Outcome of Total Laryngectomy in Regional Hospitals of Bangladesh

Objectives: To analyze post operative complications, local recurrence, functional outcome of speech & swallowing and survival rate following total laryngectomy. Methods: This prospective observational study was done in four major tertiary care medical college hospitals of Bangladesh from July 2000 to December 2019. All operations were done by a single surgeon, one of the authors of this study based on the personal experience. 45 patients were selected who underwent total laryngectomy for biopsy proven advanced (T3 and T4) laryngeal cancer as primary case & recurrent cases following radiotherapy. Patients were followed up monthly for three months and then six monthly for two years and yearly for rest of their life. Results: Age of the patients ranged from 42 to 80 years with mean age 56.7 years. In postoperative period 03 (6.6%) patients developed wound infection, 03 (6.6%) stomal stenosis, 03 (6.6%) stomal recurrence, 02 (4.4%) seroma, 02 (4.4%) pharyngo-cutaneous fistula and 01 (2.2%) case developed pharyngeal stenosis. In post laryngectomy voice rehabilitation 33 (73.3%) cases used esophageal voice, 07 (15.5%) cases used electrolarynx and 05 (11.1%) cases used bloom singer valve. Out of oesophageal speech, 2 patients had poor speech, Regarding swallowing all patients had very good swallowing except one patient who got pharyngeal stenosis, needed dilation. 3 patients died in subsequent 2 years follow-up and overall survival was 93.3%. Conclusion: Outcome of total laryngectomy depends on site and size of tumour, nodal metastases, recurrent cases and co-existing co-morbidities. Total laryngectomy with or without radiotherapy offers significantly higher local control and survival benefit with advanced laryngeal cancer, compared to radiotherapy only. Bangladesh J Otorhinolaryngol 2021; 27(2): 139-144

Acoustic Analysis of Voice Signal of Patients with Unilateral Laryngeal Paralysis a View to Objective Evaluation after Rehabilitation

We propose in this study an acoustic analysis called objective, based on physical measurements, to extract the acoustic characteristics of the voice of patients with Unilateral Laryngeal Paralysis. Our experiments were made at the Otorhinolaryngology service of the hospital of Bab El Oued. Algiers. (Algeria). In this work, an acoustic analysis of the vocal signal is based on measurements of the instability of the amplitude and frequency of the vibrations of the vocal cords. The results obtained are compared with those of a group of reference of subjects who normally speak. The study of the results obtained by the acoustic analysis of the pathological voice during the rehabilitation phase shows a strong correlation of the acoustic parameters between the pathological voice and the reference one. The exclusive use of hearing to evaluate the effect of voice rehabilitation in the Algerian hospital environment remains insufficient. It is important to correlate the perceptual information with the interpreted acoustic measurements, in a manner to be able to develop a therapeutic project appropriate to the patient’s expectations and difficulties.

Psychometric Analysis of an Ecological Vocal Effort Scale in Individuals With and Without Vocal Hyperfunction During Activities of Daily Living

Objective The purpose of this study was to examine the psychometric properties of an ecological vocal effort scale linked to a voicing task. Method Thirty-eight patients with nodules, 18 patients with muscle tension dysphonia, and 45 vocally healthy control individuals participated in a week of ambulatory voice monitoring. A global vocal status question was asked hourly throughout the day. Participants produced a vowel–consonant–vowel syllable string and rated the vocal effort needed to produce the task on a visual analog scale. Test–retest reliability was calculated for a subset using the intraclass correlation coefficient, ICC(A, 1). Construct validity was assessed by (a) comparing the weeklong vocal effort ratings between the patient and control groups and (b) comparing weeklong vocal effort ratings before and after voice rehabilitation in a subset of 25 patients. Cohen's d, the standard error of measurement ( SEM ), and the minimal detectable change (MDC) assessed sensitivity. The minimal clinically important difference (MCID) assessed responsiveness. Results Test–retest reliability was excellent, ICC(A, 1) = .96. Weeklong mean effort was statistically higher in the patients than in controls ( d = 1.62) and lower after voice rehabilitation ( d = 1.75), supporting construct validity and sensitivity. SEM was 4.14, MDC was 11.47, and MCID was 9.74. Since the MCID was within the error of the measure, we must rely upon the MDC to detect real changes in ecological vocal effort. Conclusion The ecological vocal effort scale offers a reliable, valid, and sensitive method of monitoring vocal effort changes during the daily life of individuals with and without vocal hyperfunction.

Systematic Review of The Outcome of Different Modalities of Voice Rehabilitation Following Total Laryngectomy

Background Speech impairment occurs in 34-70% of head and neck oncologic patients. Management of this impairment is through surgical and nonsurgical methods. Progress in voice rehabilitation following total laryngectomy has over the last 30 years, made an enormous difference in the whole concept of the management of laryngeal cancers. Objective To explore the outcome of different options of voice rehabilitation after total laryngectomy and the advantages and disadvantages of each method in order to improve the quality of life of laryngectomized patients and the suggestion of future directions for research. Patients and Methods The Aim of this work is to provide cumulative data about the efficacy and safety of the outcome of different modalities of voice rehabilitation following total laryngectomy. This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) statement guidelines. Results Voice rehabilitation is one of the most important determinants of the quality of life after total laryngectomy. Recent advances in prosthetic voice devices have made such devices the gold standard for voice rehabilitation. They are thus preferred and used more often than old methods (esophageal speech and artificial larynx). Conclusion Although, no single method is considered to be the best for every patient, the tracheoesophageal puncture has become the most preferred method in the past decade. But it is not always possible in all patients, the results of this study indicate that ES, when achievable, is a viable option that should be considered by surgeons when making intervention decisions on patients, and should be revived when indicated. But we need much more studies.

Effects of a conservative in-patient voice treatment on the voice-related self-concept

Purpose Observational study to determine if the voice-related self-concept as measured via the Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts FESS (questionnaire for the assessment of the voice self-concept) can be improved through in-patient voice therapy. Methods 234 female and 80 male patients that underwent an intensive 3- to 4-week in-patient voice treatment due to varying types of dysphonia. After imputation of missing items but not missing questionnaires, 255 patients were eligible for FESS evaluation, 313 for VHI-12 evaluation. The German questionnaire for the assessment of the voice self-concept (FESS) and the German 12-item short-form of the Voice Handicap Index (VHI-12) were administered at the beginning and at the end of the hospital stay. Before–after comparisons are made visually and via t test. Results The Voice Handicap was significantly reduced, demonstrating the effectiveness of the administered therapy. Of the three scales of the FESS, the relationship with one's own voice and the awareness of the use of one's own voice was increased and thus improved. The connection between voice and emotional changes decreased significantly but only slightly. Conclusion Conservative voice rehabilitation can not only reduce the voice handicap, but also improve the voice self-concept and the results can be measured.

The influence of vocal rehabilitation methods on communication in patients with total laryngectomy

BACKGROUND. Considering the problematic social integration after total laryngectomy, evaluation of communicational aptitudes of patients after the surgical intervention is necessary in order to optimize their vocal rehabilitation process. MATERIAL AND METHODS. A prospective clinical study was conducted on 24 randomly selected patients of the Otolaryngology Clinic of Targu Mures County Emergency Clinical Hospital that underwent total laryngectomy. We adapted and implemented the questionnaire for Self-Evaluation of Communication Experiences after Laryngectomy – SECEL. Three groups of patients were created: the first containing those with voice prosthesis, the second those using electrolarynx and esophageal voice, and the third with no rehabilitation. We used the Kruskal-Wallis test for the statistical analysis of the results. RESULTS. The mean age of the patients included in our study group was 63 years (+/− 7.56 SD). 95.83% of the participants were male. 79.16% were married. The majority (87.50%) of patients were retired. In 75% of cases, 0 to 5 years have passed since the surgery. 75% reported diminished communication after surgery. The test used to determine if significant differences were present between the examined groups showed a p-value of 0.1329 (total scores), p-value of 0.3244 (the first score of SECEL), p-value = 0.6004 (the second score of SECEL) and a p-value of 0.0613 (the third score of SECEL). Given that p was higher than 0.05, the null hypotheses could not be rejected. The patients who underwent rehabilitation by tracheoesophageal prosthesis showed the best results in all tested categories. CONCLUSION. The SECEL questionnaire adapted in Romanian language could be used as a valid screening instrument in order to improve voice rehabilitation, but it needs further testing.