Total laryngectomy often results in significant postoperative complications, including loss of voice. To enhance the patient’s quality of life, it is crucial to address speech and voice rehabilitation as soon as possible. Three primary techniques have been developed for voice rehabilitation: (1) esophageal speech, (2) speaking valves, and (3) electrolarynx. Esophageal speech often results in a weak voice due to the limited capacity of the stomach and esophagus (60–80 mL), and the electrolarynx produces a mechanical sounding voice, which most patients find undesirable. Conversely, speaking valves are used to maintain an artificially created tracheoesophageal puncture (TEP). These valves prevent esophageal contents from entering the trachea, while allowing lung air to pass through the esophagus, producing a sufficiently loud voice. The large capacity of the lungs results in a much louder voice than that produced by esophageal speech. Valve implantation can be done either during total laryngectomy or several months later. The need for postoperative irradiation is not a contradiction for primary implantation. However, speaking valves are not without complications, and patients must take care of them to prevent TEP failure or local infections. Gastroesophageal reflux is the most common factor predisposing to local complications. Unfortunately, in some cases, the TEP must be closed due to persistent failure.