Tracheoesophageal puncture (TEP) voice is a communication option after laryngectomy. It is made possible by creating a small surgical opening at the back of the trachea (windpipe) and into the esophagus (food pipe). This opening can be made at the time of the laryngectomy or anytime afterwards. A small prosthesis is placed in the tunnel-like opening. Voice is obtained by temporarily blocking the stoma and directing the flow of air from the lungs, through the prosthesis, and into the esophagus. This causes the tissue in the throat to vibrate and voice is produced. The prosthesis has a one-way valve that allows air flow but prevents food or liquid from entering the airway during swallowing. The speech-language pathologist teaches the patient how to use their new voice and how to care for the prosthesis. Fluent conversational speech may occur the day the prosthesis is inserted or within a few days of practice. The patient may also be introduce to hands-free voicing.