Factors contributing to clinician training and development in the clinical area of laryngectomy and tracheoesophageal voice.

BACKGROUND: It has long been recognized that tracheoesophageal speech (TES) rehabilitation after laryngectomy is a specialized area of practice for speech and language therapist (SLTs) due to the complex nature of patient presentation and the invasive components of the SLT's role in this area. Therefore, postgraduate experience and training is required to work competently and safely in this clinical area. However, it is generally acknowledged that the steps and processes followed by individual clinicians to achieve this training and clinical skill development are inconsistent and vary widely across services. There is a need to identify critical elements deemed most beneficial to clinical skill development in order to inform future training models. AIMS: To explore clinicians' perceptions of factors that contribute to training and clinical skills development in the area of TES rehabilitation post-laryngectomy. METHODS & PROCEDURES: All participants were SLTs working in an Australian clinical service, with a current or recent clinical caseload that included patients using TES. A total of 36 SLTs were recruited and then grouped by level of experience (novice n = 15, intermediate n = 7, experienced n = 14). Each participant took part in one small focus group with other participants of similar experience level. Ten focus groups were conducted, each of approximately 60 min in duration. A semi-structured interview guide was used to facilitate the discussion of issues relating to training in this area. Thematic analysis was used to analyse transcripts and identify themes. OUTCOMES & RESULTS: Interviews identified six key themes, including: Learning with and from others; Formal programmes; Hands-on learning; Processes that influence training; and Individual influences. SLTs reported both positive issues and elements that were challenging across all five themes. The final (sixth) theme was identified regarding clinician perceptions of how this area differed to specialized training in other areas of the profession. The majority of themes were discussed equally by clinicians across all three experience levels. CONCLUSIONS & IMPLICATIONS: Participants across all experience levels identified that multiple factors contributed to clinicians successfully gaining skills, understanding and competency when working in TES rehabilitation post-laryngectomy. These factors, when fully considered and incorporated into future SLTs training pathways and opportunities, have the potential to optimize competency, skill acquisition and maintenance in this area. What this paper adds What is already known on this subject While studies have considered the training, preparation and knowledge base of SLTs working in the clinical area of TES, the focus has predominantly been at the immediate postgraduate level or assessment of university course work. No studies have used a qualitative methodology to consider the reflections and perceptions of clinicians' training pathways and training needs across all levels of experience for this clinical area. What this paper adds to existing knowledge The results of this study build upon the existing body of literature regarding education and training in this area, determining factors SLTs feel are required to successfully gain skills, understanding and competency when working in TES rehabilitation. The findings highlight that training pathways and methods in this clinical area are an ongoing consideration for SLTs regardless of experience level and have the ability to impact on future competency programmes, training opportunities and delivery methods in this area. What are the potential or actual clinical implications of this work? Effective and ongoing postgraduate training programmes and professional development opportunities have the potential to positively impact on professional competence and confidence, patient safety and overall service delivery. Hence, the themes generated from this research highlight essential factors to include within training and professional development programmes for SLTs in TES rehabilitation. This information can be used to help optimize current training pathways for all experience levels.

Influence of Collective Esophageal Speech Training on Self-efficacy in Chinese Laryngectomees: A Pretest-posttest Group Study.

Total laryngectomy affects the speaking functions of many patients. Speech deprivation has great impacts on the quality of life of patients, especially on self-efficacy. Learning esophageal speech represents a way to help laryngectomees speak again. The purpose of this study was to determine the influence of collective esophageal speech training on self-efficacy of laryngectomees. In this study, 28 patients and 30 family members were included. The participants received information about training via telephone or a WeChat group. Collective esophageal speech training was used to educate laryngectomees on esophageal speech. Before and after collective esophageal speech training, all participants completed the General Self-Efficacy Scale (GSES) to assess their perceptions on self-efficacy. Through the training, laryngectomees recovered their speech. After the training, the self-efficacy scores of laryngectomees were higher than those before the training, with significant differences noted (T<0.05). However, family members' scores did not change significantly. In conclusion, collective esophageal speech training is not only convenient and economical, but also improves self-efficacy and confidence of laryngectomees. Greater self-efficacy is helpful for laryngectomees to master esophageal speech and improve their quality of life. In addition, more attention should be focused on improving the self-efficacy of family members and making them give full play to their talent and potential on laryngectomees' voice rehabilitation.

Novel esophageal speech therapy method in total laryngectomized patients: biofeedback by intraesophageal impedance.

The loss of the best communication port after total laryngectomy surgery makes speech rehabilitation an important goal. Our aim was to improve the quality of esophageal speech (ES) using online esophageal multichannel intra-luminal impedance (MII) as a new biofeedback method. Twenty-six total laryngectomized patients were included. Before ES therapy, an esophageal motility test was carried out. MII catheters were placed in all subjects who were then randomized into two groups. Group 1 included 13 cases, who were retrained according to the classical method. Group 2 included 13 cases, who were retrained according to the simplified animation of air movements within the esophagus and upper stomach resulting from the modifications of intra-esophageal air kinetics gained by MII. The level of speech proficiency was evaluated relative to pretraining levels using perceptual scales in the third and sixth months. Acoustic voice was analyzed. The number of syllables read per minute and the intelligibility of monosyllabic and dissyllabic words were calculated. In this study, MII was used for the first time in alaryngeal speech rehabilitation as a biofeedback method; an overall sufficient speech level was achieved by 68.4% at the end of therapy, whereas attendance was 90%. A statistically significant improvement was found in both groups in terms of ES level compared with the pretraining period although there was no significant difference between groups. Although we did not observe the expected difference between groups suggested by our hypothesis, MII may be used as an objective tool to show patients how to swallow and regurgitate air during training, and may thus expedite ES therapy both for the speech therapist and the patient in the future.

[Larynx cancer: quality of life and voice after treatment]. / Câncer de laringe: qualidade de vida e voz pós-tratamento.

INTRODUCTION: Treatments for patients with laryngeal cancer often have an impact on physical, social, and psychological functions. OBJECTIVE: To evaluate quality of life and voice in patients treated for advanced laryngeal cancer through surgery or exclusive chemoradiation. METHODS: Retrospective cohort study with 30 patients free from disease: ten total laryngectomy patients without production of esophageal speech (ES); ten total laryngectomy patients with tracheoesophageal speech (TES), and ten with laryngeal speech. Quality of life was measured by SF-36, Voice-Related Quality of Life (V-RQOL), and Voice Handicap Index (VHI) protocols, applied on the same day. RESULTS: The SF-36 showed that patients who received exclusive chemoradiotherapy had better quality of life than the TES and ES groups. The V-RQOL showed that the voice-related quality of life was lower in the ES group. In the VHI, the ES group showed higher scores for overall, emotional, functional, and organic VHI. DISCUSSION: Quality of life and voice in patients treated with chemoradiotherapy was better than in patients treated surgically. CONCLUSION: The type of medical treatment used in patients with laryngeal cancer can bring changes in quality of life and voice.

Larynx cancer: quality of life and voice after treatment / Câncer de laringe: qualidade de vida e voz pós-tratamento

INTRODUCTION: Treatment for patients with larynx cancer often results in a negative impact on their physical, social and psychological functions. OBJECTIVE: To evaluate quality of life and voice in patients treated for advanced laryngeal cancer as a consequence of surgery or exclusive chemoradiation. METHODS: Retrospective cohort study with 30 patients free of disease: 10 total laryngectomy patients without production of esophageal speech (EVS); 10 Total laryngectomy patients with tracheoesophageal voice (TEV) and 10 patients with laryngeal voice. Quality of life was measured by SF-36; Voice-Related Quality of Life (V-RQOL) and Voice Handicap Index (VHI) protocols, applied on the same day. RESULTS: The SF-36 demonstrated that patients who received chemoradiotherapy exclusively enjoyed a feature better quality of life than the group of TEV and EVS. In V-RQOL it was observed that the quality of life related to voice is lower than in the EVS. In the VHI group EVS presented higher scores for overall VHI, emotional, functional and organic. DISCUSSION: Quality of life and voice in patients treated with chemoradiotherapy was better than in patients treated surgically. CONCLUSION: The type of medical treatment selected in patients with laryngeal cancer can influence changes in quality of life and voice. .

INTRODUÇÃO: Tratamentos para pacientes com câncer de laringe podem ter grande impacto negativo na função física, social e psicológica. OBJETIVO: Avaliar qualidade de vida e voz de pacientes tratados de câncer avançado de laringe por meio cirúrgico ou quimioradioterapia exclusiva. MÉTODOS: Estudo coorte retrospectivo com 30 pacientes livres da doença: sendo 10 laringectomizados totais sem produção de voz esofágica (SVE); 10 laringectomizados totais com voz traqueoesofágica (VTE) e 10 com voz laríngea. A qualidade de vida foi mensurada pelos protocolos SF-36; Qualidade de Vida em Voz (QVV) e Índice de Desvantagem Vocal (IDV), aplicados no mesmo dia. RESULTADOS: No SF-36, observou-se que pacientes que receberam quimioradioterapia exclusiva apresentaram melhor qualidade de vida do que o grupo de VTE e SVE. No QVV observou-se que a qualidade de vida relacionada à voz é menor no grupo SVE. No IDV grupo, SVE apresentou escore maior para IDV total, emocional, funcional e orgânica. DISCUSSÃO: Qualidade de vida e voz dos pacientes tratados com quimioradioterapia e melhor do que os pacientes tratados cirurgicamente. CONCLUSÃO: O tipo de tratamento médico utilizado em pacientes com câncer de laringe pode trazer alterações na qualidade de vida e voz. .

Listener effort for highly intelligible tracheoesophageal speech.

UNLABELLED: The purpose of this study was to determine whether: (a) inexperienced listeners can reliably judge listener effort and (b) whether listener effort provides unique information beyond speech intelligibility or acceptability in tracheoesophageal speech. Twenty inexperienced listeners made judgments of speech acceptability and amount of effort required to listen to 14 male tracheoesophageal speakers using a paired comparison paradigm. Intelligibility was controlled to limit the analysis to the relationship between ratings of listener effort and speech acceptability. Results showed that as a group, inexperienced listeners reliably rated both speech acceptability and listener effort. In addition, ratings of speech acceptability and listener effort were strongly correlated (r>.99); however, there was evidence that some individual listeners assigned different ratings for each dimension for the same speech samples. Results have important implications for communication success for tracheoesophageal speakers. LEARNING OUTCOMES: Readers will be able to describe: (a) the measurement of listener burden in speech and (b) the differences and relationships among listener effort, speech acceptability and speech intelligibility.

[The role of sex in voice restoration and emotional functioning after laryngectomy]. / Die Rolle des Geschlechts bei stimmlicher Rehabilitation und emotionalem Befinden nach Laryngektomie.

BACKGROUND: Data on psychosocial factors of laryngectomized women is rare. All means of alaryngeal voice production sound male due to low fundamental frequency and roughness, which makes postlaryngectomy voice rehabilitation especially challenging to women. Aim of this study was to investigate whether women use alaryngeal speech more seldomly and therefore are more emotionally distressed. MATERIAL AND METHODS: In a cross-sectional multi-centred study 12 female and 138 male laryngectomees were interviewed. To identify risc factors on seldom use of alaryngeal speech and emotional functioning, logistic regression was used and odds ratios were adjusted to age, time since laryngectomy, physical functioning, social activity and feelings of stigmatization. RESULTS: Esophageal speech was used by 83% of the female and 57% of the male patients, prosthetic speech was used by 17% of the female and 20% of the male patients and electrolaryngeal speech was used by 17% of the female and 29% of the male patients. There was a higher risk for laryngectomees to be more emotionally distressed when feeling physically bad (OR=2,48; p=0,02) or having feelings of stigmatization (OR=3,94; p≤0,00). Besides more women tended to be socially active than men (83% vs. 54%; p=0,05). CONCLUSIONS: There was no influence of sex neither on use of alaryngeal speech nor on emotional functioning. Since there is evidence for a different psychosocial adjustment in laryngectomized men and women, more investigation including bigger sample sizes will be needed on this special issue.

The voice handicap index with post-laryngectomy male voices.

BACKGROUND: Surgical treatment for advanced laryngeal cancer involves complete removal of the larynx ('laryngectomy') and initial total loss of voice. Post-laryngectomy rehabilitation involves implementation of different means of 'voicing' for these patients wherever possible. There is little information about laryngectomees' perception of their changed voice quality and communication status. Surgical voice restoration (SVR) has become the 'gold standard' rehabilitation, but there continue to be patients who use other methods of communication. There is no clear evidence comparing patients' perception of their voice handicap across different types of alaryngeal communication. AIMS: To compare the self-assessed vocal handicap of laryngectomees using SVR with those using non-SVR methods of post-laryngectomy communication. METHODS & PROCEDURES: Potential participants were identified from one Head and Neck cancer centre in South Wales. They included both male and female participants using all methods of post-laryngectomy communication. Each patient's Voice Handicap Index (VHI) score, sub-set scores, and group means were calculated. Two major confounding factors: age and time since surgery, and communication method (SVR/non-SVR), were considered to identify factors, other than method of communication, which may influence rehabilitation outcomes. OUTCOMES & RESULTS: A total of 71 questionnaires were sent out and 62 (82%) were returned from 35 patients who had undergone SVR and 27 patients who used non-SVR methods of communication. Of the non-SVR group, twelve used oesophageal voice, eleven an electrolarynx, two writing and two mouthing for communication. The gender ratio (53:9), age (43-90 years) and time since surgery (1-40 years) were broadly representative of this population, but because of the small number of females, we excluded the women from further analysis. Individual VHI scores ranged from 4 to 106. Both the SVR and non-SVR group mean scores: 44.7 and 50.9, were within the range of moderately severe voice handicap. There was no significant difference between the groups for total VHI scores or two of the three sub-domains, nor any significant effect on voice handicap due to the confounding factors assessed: age or time since surgery. The total VHI score was better by 6.5 ( - 4.9 to 17.9) points in the SVR group (p = 0.3), probably reflecting the literature reporting superior voice in SVR. CONCLUSIONS & IMPLICATIONS: The data suggest that where patient-assessed quality of life is concerned, SVR and non-SVR outcomes are comparable. This is an important consideration when planning and carrying out treatment recommendations. The study has clear clinical implications; understanding the potential of all methods of post-laryngectomy communication is essential for holistic patient management.

An acoustical and perceptual study of vowels produced by alaryngeal speakers of Cantonese.

OBJECTIVE: The present study determines the acoustical and perceptual differences between alaryngeal and laryngeal speakers of Cantonese in the production of Cantonese vowels. SUBJECTS AND METHODS: Formant frequencies (F1 and F2) associated with eight Cantonese vowels [see text] produced by 40 alaryngeal (10 esophageal, 10 tracheoesophageal, 10 with pneumatic artificial larynx, 10 electrolaryngeal) and 10 laryngeal speakers were obtained. To assess how formants affect vowel perception, the vowels were identified by 20 naïve listeners, based on which confusion matrices were established. RESULTS: Spectral analysis revealed that F1 and F2 values of Cantonese vowels produced by the alaryngeal speakers were significantly higher than those produced by laryngeal speakers, with the exception of F2 of [see text], /i/ and /y/ produced by alaryngeal speakers using pneumatic artificial larynx, and [see text] produced by electrolaryngeal speakers. CONCLUSION: The acoustic findings suggest a general shortening of the effective vocal tract length for resonance in alaryngeal speakers after laryngectomy. Percent correct identification of vowels from the perceptual experiment indicated similar error patterns in vowel identification between alaryngeal and laryngeal speaker groups. Among the different alaryngeal speaker groups, naïve listeners tended to perceive the vowels produced by electrolaryngeal speakers more accurately.

Formant characteristics of vowels produced by Mandarin esophageal speakers.

With the use of the pharyngoesophageal (PE) segment as the neoglottis in esophageal speakers, their voice quality becomes significantly different from that of laryngeal speakers. The present study investigated the characteristics of the vocal tract resonance in Mandarin esophageal speakers. The first three formant frequencies of vowels /a, epsilon, i, [see in text], u, y/ produced by seven superior esophageal and seven laryngeal speakers of Mandarin were obtained. For each formant, the formant frequencies measured from the medial 80% of the vowel portion were averaged, and data obtained from esophageal speakers were compared with that obtained from laryngeal speakers. The results indicated that esophageal speakers were associated with significantly higher formant frequencies (F(1), F(2), and F(3)) and a significantly diminished vowel space circumscribed by the three corner vowels /i/, /a/, and /u/ when compared with laryngeal speakers. The findings that formant frequency changes across vowels were systematic and similar for esophageal and laryngeal speakers are consistent with those previously reported in English. It can be concluded that vocal tract transmission has been changed in esophageal speakers of Mandarin after laryngectomy.

Electroglottographic and perceptual evaluation of tracheoesophageal speech.

To optimize tracheoesophageal (TO) speech after total laryngectomy, it is vital to have a robust tool of assessment to help investigate deficiencies, document changes, and facilitate therapy. We sought to evaluate and validate electroglottography (EGG) as an important tool in the multidimensional assessment of TO speech. This study is a cross-sectional study of the largest cohort of TO speakers treated by a single surgeon. A second group of normal laryngeal speakers served as a control group. EGG analysis of both groups using connected speech and sustained vowels was performed. Two trained expert raters undertook perceptual evaluation using two accepted scales. EGG measures were then analyzed for correlation with treatment variables. A separate correlation analysis was performed to identify EGG measures that may be associated with perceptual dimensions. Our data from EGG analysis are similar to data obtained from conventional acoustic signal analysis of TO speakers. Sustained vowel and connected speech parameters were poorer in TO speakers than in normal laryngeal speakers. In perceptual evaluation, only grade (G) of the GRBAS scale and Overall Voice Quality appeared reproducible and reliable. T stage, pharyngeal reconstruction and method of closure, cricopharyngeal myotomy, and postoperative complications appear to be correlated with the EGG measures. Five voice measures-jitter, shimmer, average frequency, normalized noise energy, and irregularity-correlated well with the key dimensions of perceptual assessment. EGG is an important assessment tool of TO speech, and can now be reliably used in a clinical setting.

Fundamental frequency and gender identification in standard esophageal and tracheoesophageal speakers.

UNLABELLED: The purpose of this study was to determine if there was a relationship between fundamental frequency (Fo) and gender identification in standard esophageal (ES) or tracheoesophageal (TE) speakers. Twenty-three male and 20 female ES and TE speakers participated in this study. Recordings of these speakers reading the Rainbow Passage were played to 48 listeners who indicated perceived gender in a forced choice format. Fo was determined using PC-AUDED [Boston University (1991). Using PC-AUDED, Audio-editor and analyses program for the study of periodic segments. Boston: Boston University]. Seventy-nine percent of the speakers were identified correctly for gender. No significant difference was found between the number of male and female or TE and ES speakers identified correctly. A significant correlation was found between Fo and correct gender identification for the female speakers only. Results suggest that Fo plays a part in gender identification for female SE and TE speakers, however, other factors may also be important cues for gender identification in these speakers. LEARNING OUTCOMES: As a result of this activity, the participant will be able to: (1) describe the relationship between Fo and gender identification for male and female standard esophageal (SE) and tracheoesophageal (TE) speakers (2) discuss other variables that may influence gender identification in SE and TE speakers.

[Relevance of psychosocial factors in speech rehabilitation after laryngectomy]. / Bedeutung psychosozialer Faktoren bei der Stimmrehabilitation nach Laryngektomie.

BACKGROUND: Often it is assumed that psychosocial and sociodemographic factors cause the success of voice rehabilitation after laryngectomy. Aim of this study was to analyze the association between these parameters. METHODS: Based on tumor registries of six ENT-clinics all patients were surveyed, who were laryngectomized in the years before (N = 190). Success of voice rehabilitation has been assessed as speech intelligibility measured with the postlaryngectomy-telephone-intelligibility-test. For the assessment of the psychosocial parameters validated and standardized instruments were used if possible. Statistical analysis was done by multiple logistic regression analysis. RESULTS: Low speech intelligibility is associated with reduced conversations (OR 0.970) and social activity (OR 1.049). Patients are more likely to talk with esophageal voice when their motivation for learning the new voice was high (OR 7.835) and when they assessed their speech therapist as important for their motivation (OR 4.794). The risk to communicate merely by whispering is higher when patients live together with a partner (OR 5.293), when they talk seldomly (OR 1.017) and when they are not very active in social contexts (OR 0.966). CONCLUSIONS: Psychosocial factors can only partly explain how voice rehabilitation after laryngectomy becomes a success. Speech intelligibility is associated with active communication behaviour, whereas the use of an esophageal voice is correlated with motivation. It seems that the gaining of tracheoesophageal puncture voice is independent of psychosocial factors.

[Use of adaptive devices by laryngectomees]. / Nutzung ausgewählter Hilfsmittel durch Laryngektomierte.

AIMS: This study is directed at the following questions: How many laryngectomees are using which adaptive devices how often? Which devices are they lacking? Which alaryngeal voice has the best results in terms of intelligibility? METHODS: 218 patients operated on in 6 ENT-clinics in Eastern Germany over the last 25 years were interviewed in person. Items from a German questionnaire for psychosocial adjustment after laryngectomy (FPAL) and from the quality of life questionnaire EORTC QLQ-H&N35 were used. Voice intelligibility was measured by an objective test, the Postlaryngectomy-Telephone-Intelligibility-Test (PLTT). RESULTS: The most common communication method in this group is the esophageal voice, only 20% use voice prostheses regularly, and 15% of the patients use electronic devices. 87% of the laryngectomees wear scarves to protect their stoma, and 82% use inhalers. Several patients lack tools for communication, some for protection of the tracheostoma and others devices for showering and swimming. The best speech results are gained with voice prostheses. Health related Quality of Life shows only poor correlation with the use of adaptive devices. CONCLUSION: In general the health care for laryngectomees in terms of device use can be seen as relatively good but not as optimal. Problematic is the fact that 15.5% of the patients could not acquire an adequate voice, that some devices are missed by patients despite the fact that they are available for purchase, and that some patients do not care for their tracheostoma. It could be useful to consider these findings within medical consultations.

Communication strategies and interpersonal skills of instructors of esophageal speech: an observation study.

OBJECTIVE: In this article, the way that the Instructor of Esophageal Speech (IES) works is considered from an interactive-analytic perspective. METHODS: The observation project data were gathered during 6 months in 2004 at the training sessions of the Ginreikai-Asian Federation of Laryngectomees' Association using the Six Category Intervention Analysis framework (6CIA) by a trained communication specialist as an active-observer. RESULTS: Mean scores of each of the six categories and a series of percentage distributions were extracted from the usage-frequency data and interpreted together with the results of Chi-square analysis of usage-frequency units. We found the IES used more frequently authoritative categories and used less facilitative categories. Our results of the data analysis show that the 30 IES used more authoritative interventions and used more frequently the prescription and information giving than the confrontation or cathartic interventions. CONCLUSION: The results of the present study show that the 6CIA framework has its potential and value as an analytic tool to explore the IES' actual behavior in a specific therapy related context. PRACTICE IMPLICATIONS: We argue for the utility of the 6CIA as an analytic framework to investigate the interpersonal behavior of the IES in the Japanese cultural setting.

Scaling of voice pleasantness and acceptability in tracheoesophageal speakers.

The purpose of this study was (1) to determine the psychophysical character of auditory-perceptual ratings of voice pleasantness (VP) and voice acceptability (VA) for tracheoesophageal (TE) speakers using direct magnitude estimation (DME) and equal-appearing interval (EAI) scaling procedures and (2) to determine the relationship between listeners' ratings of VP and VA. Ten adult listeners judged overall VP and VA from connected speech samples produced by 20 adult male TE speakers. Although results yielded a prothetic continuum for VP and a metathetic continuum for VA, the amount of variance accounted for by a curvilinear model of VP was minimally more than that accounted for by a linear model. Results also revealed a significant relationship between VP and VA (r = 0.939). Findings from this study do not suggest any greater validity associated with VP and VA ratings obtained by the DME than the EAI method. As a result of the significant relationship between these ratings and to the ease of applying EAI scales, it is recommended that VA be used as a current clinical outcome measure. These data illustrate the need to identify attributes that best describe TE speech that are measured appropriately and are clinically useful.

Quality of life in male tracheoesophageal (TE) speakers.

For this study, we determined the quality of life (QOL) in individuals who had undergone total laryngectomy (TL) and who used tracheoesophageal (TE) speech as their primary method of postlaryngectomy communication. We also descriptively compared present QOL outcomes with those found in an extension of the Department of Veterans Affairs' (VA) Laryngeal Cancer Study. Thirty laryngectomized men with TE speech as their primary mode of communication were recruited for participation in the investigation. Participants completed a general information form as well as the University of Michigan Head and Neck Quality of Life (HNQOL) instrument. Results revealed a high level of self-perceived QOL in the domains of communication, eating, pain, and emotion that was empirically better than results found in a previous study involving individuals who had undergone TL and who were treated in VA hospitals. Possible reasons for the improved self-reported QOL among individuals in the present group include use of TE speech for postlaryngectomy communication, a higher level of education, and membership in a support group. The results suggest to us that these factors should be considered in postlaryngectomy care in the veteran population to optimize rehabilitation outcomes.

[Quality of life and voice handicap of laryngectomees using tracheoesophageal substitute voice]. / Lebensqualität und Stimmbeeinträchtigung Laryngektomierter mit Stimmventilprothesen.

BACKGROUND: Health-related quality of life (QoL) and subjective health have become popular constructs for the evaluation of both efficacy and efficiency of diagnostic and therapeutic procedures in medicine. QoL is considered a multidimensional construct encompassing physical, mental and social facets of life. It is an accepted outcome parameter not only in international classification systems such as ICIDH and ICF, but as well in clinical guidelines and disease management programs. Measuring quality of life allows for comparison of different diseases though it certainly lacks disease specific aspects. Thus, it has to be assumed that in patients with distinct functional deficits QoL cannot cover all aspects that are important for the individual patient. This study focuses on laryngectomies and their self-evaluation of post-laryngectomy speech. It is well known that these patients experience a decreased QoL compared to patients after partial laryngectomy or healthy persons. In this study, the impact of voice restoration on the laryngectomies' QoL was evaluated. PATIENTS AND METHODS: In 20 male laryngectomies aged 62 +/- 8 years, relations between QoL and voice handicap were evaluated using two instruments as proposed in the international literature, i. e. the Short-Form Health Survey (SF-36) and the Voice Handicap Index (VHI). All patients had successfully been using tracheoesophageal substitute voice for at least one year. Complete data sets were available from all patients. Data were analysed using Microsoft Excel and Sigma Plot, Jandel Corp. software packages. RESULTS: Results of both the SF-36 and the VHI reveal wide interindividual ranges. There are statistically significant correlations (p < 0.05) between the SF-36's scales General Health and Vitality and the VHI, whereas no correlations were found between social and psychological scales and the voice handicap. DISCUSSION: Wide ranges of the data obtained reveal that obviously both health related quality of life and voice handicap are not affected in a group specific way. So, both tests are of clinical value to depict individual aspects of wellbeing after laryngectomy. The combination of VHI and SF-36 illuminates correlations between general and special subjective aspects. Strikingly, the laryngectomies' social and psychological status is not related to their voice handicap. Data allow for conclusion that laryngectomies' substitute voice problems do not affect social aspects of quality of life in a disease specific way, at least as long as voice restoration was successful at all.

Voice handicap of laryngectomees with tracheoesophageal speech.

The evaluation of diagnostics and therapies includes more and more subjective, i.e. emotional and social aspects. Focussing on the handicap experienced by dysphonic patients, the Voice Handicap Index (VHI) has previously been found to be of significant clinical and scientific value for different voices. In this study the VHI questionnaire was applied to demonstrate the voice handicap of 20 male laryngectomees using tracheoesophageal voice (Provox), aged 65.5 +/- 8.7 years. Their VHI was 45.5 +/- 24.1, which was significantly higher than the score of patients with functional voice disorders, but differed only slightly from patients with organic laryngeal dysphonia. Focussing on individual data, VHI scores ranged from values similar to persons without voice disorder to maximum handicap of 101. Comparing the VHI scores with the laryngectomees' gradual self-perception of voice disorder severity, no consistent relationship was found. Considering the large interindividual differences, the VHI may serve as a valuable instrument for the assessment of individual interventional needs rather than for the identification of a general laryngectomees' handicap.

Pre- and post-operative counseling for laryngectomees and their spouses: an update.

This survey was developed to determine if pre-operative counseling services have improved since the 1978 Keith, Linebaugh, and Cox study. The questions were aimed to obtain information on the quality and quantity of support services available to laryngectomees and their spouses. Questions addressed the type, amount, and content of information received. In addition, questions regarding post-operative counseling services for laryngectomees and spouses of laryngectomees also were included. Results indicated that 21% of the laryngectomees were not aware that laryngectomy surgery would result in loss of voice. In addition, not all speech rehabilitation options were explained to the patients. Pre- and post-operative counseling services for laryngectomees continue to be inadequate. It appears that little change has been made to improve this situation.