| Theme | Sub-topics | Observations |
| Changes of mindset | Pain | Inability to speak; loss of loved jobs; a cancer patient |
| Humiliation | Bad appearance; cough with sputum | |
| Helplessness | Feeling like a mute at the beginning; esophageal speech sounds like a robot; inability to argue but to swallow an insult | |
| Optimism | Taking initiative to try new things; face life with a positive attitude | |
| Showing positive attitudes and behaviors in training | Mutual support | Model and communicate in the sound lab; create a Wechat and QQ group |
| Voluntary training | Stick to the training plan themselves; under the guidance of trainers, patients practice esophageal speech in their preferred ways | |
| “Resocialization” | After successfully acquiring ES, patients return back to their jobs, gatherings, and other social activities | |
| Shift in social relations | Alienation | Inability to speak; friends encourage less talk for fear of fatigue; embarrassment about special treatment from friends |
| Social interaction limitations | Low volume of ES causes difficulty in arguing when irritated. Emotionless speech mistaken for rudeness or hostility | |
| Discrimination | Patients are called mutes and treated with less patience. Getting trash talk and unfair distance from other people | |
| New connections | Patients bind together to gather, travel, and socialize | |
| Arduous training process | Physical discomfort | Stomach flatulence and increased nasal mucus |
| Negative life events | Long commute; forced resignation; lonely life | |
| Various assisting methods | Applying various assisting methods for voice production to increase communication with speech | |
| Dissatisfaction | Feeling unsatisfied with ES training program |