Factors influencing clinical consistency and variability in voice prosthesis management.

PURPOSE: Anecdotally it is recognised that management of tracheoesophageal speech (TES) post-laryngectomy varies between speech language pathology (SLP) services and clinicians. This study reviewed patterns of practice for TES management to examine patterns of practice and explore factors influencing variability. METHOD: A national survey was completed by SLP's from clinical services which manage TES. This online survey examined demographic and caseload information, initial voice prosthesis (VP) placement and procedures, VP cleaning and care recommendations, humidification management, equipment and service provision, and service delivery options at each site. RESULT: Lead clinicians from 34 sites (85% response rate) responded. Most clinical practice regarding initial VP insertion and management, as well as the timing and delivery of voice rehabilitation was highly consistent. Patient use of antifungal medications, TES and associated equipment provision, humidification management immediately post-surgery and some aspects of initial VP insertion were variable between services. The nature of the clinical setting, equipment funding and level of research evidence influenced variability in practice. CONCLUSION: Variability exists in a number of aspects of practice across Australian services offering TES management. Sources of variability need to be addressed nationally to ensure there is consistent, quality care available for all patients.

Objective and subjective changes in voice quality after radiotherapy for early (T1 or T2, N0) laryngeal cancer: a pilot prospective cohort study.

BACKGROUND: Limited data exist on long-term voice quality after treatment for early laryngeal cancer. We report on the feasibility of establishing a dedicated service to assess changes after radiotherapy. METHODS: From June 1999 to December 2005, all patients referred for radical radiotherapy for early laryngeal cancers were invited to join a prospective cohort study. Subjective and objective voice quality tests were performed before and after treatment and at 3, 6, 12, and 24 months after treatment. RESULTS: Twenty-seven patients were screened for the study. Sufficient data were available for 15 (56%) patients. Both subjective and objective assessments improved significantly. CONCLUSIONS: This pilot study shows that it is possible to collect prospective voice quality data. There are both subjective and objective improvements in voice that persist to at least 2 years after radiotherapy. We propose the use of the methods described here to study voice outcomes in a lager cohort of patients treated with both surgery and radiotherapy.