Telephonic voice intelligibility after laryngeal cancer treatment: is therapeutic approach significant?

Substitution Voice Rehabilitation After Open Partial Horizontal Laryngectomy Through the Proprioceptive Elastic Method (PROEL): A Preliminary Study

OBJECTIVE

The aim was to investigate the efficacy of the Proprioceptive Elastic Method (PROEL) in the rehabilitation of the substitution voice after open partial horizontal laryngectomy (OPHL).

STUDY DESIGN

Prospective outcome study.

METHODS

Fifteen patients surgically treated by OPHL type II or type III for laryngeal cancer were recruited (experimental group). Each patient underwent a specific program of voice rehabilitation based on the PROEL method with the same speech and language pathologist. Acoustic-aerodynamic analysis: maximum phonation time (MPT); spectrographic classification (Titze's modified classification), perceptual analysis (INFVo rating scale) and self-assessments (SECEL questionnaire) were performed before the treatment (T0), after 3 months of rehabilitation (T1), and at the end of the 6-month rehabilitation program (T2). A control sample of other 15 patients who underwent OPHL type II or type III and who underwent a standard perioperative rehabilitation was randomly extracted from an historical database and compared to the experimental group.

RESULTS

Significative voice improvements between T0-T1 and T2 were found for acoustic, aerodynamic, perceptual, and self-assessments analysis in the experimental group. Significative differences were found between the experimental group at T2 and the control sample for aerodynamic, self-assessment, and perceptual analysis.

CONCLUSIONS

The results of the present study support PROEL method as an effective approach for substitution voice rehabilitation after OPHL type II and III. Randomized controlled trials on larger groups of patients are needed in future in order to compare PROEL with other rehabilitative approaches.

Diagnosis and Monitoring Value of Diffusion-Weighted Magnetic Resonance Imaging Using Neuroendocrine Analysis During Radiotherapy for Laryngeal Cancer

We used 1.5T magnetic resonance imaging (MRI) to investigate the role of semiquantitative parameters related to dynamic contrast-enhanced (DCE)-MRI and the apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in predicting and monitoring the efficacy of concurrent radiotherapy and chemotherapy for laryngeal cancer. The data from 58 patients with newly diagnosed laryngeal cancer who had been treated at our hospital from August 2016 to March 2018 were collected. The 58 patients included 56 men and 2 women, with a median age of 57 years. The pathologic examination of the biopsy specimens revealed squamous cell carcinoma. The time signal curve (TIC) of the tumor and related semiquantitative parameters was measured before, during (radiation dose, 50 Gy), and at the end of treatment (monitoring value after treatment). The results revealed that the TIC types and DCE-MRI-related semiquantitative parameters can predict the efficacy of concurrent chemoradiotherapy for laryngeal and hypopharyngeal cancer. Of the semiquantitative parameters, the signal enhancement ratio at 56 seconds had the greatest predictive value. Patients with TIC type I before treatment had a better prognosis than those with TIC type III. The pre-ADC value was not enough to predict the efficacy. The ADC value, DCE-MRI-related semiquantitative parameters, and their change before treatment had a certain effect in monitoring the changes in water molecule diffusion movement and hemodynamic changes after tumor treatment. However, these were not enough to predict the efficacy.

Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs

The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access.

Objective and subjective voice outcomes after total laryngectomy: a systematic review

Background

Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL).

Methods

A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers.

Results

Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes.

Conclusions

Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered.

Electronic supplementary material

The online version of this article (doi:10.1007/s00405-017-4790-6) contains supplementary material, which is available to authorized users.