Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments.

OBJECTIVE: The aim of this study was to correlate several instruments currently used for the assessment of the quality of life of patients who underwent total laryngectomy and speech rehabilitation. METHODS: A cross-sectional, observational study was conducted with 38 patients after total laryngectomy and speech therapy aiming to develop oesophageal speech. The patients were divided into the following two groups (19 participants each): speakers and non-speakers. The quality of life instruments used were as follows: visual analogue scale (VAS); Voice Handicap Index (VHI); Voice-Related Quality of Life (V-RQOL); Functional Assessment of Cancer Therapy - Head & Neck (FACT-H&N); European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck (EORTC QLQ-H&N35); and University of Washington Quality of Life (UW-QOL). RESULTS: The V-RQOL global health domain exhibited a strong correlation with the VHI. The EORTC QLQ-C30 exhibited a moderate to strong correlation with the EORTC QLQ-H&N35 functional domain in both groups. The EORTC QLQ-C30 functional domain exhibited a strong to moderate correlation with all other instruments in both groups. The UW-QOL exhibited a moderate to strong correlation with the VHI and EORTC QLQ-C30 in both groups. CONCLUSION: The EORTC QLQ-C30, EORTC QLQ-H&N35 and UW-QOL were the instruments that most correlated with the remaining instruments, indicating that any of the three can be used to assess the quality of life of the target population regardless of oesophageal voice development.

Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments

OBJECTIVE: The aim of this study was to correlate several instruments currently used for the assessment of the quality of life of patients who underwent total laryngectomy and speech rehabilitation. METHODS: A cross-sectional, observational study was conducted with 38 patients after total laryngectomy and speech therapy aiming to develop oesophageal speech. The patients were divided into the following two groups (19 participants each): speakers and non-speakers. The quality of life instruments used were as follows: visual analogue scale (VAS); Voice Handicap Index (VHI); Voice-Related Quality of Life (V-RQOL); Functional Assessment of Cancer Therapy - Head & Neck (FACT-H&N); European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck (EORTC QLQ-H&N35); and University of Washington Quality of Life (UW-QOL). RESULTS: The V-RQOL global health domain exhibited a strong correlation with the VHI. The EORTC QLQ-C30 exhibited a moderate to strong correlation with the EORTC QLQ-H&N35 functional domain in both groups. The EORTC QLQ-C30 functional domain exhibited a strong to moderate correlation with all other instruments in both groups. The UW-QOL exhibited a moderate to strong correlation with the VHI and EORTC QLQ-C30 in both groups. CONCLUSION: The EORTC QLQ-C30, EORTC QLQ-H&N35 and UW-QOL were the instruments that most correlated with the remaining instruments, indicating that any of the three can be used to assess the quality of life of the target population regardless of oesophageal voice development.

Combined Vocal Exercises for Rehabilitation After Supracricoid Laryngectomy: Evaluation of Different Execution Times.

INTRODUCTION: The supracricoid partial laryngectomy allows the preservation of laryngeal functions with good local cancer control. OBJECTIVE: To assess laryngeal configuration and voice analysis data following the performance of a combination of two vocal exercises: the prolonged /b/vocal exercise combined with the vowel /e/ using chest and arm pushing with different durations among individuals who have undergone supracricoid laryngectomy. METHODS: Eleven patients undergoing partial laryngectomy supracricoid with cricohyoidoepiglottopexy (CHEP) were evaluated using voice recording. Four judges performed separately a perceptive-vocal analysis of hearing voices, with random samples. For the analysis of intrajudge reliability, repetitions of 70% of the voices were done. Intraclass correlation coefficient was used to analyze the reliability of the judges. For an analysis of each judge to the comparison between zero time (time point 0), after the first series of exercises (time point 1), after the second series (time point 2), after the third series (time point 3), after the fourth series (time point 4), and after the fifth and final series (time point 5), the Friedman test was used with a significance level of 5%. The data relative to the configuration of the larynx were subjected to a descriptive analysis. RESULTS: In the evaluation, were considered the judge results 1 which have greater reliability. There was an improvement in the general level of vocal, roughness, and breathiness deviations from time point 4 [T4]. CONCLUSION: The prolonged /b/vocal exercise, combined with the vowel /e/ using chest- and arm-pushing exercises, was associated with an improvement in the overall grade of vocal deviation, roughness, and breathiness starting at minute 4 among patients who had undergone supracricoid laryngectomy with CHEP reconstruction.

Impacto da videoendoscopia da deglutição na fonoterapia após tratamento de tumor de cabeça e pescoço / Impact of swallowing videoendoscopy in Speech therapy after treatment of head and neck tumor

Objetivo: Investigar mudanças na conduta terapêutica fonoaudiológica após resultados da vídeoendoscopia da deglutição (VED) de pacientes após cirurgia de tumor de cabeça e pescoço ou após tratamento exclusivo ou coadjuvante com radioterapia e quimioterapia. Métodos: Estudo retrospectivo, com coleta de dados de prontuário e análise de exame funcional. A amostra constou de 20 pacientes com disfagia moderada ou grave (11 homens e nove mulheres), com média de idade de 58 anos. Do total, 17 pacientes realizaram tratamento cirúrgico e três apenas radioquimioterapia. A VED foi realizada após o mínimo de três sessões de terapia fonoaudiológica para disfagia. Para análise do pós exame foi considerado igualmente o mínimo de três sessões de fonoterapia. Os dados coletados foram relacionados à classificação de deglutição no período terapêutico baseado na Functional Communication Measures - Swallowing (ASHA-NOMs) (FCM), estratégias terapêuticas utilizadas quanto à consistência e manobras de deglutição, necessidade de outro exame funcional e encaminhamento médico. Os dados foram comparados nos momentos pré e pós VED. Resultados: Houve 25% de mudança na conduta fonoaudiológica pós VED; 50% de mudança na classificação FCM, dos quais 30% para maior grau; 70% de influência da VED nas estratégias terapêuticas - modificação em 30% quanto às consistências seguras; 30% no uso de manobras posturais, 25% em manobras de limpeza e 40% em manobras de proteção. Houve 25% de necessidade de outro exame funcional, sendo a videofluoroscopia o exame indicado; 10% foram encaminhados ao médico. Conclusão: Há impacto da VED na conduta fonoaudiológica, especialmente em relação às estratégias terapêuticas com predomínio de mudanças de consistência e manobras seguras.

Purpose: Investigate changes in speech therapy after Fiberoptic Endoscopy Evaluation of Swallowing (FEES) in patients after head and neck oncological treatment. Methods: retrospective study, based in collection and analysis of speech therapy and functional examination. The sample consisted of 20 patients (11 males and nine females), mean age 58 years. Of the total, 17 patients underwent surgical treatment and three only radiochemotherapy. The VED was performed after a minimum of three sessions of speech therapy for dysphagia. For analyzing the post test was also considered at least three speech therapy sessions. The data collected were related to the classification of swallowing during treatment based on the Functional Communication Measures - Swallowing (ASHA-NOMs) (FCM), therapeutic strategies related to consistency, swallowing maneuvers, functional test and physician evaluation. Data were compared for the pre and post FEES. Results: There was change 25% in speech behavior after FEES, 50% in the classification FCM, of which 30% to greater scale, 70% in therapeutic strategies - 30% in regard to safe consistencies, 30% the use of postural maneuvers, in 25% cleaning maneuvers and 40% protection maneuvers. There was 25% of the necessity of a functional examination, with the fluoroscopy examination indicated, 10% were referred to a doctor. Conclusion: There was impact of FEES on the speech therapy purpose, especially in relation to therapeutic strategies with predominant changes for consistency and safely operated.