Abstract
PurposeThe purpose of this study is to assess the general course of acoustic, patient rated, and clinician-rated voice outcomes from pre- up to 12 months post total laryngectomy.MethodsPatients admitted to a total laryngectomy in five participating hospitals in Australia and The Netherlands were included. Assessments took place at pre-, 3 months, 6 months, and 12 months post-surgery. Voice outcomes are evaluated with the Acoustic Voice Quality Index (AVQI), perceptual scales, and patient-reported outcome measures including VHI-10 and EQ-5D-5L. Statistical analyses include descriptive statistics, t tests (pre- to 6 months post-surgery), Linear Mixed Effect models.ResultsThe study included 43 participants. A significant worsening of AVQI is seen from pre- to post-surgery evaluated with t test (p < 0.001). The Linear Mixed Effect model confirmed Time as a significant factor in predicting AVQI score (p ≤ 0.001), as well as perceptual rated voice quality by the clinician (p = 0.015) and patient-reported perceptual rated voice quality (p = 0.002). No statistical significance was found in VHI-10 scores over time.ConclusionSuccessful TE-speech was achieved in most participants, some had to rely on augmentative alternative communication methods. Patient-reported outcomes indicate acceptance of the condition and sufficient coping in the long term. However, acoustic rated voice quality is abnormal at all post-surgery time-points. AVQI proved to be a useful instrument to evaluate TE-speech. There is a need for validation and determination of cut-off values for VHI-10 and AVQI for use in TE-speech.
Highlights
One of the most important rehabilitation goals after total laryngectomy is voice rehabilitation
We evaluated the effects of medical detail on voice outcome, and the number of participants of our study led to no significant results in medical history factors, this framework is useful for ongoing work
To develop a full picture of what speech-related Quality of Life (QoL) means for individuals before and after a total laryngectomy we suggest to perform studies with a combination of acoustic, patient-rated, and clinician-rated methods, to explore how speech-related QoL is related to these measures
Summary
One of the most important rehabilitation goals after total laryngectomy is voice rehabilitation. To compensate for the loss of voice, patients ideally rehabilitate speech with a voice prosthesis, so called Tracheo-Esophageal Speech (TE-speech) [1,2,3]. If this is not possible, alternative communication methods include esophageal speech, electrolarynx speech, or augmentative alternative communication. Successful TE-speech after laryngectomy is not guaranteed as outcomes in intelligibility, voice quality, and experienced. It is recommended to use multi-dimensional analysis which combines objective and subjective outcome measures [4]. Subjective measures, on the other hand, include clinician and patient-rated perceptual evaluation of voice and speech, and Patient-Reported Outcome Measures (PROMs) assessing Quality of Life (QoL) and speech-related QoL
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