Verbal performance of total laryngectomized patients rehabilitated with esophageal speech and tracheoesophageal speech: impacts on patient quality of life
Received 18 April 2019
Accepted for publication 18 July 2019
Published 15 August 2019 Volume 2019:12 Pages 675—681
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Mei-chun Cheung
Eugenia Allegra,1 Ignazio La Mantia,2 Maria Rita Bianco,1 Gaetano Davide Drago,3 Maria Cristina Le Fosse,1 Alfio Azzolina,4 Calogero Grillo,2 Vincenzo Saita4
1Otolaryngology, Department of Health Science, University of Catanzaro, Catanzaro, Italy; 2Otolaryngology, "G.F Ingrassia" Department, University of Catania, Catania, Italy; 3Grand Hôpital de l’Est Francilien, Jossigny, France; 4Otolaryngology Unit, Cannizzaro Hospital, University of Catania, Catania, Italy
Introduction: Total laryngectomy has important psychophysical and social consequences for patients’ quality of life because of the functional changes resulting from the removal of the larynx. Voice deprivation is perhaps the most relevant limiting factor in social relationships, increasing feelings of solitude and tending to drive individuals into social isolation. Multiple voice rehabilitation methods after total laryngectomy are available. This study aimed to determine the acoustic quality of the rehabilitated voice achieved with esophageal speech (ES) and tracheoesophageal speech (TES), and acoustic quality impacts on patients’ perceptions of their quality of life.
Materials and methods: The patient inclusion criterion was the completion of a speech rehabilitation course with ES or TES at least 6 months after total laryngectomy. The voice acoustic analysis was carried out automatically by using the Multidimensional Voice Program. The following parameters were extracted: fundamental frequency (F0), Jitter% (Jitt), Shimmer% (Shim), and noise-to-harmonic ratio (NHR). Subjective voice evaluation was performed by using the following questionnaires: Voice Handicap Index (VHI), Voice-related Quality of Life (V-RQOL), and Voice Performance Questionnaire (VPQ).
Results: The acoustic analysis showed a difference between ES and TES patients on all acoustic parameters; this difference was significant for F0 (133.09±2.4 and 119±3.3, respectively; p<0.001), NHR (0.43±0.21 and 0.31±0.14, respectively; p=0.02), and maximum phonation time (2.02±038 s and 10.64±0.28 s, respectively; p=0.01. Regarding patient-related outcomes, TES correlated with better total scores compared with ES; however, the differences in the total scores on the VHI (p=0.09), V-RQOL (p=0.39), and VPQ (p=0.52) were not statistically significant.
Conclusion: The rehabilitation of laryngectomized patients must be addressed by a multidisciplinary team that considers the personalities, personal needs, and relational conditions of individual patients in order to determine and apply the phonatory rehabilitation method most suitable for achieving a better quality of life.
Keywords: total laryngectomy, tracheoesophageal speech, esophageal speech, laryngeal cancer
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