Objective: To investigate (1) speech intelligibility and acceptability in using 4 different alaryngeal speech methods: esophageal (ES), electrolaryngeal (EL), pneumatic device (PD), and tracheosophageal (TE) speech; and (2) communication-related quality of life (QOL) in the alaryngeal speakers who used these 4 alaryngeal speech methods. Design: Survey. Participants: Alaryngeal speakers who had undergone speech rehabilitation and were recruited from the New Voice Club of Hong Kong. Main Outcome

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... easures: Speech samples collected from 49 alaryngeal speakers were rated by 6 judges for speech intelligibility and acceptability. The speakers also completed a communication-related QOL question-naire called the Communication Activity and Participation After Laryngectomy. Results: We found that the ES and EL speakers showed considerably poorer speech intelligibility and communication-related QOL. The PD speakers demonstrated notably better speech intelligibility and acceptability ratings. However, high intelligibility and acceptability do not necessarily mean better QOL. The TE speakers, who demonstrated only the second highest speech intelligibility and acceptability, showed the best functional QOL. Conclusion: In speech rehabilitation after laryngectomy, QOL and speech intelligibility and acceptability should be considered together to find a balance that is acceptable to the patient.