Some of these people have not fully understood the precise region of the vocalization. Once they aquire the utterance technique described in 1), they can utter much better voice with more clarity.
You can check the vocalization region easily; if you press the region with your finger, you can feel the region vibrate as you utter, or press the region hard when you utter, then you will notice the difficulty in utterance due to the prevention of the vibration.
Also a tight collared shirt, or tightly knotted tie would press the vocalization region and hinder utterance: this also proves the region of vocalization. This part is the very part which could be termed as the second vocal cord necessary for us laryngectomees to make esophageal speech.
It is effective and would lead to quick improvement in esophageal speech to practice utterance by pushing the air hard to the vocalizing region, not merely let the air go through the esophagus.
