Exploring laughter and identity after laryngectomy  

How much do we value laughter in our lives? Danielle Holbrook, Highly Specialist SLT working in head and neck cancer at Bristol Foundation Trust, explores the lived experience of audible difference after laryngectomy, with a particular interest in laughter, identity and social connection. 

 

As a Highly Specialist SLT working in head and neck cancer, I love my job. Balancing a busy clinical role with family life has often left little space to think about career development, but with my children now at school and a recent move to the countryside, I found myself ready for a new challenge. Although increasing my clinical hours wasn’t an option, I began exploring the possibility of a clinical academic career. The NIHR Health and Care Professional Internship Programme, offered through my trust, provided the perfect opportunity. I was delighted to secure a place and wanted to share my experience in the hope of encouraging other SLTs to take the first step into research. 

 

Developing a research idea 

Anyone who knows me will know that I love to laugh. After attending a Seed talk in Bristol by Professor Sophie Scott (University College London), which explored the neuroscience and physiological benefits of laughter, an idea began to take shape. This led me to think about people with laryngectomy and their experiences of laughter after the removal of their voice box.

We know that laughter plays a vital role socially – helping us connect, share moments, and experience belonging.

There is also evidence that laughter supports autonomic regulation and stress reduction (Zander-Schellenberg, 2020), as well as social bonding (Bänninger-Huber and Salvenauer, 2022).  However, people who undergo laryngectomy experience permanent changes to breathing, voice production, and the acoustic expression of laughter. This raises several questions: 

• How is laughter experienced after laryngectomy? 

• Are the physiological benefits of laughter the same?
  
  
• What are the psychosocial consequences when laughter is no longer heard in the same way? 

As part of my internship, I carried out a literature search to find out the answers to these questions and realised there was a gap in the evidence. This became the focus of my research interest.

I knew from the NIHR internship programme that early engagement with people and communities was essential to ensure that my future research was a priority for people with laryngectomy, not just my interest.

I used a portion of my internship fund to pay for one group session with both people with laryngectomy, and family members. There were also two individual discussions with people with laryngectomy as part of my early working with people and communities (previously known as patient and public involvement) work.  

 

 

How did people feel about losing their laughter? 

Twelve participants took part in the research: nine people with laryngectomy and three family members. Participants had undergone laryngectomy an average of eight years previously (range 3.5–14 years); seven were female and five were male. 

People with laryngectomy, consistently described laughter as physically altered, often silent, chest-based, or expressed primarily through facial cues rather than audible vocalisation. While the internal experience of humour remained, reduced audibility could create social ambiguity. Others may not realise that people with laryngectomy are sharing humour, which can affect inclusion.

One person reflected: “Oh my god… I just wish I had it back. I loved to laugh. People just don’t get me now. They think I’m having some kind of coughing episode. Even my friends don’t understand it. If there’s a few of us, I’m just not brought into the joke. I feel like I’m on the outside.”

People with laryngectomy described laughter as quieter and less physically expressive, often relying on facial expressions rather than audible sounds. Over time, friends and family often adapt, while peer-support groups provide important spaces for shared understanding and connection.

Group members also described an impact on identity and social roles, particularly for those who had previously identified as humorous or expressive:  “I was a very happy, jokey, bubbly person before. I’ve only got 10% of it now… If I am making a joke, before everyone would laugh. Now, people don’t understand what I am saying to make it funny.”

 

Changes in laughter also affected identity and self-expression, particularly for those who previously saw themselves as humorous or outgoing. At the same time, people told me that humour remained an important coping strategy during recovery. They emphasised the relational nature of laughter, highlighting the role of family and friends in adapting to new forms of non-verbal communication: “You definitely feel different at first but when your friends get used to you, that’s when you feel part of it again.” 

 

What do we need to consider?

Changes in audible expression sat within a broader concept of ‘audible difference’ as a body image issue. After laryngectomy, differences in voice and sound production could shape how people are perceived, how easily they are understood, and how they access social and healthcare interactions. The psychosocial impact of visible difference has been widely explored in the literature, whereas comparatively little attention has been given to audible differences. Furthermore, people with communication impairments may be underrepresented in research, often due to barriers to access and participation. Preferences for research methods included one-to-one interviews, physiological monitoring (e.g. heart rate), questionnaires, and the use of humour stimuli such as short comedy clips. 

This work highlighted a need to consider how environments, including healthcare systems, could better support people with audible differences. This may involve adapting systems, communication approaches and increasing awareness, so that differences in sound are not mistaken for absence of expression or engagement.  

 

What I learned 

This internship brought together my clinical experience, undergraduate background in biomedical science (physiology), and interest in working with people who have undergone laryngectomy. Finding a research topic that truly resonated with me changed how I experienced research. What had once felt like an obligation became a source of motivation, creativity, and genuine enjoyment.

The work also directly informed the design of a mixed-methods study, highlighting the value of in-depth individual interviews, accessible participation, and considering both physiological and psychosocial outcomes.

I have since secured a Research Capability Fund grant to continue this work.  

For those interested in getting involved in research, I would recommend exploring opportunities through the National Institute for Health and Care Research (NIHR) and  find any external opportunities and what projects or initiatives are already underway, and whether your organisation has established research links or partnerships. It is helpful to think early about how you might secure clinical backfill to protect time for research activity, and to have open conversations with your manager about the value of this work to ensure their support. 

 

Are you an SLT looking for opportunities to explore an idea?

You can find out about these through our RCSLT webpages, signing up to our Research newsletter or becoming an RCSLT Research Champion.  

RCSLT also offers CPD grants of up to £800 for applicants seeking to benefit the profession of speech and language therapy and to enhance their own professional development. Grants can be offered for attending conferences, short courses, conducting research, or purchasing specialist resources. Make sure you apply by the 5 October for your chance to receive a grant. 

Apply for a RCSLT grant today.