Differential Modes of Alaryngeal Communication and Long-Term Voice Outcomes following Pharyngolaryngectomy and Laryngectomy

Abstract

Patterns of vocal rehabilitation for 37 pharyngolaryngectomy patients and 55 total laryngectomy patients over a 5-year period were compared. An electrolarynx (EL) was introduced as the initial communication mode immediately after surgery for 98% of patients, with 30% of pharyngolaryngectomy and 74% of laryngectomy patients subsequently developing tracheoesophageal speech (TES) as their primary mode of communication. Follow-up with 14 of 37 pharyngolaryngectomy patients and 36 of 55 laryngectomy patients was conducted 1–6 years following surgery and revealed that 90% of the pharyngolaryngectomy patients maintained the use of TES in the long term compared to 69% of the laryngectomy group. Long-term outcomes relating to communication disability and handicap did not differ significantly between the two surgical groups, however the laryngectomy patients had significantly higher levels of wellbeing. Across the whole group of patients, statistical comparison revealed that patients using TES had significantly lower levels of disability, handicap and distress than EL users. Considering that lower levels of disability, handicap and distress are associated with TES, and the data supports that suitably selected patients can maintain functional TES in the long term, increased application of this form of communication rehabilitation should be encouraged where viable for the pharyngolaryngectomy population.

Speech rehabilitation during the first year after total laryngectomy

“…This finding is in accord with other studies 30,35,36 ; thus, we can conclude that there is good evidence for superior rehabilitation results when using a TEP. There is, however, an important limitation to mention, that is that we did not control for confounders such as age or stage of disease.…”

“…This is a larger proportion than described earlier 7,[28][29][30] ; only Bremerich et al 31 and M€ akitie et al 32 found similar percentages of patients unable to speak. In contrast, in a survey of all ENT clinics in Germany, the doctors reported that 6.7% of the patients could not speak at all 33 and Jassar et al 34 found in their review that 10% to 15% of all patients do not acquire any voice at all.…”

Speech Breathing Patterns During Tracheoesophageal Speech

“…Of these, the most frequently used is TES with research revealing that the majority of patients achieve successful rehabilitation by this method (Ward, Koh, Frisby, & Hodge, 2003). It has been documented that patients using TES report higher satisfaction levels, and significantly lower levels of disability, handicap, and distress than patients using other forms of alaryngeal communication (Ward et al, 2003).…”

Voice Restoration After Total Laryngectomy

“…Compared with patients using the electrolarynx, TL patients with TEP were significantly more satisfied with their speech (P<.001), perceived their speech to be of better quality (P<.001), had improved ability to communicate over the telephone (P<.001), had less limitation of their interactions with others (P<.004), and rated their overall QOL higher (P 5 .23). In a study by Ward and colleagues, 22 statistical comparison revealed that patients using TEP had significantly lower levels of disability, handicap, and distress than electrolarynx users.…”

“…12,20,22 Access to a speech therapist in the preoperative, perioperative, and postoperative settings is essential for proper TEP management, including learning to use the TEP, care for the puncture site, and replacement of the prosthesis with device malfunctions. A potential disadvantage of TEP is the expense of the prostheses, which can be prohibitive for low-income patients and those in the developing world.…”