Total laryngectomy requires the patient to learn some form of alaryngeal speech for communication. Generally, esophageal speech is regarded as one of the most available technique of alaryngeal speech. But it is difficult to learn, so many patients are unable to master esophageal speech for communication. To understand the mechanism of esophageal speech in the total laryngectomee, evaluation of the anatomical change of the pharyngoesophageal segment is very important. We used videofluoroscopy, endoscopic videodocument and esophageal manometry to evaluate the pharyngoesophageal segment during esophageal speech in eighteen total laryngectomees. The result was as follows ; 1) The pseudoglottis was the most important factor for esophageal speech and it was visualized in 7 of 8 patients in the excellent speech group. 2) Two patients who had pseudoglottis with longer A-P diameter had the best quality of esophageal speech. 3) The causes of failure of esophageal speech were poor aerophagia, 6 cases, absence of the pseudoglottis, 4 cases, and poor air ejection, 3 cases. 4) Aerophagia was synchronized with diaphragmatic motion in the 8 cases of excellent esophageal speech.