[Rehabilitation after laryngectomy].

Comparing laryngectomized patients with deaf persons whose disablement in terms of German law is approximately of the same degree, the former seem to be better off in respect of communication due to the availability of better substitute aids. The first step in any rehabilitation-programme is comprehensive information and instruction of the patient, his family and also of his employer by the surgeon, the speech therapist and if necessary by a social worker. Speech rehabilitation may be the most important aspect of such a programme, but reintegration into the family and professional rehabilitation but also not be neglected. The patient should be given an official invalid status without delay to protect him against unwarranted dismissal, and, after having discussed other and minor problems, a timetable to teach him the oesophageal speech is set up; in this regard, we prefer the aspiration method. The patient is informed about oesophageal speech and the use of electronic devices in speech rehabilitation and also about a neoglottis voice. The article demonstrates the character of the resulting "substitute" voice by means of sonagraphic pictorial representations; this also comprises an assessment of the quality of the voice by neutral observers. The problems arising with a neoglottis due to the communication of oesophageal and respiratory tract are discussed and compared with those with oesophageal speech where the voice-forming system and the respiratory system are kept completely separate. Taking the great range of the various situations into consideration, the physical and emotional status and the course of acquiring oesophageal speech are described. The results are partly contradictory to earlier publications. The importance of teamwork in the care of these patients is emphasized.