Each year almost 2000 people in England and Wales develop either laryngeal or hypopharyngeal cancer.1 Radiotherapy controls or cures this disease in many patients, but those with advanced tumours or disease that has failed to respond to radiotherapy require surgery for any hope of cure.

Partial laryngectomy may be suitable for a few patients, who are left with a compromised, but often satisfactory, oral airway. Some patients may also require a permanent tracheostomy. For these fortunate patients speech is retained, but even if altered it is at least immediately understandable. Many more patients lose their larynx completely; to preserve any part would compromise their chance of survival. For them, no matter how well counselled before operation, there is the intense frustration of waking from their surgery aphonic and able to express themselves only by gestures, writing, or mouthing messages. The rehabilitation of voice was discussed fully in a previous editorial,2 but for these patients this represents just one of many problems that they have to contend with, and they justifiably feel that few, even their general practitioners, fully comprehend the extent of their disability.

If there are no complications patients are discharged home 10 to 14 days after their laryngectomy with a plastic stent or metal cannula to maintain the patency of their tracheostome. After …