BackgroundThe incidence of oropharyngeal squamous cell carcinoma (OPSCC) has markedly increased over the last three decades due to newly found associations with human papillomavirus (HPV) infection. Primary radiotherapy (RT) is the treatment of choice for OPSCC at most centers, and over the last decade, the addition of concurrent chemotherapy has led to a significant improvement in survival, but at the cost of increased acute and late toxicity. Transoral robotic surgery (TORS) has emerged as a promising alternative treatment, with preliminary case series demonstrating encouraging oncologic, functional, and quality of life (QOL) outcomes. However, comparisons of TORS and RT in a non-randomized fashion are susceptible to bias. The goal of this randomized phase II study is to compare QOL, functional outcomes, toxicity profiles, and survival following primary RT (± chemotherapy) vs. TORS (± adjuvant [chemo] RT) in patients with OPSCC.Methods/DesignThe target patient population comprises OPSCC patients who would be unlikely to require chemotherapy post-resection: Tumor stage T1-T2 with likely negative margins at surgery; Nodal stage N0-2, ≤3 cm in size, with no evidence of extranodal extension on imaging. Participants will be randomized in a 1:1 ratio between Arm 1 (RT ± chemotherapy) and Arm 2 (TORS ± adjuvant [chemo] RT). In Arm 1, patients with N0 disease will receive RT alone, whereas N1-2 patients will receive concurrent chemoradiation. In Arm 2, patients will undergo TORS along with selective neck dissections, which may be staged. Pathologic high-risk features will be used to determine the requirement for adjuvant radiotherapy +/- chemotherapy. The primary endpoint is QOL score using the M.D. Anderson Dysphagia Inventory (MDADI), with secondary endpoints including survival, toxicity, other QOL outcomes, and swallowing function. A sample of 68 patients is required.DiscussionThis study, if successful, will provide a much-needed randomized comparison of the conventional strategy of primary RT vs. the novel strategy of primary TORS. The trial is designed to provide a definitive QOL comparison between the two arms, and to inform the design of an eventual phase III trial for survival outcomes.Trial registrationNCT01590355

Women who use tracheoesophageal speech may be differentially penalized for dimensions related to voice quality. Limitations in voice did not necessarily translate into worse overall quality of life, indicating that auditory-perceptual evaluation and quality of life questionnaires are evaluating different aspects of function after laryngectomy.

Patients using TES had similar V-RQOL outcomes compared to ES and both performed significantly better than ELS. For ELS, the total V-RQOL score was better with longer time after surgery and older age.

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BACKGROUND This study examined relationships between communicative participation and post-laryngectomy speech outcomes including: a) listener-rated speech intelligibility and acceptability; and b) patient-rated speech acceptability and voice handicap. METHODS Thirty-six laryngectomized individuals completed the Communicative Participation Item Bank short form and the Voice Handicap Index-10. They provided recordings from the Sentence Intelligibility Test (SIT) and a reading passage, and rated their own speech acceptability. Forty-eight inexperienced listeners transcribed the SIT sentences to derive intelligibility scores. Eighteen additional listeners judged speech acceptability using rating scales. RESULTS Listeners judged tracheoesophageal speakers significantly more intelligible and acceptable than electrolaryngeal speakers (p < .05). Speech acceptability was significantly more acceptable to speakers than listeners (p < .05). Weak, non-significant relationships were found between communicative participation and listener-rated outcomes. Stronger, significant relationships were found between communicative participation and self-rated speech acceptability and voice handicap (p < .05). CONCLUSIONS Patient-reported communication outcomes are complementary to listener-rated outcomes.

The purpose of this study was to determine the psychophysical character and validity of auditory-perceptual ratings of naturalness and overall severity for tracheoesophageal (TE) speech. This was achieved through use of direct magnitude estimation (DME) and equal-appearing interval (EAI) scaling procedures. Twenty adult listeners judged speech naturalness and overall severity from connected speech samples produced by 20 adult male TE speakers. A comparison of DME- and EAI-scaled judgments yielded a metathetic continuum for naturalness and a prothetic continuum for overall severity. These data provide support for the use of either DME or EAI scales in auditory-perceptual ratings of naturalness, but they provide support only for DME scales in judging overall severity for TE speech. The present results suggest that the nature of perceptual phenomena (prothetic vs. metathetic) for TE speakers is consistent with findings for the same dimensions produced by normal laryngeal speakers. These data also support a need for further study of perceptual dimensions associated with TE voice and speech in order to avoid the inappropriate and invalid use of EAI scales frequently found in diagnosis, assessment, and evaluation of this clinical population.

The purpose of this study was to determine the validity of voice pleasantness and overall voice severity ratings of dysphonic and normal speakers using direct magnitude estimation (DME) and equal-appearing interval (EAI) auditory-perceptual scaling procedures. Twelve naive listeners perceptually evaluated voice pleasantness and severity from connected speech samples produced by 24 adult dysphonic speakers and 6 normal adult speakers. A statistical comparison of the two auditory-perceptual scales yielded a linear relationship representative of a metathetic continuum for voice pleasantness. A statistical relationship that is consistent with a prothetic continuum was revealed for ratings of voice severity. These data provide support for the use of either DME or EAI scales when making auditory-perceptual judgments of pleasantness, but only DME scales when judging overall voice severity for dysphonic speakers. These results suggest further psychophysical study of perceptual dimensions of voice and speech must be undertaken in order to avoid the inappropriate and invalid use of EAI scales used in the auditory-perceptual evaluation of the normal and dysphonic voice.

OBJECTIVE i) To determine potential relationships between speech intelligibility, acceptability, and self-reported quality of life (QOL) after total laryngectomy; and ii) to determine whether relationships are stronger when QOL is measured by a head and neck cancer-specific or discipline-specific QOL scale. STUDY DESIGN Cross-sectional. SETTING University-based laboratory and speech clinic. SUBJECTS AND METHODS Twenty-five laryngectomized individuals completed disease-specific (University of Washington Quality of Life; UW-QOL) and discipline-specific (Voice Handicap Index-10; VHI-10) QOL scales. They also provided audio recordings that included the Sentence Intelligibility Test and a reading passage. Thirty-three listeners transcribed the SIT sentences to yield intelligibility scores. Fifteen additional listeners judged speech acceptability of the reading passage using rating scales. RESULTS QOL scores were moderate across the UW-QOL physical (mean = 77.63) and social-emotional (mean = 78.02) subscales, and VHI-10 (mean = 17.91). Speech acceptability and intelligibility varied across the samples, with acceptability only moderately related to intelligibility (r = 0.41, p < .05). Relationships were weak between ratings of intelligibility and self-reported QOL (range r = 0.00 – 0.22), and weak to moderate between acceptability with QOL (range r = 0.01 – 0.46). The only statistically significant, but moderate, relationship was found between speech acceptability with the UWQOL speech sub-score (r = 0.46, p < .05). CONCLUSION Listeners’ ratings of speech acceptability and intelligibility were not strongly predictive of disease-specific or voice-related QOL, suggesting that listener-rated and patient-reported outcomes are complementary.