Aim: To assess the preference of the different modalities of post-laryngectomy speech rehabilitation in patients and review the outcome parameters of esophageal speech and tracheoesophageal puncture (TEP) prosthesis modalities in comparison with the corresponding existing data. Materials and methods: A longitudinal prospective study conducted over a period of 1 year in the Department of ENT and Head-Neck Surgery in a tertiary care hospital. Patients of advanced laryngeal malignancies that were planned for total laryngectomy were included in this surgery. Based on the patients’ choice different modalities were adopted and the patients were followed up with regular training. Maximum takers were for esophageal speech followed by TE puncture and prosthesis insertion, and the outcomes in these two modalities were evaluated in detail. Six outcome parameters were assessed for the patients and consolidated. Then they were compared with the corresponding values obtained from previous studies to arrive at the results. Results: A total of ten cases of total laryngectomy was studied during the period of study. It was found that greater patient preference was for the TEP prosthesis modality. The mean frequency of phonation, mean intensity for vowels, and word production per minute in the TEP prosthesis were almost 80% of that seen in the esophageal prosthesis group. The most significant difference was in mean maximum phonation time which was only 37% of that seen in the TEP prosthesis group. Conclusion: In the present scenario until more advanced modalities of post-laryngectomy speech rehabilitation become more easily accessible to and affordable for the economically weaker sections of the society, esophageal speech modality is a dependable alternative. Further with proper training and follow-up, results with esophageal prosthesis are promising.