Preference ratings of laryngectomized client's production of three types of alaryngeal speech—Tokyo pneumatic aid speech, Servox electro-larynx speech, and poor esophageal speech were composed. Judges rated the three methods from an audiovisual recording. Ratings were obtained for voice quality, loudness, intelligibility, rate, pitch, visual appearance and overall preference. Speech produced using the Tokyo aid was preferred by the majority of judges, although the visual appearance of the Tokyo usage was least preferred. The findings were interpreted to highlight the need to offer a range of communication alternatives to laryngectomized clients.