Voice and Resonance Disorders 85I asked the designated clinician if I could have it, and she agreed. The patient’s chart indicated
that he had under gone a complete laryngectomy with no complications. He had been counseled
presurgically and said that he wanted the esophageal speech option.
The first time I met Alvin, I immediately liked him. He was about 6 feet tall, slender, and
completely bald. He had an expressive smile and a strong handshake. To communicate, he wrote a
note. Because of the communication barrier, I did most of the talking, explaining the idea behind
esophageal speech and showing him several pictures from a textbook. He wrote that he looked for-
ward to being able to talk again and wanted to know how long it would take. I said that individuals
learn at dif fer ent rates, and unfortunately, some patients cannot achieve functional esophageal
speech. It would prob ably take 3 months of individual therapy three times a week, and there would
be extensive homework assignments. Recently, a “Lost Chord Club” consisting of persons with
laryngectomies had been formed, and I encouraged Alvin to attend the next meeting in 2 weeks.
By then, Alvin should be able to say a few words. Then we got down to work, and I explained the
injection method.
In my experience, most patients prefer the piston injection method, and Alvin was no excep-
tion. I showed him how to touch the tongue to the alveolar ridge and capture as much air as pos-
si ble. Then gradually, using the entire tongue in a progressive movement, I showed Alvin how
to move the air mass to the back of the throat, explaining that the air is not swallowed, but held
midway in the throat. I demonstrated the pro cess several times and was able to expel an acceptable
amount of air. Then I showed Alvin how speech is made on the belching noise coming from that
air mass vibrating the lower part of the throat. After several attempts, I could say “I want” with
reasonable intelligibility. I explained that the goal is to make a belching sound of sufficient volume
and to prolong it as long as pos si ble while mouthing speech. Alvin could prob ably do better than
I did, I observed, because he had more space due to the surgery and fewer structural limitations.
Then I asked him to give it a try.
Alvin carefully touched his tongue to his alveolar ridge and, spreading it out laterally, he grad-
ually pistoned the captured air to the back of his throat and partially down the esophagus. Then,
loudly and articulately, he said, “How’s that?” Automatically I said, “Fine,” before I could register
what had just occurred. Believing his utterance was a f luke, I asked him to do it again, and with
even more volume and precision, he said, “This is fun.” He had actually said the three words on
one injection! Thinking that this had to be an episode of Candid Camera, I looked around to see if
there were any witnesses to this remarkable event. I asked Alvin if he had been getting therapy or
practicing before our session, and he said that this was the first time he had tried it since he was a
youngster. As a young boy, he and his cousins played games involving belch talking and even had
a club where every one was required to talk that way. He was very proficient, and his skills had not
diminished over the years. During the remainder of the session, he continued to show a remark-
able esophageal speaking ability. He picked it up so fast that I labeled him “Alvin the Great,” a title
he appreciated.
We had two more sessions, and by the end of the week I discharged him from therapy. He
practiced esophageal speech for several hours each night and by the end of the week had mastered
it. I offered advice on improving his intelligibility by exaggerating the precision of articulation and
emphasizing sounds in the final positions of words. The only negative speech be hav ior he acquired