Voice after supracricoid laryngectomy: Subjective, objective and self-assessment data

Abstract

Supracricoid laryngectomy (SCL) is an efficient surgical procedure for the treatment of selected laryngeal carcinoma, presently being performed not only in Europe but also in North America. The functional goals of the technique are voice and swallowing without a permanent tracheostoma. Perceptual and acoustic voice characteristics after SCL have been reported by different authors, but self-assessment data together with subjective and objective data have only been reported for a small number of subjects. Twenty male subjects, with a mean age of 71 years (range: 51-82 years) who underwent a SCL at least one year before our observation, were included in the study. Each subject underwent a flexible laryngoscopy and his voice was perceptually rated using the GRBAS scale. Objective examination included: maximum phonation time (MPT), voice spectrograms and syllable diadochokinesis on a single breath. Finally, each subject assessed his own voice using the Voice Handicap Index (VHI). The mean values of the GRBAS scale were respectively 2.4, 2.6, 2.4, 0.8, 0.5, 0.8. Mean MPT was 7.5 s, while for voice spectrograms the mean value of the Yanagihara scale was 3.7. Mean syllable diadochokinesis appeared as 3.3 syllables/s. Mean value of the VHI was 29.9. Subjective and objective data show a severely dysphonic voice after SCL; self-assessment data, on the contrary, reveal only moderate functional and emotional consequences. While perceptual, aerodynamic and acoustic data are in line with previous reports, self-assessment data were less severe in our subjects compared to what appears in the literature. It is concluded that self-assessment explores a different dimension of the patient's voice and that even if a severe dysphonia is present the consequences on everyday oral communication are only moderate.

Communication adjustment of patients with a laryngectomy in Turkey: Analysis by type of surgery and mode of speech

“…Schindler et al, 2005Schindler et al, , 2006. In fact, it has been suggested that as long as the patient has a functional voice for verbal communication, QoL may return to near-normal (Schindler et al, 2005). However, that conclusion was based on results obtained using the VHI which, again, was not developed specifically for patients with laryngeal cancer and, when compared to the SECEL, has been shown to not be as sensitive to communication dysfunction (Johansson et al, 2008).…”

“…Although numerous studies have reported a severely dysphonic voice following supracricoid laryngectomy, these studies have also shown that patients only report few or moderate problems with concern to QoL (e.g. Schindler et al, 2005Schindler et al, , 2006. In fact, it has been suggested that as long as the patient has a functional voice for verbal communication, QoL may return to near-normal (Schindler et al, 2005).…”

Factors associated with supracricoid laryngectomy functional outcomes

“…Although the neoglottic mechanism for swallowing and generating voice after SCPL more closely resembles the physiology of the normal larynx than that in patients after total laryngectomy, function is not normal. There is evidence that these patients have chronic problem with swallowing and aspiration, and a perceptually abnormal voice with a breathy, strained, and rough quality . Much of these data come from large case series in Europe where this procedure is performed more commonly.…”

“…There is evidence that these patients have chronic problem with swallowing and aspiration, [5][6][7] and a perceptually abnormal voice with a breathy, strained, and rough quality. 8,9 Much of these data come from large case series in Europe where this procedure is performed more commonly. Functional data after SCPL in the United States is much more limited, consisting of smaller series and shorter follow-up times, although excellent voice and swallowing results have been reported.…”

Long-Term Evaluation After Supracricoid Partial Laryngectomy

“…methods (cricohyoidopexy=CHP, cricohyoi-doepiglottopexy= CHEP) based on whether the epiglottis is preserved or not. 1,2 Voice always gets modified after SCPL operation. The degree of dysphonia could significantly vary between different patients.…”