Restoring speech in patients requiring total laryngectomy is very important for their psychological and social lives. And various procedures during or after total laryngectomy were developed for speech rehabilitation. These techniques unfortunately have been focused largely on voice production and the patients were frequently plagued with complications, especially aspiration. The author has recently experienced 37 cases of Amatsu's tracheoesophageal shunt operation at the time of total laryngectomy and tried to evaluate the results in view of speech, aspiration and role of radiotherapy. 1) The total success rate of voice production using tracheoesophageal shunt was 62.2%. Among the 16 cases which did not receive radiotherapy or received it preoperatively, 15 cases(93.7%) had successful voice production. Of 21 cases who received radiotherapy postoperatively, 19 cases(90.5%) could communicate primarily with voice before radiotherapy but only 8 cases(38.1%) could continue successful communication with voice using tracheoesophageal shunt after completion of radiotherapy. 2) Aspiration was noted in four of 37 cases(10.8%) and three cases were tolerable because the degree of aspiration was minimal in one case, however, it was necessary to close the fistula for control so intractable aspiration. 3) The results of acoustic parameters in case of speech grade I & II were as follows : fundamental frequency was significantly higher than normal laryngeal speaker ; sound intensity, maximum phonation time of tracheoesophageal shunt speaker, was nearly the same as that of a normal speaker ; and the number of counting/breath, syllables/breath, words/breath, and speech intelligibility of shunt speakers was lowerer than that of a normal speaker. In conclusion, voice production using the Amatsu tracheoesophageal shunt has some inconvenience because the patients have to occlude tracheostoma with their finger during phonation. But the Amatsu tracheoesophageal shunt can produce nealy normal phasing without interruption and louder voice than. The Amstsu tracheoesophageal shunt operation has the additional merit of high success rate and ease of operation. So, it can be considered that the Amatsu tracheoesophageal shunt operation is a very useful method for speech rehabilitation after total laryngectomy.