Changing Trends of Speech Outcomes after Total Laryngectomy in the 21st Century

Abstract

Objectives: Management of laryngeal cancer has changed significantly in the past decade. Total laryngectomy (TL) has been mainly reserved for patients with recurrence or failure after chemo-radiation or patients requiring major ablative and reconstructive surgeries. Tracheoesophageal puncture (TEP) continues to be the gold standard for speech rehabilitation, yet it is unknown what the overall speech outcomes are for individuals undergoing TL in the 21st century. Our study will describe the speech rehabilitation outcomes of patients after TL in the 21st century. Methods: This is a retrospective analysis of 391 patients who underwent TL from June 2000 to February 2012 with a minimum of one year follow-up. Demographic variables and medical/surgical factors related to laryngectomy will be reviewed. Patient speech rehabilitation outcomes will be assessed and categorized into the following groups: 1) use of esophageal speech; 2) use of electrolarynx; 3) use of TEP; 4) failure to achieve functional speech; and 5) non-compliant. To be in groups 1, 2, or 3, patients must use speech as the dominant mode of communication. Results: Patients who underwent TL in the 21st century may have overall decreased success rate in speech rehabilitation; there may be decreased success rate in the use of esophageal speech and TEP. Conclusions: The current gold standard for speech rehabilitation should be readdressed, as it may not adequately meet the need of the current patient populations. More up-to-date techniques and technologies are needed to improve the communication and speech rehabilitation of current laryngectomy patients.