually picked up and amplified, and even more so when food or beverage is being swallowed – so this kind of mic may be unacceptable for social use by someone who could use another type of mic.
Care must be used in positioning mic – especially those on a band that completely circles the throat – to avoid undue pressure on the carotid arteries.
All the negatives aside, a good throat mic may be very useful in some instances, especially for people who have multiple problems or unusual special needs.
Some of these mics work quite well artificial larynges – especially with intra-oral artificial larynges with no neck involvement such as the Cooper-Rand or neck held units with oral adapter.

Microphones (with the exception of the contact and throat mics) are available in broad field pick-up (omni-directional) and narrow field pick-up (directional), some with noise canceling features. Directional mics, particularly those with noise canceling features, are a better choice for personal amplification systems because they can increase the “signal-to-noise ratio” of the voice (pick up more of the voice and less ambient noise) and reduce problems with feedback. Directional, noise-canceling mics are especially valuable when a person with a weak voice needs to be amplified in a very noisy area such as a room with a TV blaring, a bustling gymnasium or a clanging factory.

A microphone must be compatible with the chosen amplifier. There are many microphones with greatly differing electrical properties. Even two mics that look very similar and are from the same source may not be interchangeable on an amplifier. In some cases, plug sizes differ and special adapters may compensate. In other cases, there is an electronic mismatch and a mic and amp just will not work well or at all together. A knowledgeable supplier is the best bet for information and should know the products that he or she handles, but the supplier will probably not be able to tell you whether a mic you have from another source will fit an amplifier that supplier handles or visa versa – it many cases it will be impossible for anyone to judge compatibility without direct hands-on testing of a mic and amplifier combination.

IF AT FIRST YOU DON’T SUCCEED:

Some amplification systems in electronic supply stores have a poorly matched mic and amplifier. Sometimes an amplification system may have been tried without good results. Don’t give up! Keep looking for a good system and a knowledgeable therapist and/or supplier. If there is any audible voicing at all, with the ability to shape words reasonably well, there will be an amplification system that will help as long as the component parts are properly matched, positioned and adjusted.

FINANCIAL ASSISTANCE FOR AMPLIFIER PURCHASE

They may sometimes be obtained though such agencies and organizations as the Veterans Administration, Sertoma Club, Lions/Lionesses, Telephone Pioneers of America, Easter Seal Society, churches, and local chapters of health, fraternal and service organizations. If one agency cannot help, it may be able to direct you to another that can. For those still working or wanting to get back to work, the Bureaus of Vocational Rehabilitation in the various states are a very important source of assistance with voice amplifier purchase.

An employer may be asked to provide amplification under the ADA act. For instance, many teachers have been able to get help from their school systems, but sometimes strings are attached like being required to leave the amplifier at school or to share the amplifier – or sometimes the employee feels that the employer may make life more difficult if pushed to provide the equipment. People may have to decide whether the assistance with the purchase of the equipment is worth any compromises or problems with the employer.

PRIVATE INSURANCE COMPANIES may provide coverage, depending on the user’s policy. Often insurance companies follow the lead of Medicare on what they cover. Some will require pre-approval. Some suppliers may file claims for customers, but most will probably leave it to the customer to use “Paid” invoice copies and recommendations from their doctors to file their own claims.

Whether Medicare, Medicaid or other Insurance, top amounts allowed may be less than the full price of the amplifier wanted. People who hope for coverage for amplifiers must expect to provide the supplier and/or insurance company with a physician’s prescription for a specific amplifier and microphone by name and a detailed write-up (at least several lines) emphasizing the medical conditions requiring amplifier use, rather than the social or psychological benefits to the user. If a claim is turned down, the individual or supplier should definitely appeal. It may require a lot of documentation to prove that coverage is warranted, especially for laryngectomees.

Originally presented to USSAAC, 08/99 by Dorothy Lennox, updated version at NCACA, 02/00 by Tom and Dorothy Lennox, further updates 08/00, 01/01 and 04/02, 04/03, 04/04, 03/08, 6/10

PLEASE NOTIFY US IF YOU FIND ANY FACTUAL OR TYPOGRAPHICAL ERRORS

PERMISSION IS GIVEN TO COPY AND DISTRIBUTE FREELY AS LONG AS CREDIT IS GIVEN TO D. LENNOX, LUMINAUD, INC.

THE FOLLOWING INFORMATION APPLIES TO AMPLIFIER PURCHASES FROM LUMINAUD, INC. BY INDIVIDUAL CUSTOMERS.

Due to the excessive cost of the newly required Accreditation process to a small company, we no longer can send claims to Medicare. There is a slight possibility that you might be able to send in a claim yourself if you provide the right documentation and use the right form. We can provide the needed form to you on request. A surer thing is to get a local accredited Durable Medicare provider to order an amplifier from us, provide it to you and file a claim with Medicare. We sometimes can direct you to a company that might be able to handle this.

We cannot participate in any Medicaid programs due to excessive paperwork and frequent non- payment, but we can often work with a local Durable Medical Equipment provider – the kind of store that would provide walkers, commodes, wheelchairs, etc. – to provide a voice amplifier. An individual, therapist, social services worker or DME dealer may contact us for further information

We cannot bill Private Insurance – that is, we cannot send out an amplifier with no prepayment and then send a bill to an insurance company – but there are 3 possibilities for insurance coverage:

1) When we sell an amplifier to an individual, the package will include the original and 2 copies of the paid invoice. The customer him/herself may be able to obtain reimbursement by completing an insurance claim form and sending it to the insurance company along with one of the invoice copies and a physician’s statement of need.

2) Some insurance companies will work with “proforma” invoices – we bill them, they pay us, then we send out the merchandise. The individual should check to see if his/her company will do this and to whom the invoice should be sent. If the insurance company agrees, we must be given the insurance company name, address, fax number, specific contact name and also the individual’s insurance numbers, date of birth, any other information the insurance company wants on the invoice and a list of the equipment that is wanted. We will send the invoice and upon receipt of payment from the insurance company, we will send out the products ordered. Because this involves a great deal of extra paperwork for us, we cannot submit a proforma invoice for an order of less than $100.

3) Any medical equipment company that is a recognized provider for an insurance company may purchase equipment from us at a small discount and then resell it to the individual and bill the insurance company. The insurance company will probably have a list of preferred providers to help locate a nearby equipment provider. If we are given the provider contact name and address, we can send information about products, prices and arrangements.

There are only a few brands of personal voice amplifiers available. At Luminaud, we offer a versatile and continually updated selection of high quality amplifiers and microphones – and over 35 years experience in providing communication equipment. We are happy to discuss specific requirements, preferences and capabilities in order to assist therapists and their patients in choosing the most appropriate voice amplification system for any individual’s needs.

LUMINAUD IS:

A northeast Ohio family owned and operated company with over 35 years experience in providing a wide variety of quality products for people with special communication needs. Tom and Dorothy Lennox and their family/staff offer personal attention and prompt service at reasonable prices.

Prior to forming Luminaud, Tom was a research and development engineer with the Rand Development Corporation, in Cleveland, where he was responsible for the manufacture of the Cooper-Rand Intra-oral Artificial Larynx. The Lennoxs purchased the rights to the Cooper- Rand in 1972. They have continued to upgrade its components and durability and have developed adaptations allowing independent use of the Cooper-Rand by people who have little or no use of their hands or arms.

Luminaud also manufactures and/or sells many other Augmentative, Assistive, Alternative and Adaptive Communication devices – several brands of artificial larynx, personal portable voice amplifiers, a device to use with the telephone to amply outgoing speech, a small “real voice” communication board, a signal device and switches for minimal movement capability – as well as tracheostoma coverings and Heat Moisture Exchangers which provide some of the lost functions of the nose to those with tracheostomas, the Thermo-Stim and other devices used in the diagnosis or treatment of dysphagia, and larger voice amplifiers/portable sound systems for institutional and commercial use. Luminaud is an FDA registered manufacturer of medical devices and serves both U.S. and foreign markets.

The Luminaud staff is happy to respond by phone, fax, letter or e-mail to individuals, physicians, speech & rehabilitation professionals, and educators to provide information about products and associated advantages/disadvantages, to discuss individual special needs and applications, and to provide reference to other products and information sources. They can sometimes provide hands-on demonstrations, work shops, in-services and exhibits for classes, medical facilities, organizations and conferences.

Luminaud is an associate member of the International Association of Laryngectomees..

FEDERAL ID NO.34-1268969

THE POSITIONING & USE OF MICROPHONES & SPEAKERS
VERY IMPORTANT: When using a mic, especially with a weak voice, KEEP IT CLOSE! Having the

foam windscreen touching the lower lip is best – ideally not more than 1/4″ away.

LET THE MIC DO THE WORK FOR YOU. With the mic close, you can get the greatest amplification with the least tiring effort and the least problem with feedback. You can get the full effect of any dynamics of your speech. And you can get natural, consistent sound without the amplification dropping off and coming back up if the mic and your mouth sometimes come close and sometimes are farther apart.

The mic should be positioned just at or just below the lip-line. Keeping the mic to one side, not in the middle, will cut down on windy, hissy sounds as from “s” and “p” and make your voice much more pleasant to listen to. You may find a dramatic difference in pick-up from one side of the mouth to the other. EXPERIMENT to find your best placement.

Many mics sound better if you talk over the top or across the face, not directly into them. And then listeners can see your mouth movements and facial expressions, an important part of any conversation.

People often find that the easiest way to use a hand-held mic is to put the cord around the back of the neck and let the mic dangle down in front, where it can be picked up and used when needed. Be sure to start out, right at the beginning, holding a hand mic in your non-dominant hand. The tendency is to pick up the mic with your “good” hand, but It is very difficult to switch later to the other hand in order to leave your dominant hand free for writing and other tasks.

SHAKY HANDS?? POOR GRIP?? You may be able to use a handheld mic by bracing 2 fingers or the palm or the heel of the hand on your chin. This often works quite well.

An amplifier’s own handheld mic will often provide the best sound quality and greatest amplification at the least expense. However, those who cannot hold a mic or need both hands free will be able to get good results by choosing among several alternative mics and mic supports.

When a headset mic, headband mic, or collar mic is being tried for the first time, the user or therapist should hold the mic in the hand and experiment to find the best pick-up position first, before putting the mic on the head or neck. Once you know the spot you are aiming for, it is much quicker and easier and less annoying to adjust the mic and/or support than if you just put it on immediately and then start experimenting.

People at the same location much of the time (desk, chair, bed, etc.) and people using wheelchairs – may want to use a goose neck support for the handheld mics. A pinch clamp allows mic insertion or removal in just a few seconds. For those with reasonable head control, this arrangement allows easy use of the mic, free of connecting wires and supports attached to the head. A slight turn of the head puts the lips near the mic to speak and a slight turn the other way will reduce the amplification of breathing, coughing, sneezing. etc.

For those special situations in which a contact/throat mic is being used, experimentation will be needed to find the best pick-up spot on the neck.

When POSITIONING AN AMPLIFIER’S SPEAKER, remember that it must face into an open area – not into a wall or piece of furniture or someone’s body. In small rooms or elevators, the volume may have to be adjusted down to avoid feedback. Wheelchair users, with an amplifier mounted on the chair, must be careful not to stop to talk with the speaker facing right into a wall, cabinet, etc. If sitting at a table or desk, a waistband amplifier may have to be moved around to the side or removed and set on the table/desk. If using a wireless system where the mic is using a transmitter and not plugged in to the speaker, the mic and speaker must be separated by at least several feet to avoid feedback.

NOTE: POSITIONING IS IMPORTANT FOR PEOPLE, TOO! A person who is positioned, as much as possible, with head erect, airway open and shoulders back to allow full use of the lungs will be able to produce a louder, clearer voice with less effort than someone who is slumped over.


MICROPHONE HANDLING AND CARE

REMEMBER, IF HAND-HOLDING THE MIC, USE YOUR NON-DOMINANT HAND.

MICS AND MIC CORDS WILL OFTEN TRANSMIT SOUNDS FROM TOUCH, BENDING AND VIBRATION. DON’T HANDLE THEM ANY MORE THAN NECESSARY. If the mic is hand held, hold it steady. If you rub your hand up and down on the mic or fiddle with the cord, your listeners will hear very annoying scritches and scrunches. If the mic is on a gooseneck or stand, keep your hands off the mic and mic support once you have them adjusted. And don’t drum your fingers on the podium or table top.

DON’T CUP YOUR HAND OVER THE MIC. Actors or singers may do this to get a special effect – and they are usually using a mixing system. If you do it, you’ll just have feedback and pick-up problems.

MICS AND MOISTURE AREN’T A GOOD COMBINATION. Spit happens! So if your mic has a removable windscreen, use it faithfully. If your mic has no wind screen, get one if possible. (It will improve sound quality too, by cutting down on windy and hissy sounds.) Meanwhile, check the mic covering or end of the voice tube for accumulation of food particles or hardened saliva. Clean them out gently with a softish, dry brush—don’t get water into the mic or scratch it. (NOTE: Wash windscreens often for hygienic reasons. After washing, blot dry and then wait until well air dried before putting back on the mic. If a windscreen fits too loosely and drops off to easily fasten it with a small rubber band – or use a tiny dot of Prit-type paste or glue. Be sure the paste/glue does not get into any of the mic openings. Replace windscreens if they begin to break up.)

MIC CORDS ARE SENSITIVE TO CRUSHING – more sensitive than lamp cord, for instance. Take care to avoid cords being walked on or having something set on them or pinched in doors or drawers.

IF YOU HAVE TO REMOVE THE MIC PLUG, PULL ON THE PLUG, NOT THE CORD. On most mics, the cord and plug pull apart fairly easily. Also, use care not to kink or fold the cord sharply, especially at the mic and plug connection areas, which are the most vulnerable.

IF YOUR MIC CORD IS LONGER THAN NEEDED coil the excess amount loosely (around 4 fingers is a good size)and fasten gently with a twist tie. This is much safer than letting it dangle and get caught in things, which might pull it out of your hand or off your head.

MANY MICS CAN BE PERMANENTLY DAMAGED IF DROPPED ON A HARD FLOOR, SO IT PAYS TO BE CAREFUL. In general, the larger the head of the mic, the more likely it is to be damaged by dropping.

ALL EXTERIOR PARTS OF YOUR AMPLIFIER CAN BE CLEANED by wiping with a cloth just dampened with Lysol or similar disinfecting spray. DO NOT spray the instrument itself. DO NOT get actual drops of moisture into the mic, speaker or any other openings.

DEVELOP GOOD MIC USE & HANDLING HABITS TO BEGIN WITH – IT WILL BE WORTH THE EFFORT!

IF YOU HAVE ALREADY ACQUIRED POOR HANDLING HABITS,
YOU WILL FIND IT WORTHWHILE TO WORK AT IMPROVING THEM!!!

Most of these suggestions should apply to the use of any mics or amplifiers, ours or others. We hope they will help and that you will have easy and trouble-free use of your amplifier.

If you have any questions about general mic or amplifier use and care, or problems with equipment purchased from us, please contact us.

06/10 PERMISSION IS GIVEN TO COPY AND DISTRIBUTE FREELY AS LONG AS CREDIT IS GIVEN TO DOROTHY LENNOX, LUMINAUD, INC.

Amplifying on the telephone

Dorothy Lennox
Luminaud, Inc.

(See listing under WW Suppliers section)

The company that made phones with good outgoing amplification discontinued them a few years ago. The last we knew, the XL40 provided up to 40 dB gain on incoming voice but no gain on outgoing voice.

There is an XL 30 which provides up to 30 dB on incoming voice and up to 15 dB on outgoing voice, which offers a little help.

The other option we know about is the Voice Magnifier, a device that can be put on to a phone, like the one where the handset can be detached from the phone. Essentially, you plug in the Voice Magnifier unit between the handset and the phone itself and get up to 25 DB gain. It works with most, but not all, phones currently used in the US and it has a slide switch to increase and decrease outgoing volume and an off/on switch so that someone else using the phone and not needing an amplification boost can just flick off the switch, and you can flick it on again when you are ready to use it.

Unfortunately, the Voice Magnifier cannot be used with a cordless phone or a cell phone. The only other way we know to amplifier your voice on the phone at this time is to use a personal voice amplifier or some sort with a speaker phone, which cuts down on the privacy of the conversation, but works well for people in many cased.

What you are talking about has been wanted/needed for a long time. We THINK that technology is developing that will make it possible before too many more years. If any other people have good information on this topic, I’d appreciate your sharing it with WW and with us, since we like to know all we can about products that are available. If we can’t provide something that someone needs, we like to be able to tell them, if at all possible, where they can get it.

Other comments

Reader’s comparison:

My job was a leader of programs which required me to teach classes and attend several meetings each week. Once I decided to I needed an amplifier, I started to investigate, and to tell the truth, it was obvious that some manufacturers had a bigger advertising budget but not so obvious which was best. I contacted the suppliers and got approval to buy the product and try them. I would keep one and return the other 2. I got these:

Voista- The best choice for my needs. Clear and small enough to fit in about 75% of my shirt pockets. I use a “Garth Brooks” type microphone. It is digital which is supposed to be a plus, although I’m not sure why. I liked it and purchased it.

Addvox- There is nothing wrong with this product as far as amplification. However, it is about the size of a fanny Pak and is worn that way. It also takes longer to charge the battery and has to be charged more frequently.

Spokeman- I was very impressed with the quality of this one. Was very small and would fit into ANY shirt pocket. The sound was clear and loud enough. It didn’t hold a charge as long as the Voista, but the lower price made up for that.

I ended up keeping the Spokeman, also. Since I could use the microphone from the Voista with it, it only cost about $100.00. On rare occasions Voista was too large for my pocket, or if I ever needed a spare, it made sense for me to keep it as a back up.

One tip, if you do the trial thing, is make sure to be in contact with your insurance company. When I asked Blue Cross for reimbursement, I got a “Sorry, this product is approved, but you bought it from the wrong vendor.” Nice huh? 
Good luck,
Ron Sexton Lary 2008

Insurance Answers

Suggestions as to how you may get to pay one an amplifier, check in the general section under insurances. Also talk to the Supplier that you purchased the amplifier from. They often know some options.

Blue Tooth Voice Amplifiers

1. One can use a wireless – portable Blue Tooth speaker to amplify. There are numerous ones available. With I-Phone all you need to do is :

Settings – turn Bluetooth on and it will find the speaker. It is fine for small groups. These types of speakers also work fine all other mobile phones, I-Pad, etc.
Bill Mc TC/VA

2. If you already have a I-Pad or I-Phone docking station they also make Blue Tooth receiver adapters that will allow you to use the docking station as an amplifier for the Blue Tooth. There are several in the $15 to $30 range at Amazon.com.

3. Different brands may be checked at
http://www.amazon.com/
http://www.walmart.com/

You might download this catalog to see a variety of electronics.
http://www.hamiltonbuhl.com

To those interested in Voice Amplifiers,

As well as the ADDvox Voice Amplifiers mentioned by Richard of Bruce Medical, there are several other personal, portable voice amplifiers which are easy to use, durable and have provided many years of excellent service at very reasonable prices for many, many users. These include the Spokeman, the ChatterVox, the Classic Power Vox, the Voicette, the
SoniVox, the BoomVox, the WPA and a variety of other brands, in sizes from 7 oz. to 25 lbs., to help in communicating one-to-one or in speaking to small, medium or very large groups.

Many special features and a choice of microphones are often available so that people can select the combination of components that will work out best for their own individual needs and preferences. Voice amplifiers are useful for esophageal, TEP or EL speakers and also for many people with Parkinson’s, ALS, MS, COPD, lung cancer, vocal nodules or any of many, many conditions which make it impossible, difficult or tiring to try to speak at a normal or louder voice level. Any personal amplifier can be used with the speaker phone version of a telephone, but there also are some phones with built in outgoing voice amplifiers or outgoing voice amplification attachments for modular phones.

Check out the Voice Amplifier information at these web sites:
Griffin Labs: www.griffinlab.com
Lauder Enterprises: www.electrolarynx.com
Luminaud, Inc: www.luminaud.com

Any of these companies will be happy to provide additional details and to go over your personal needs to assist you in making choices.

Happy Talking,
Dorothy Lennox
Luminaud, Inc.
Vendor Member

Other causes of voice problems

BOTOX – for overactive muscle activity

Let’s dispel some misconceptions about this drug. You know, the old “Law of the Hammer”? Once you acquire a hammer, everything starts to look like a nail. That has been happening with Botox, and it is important to understand how this drug works to prevent its misuse and overuse. If not administered properly, it can cause very serious consequences. It is also quite expensive.

Most of you have heard of botulism poisoning, which is often fatal, usually acquired through consumption of improperly canned foods or processed meats. A toxin, produced by the bacteria Clostridium botulinum is the cause but this bacteria can easily be destroyed at high temperatures, This is why canned foods must be heated thoroughly as part of their processing.

For a muscle to contract, a signal is sent from the brain through a nerve towards the muscle. At the neuromuscular junction, where the nerve meets the muscle, the signal passes by a chemical called acetylcholine. Then the muscle will contract and movement occurs. The botulinum toxin blocks the release of acetylcholine, which will cause a partial paralysis of the muscle which lasts about 3-4 months.

In the 1950’s, researchers realized that you could prevent overactive muscles from contracting by injecting VERY small amounts of the toxin into the muscles. The injectable drug Botox was developed by the company Allergen to treat muscle spasm and overactivity, initially to treat excessive blinking (blepharospasm). It has since been used to control muscle spasms throughout the body in the dystonias, and also has gained considerable popularity because of its cosmetic uses for treating wrinkles.

For laryngectomees, Botox has been used to reduce the hypertonicity and spasm of the vibrating segment, resulting in a less effortful esophageal (E) or tracheoesophageal (TE) voice. But it is only effective for conditions that are due to overactive muscle activity, and may require relatively large doses (when compared to the amounts used cosmetically), administered precisely at the location of the hyperactive muscles. It is helpful to do the injections into the pharyngeoesophagus under fluoroscopy in radiology so that the precise point of hyperactivity can be pinpointed. Other voice and/or swallowing problems that are the result of scar tissue, diverticula, or stricture aren’t helped by Botox. These are structural problems, not movement problems caused by overactive muscles.

Ideally, before Botox is attempted, the clinician will do a thorough investigation to determine the cause of the voice or swallowing problem. That will prevent the needless use of this drug. The typical side effects include soreness at the site of injection, allergic reaction, and injection of the wrong muscle group, which could result in very undesirable weakness of some muscles, on a temporary basis. Injectable Botox is also known to travel to areas of the body distant to the site of injection. Between 1989 and 2003, there were 28 deaths attributed to its non-cosmetic use in a variety of medical conditions. Not a huge risk overall in 14 years, but one that you should be aware of.

As always, I suggest that anyone considering a new treatment have a thorough understanding of what it is all about, and be certain that your clinician has a clear rationale for recommending it.
Carla DeLassus Gress, ScD, CCC-SLP Charlottesville, VA