- Everything from the epiglottis to the glottis is removed (larynx) - Breathe through the stoma (permanent opening in the neck) with no connection to the mouth - Air is no longer filtered, heated or moisturized - Mucus is expelled through stoma - Sound is generated by a sound source (AL, TEP, esophageal speech) - Not able to aspirate due to the disconnection between the aerodigestive track separation