Speech Determines Quality of Life Following Total Laryngectomy: The Emperors New Voice?

Abstract

>Total laryngectomy, performed for advanced laryngeal carcinoma, results in loss of the vocal chords and a permanent >neck stoma. To help restore speech various voice restoration methods – > tracheoesophageal speech (TEP), > electrolarynx and > esophageal speech – are commonly employed. Whilst different methods exist however, TEP produces the best voice quality, is assumed to maximize patient quality of life and unsurprisingly is most commonly adopted by medical and health professionals. Although voice quality is clearly of importance however, each method is associated with varied costs and benefits that impact upon other areas related to quality of life in total laryngectomy patients. Following a discussion concerning the etiology, epidemiology and treatment for laryngeal carcinoma, this chapter reviews the literature related to health-related quality of life amongst total laryngectomy patients employing different voice restoration methods. It argues that, although important, voice quality alone does not determine quality of life following total laryngectomy. Consideration should therefore be given to the impact that each voice restoration method has upon all areas of quality of life, rather than focus upon voice quality alone. Implications of these conclusions for clinical practice are discussed at the end of the chapter. List of Abbreviations: HNQOLQ, University of Michigan head and neck quality of life questionnaire; > SF-36, health specific quality of life measure; TEP, tracheoesphageal speech