To establish a vocal rehabilitation program following total laryngectomy, we evaluated the vocal restoration status of 59 laryngectomized patients who had been operated on in our hospb al from 1976 to 1987. Of the 25 patients who had practiced esophageal speech, 15 were able to speak fluently in about one year, but 10 patients failed to acquire esophageal speech. Of the 11 patients who used a voice prosthesis, 10 achieved good speech. Although esophageal speech is difficult to acquire, it is recognized to be the best way to speak after total laryngectomy. It is easy to speak with the voice prosthesis, which can be used by patients who fail to acquire esophageal speech. On the basis of these results, we propose a vocal rehabilitation program in which esophageal speech and voice prosthesis are the core. © 1989, The Society of Practical Otolaryngology. All rights reserved.