Dysphonia and dysphagia after anterior cervical decompression.

OBJECT: In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. METHODS: The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology-Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. RESULTS: Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. CONCLUSIONS: Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD. Recurrent laryngeal nerve damage detected by EMG is not rare. Pre-and postoperative laryngeal examination of ACD patients should be considered.

Automatic speaking valve in speech rehabilitation for laryngectomized patients.

For speech rehabilitation after total laryngectomy, the Provox FreeHands Heat and Moisture Exchanger (FreeHands HME; Atos Medical AB, Hörby, Sweden) was compared with the Provox Heat and Moisture Exchanger (HME), and the patients' Health-Related Quality of Life (HRQoL) was assessed. A review of the English literature was performed considering automatic speaking valves. The study design was a cohort study. Fourteen laryngectomized male patients who had used the HME successfully before receiving the FreeHands HME entered the study. An ENT specialist and a speech pathologist examined these patients. Data concerning voicing, breathing, skin adhesion, voice and speech quality, and HRQoL were collected by a structured questionnaire. Voice recordings were performed for evaluation of the quality of the voice. A computer-aided search of the MED-LINE database was conducted, supplemented by hand searches of key journals. Twelve patients had used the FreeHands HME on special social occasions and reported three main reasons why FreeHands HME was unsuitable for continuous use: heavier breathing, more difficult speaking, and worse subjective quality of voice. With HME, phonation time tended to be longer and the softest phonation softer ( P =0.034). The loudest phonation was louder with FreeHands HME ( P =0.015). Patients' HRQoL assessed by the 15D profile was similar to that of the age- and sex-matched male Finnish general population (patients 0.877, population 0.884). A review of the literature showed few works dealing with automatic speaking valves. The FreeHands HME is a useful additional device in a selected group of laryngectomized patients. Total laryngectomy did not lower patients' HRQoL notably.

Postlaryngectomy voice restoration using a voice prosthesis: a single institution's ten-year experience.

We describe the speech rehabilitation outcome of patients treated with total laryngectomy or total laryngopharyngectomy and insertion of Provox voice prostheses (Atos Medical AB, Hörby, Sweden) at the Helsinki University Central Hospital. We performed a retrospective chart review of 95 patients (88 men and 7 women; mean age, 63.5 years) who underwent insertion of a voice prosthesis in the period 1992 to 2002. Eighty-one percent (77/95) of the patients underwent a primary prosthesis insertion at the time of laryngectomy. A head and neck surgeon, a laryngologist, and a speech therapist rated the long-term tracheoesophageal speech of 78% (74/95) of the patients as good or average. The main causes for replacement of the device were obstruction, leakage or inadequate size of the prosthesis, and granulation or leakage around the fistula. According to our 10-year experience, use of the Provox prosthesis is an effective method of postlaryngectomy voice rehabilitation, and it continues to be our preferred method of voice restoration in the majority of cases.