Abstract
Total laryngectomy still plays an essential part in the treatment of laryngeal cancer and loss of voice is the most feared consequence of the surgery. Commonly used rehabilitation methods include esophageal voice, electrolarynx, and implantation of voice prosthesis. In this paper we focus on a new perspective of vocal rehabilitation utilizing alternative and augmentative communication (AAC) methods. 61 consecutive patients treated by means of total laryngectomy with or w/o voice prosthesis implantation were included in the study. All were offered voice banking and personalized speech synthesis (PSS). They had to voluntarily express their willingness to participate and to prove the ability to use modern electronic communication devices. Of 30 patients fulfilling the study criteria, only 18 completed voice recording sufficient for voice reconstruction and synthesis. Eventually, only 7 patients started to use this AAC technology during the early postoperative period. The frequency and total usage time of the device gradually decreased. Currently, only 6 patients are active users of the technology. The influence of communication with the surrounding world on the quality of life of patients after total laryngectomy is unquestionable. The possibility of using the spoken word with the patient's personalized voice is an indisputable advantage. Such a form of voice rehabilitation should be offered to all patients who are deemed eligible.
Highlights
With an estimated incidence of over 135,000 patients worldwide, squamous cell carcinoma of the larynx accounts for about 2-4.5% of all malignancies[1,2,3]
All were scheduled for total laryngectomy for T3-T4a laryngeal or hypopharyngeal cancer with uni or bilateral neck dissection according to the regional lymph node involvement
The frequency and time of use of the technology further decreased after the implanted voice prosthesis became fully functional (11 of 18 patients with personalized speech synthesis (PSS))
Summary
With an estimated incidence of over 135,000 patients worldwide, squamous cell carcinoma of the larynx accounts for about 2-4.5% of all malignancies[1,2,3]. Non-surgical treatment modalities, endoscopic surgery and partial laryngeal procedures from the external approach are aimed at maintaining the most important functions of the larynx, i.e. swallowing control, respiratory protection and the highest possible quality of voice. Laryngeal carcinoma is not the only pathology that threatens people with loss of voice. Recent review article by Creer et al provided a full and surprisingly rich list of pathologies related to voice deterioration or its loss[5]. Unlike, for example, patients with motor neuron degeneration, the physiological form of the (though altered) voice can be preserved and even for a part of the population the eventual loss of the voice is preventable (smoking cessation, alcohol avoidance)
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