Most laryngectomies are performed for neoplastic disease. Recently, the authors have managed four patients with chronic aspiration who ultimately required laryngectomy to control leakage of food and saliva into the tracheobronchial tree. Various surgical procedures have been devised to conserve the larynx and protect the lower airway. Although potentially reversible, these procedures are fraught with complications, and the patients seldom recover sufficiently to justify repair of the larynx. The authors feel that those patients with poor prognoses, associated medical problems, and evidence of impaired wound healing should undergo laryngectomy. This approach removes doubt about the cause of the aspiration and spares the patients additional surgical procedures should a more conservative approach fail.