Total laryngectomee requires some form of alaryngeal speech for communication. Generally esophageal speech is regarded as the most available and comfortable technique for alaryngeal speech.But esophageal speech is difficult to train so many patients ar unable to attain esophageal speech for communication. To understand mechanism of esophageal speech on total laryngectomee evaluation of anatomical change of the pharyngoesophageal segment is very important. We used videofluoroscopy for evaluation of pharyngesophageal segment during esophageal speech. Eigh-teen total laryngectomees were evaluated with videofluoroscopy from Dec. 1986 to May 1987 at Y.U.M.C Our results were as follows: 1. Peseudoglottis is the most important factor for esophageal speech which is visualized in 7 cases among 8 cases of excellent esophageal speech group. 2. Two cases of longer A-P diameter at the pseudoglottis have the best quality of esophageal speech than others.3. Two cases of mucosal vibration at the pharyngoesophageal segment can make excellent esophageal speech. 4. The causes of failed esophageal speech are poor aerophagia in 6 cases abscence of pseudoglottis in 4 cases and poor air ejection in 3 cases. 5. Aerophagia synchronizes with diaphragmatic motion 8 cases of excellent esophageal speech.