Assessing vocal function after chemoradiation for advanced laryngeal carcinoma.

Abstract

To identify objective parameters that could serve as valid indicators of vocal function in evaluating patients treated at multiple centers for head and neck cancer. Objective measures of voice were validated against functional outcome measures of voice and communication. A multidisciplinary university-based ambulatory head and neck cancer clinic. Fifteen patients at varying posttreatment intervals after chemoradiation therapy for head and neck cancer and 5 volunteers with no cancer but with a history of heavy smoking and drinking. Acoustic and aerodynamic parameters were measured in patients with head and neck cancer after treatment with combined chemotherapy and irradiation and in control subjects. Communicative function was assessed by perceptual assessment of recorded voice samples, by a clinician-based communication score, and by patient self-rating of voice and communication. Both perceptual analysis and communication score were concordant with patient self-rating of voice and communication ability. Acoustic measures were abnormal in patients, and jitter scores correlated with listener ratings of perceived voice quality. However, acoustic measures did not relate to communication function, as assessed by either the patient or the clinician. Laryngeal resistance demonstrated a significant correlation with both patient and observer assessments of voice quality and communication function. Laryngeal resistance was on average twice as high in patients who complained of voice fatigue, but this difference was not statistically significant. Laryngeal resistance, determined during standardized phonation, is a reliable objective parameter of vocal function after chemoradiation therapy for head and neck cancer. A standardized clinician-based communication scale holds promise as a useful tool. Acoustic measures reflect the sound of the voice but not the ability to communicate effectively.