Mean Voice Handicap Index Score Research Articles

Evaluation of voice handicap and emotional status among dysphonic and non-dysphonic individuals: A cross-sectional survey

Background: Dysphonia impairs verbal communication of the sufferer, which can lead to social isolation, depression, and reduced quality of life. Evaluation of voice handicap and emotional impact of dysphonia are not routinely consider in our laryngology and voice clinics, despite the fact that about 50% to 60% of patients with dysphonia have social and psychological problems. Aims: The aim of this study is to investigate the voice handicap and emotional status among dysphonic and non-dysphonic individuals in our environment. Materials and Methods: It was a cross-sectional study that included dysphonic patients and non-dysphonic individuals matched for age and gender. A detailed clinical history was obtained, and the Voice Handicap Index (VHI) questionnaire was used to assess the voice handicap and emotional status of the participants. The mean VHI score of dysphonic and non-dysphonic participants was compared. Results: Ninety dysphonic patients and equal number of non-dysphonic controls completed the study. The mean VHI score dysphonic patients was higher (46.8 ± 17.7) than that of the controls (5.2 ± 3.9), and there was a statistical significant difference between the two groups (P = 0.000). Most of the dysphonic patients 69(77.8%) had poor emotional status, while most of the controls had good emotional status 83(92.3%). Conclusion: This study found high Voice Handicap Index and poor emotional status among dysphonic patients compared to controls. Therefore, patients with dysphonia should be reviewed by a psychologist in order to address the emotional aspect of their problem.

Application of Voice Handicap Index score and flexible laryngoscopy in the evaluation of patients with laryngeal disorders

Background: Laryngeal disorders are common in our environment, and a number of studies have been carried out. However, there is a paucity of literature with regard to the evaluation of voice-related handicap, and Voice Handicap Index (VHI) score for specific laryngeal disorders. Aim: The aim of this study was to apply the VHI score and flexible laryngoscopy in the evaluation of patients with laryngeal disorders and to determine the mean VHI score for specific laryngeal disorders in our environment. Methodology: A cross-sectional study was conducted among patients with the clinical diagnosis of laryngeal disorder who presented at the otolaryngology clinic of our institution. Patients who had previous laryngeal surgery or tracheostomy were excluded. Data was collected on sociodemographic variables, clinical history, and flexible laryngoscopic findings. The VHI score, which comprised of functional, physical, and emotional subscales was also collected and analyzed. Results: A total of 90 patients completed the study; 56.7% of them were males, whereas 43.3% were females. The mean VHI was highest in patients with laryngeal tumor (68.8 ± 14.8) followed by patients with vocal cord palsy (58.2 ± 5.7), but it was lowest in patients with acute laryngitis (27.1 ± 5.3). There was a statistically significant difference in mean VHI for each laryngeal disorder (P = 0.000). Conclusion: The patients with laryngeal tumor and those with vocal cord palsy had the highest VHI score, which affected their functional and emotional well-being. Therefore, applying VHI score and flexible laryngoscopy is important in the holistic evaluation of patients with laryngeal disorders.

Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes.

There is a debate regarding the durability of fat implants. Our experience and recent publications suggest fat implantation may deliver a long-lasting improvement. This study aims to present the long-term outcomes for vocal fold fat augmentation using strict harvesting, preparing, and implantation protocols. A prospective cohort conducted between 2014 and 2020 (recruitment 2014-2017). An academic tertiary referral center. Twenty-two patients with glottic insufficiency were enrolled: 11 had unilateral vocal fold paralysis (UVFP), and 11 had atrophy or scar. Harvested fat was injected unilaterally or bilaterally into multiple sites. Six of these patients also had simultaneous microlaryngoscopic removal of other benign glottic lesions. Outcome measurements included video stroboscopy; Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) score; Voice Handicap Index (VHI); and acoustic analysis, performed preoperatively, 3, 12, 24, and 36 months after surgery. Ten augmentations were unilateral and 12 bilateral. Comparing the preoperative and 36-month postoperative periods, the mean VHI score improved from 73.45 (±22.78) to 44.88 (±28.93), P = .001, and the mean GRBAS decreased from 8.64 (±3.89) to 2.82 (±2.3), P = .001; 24 months postoperatively, the mean fundamental frequency decreased from 163.88 Hz (±41.61) to 150.44 Hz (±41.47), P = .012. Stroboscopic analysis revealed statistically significant improvement in mucosal wave propagation, phase closure, and phase symmetry. Best results were achieved in the UVFP subgroup. Computed tomography scans demonstrated long-term viability of the implanted adipose tissue. Fat is an excellent source of autologous graft. With careful patient selection and proper surgical technique, fat is suitable for long-term correction of glottic insufficiency. Fat augmentation should be considered as a long-lasting or even permanent solution, rather than temporary.

Subjective and Objective Assessment of Effect of Allergic Rhinitis on Voice in Indian Patients.

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR.

Changes in Voice After Septoplasty: A Pilot Study.

The aim of this study was to evaluate changes in voice after septoplasty in adults using the Dr.Speech assessment module in conjunction with subjective evaluation using Voice Handicap Index (VHI). A total of 50 consecutive patients with symptomatic Deviated Nasal Septum (DNS) undergoing septoplasty were included in the study. Patients fit for surgery underwent septoplasty by standard technique. Voice assessment was done by subjective voice evaluation and Acoustic voice analysis preoperatively, 1week after surgery and 1month after surgery. Mean values of both males and females for Fundamental frequency (F0) were within the normal range at all the three times of assessment. No- significant differences were obtained at all the three times of assessment in males and females respectively. Significant results were obtained while comparing the preoperative and postoperative SNR dB values. Mean VHI score at preoperative, 1week postoperative and 1month postoperative was 23.2, 22 and 21.5 respectively. No statistical difference was obtained while comparing the mean VHI score at different time intervals. The scores between 0 and 30 are in the mild category, i.e. minimal amount of handicap. The scores of all the patients were less than 30 at all times of assessment.To conclude, post-operative changes in the voice parameters were minimal and not significant, they were indicative of greater acoustical quality of voice and lesser nasalized speech, thus reflecting the positive outcome of surgery.

Potential Risk Factors and Prevalence of Voice Symptoms in Students Starting Their Teacher Education

The aim of the present study was to determine prevalence of voice problems and potential risk factors in teacher students at the start of their education. A total of 1494 students from seven teacher education schools participated in the study. The students answered a questionnaire about 11 risk factors, and one with six questions about voice symptoms, Screen6, and 30 statements in the Voice Handicap Index (VHI). Students reporting at least 2 weekly voice symptoms in Screen6 were assigned to the group with voice problems. Significance level was P < 0.05. Results: prevalence of risk factors was about the same in the seven groups of teacher students except the group with highest proportion of women that also showed the highest proportion of voice problems, 38%. Prevalence of voice problems in the total group was 17%. Comparison of students with or without voice problems showed that all factors except one were more prevalent among students with voice problems and women were overrepresented. Mean total VHI score was 22 in students with voice problems and eight in students without voice problems. Multiple regression analyses showed that frequent throat infections, hearing problems, previous speech therapy, or voice training were the potential risk factors that had the strongest association with voice symptoms as well as with total score in VHI. Conclusions: results from this study show that it is common that teacher students experience voice problems already at the start of their education and potential risk factors associated with voice problems are identified. Knowing that teaching is a high-risk profession for developing voice disorders, it is crucial that teacher students should receive compulsory preprofessional voice education including voice ergonomics and voice training.

Effect of septoplasty on quality of voice

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Septoplasty is one the most commonly performed surgery in ENT. The aim of this study was to evaluate change in voice after septoplasty using voice handicap index (VHI).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The current study was conducted at Department of ENT, SMGS Hospital, Government Medical College, Jammu, from October 2017 to November 2018. The study population was the patients who had come to the department with deviated nasal septum admitted for septoplasty. Voice assessment was done by Subjective Voice evaluation using VHI. It was done at three times i.e. preoperatively, postoperatively at 1 week and then postoperatively at 1 month. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 50 cases operated, 84% patients of present study were in the age group of 18-30 years. The mean age was 25 years. The eldest patient in our study was 55 years old. 40 patients were males and 10 were females with male: female ratio of 4:1. Mean VHI score at preoperative, postoperative 1 week and postoperative 1 month were 23.2, 22 and 21.5 respectively. No statistical difference was obtained while comparing the mean VHI score at different time intervals. The scores between 0-30 are in the mild category i.e. minimal amount of handicap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; According to our experience a widened nasal cavity has no effect on voice quality and procedures about nasal obstruction like septoplasty can be performed safely. However, professional voice users, in particular, should be informed about the possible minor postoperative changes, before the septoplasty procedure. &lt;/p&gt;

Influence Disease Activity on Voice and Laryngeal Findings of Rheumatoid Arthritis Patients

To reveal and to compare the voice pathologies and the detectable laryngeal findings in different phases of rheumatoid arthritis (RA). Prospective clinical study. Sixty-seven consecutive patients with RA, followed up at our Physical Therapy and Rehabilitation Clinic, were included in the study. Disease activity indices of patients were calculated with Disease Activity Score-28 Index. With Voice Handicap Index (VHI), patients answered 30 questions of functional, physical, and emotional aspects. Videolaryngostroboscopy was performed by the same physician for all patients with a 70° rigid telescope (Karl Storz, Tuttlingen, Germany), and then acoustic voice analysis (PRAAT program) was performed. Reflux Finding Score was used in evaluating the laryngopharyngeal reflux. Posterior comissure hypertrophy (25.3%) and hyperemia/edema in arytenoid mucosa (22.3%) were detected as the most frequent findings. Other common findings were thick endolaryngeal mucus, vocal cord varices. Twenty-two patients had reflux findings (32.8%). Fundamental frequency, shimmer, maximum phonation time and VHI value were not significantly different between active and remission phases of the disease (P > 0.05). In remission phase, the jitter value and the noise to harmonic ratio value were significantly higher (P < 0.05) than active phase of the disease (P < 0.05). Abnormal laryngeal findings are higher in active phase (28% in remission phase, 54% in active phase). The mean VHI score of patients in remission phase was lower than that in active phase. RA should be included in the differential diagnosis of patients with voice disorders. Nonspecific pathologies are more prevalent in the picture. There are more objective findings and subjective complaints of patients in active phase of the disease than in the remission phase.

Patient characteristics and intervention effect as measured by Voice Handicap Index

Objective: To analyze patients with a confirmed voice disorder in order to identify patterns regarding age, gender, and occupation compared to the general public. To explore effects of voice therapy according to the Voice Handicap Index (VHI) score pre- and post-therapy in relation to the number of sessions, age, and gender.Design: Prospective cohort study.Materials and methods: This study was conducted as a collaborative project between Linköping University and hospitals in the south-east health care region in Sweden. Six voice clinics participated by asking their patients voluntarily to complete the Swedish version of the VHI at the beginning and end of therapy.Results and conclusions: The two most prevalent diagnoses were dysphonia (43%) and phonasthenia (25%). Among the working population, the three most common occupational fields were education, health care, and child-care. The majority of the patients were women (74.3%), and the mean age of all patients was 55 years. A significant improvement in VHI scores was found after therapy, with an average decrease of 19 median points in total score and a substantial effect size (0.55). The number of sessions did not significantly correlate with the mean VHI score difference but had a weak correlation to the start and end scores. Increasing age correlated with a higher median VHI score both at the start and end of therapy but did not affect the average decrease between the two measurements.

Functional Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma.

Transoral laser microsurgery (TLM) has been increasingly used in lieu of total laryngectomy to treat malignancy after definitive radiation. There are few data in the literature regarding functional outcomes. We retrospectively reviewed voice and swallowing outcomes in patients who underwent TLM for recurrent laryngeal carcinoma. Case series with chart review. Tertiary care center. Forty-two patients were identified with recurrent squamous cell carcinoma of the larynx after definitive radiation therapy from 2001 to 2013: 28 patients with glottic recurrence and 14 with supraglottic recurrence. Swallowing outcomes were evaluated by gastrostomy tube dependence, the MD Anderson Dysphagia Inventory, and the Functional Oral Intake Scale. Voice outcomes were evaluated by the Voice Handicap Index and observer-rated perceptual analysis. No significant difference was noted between mean pre- and postoperative MD Anderson Dysphagia Inventory scores: 78.25 and 74.9, respectively (P = .118, t = 1.6955). Mean Functional Oral Intake Scale scores after TLM for supraglottic and glottic recurrences were 6.4 and 6.6, respectively. Of 42 patients, 17 (40.5%) required a gastrostomy tube either during radiation or in conjunction with the salvage procedure. Of 17 patients, 15 resumed sufficient oral diet for tube removal. Patients' mean Voice Handicap Index score did increase from 34.3 to 51.5 (P = .047), and their mean perceptual score did decrease from 60.0 to 45.3 (P = .005). However, at 1-year follow-up, there was no significant difference in perceptual score: 61.1 to 57.1 (P = .722). TLM is a successful surgical option for recurrent laryngeal cancer with acceptable functional outcomes.

Injection laryngoplasty outcomes in vocal fold paralysis using calcium hydroxylapatite

This study aims to evaluate our injection laryngoplasty experience in patients with unilateral vocal fold paralysis. Sixty-eight patients (32 males, 36 females; mean age 59.5 years; range 27 to 86 years) who were diagnosed with unilateral vocal fold paralysis at our clinic and who underwent injection laryngoplasty using calcium hydroxylapatite between January 2005 and June 2012 were included in this study. Mean follow-up period was 36 weeks (range 0-340.4 weeks). Data of 29 patients with post-injection Voice Handicap Index (VHI) scores were retrospectively analyzed. Of these patients, 16 (55%) were female, and the mean patient age was 60 (range 27 to 86 years). Seventeen patients underwent suspension laryngoscopy in the operating room, 12 patients underwent in-office percutaneous injection. Post-injection mean VHI score was 36.7 (range 4 to 87). Percutaneous injection laryngoplasty was performed to half of the 20 patients with pre- and post-injection VHI data. Mean VHI scores of these 20 patients improved by 27.9 points. Mean VHI score improved by 35.1 points in the percutaneous group, and by 20.7 points in the suspension group (p=0.29). Post-injection VHI score of one patient with lung cancer decreased, as his general health deteriorated. This study supports injection laryngoplasty in vocal fold paralysis. Calcium hydroxylapatite is a safe and effective treatment method in both percutaneous and operating room procedures.

Comparison of Acoustic and Stroboscopic Findings and Voice Handicap Index between Allergic Rhinitis Patients and Controls

In our experience Allergic Rhinitis (AR) patients suffer from voice problems more than health subjects. To investigate the acoustic analysis of voice, stroscopic findings of larynx and Voice Handicap Index scores in allergic rhinitis patients compared with healthy controls. Case-control study. Thirty adult patients diagnosed with perennial allergic rhinitis were compared with 30 age- and sex-matched healthy controls without allergy. All assessments were performed in the speech physiology laboratory and the testing sequence was as follows: 1. Voice Handicap Index (VHI) questionnaire, 2. Laryngovideostroboscopy, 3. Acoustic analyses. No difference was observed between the allergic rhinitis and control groups regarding mean Maximum Phonation Time (MPT) values, Fo values, and stroboscopic assessment (p>0.05). On the other hand, mean VHI score (p=0.001) and s/z ratio (p=0.011) were significantly higher in the allergic rhinitis group than in controls. Our findings suggest that the presence of allergies could have effects on laryngeal dysfunction and voice-related quality of life.

Evaluation of Subjective Voice Changes in Seasonal Allergic Rhinitis

Objectives: Voice is a person’s main communication tool and affected by many factors, including the upper respiratory tract. The upper respiratory tract influences mainly resonation, and the nose is one of the key points. Seasonal allergic rhinitis may affect voice quality via changing resonation. This study aims to evaluate the possible changes on voice caused by seasonal allergic rhinitis subjectively. Methods: Between October 15, 2013, and January 15, 2014, 28 patients who applied to our out-patient clinic and diagnosed with seasonal allergic rhinitis were included in the study. Mean age of the patients was 28.4 and all were female. Patients were asked to complete voice handicap index 30. Control group was composed of 30 female patients who did not have seasonal allergic rhinitis. Values were analyzed in statistically nonpaired samples using Student t test. Results: The mean voice handicap index score was 16.4 in the study group and 5.5 in the control group. There was a statistically significant difference between the 2 groups ( P &lt; .05). Conclusions: Seasonal allergic rhinitis has an adverse affect on vocal quality, subjectively.

A Meta‐analysis of Injection Laryngoplasty vs Thyroplasty

Objective: Compare the long-term voice outcome following calcium hydroxylapatite injection laryngoplasty (IL) vs silicone medialization laryngoplasty (ML) as the long-term treatment modalities for the treatment of unilateral vocal fold paralysis (UVFP) through a meta-analysis study. Method: A systematic literature review was performed from MEDLINE, Google Scholar, Web of Science, Scopus, and Cochrane between January 1, 1980, and December 31, 2010. Studies reporting voice outcome after IL with calcium hydroxylappatite and/or ML with silicone for the treatment for UVFP were included. The primary outcome measure was change in Voice Handicap Index (VHI). Results: Seven hundred and forty-two abstracts were screened for relevancy. Seventy-one articles were reviewed in detail. Twelve studies satisfied the inclusion criteria. The mean VHI score, following IL (n = 209), improved from 68.36 (±6.88) to 32.24 (±7.33). The mean VHI score, following ML (n = 110), improved from 72.22 (±11.06) to 34.02 (±6.48). The improvement in VHI following both techniques was statistically significant. Conclusion: Injection laryngoplasty with calcium hydroxylapatite and medialization laryngoplasty with silicone offer comparable voice improvement as long-term treatment modalities for UVFP. The choice of procedure should be based on planned duration of medialization, patient’s preference, and physician’s preference.

Allergic laryngitis as a cause of dysphonia: a preliminary report

Objectives. To investigate the relationship between air-borne allergen exposure and Voice Handicap Index scores in patients seeking medical treatment for rhinitis. Methods. As we had previously identified a higher-than-expected incidence of allergy in patients presenting to a voice clinic, we undertook a prospective audit of patients without specific voice-related complaints presenting to a rhinology clinic to see if these patients might have unrecognized vocal dysfunction. To this end 70 consecutive patients with no pre-reported voice-related symptoms presenting to a teaching hospital rhinology clinic underwent skin prick testing to common air-borne allergens and completed the Voice Handicap Index (VHI) questionnaire. Discriminant performances in the Voice Handicap Index and its individual domains and questions were determined using analysis of variance. An allergy-specific subset of the VHI was constructed and tested using receiver operating characteristic (ROC) statistics. Results. There were 30 males and 40 females. Mean age was 36 ± 12 years. Dust mite (83%), house dust mite (55%), and grass pollen (40%) were the commonest allergens, and 23 patients did not react to common allergens. Mean VHI score was 23.7 ± 20.1 in patients with ≥4 allergens, 10.8 ± 21.3 in patients with fewer than 4 allergies, and 7.8 ± 8.5 in non-allergics (P = 0.044; analysis of variance). Nine VHI questions best discriminated between allergic and non-allergic patients (P < 0.05), and the combined VHI-9 score had a ROC area under the curve of 0.85. Conclusions. Patients with more air-borne allergies have a higher incidence of undiagnosed vocal dysfunction, as determined by the raised Voice Handicap Index score, than those with fewer or no such allergies. As noted, earlier work has shown that, conversely, patients with vocal dysfunction have a high incidence of undiagnosed allergy.

How does Cricotracheal Resection Affect the Female Voice?

We measured the effects of cricotracheal resection on the adult female voice. Voice recordings of 14 women (mean age, 53 years; range, 35 to 69 years) who underwent cricotracheal resection for chronic airway obstruction associated with idiopathic laryngotracheal stenosis were acquired before and after surgery. The recordings were analyzed with voice analysis software. The measures included the mean fundamental frequency of a sustained vowel at a comfortable pitch and loudness (F0), the mean F0 of connected speech (ie, speaking F0), the pitch range (F0 range), and the maximum phonation time. Self-assessment measures of the Voice Handicap Index were taken. The mean speaking F0 lowered significantly, by 21 Hz, from 186 Hz to 165 Hz (p = .04). In 7 patients, the speaking F0 was below 160 Hz after the operation. The mean sustained vowel frequency also dropped by 32 Hz (p = .03). The F0 range was reduced by an average of 5.9 semitones, from 21.5 to 15.6 (p = .05). The maximum phonation time did not change significantly. The postoperative mean Voice Handicap Index score was 21.9. Cricotracheal resection can significantly impact the adult female voice. It often lowers the pitch of the speaking voice into the male range and reduces the pitch range of the voice. The change in voice that potentially accompanies this procedure should be discussed with patients in preoperative counseling.

A Retrospective Study Concerning the Psychosocial Impact of Voice Disorders: Voice Handicap Index Change in Patients With Benign Voice Disorders After Treatment (Measured With the Dutch Version of the VHI)

The goal of this study was to gain better understanding of psychosocial effects of benign voice problems as measured with the Dutch version of the Voice Handicap Index (VHI). The effect of voice problems on daily life differs from person to person. Over the last few decades there has been a growing understanding of the fact that the psychosocial effect of this medical problem needs to be acknowledged. The VHI is a known voice specific Quality-of-Life measuring instrument, which is often used for this purpose. In the University Medical Center Groningen, Groningen, the Netherlands, patients with voice problems are analyzed at a Voice Clinic by a multidisciplinary team of voice specialists. In this study, we have analyzed patients with benign voice problems before and after treatment in the period of April 2004 to October 2006. The study group consisted of 68 patients (39 female). For comparison reason, we included a control group (n=68), matched for age and gender. The mean VHI score of the patient group before treatment was 48.9 (SD=20.9). After treatment, there was a significant improvement to 28.3 (SD=20.5) (P<0.001). There was no significant difference between the VHI scores of men and women. As could be expected, voice disorders of different etiology showed different VHI scores. Before and after treatment, the patient group showed a statistically significantly higher VHI score (P<0.001) compared with the control group (mean VHI score of 3.62, SD=3.82). Patients with different voice problems seem to have different results with the VHI. Treatment leads to statistically significant improvement in VHI scores. The VHI has proven to be a good instrument to evaluate the psychosocial consequences of voice problems.

Cricohyoidoepiglottopexy vs Near-Total Laryngectomy With Epiglottic Reconstruction in the Treatment of Early Glottic Carcinoma

To compare functional and oncological outcomes of cricohyoidoepiglottopexy (CHEP) and near-total laryngectomy with epiglottic reconstruction (NTLER) techniques in early glottic carcinoma. Case series, clinical study. Two tertiary care referral centers. Seventeen patients with T1b glottic squamous cell carcinoma were treated with CHEP and 21 were treated with NTLER. Fundamental frequency, maximum phonation time, maximum phonation intensity, Voice Handicap Index, and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale were used to evaluate voice. Nasogastric tube removal times and late postoperative aspiration scales were used to evaluate swallowing ability. Fundamental frequency (P=.78), maximum phonation time (P=.44), and maximum phonation intensity (P=.94) measurements were not significantly different in the 2 groups. There was also no significant difference in mean Voice Handicap Index score (P=.62), mean decannulation time (P=.25), time to nasogastric tube removal (P=.12), or clinical grades of late postoperative aspiration (P=.87) between the 2 groups. The mean Voice Handicap Index score was 55.58 in the CHEP group and 52.78 in the NTLER group. According to the GBRAS scale, overall voice quality was moderately altered in both groups. All patients were successfully decannulated. In the CHEP and NTLER groups, the mean decannulation times were 27 and 20 days, respectively, and the nasogastric tubes were removed after an average of 23 and 17 days. The overall (Kaplan-Meier) survival rate was 94% in the patients who underwent CHEP and 90% in the patients who underwent NTLER (P=.76). The disease-free survival rates were 100% and 76% in the CHEP and NTLER groups, respectively (P=.07). Functional and oncological results appear to be similar with both treatment methods. If open surgery is planned, the choice between these procedures mainly depends on the experience and preference of the surgeon.