Scientific Evidence Regarding the Quality of Life of Total Laryngectomees

Introduction: The loss of laryngeal voice after total laryngectomy can have an impact on the quality of life and communication of affected individuals. Postoperative phonatory methods may promote advantages in oral communication and reduce the functional, organic and emotional changes experienced by the patients. On this basis, the objective of the present study was to review the literature in order to determine the impact on the quality of life of total laryngectomees according to the form of rehabilitation chosen after the procedure and to identify the protocols most frequently used to assess the quality of life of these individuals.&nbsp;Results and Discussion: The application of quality of life protocols reveals that total laryngectomees face an impact at the social, physical and psychological levels. Regarding the forms of rehabilitation, success can be achieved with any one of the phonatory methods used after total laryngectomy as long as the patients are guided by a speech therapist and monitored by a multidisciplinary team. Users have reported that a tracheoesophageal prosthesis produced a voice most similar to laryngeal voice, with better scores in the physical and socioemotional domains compared to other alaryngeal methods. A wide diversity of questionnaires used to assess quality of life was detected, those most frequently employed being the “Vocal Disadvantage Index” (VDI), “Quality of Life and Voice “(QLV) protocol, “Quality Assessment Questionnaire of Life at the University of Washington” (UW-QOL), “Functional Assessment of Cancer Therapy” (FACT-H&amp;N), “European Organization for Research and Treatment of Cancer” (EORTC QLQ-C30), and “Medical Outcomes Study 36-Item Short–Form Health Survey” (SF-36). Despite such diversity of protocols for assessment, the results demonstrate an increased voice quality (VQ) after alaryngeal rehabilitation.&nbsp;Conclusion: The present review revealed that total laryngectomy has a relevant impact at the physical, emotional and psychological levels on the patients, as shown by most of the questionnaires applied. In general, the results of the present study revealed moderate VQ scores after total laryngectomy. The tracheoesophageal prosthesis yielded a better result in terms of quality of life because of its closer proximity to laryngeal voice compared to esophageal voice.&nbsp;</p

Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers

The objective of this study is to assess surgical parameters correlating with voice quality after total laryngectomy (TL) by relating voice and speech outcomes of TL speakers to surgical details. Seventy-six tracheoesophageal patients' voice recordings of running speech and sustained vowel were assessed in terms of voice characteristics. Measurements were related to data retrieved from surgical reports and patient records. In standard TL (sTL), harmonics-to-noise ratio was more favorable after primary TL + postoperative RT than after salvage TL. Pause/breathing time increased when RT preceded TL, after extensive base of tongue resection, and after neck dissections. Fundamental frequency (f0) measures were better after neurectomy. Females showed higher minimum f0 and higher second formants. While voice quality differed widely after sTL, gastric pull-ups and non-circumferential pharyngeal reconstructions using (myo-)cutaneous flaps scored worst in voice and speech measures and the two tubed free flaps best. Formant/resonance measures in/a/indicated differences in pharyngeal lumen properties and cranio-caudal place of the neoglottic bar between pharyngeal reconstructions, and indicate that narrower pharynges and/or more superiorly located neoglottic bars bring with them favorable voice quality. Ranges in functional outcome after TL in the present data, and the effects of treatment and surgical variables such as radiotherapy, neurectomy, neck dissection, and differences between partial or circumferential reconstructions on different aspects of voice and speech underline the importance of these variables for voice quality. Using running speech, next to sustained/a/, renders more reliable results. More balanced data, and better detail in surgical reporting will improve our knowledge on voice quality after TL