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voice. The consequences of a laryngectomy negatively affect the patient\u2019s quality of life (Da Silva, Feliciano et al. 2015).\u000DThe voice may be restored with the use of several methods, whereby the voice is reproduced by a substitute vibration source. This can be achieved by oscillating the neoglottis (pharyngoesophageal segment) or with an electrical device (electrolarynx) held against the neck or cheek (De Vries, Van de Heyning et al. 2013, Ward and Van As 2014). An electrolarynx offers patients immediate restoration of the voice, as well as an easy way to speak. For speaker and listener, however, the electrolarynx is a less acceptable (voice) alternative due to the monotonous mechanical sound it produces (Ward and Van As 2014). A second method of voice rehabilitation is oesophageal speech. This allows for the oscillation of the \u2018voice source\u2019 without an artificial device by the injection and release of air from the oesophagus. By the quick release of air the pharyngoesophageal segment in the hypopharynx is oscillated, due to which (adapted) voicing becomes possible. Learning this adapted form of voicing is not easy, however. The success rate of acquiring oesophageal speech is low (Gates, Ryan et al. 1982, Hakeem, Hakeem et al. 2010) and intelligibility is worse than with tracheoesophageal speech (Doyle, Danhauer et al. 1988). The third method to restore the voice, considered to be the golden standard in the Netherlands, is tracheoesophageal speech. After a total laryngectomy, whereby a permanent tracheostoma is created for air supply, a voice prosthesis is placed by means of a tracheoesophageal puncture, allowing for phonation via the \u2018normal\u2019 pulmonary airflow (Starmer, Tippett et al. 2008). By closing the tracheostoma the airflow from the lungs can pass into the oesophagus via the prosthesis, upon which the air causes the pharyngoesophageal mucosa to vibrate: the neoglottis. These vibrations form the new voice source. Possible procedures include a primary puncture, where the voice prosthesis is placed during the laryngectomy, or a secondary puncture, where the prosthesis is placed after wound healing. Voice restoration appears to be most successful after primary puncture (Guttman, Mizrachi et al. 2013). With primary puncture, success rates of up to 95% are reported (Op de Coul, Hilgers et al. 2000, Guttman, Mizrachi et al. 2013). With oesophageal and TE speech, voice quality depends on the muscle tension of the neoglottis. This in turn largely depends on the techniques applied by the surgeon. Because of this, there are significant differences in voice quality among laryngectomees, which impacts their quality of life accordingly (Farrand and Endacott 2010). For women this new voicing method brings about an additional handicap. The new oscillations produces a voice that, in terms of pitch and timbre, is more like a man\u2019s than a woman\u2019s voice (Cox, Theurer et al. 2015).\u000DVoice training after total laryngectomy with primary placement of the voice prosthesis starts after wound healing (Guttman, Mizrachi et al. 2013, Van der Molen, Kornman et al. 2013). Therapy after a laryngectomy is primarily aimed at the coordination of respiration and proper stoma closure, in order for the speech to sound more natural. The speech therapy treatment focuses on coordination of respiratory muscles, air pressure and voicing, improving prosody, voice range, onset time, voiced- unvoiced differences and the appropriate amount of muscle tension (Samlan and Webster 2002, Starmer, Tippett et al. 2008).\u000D5.3.2.4 Efficacy of voice therapy\u000DA wide range of studies are available on the efficacy of voice therapy with various non-cancer-related voice problems. Evidence-based studies assessing the usefulness and the timing of voice therapy for different tumour and treatment groups are scarce (Lazarus 2009), despite the fact that the positive impact of rehabilitative and preventive voice therapy in combination with radiotherapy was shown early on (Fex and Henriksson 1969, Lehman, Bless et al. 1988).\u000D110\u000D