The impact of vocal rehabilitation on quality of life and voice handicap in patients with total laryngectomy

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication.

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Is there a difference in quality of life, comparing summer and winter, in patients who have undergone total laryngectomy?

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000357 ◽

2007 ◽

Vol 122 (9) ◽

pp. 967-971

Author(s):

F C Van Wyk ◽

F Vaz ◽

M Harries ◽

J Weighill

Keyword(s):

Quality Of Life ◽

Total Laryngectomy ◽

Cross Sectional Study ◽

Short Term ◽

Cross Sectional ◽

European Organization ◽

Eortc Qlq C30 ◽

Eortc Qlq ◽

The Impact

AbstractIntroduction:Several studies have implied that patients' quality of life stabilises six months after undergoing total laryngectomy. However, these studies may well have overlooked persistent short term variations in patients' quality of life. The aim of this study was to assess the impact of seasonal change (i.e. summervswinter) on the quality of life of patients following total laryngectomy.Methods:A prospective, cross-sectional study of recurrence-free laryngectomy patients was performed, using the European Organization for Research and Treatment of Cancer (version three) QLQ-C30 questionnaires (EORTC QLQ-C30), during January 2004 (i.e. winter), August 2004 (summer) and January 2005 (winter).Results:Thirty-six patients were entered into the study. The response rate was 70.3 per cent. Patient's time elapsed since surgery varied from six months to 12 years. In all questionnaire domains, responses seemed remarkably consistent over time.Conclusion:No statistically significant differences were found between summer and winter scores in all the domains analysed by the EORTC QLQ-C30.

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Quality of Life after Surgical Treatment of Cancer of the Larynx

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949510401003 ◽

1995 ◽

Vol 104 (10) ◽

pp. 763-769 ◽

Cited By ~ 93

Author(s):

Lawrence W. DeSanto ◽

Kerry D. Olsen ◽

Daniel E. Rohe ◽

William C. Perry ◽

Robert L. Keith

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Psychosocial Adjustment ◽

Total Laryngectomy ◽

Negative Impact ◽

Partial Laryngectomy ◽

Partial Operation ◽

As Stress ◽

The Impact

The purpose of the study was to assess the quality of life of patients after surgical treatment for cancer of the larynx. Three groups of patients were identified according to surgical treatment: total laryngectomy, 111 patients; near-total laryngectomy, 38 patients; and partial laryngectomy, 23 patients. The impact of successful surgical treatment on their life roles was analyzed in terms of work, activities, familial and spousal relationships, sexuality, and psychologic features such as stress and anxiety. Two questionnaires were used: the Psychosocial Adjustment to Illness Scale (PAIS) and the Mayo Clinic Postlaryngectomy Questionnaire. With the PAIS questionnaire, no difference was found in role adjustment between the total laryngectomy and near-total laryngectomy groups, with one exception. In the work domain, the total laryngectomy patients who were working had better adjustment than the near-total laryngectomy patients. The overall adjustment of both groups was less favorable than that of a comparison group of patients with nonlaryngeal cancer. The patients who had the classic conservation operations adjusted in all domains more favorably than the patients with permanent tracheostomas. The partial operation patients adjusted better than the nonlaryngeal cancer patients. We conclude that the stoma has a negative impact on adjustment postoperatively and that it may have a more serious impact on life adjustment than voice alteration. Further investigation and standardization of measurement tools are needed.

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Olfaction and gustation abilities after a total laryngectomy

Radiology and Oncology ◽

10.2478/raon-2013-0070 ◽

2014 ◽

Vol 48 (3) ◽

pp. 301-306 ◽

Cited By ~ 10

Author(s):

Gordana Mumovic ◽

Irena Hocevar-Boltezar

Keyword(s):

Quality Of Life ◽

Respiratory Tract ◽

Total Laryngectomy ◽

Nasal Discharge ◽

Substantial Impact ◽

Nasal Symptoms ◽

The Impact

Abstract Background. A laryngectomy affects many of a patient’s functions. Besides speech and respiratory-tract problems, olfaction and gustation problems can also have an influence on the quality of life. The aim of this study was to find out how often various nasal problems and decreased gustation appear after a laryngectomy. Patients and methods. One hundred and five laryngectomized patients (9 women, 96 men, aged 45-88 years), treated in two tertiary centers, were included in the study. They completed a questionnaire about various nasal problems, olfactory and gustatory capabilities, possible allergies and irritants in their environment, and the impact of the nasal and gustation problems on their quality of life. Results. Olfaction was impaired in 51.4%, and was even not possible in 30.5%, of patients. Decreased gustation abilities were reported in 26.7%, and dysgeusia in 11.4%, of patients. Almost 21% of patients were bothered by an impaired gustatory ability and 50.5% of patients were affected by their loss of olfaction. Frequent nasal discharge was reported in 20%, frequent sneezing in 58.1%, and nasal itching in 33.3% of the laryngectomized patients. There were no correlations between the age and the olfaction and gustation abilities and between the allergy and the nasal symptoms, whereas the correlation between olfaction and gustation appeared significant (p=0.025). Conclusions. Various nasal and gustatory problems were reported in more than 80% of laryngectomized patients. The olfaction and gustation abilities are connected and have a substantial impact on the quality of life. Like in the case of speech, the rehabilitation of olfaction is also necessary in all laryngectomized patients and must take place soon after the completion of the treatment.

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Self-Compassion and Quality of Life in Adults Who Stutter

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-20-00055 ◽

2020 ◽

Vol 29 (4) ◽

pp. 2097-2108

Author(s):

Robyn L. Croft ◽

Courtney T. Byrd

Keyword(s):

Quality Of Life ◽

Social Connectedness ◽

The Self ◽

Future Research ◽

Self Compassion ◽

Adults Who Stutter ◽

And Gender ◽

Relationship Of ◽

The Impact

Purpose The purpose of this study was to identify levels of self-compassion in adults who do and do not stutter and to determine whether self-compassion predicts the impact of stuttering on quality of life in adults who stutter. Method Participants included 140 adults who do and do not stutter matched for age and gender. All participants completed the Self-Compassion Scale. Adults who stutter also completed the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed for self-compassion differences between and within adults who do and do not stutter and to predict self-compassion on quality of life in adults who stutter. Results Adults who do and do not stutter exhibited no significant differences in total self-compassion, regardless of participant gender. A simple linear regression of the total self-compassion score and total Overall Assessment of the Speaker's Experience of Stuttering score showed a significant, negative linear relationship of self-compassion predicting the impact of stuttering on quality of life. Conclusions Data suggest that higher levels of self-kindness, mindfulness, and social connectedness (i.e., self-compassion) are related to reduced negative reactions to stuttering, an increased participation in daily communication situations, and an improved overall quality of life. Future research should replicate current findings and identify moderators of the self-compassion–quality of life relationship.

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