Deep Dive · 7 min read
Head and Neck Cancer: Laryngectomy and Alaryngeal Speech on the Praxis
One surgery and three voice options cover nearly all head and neck cancer items on the 5331.
Cross-checked against the current ETS Praxis 5331 Speech-Language Pathology Test at a Glance and ASHA CCC-SLP standards.
Head and neck cancer questions on the Praxis 5331 cluster around one surgery — total laryngectomy — plus the swallowing consequences of radiation. Learn the altered anatomy and the three alaryngeal voice options and you have the topic covered.
Total laryngectomy: the anatomy change
The larynx is removed and the trachea is sutured to a permanent stoma in the neck. The airway and the digestive tract are now fully separated. Consequences the exam tests:
- No voice — there are no vocal folds.
- Breathing happens only through the stoma; the nose no longer warms, filters, or humidifies air.
- Loss of smell and much of taste until nasal airflow is restored with a polite yawn technique.
- Aspiration is not possible through the separated airway — a favorite distractor.
- No breath support for coughing, nose blowing, or lifting via closed glottis.
Contrast this with a partial laryngectomy or supraglottic laryngectomy, where the airway remains connected and aspiration risk is high.
Three alaryngeal voice options
- Tracheoesophageal puncture (TEP) with a voice prosthesis: a one-way valve shunts pulmonary air from trachea into esophagus; the patient occludes the stoma to speak. Best fluency and loudness; requires prosthesis maintenance and candidacy screening.
- Esophageal speech: air is injected or insufflated into the esophagus and released to vibrate the pharyngoesophageal segment. No device, no maintenance, but hard to learn with short phrase length and low intensity.
- Electrolarynx: external vibratory source held on the neck or an intraoral adapter. Fastest to acquire, immediately usable post-op, but mechanical quality.
Radiation and chemoradiation effects
Xerostomia, mucositis, altered taste, edema, and — the long-term problem — fibrosis. Radiation fibrosis produces progressive reduced tongue base retraction, reduced laryngeal elevation, and cricopharyngeal restriction, sometimes appearing years later. Prophylactic swallowing exercises and maintaining oral intake during treatment are the evidence-supported answers; prolonged NPO worsens outcomes through disuse atrophy.
Assessment and management
Instrumental assessment guides diet and exercise decisions — see MBSS vs. FEES. Counseling is a real part of these items: communication loss, body image, and stoma care support are within scope, while medical management is not. Review the boundaries in our counseling and scope guide.
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