Forty laryngectomy patients in Iowa have received a tracheoesophageal fistula and voice button prosthesis. The fistula was successfully completed in all patients using local anesthesia. Delayed insertion of the voice prosthesis, approximately a month after the fistula is created, appears to be helpful in establishing the respiratory muscle control needed to achieve tracheoesophageal speech. In addition, delayed insertion allows for longer fistula maturation, recognition by the patient that speech is formed by vibrations within the pharyngoesophageal segment, and improved ability to manage the fistula site by proper insertion of the stent. The tracheoesophageal fistula-voice button prosthesis technique has proved to be a relatively simple, uncomplicated, reproducible and inexpensive method of achieving effective speech in a majority of laryngectomy patients.