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Migliorelli A, Natale E, Manuelli M, Ciorba A, Bianchini C, Pelucchi S, Stomeo F. Analysis of Tracheoesophageal Voice after Total Laryngectomy: A Single Center Experience. J Clin Med 2024; 13:4392. [PMID: 39124659 PMCID: PMC11313134 DOI: 10.3390/jcm13154392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/15/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Tracheoesophageal voice is the most commonly used voice rehabilitation technique after a total laryngectomy. The placement of the tracheoesophageal prosthesis can be performed at the same time as the total laryngectomy (primary placement) or in a second procedure after surgery (secondary placement). The purpose of this study is to analyze the substitution voice in patients with a tracheoesophageal prosthesis, considering the influence of radiotherapy and timing of prosthesis placement (primary or secondary) on voice quality. Methods: A retrospective analysis was conducted of all patients who received a tracheoesophageal phonatory prosthesis after a total laryngectomy was performed. We assessed whether patients received radiotherapy and whether they had a primary or secondary tracheoesophageal prosthesis. For the voice analysis, maximum phonation time (MPT), INFVo, SECEL, AVQI, CPPS, harmonic to noise ratio (HNR), unvoiced fraction (UVF), and number of voice breaks (NVB) were evaluated. Results: A total of 15 patients (14 males and 1 female) with a mean age of 71.8 years (SD ± 7.5) were enrolled. Eight had a primary prosthesis placement and five did not receive radiotherapy. INFVo parameters I and Vo were higher in patients with a primary placement of the phonatory prosthesis (p = 0.046 and p = 0.047). Patients who received the prosthesis secondarily had a higher mean CPPS and lower mean AVQI. Conclusions: A secondary placement of the prostheses seems to result in a minimal advantage in voice quality compared to a primary placement. Radiation therapy, on the other hand, has no effect on voice quality, according to these preliminary data.
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Affiliation(s)
- Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, via Aldo Moro 8, 44100 Ferrara, Italy
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Giorgi V, Apostolo G, Bertelè L. Treating Dystonia in a Soccer Player Through an Integrated Rehabilitative Approach: A Case Report. J Sport Rehabil 2024; 33:365-375. [PMID: 38702050 DOI: 10.1123/jsr.2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 02/24/2024] [Accepted: 03/19/2024] [Indexed: 05/06/2024]
Abstract
CONTEXT Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete's ability to perform. Due to a lack of data on the condition, it is difficult to diagnose and often overlooked, and no gold standard treatment has yet been defined. CASE PRESENTATION We present a rare and challenging case of sport-related dystonia that affected a 24-year-old male professional soccer player. The patient presented with severe rigidity and dystonia of the right lower-extremity, particularly the ankle and foot. The symptoms set on >1 year prior to the presentation to our outpatient clinic. He began to complain of stiffness and difficulty moving his lower limbs, especially his right leg, initially when playing soccer, but then also when walking normally. On presentation, he was unable to run and walked with difficulty, supporting his body weight only on the outside of his right foot. He also reported a motor trick and reverse motor trick involving the oral musculature in order to move his lower limb more freely. MANAGEMENT AND OUTCOMES An integrated rehabilitation approach based on postural rehabilitation, neuromuscular rehabilitation, and dental intervention was used to successfully treat this condition. The approach included: (1) postural rehabilitation with the Mézières-Bertelè method to reduce muscular stiffness, (2) neuromuscular re-education with Tai Chi exercises and electromyography-guided biofeedback, and (3) dental intervention and swallowing rehabilitation to limit impaired oral habits (due to the relationship between his impaired lower limb movements and motor tricks of the oral musculature). After 7 months of integrated rehabilitation, the patient returned to professional soccer. CONCLUSIONS This case report highlights the potential efficacy of an integrative rehabilitation approach for sports dystonia, particularly in cases where traditional treatments may not be effective. Such an approach could be considered a valuable option in the management of this rare, but debilitating, condition in athletes. Further research is needed to assess the effectiveness of this approach in larger populations.
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Affiliation(s)
- Valeria Giorgi
- Rehabilitation Center, Apostolo Foundation, Merate, Italy
- Unità di Ricerca Clinica, Gruppo Ospedaliero Moncucco, Lugano, Switzerland
| | | | - Laura Bertelè
- Rehabilitation Center, Apostolo Foundation, Merate, Italy
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Longobardi Y, D'Alatri L, Brandi VF, Mari G, Marenda ME, Marchese MR, Galli J, Parrilla C. Automatic speaking valve in tracheo-esophageal speech: treatment proposal for a widespread usage. Eur Arch Otorhinolaryngol 2024; 281:3197-3205. [PMID: 38568297 DOI: 10.1007/s00405-024-08605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Aim of this study was to calculate the percentage of the Automatic Speaking Valve (ASV) use in a large cohort of laryngectomized patients with voice prosthesis (VP) and to analyze the main reasons for non-use. Subsequently, a specific rehabilitation training was proposed. METHODS One hundred-ten laryngectomized patients with VP were enrolled in the first phase of the study (census). Among them, 57 patients were included in the second phase (intervention), in which a training based on moving phonatory exercises was proposed. Structured questionnaires were used before and after training in order to investigate ASV use rate (days/week and hours/day; reasons for impeding the ASV use), average adhesive life-time during ASV use; hands-free speech duration; skin irritation. Patients also expressed their degree of on a VAS scale from 0 to 100. RESULTS In the census phase the percentage of use of ASV (everyday, without problems) was equal to 17.27% (19/110 patients). The main causes of disuse concerned excessive fatigue and poor durability of the adhesives. The analysis of the results pre vs. post-training showed a statistically significant increase (p < 0.05) in all the investigated parameters. Patients reported a good level of treatment compliance (average frequency of performing exercises equal to 4.2 ± 2.5 days/week for 1.4 ± 1.01 h/day) and high degrees of satisfaction. After treatment, the percentage of use of AVS increased by 43% reaching a rate of 60% (66/110 patients). CONCLUSION A specific and targeted approach that simulate the phonatory and breathing difficulties of everyday life can increase the ASV usage rate.
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Affiliation(s)
- Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia.
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Roma, Italia.
| | | | - Giorgia Mari
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Maria Elisabetta Marenda
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Maria Raffaella Marchese
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Jacopo Galli
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Claudio Parrilla
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
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Cheng JT, Ramos Emos M, Leite V, Capozzi L, Woodrow LE, Gutierrez C, Ngo-Huang A, Krause KJ, Parke SC, Langelier DM. Rehabilitation Interventions in Head and Neck Cancer: A Scoping Review. Am J Phys Med Rehabil 2024; 103:S62-S71. [PMID: 38364033 DOI: 10.1097/phm.0000000000002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The aim of the study is to identify and appraise current evidence for rehabilitation interventions in head and neck cancer. DESIGN A previously published scoping review spanning 1990 through April 2017 was updated through January 11, 2023 and narrowed to include only interventional studies (Arch Phys Med Rehabil. 2019;100(12):2381-2388). Included studies had a majority head and neck cancer population and rehabilitation-specific interventions. Pairs of authors extracted data and evaluated study quality using the PEDro tool. Results were organized by intervention type. RESULTS Of 1338 unique citations, 83 studies with 87 citations met inclusion criteria. The median study sample size was 49 (range = 9-399). The most common interventions focused on swallow (16 studies), jaw (11), or both (6), followed by whole-body exercise (14) and voice (10). Most interventions took place in the outpatient setting (77) and were restorative in intent (65 articles). The overall study quality was fair (median PEDro score 5, range 0-8); none were of excellent quality (PEDro >9). CONCLUSIONS Most head and neck cancer rehabilitation interventions have focused on restorative swallow and jaw exercises and whole-body exercise to address dysphagia, trismus, and deconditioning. More high-quality evidence for head and neck cancer rehabilitation interventions that address a wider range of impairments and activity and social participation limitations during various cancer care phases is urgently needed to reduce head and neck cancer-associated morbidity.
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Affiliation(s)
- Jessica T Cheng
- From the Department of Supportive Care Medicine, City of Hope Orange County Lennar Foundation Cancer Center, California (JTC); Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, New York (ME); Rehabilitation Department, Instituto do Cancer, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (VL); Faculty of Kinesiology, University of Calgary, Calgary, Canada (LC); Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Canada (LC); Department of Internal Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada (LEW); Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth Houston, Houston, Texas (CG); Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (AN-H); Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas (KJK); Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, Phoenix, Arizona (SCP); and Department of Medicine, Division of Physical Medicine and Rehabilitation, University Health Network and University of Toronto, Toronto, Canada (DML)
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Sparks F, Coffey M, Dipper L, Morgan S, Hilari K. Tracheoesophageal Voice Therapy in Postlaryngectomy Rehabilitation: A Systematic Review. J Voice 2023:S0892-1997(23)00355-7. [PMID: 38000962 DOI: 10.1016/j.jvoice.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Following total laryngectomy, surgical voice restoration is considered the optimal modality for re-establishing communication via tracheoesophageal voice. Yet beyond the insertion of a voice prosthesis to elicit voice production, there is suboptimal clinical knowledge of how to rehabilitate the perceptual quality of tracheoesophageal voice. This systematic review will identify and critically evaluate the quality and effectiveness of therapeutic interventions for tracheoesophageal voice. The findings of this review will inform the development of a novel tracheoesophageal voice therapy intervention. STUDY DESIGN Systematic literature review carried out in accordance with PRISMA guidelines. METHODS The review protocol was registered with PROSPERO. Eight electronic databases were searched using a prespecified search strategy. Records were independently screened by two reviewers against inclusion and exclusion criteria. Eligible studies were assessed for quality using the PEDro, ROBIN-T, and NHLBI critical appraisal tools. Data was extracted pertaining to participant characteristics and the content, dosage, intensity and outcomes of interventions. RESULTS 6344 records were identified, of which 38 were included for full-text review. Six studies met the eligibility criteria for inclusion. Voice rehabilitation was not the primary focus in the majority of studies, and the risk of bias was identified across studies. There was significant heterogeneity in the interventions and outcome measures used within studies with insufficient detail provided on intervention content for tracheoesophageal voice. Evidence for the effectiveness of interventions was limited and inconsistent across studies. CONCLUSIONS This review found that tracheoesophageal voice therapy is an under-researched area of clinical practice. Evidence from the small body of existing studies was not sufficiently robust to inform clinical practice at this time. This review highlights the necessity to develop and test interventions aimed at improving the perceptual quality of tracheoesophageal voice.
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Affiliation(s)
- Freya Sparks
- Department of Language and Communication Sciences, City, University of London, London, United Kingdom; Speech and Language Therapy Department. Barts Health NHS Trust, London, United Kingdom.
| | - Margaret Coffey
- Speech and Language Therapy Department. Imperial College Academic Health Science Centre, London, United Kingdom
| | - Lucy Dipper
- Department of Language and Communication Sciences, City, University of London, London, United Kingdom
| | - Sally Morgan
- Department of Language and Communication Sciences, City, University of London, London, United Kingdom
| | - Katerina Hilari
- Department of Language and Communication Sciences, City, University of London, London, United Kingdom
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Leemans M, Longobardi Y, Dirven R, Honings J, D'Alatri L, Galli J, van den Brekel M, Parrilla C, van Sluis KE. Improving Hands-Free Speech Rehabilitation in Laryngectomized Patients with a Moldable Adhesive. Laryngoscope 2023; 133:2965-2970. [PMID: 36883657 DOI: 10.1002/lary.30636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands-free speech in laryngectomized patients. METHODS Twenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study-specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands-free speech, use and duration of hands-free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability. RESULTS The moldable adhesive enabled ASV fixation adequate for hands-free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands-free speech compared to participants' baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands-free speech at baseline. The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8-144 h) and improved comfort, fit, and ease of speech. CONCLUSION The moldable adhesive's lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands-free speech more regularly. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2965-2970, 2023.
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Affiliation(s)
- Maartje Leemans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Ylenia Longobardi
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucia D'Alatri
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Galli
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michiel van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, The Netherlands
| | - Claudio Parrilla
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Klaske E van Sluis
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Longobardi Y, Savoia V, Libero R, Marenda ME, Proietti I, Picciotti PM, Mari G, Parrilla C, D'Alatri L. Rehabilitation After Total Laryngectomy: An Integrated Protocol Remotely Delivered During COVID-19. Int J Telerehabil 2023; 15:e6548. [PMID: 38046556 PMCID: PMC10687949 DOI: 10.5195/ijt.2023.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
The aim of this paper was to evaluate the results of an integrated treatment delivered remotely to laryngectomized patients with voice prosthesis. Eighteen laryngectomized patients were treated remotely in groups co-led by a speech therapist and a psychologist ("Online Group"). The results were compared with those of 17 patients ("In-Person Group") previously studied. The two groups obtained comparable results on all parameters of the INFVo perceptual rating scale, in the DEP, ANX, PHO and HOS areas of the Symptom Check List-90-Revised questionnaire, and in the areas investigated by the WHOQOL-B questionnaire. The "In-Person Group" obtained statistically better results on the Italian Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire. Although the in-person treatment favored the acceptance of the new voice and the development of conversational skills, telerehabilitation guaranteed an adequate level of assistance in terms of voice acquisition, prevention of anxiety and depression, and recovery of a good QoL.
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Affiliation(s)
- Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Vezio Savoia
- Unità Operativa Semplice di Psicologia Clinica-Governo Clinico, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Rosa Libero
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Maria Elisabetta Marenda
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Ilaria Proietti
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Pasqualina Maria Picciotti
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
- Sezione di Otorinolaringoiatria, Dipartimento Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgia Mari
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Claudio Parrilla
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
- Sezione di Otorinolaringoiatria, Dipartimento Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
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Mesolella M, Allosso S, D’aniello R, Pappalardo E, Catalano V, Quaremba G, Motta G, Salerno G. Subjective Perception and Psychoacoustic Aspects of the Laryngectomee Voice: The Impact on Quality of Life. J Pers Med 2023; 13:jpm13030570. [PMID: 36983751 PMCID: PMC10057772 DOI: 10.3390/jpm13030570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/17/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Purpose: A retrospective study is presented to correlate the inter-judge consistency for the different psycho-perceptual parameters of the recently proposed Impression Noise Fluency Voicing (INFVo) perceptual rating scale for substitution voices, and the vocal function as perceived by the patient. Methods: The scale Voice-Related Quality of Life (V-RQoL) and the Self Evaluation of Communication Experiences After Laryngectomy scale (SECEL)—a self-evaluation questionnaire of communicative experience after laryngectomy surgery—were administered to 89 total laryngectomees, subdivided in four groups depending on their type of alaryngeal voice (i.e., tracheoesophageal and esophageal speakers, electro larynx users, voiceless patients), in order to evaluate the impact of the impairment of the phonatory function on the quality of life. Results: No significant differences exist among the various groups on their perception of QoL using subjective questionnaires, whereas the INFVo scale has proven to be a useful tool for the description and analysis of the psychoacoustic characteristics of the vocal signal and a reliable instrument to correctly classify the patients. It is also notable that the judgement of the patients on their own voice and those of the referees are highly significant. Conclusion: Although speech rehabilitation for the acquisition of a substitution voice offers a new way of communication for the laryngectomized patients, nonetheless, their QoL is not significantly related to the type of substitution voice. Therefore, improving the patient’s adaptation to the new phonatory condition is mandatory.
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Cioce M, Borrelli I, Cappucciati L, Giori M, Gobbi G, Lucifora R, Mabilia P, Marsullo M, Prendin C, Russo L, Zucca MS, Zega M, Sica S, Bacigalupo A, De Stefano V, Savoia V, Celli D, Garau P, Serra N, Botti S. The impact of education on patients' psycho-emotional status during allogeneic hematopoietic stem cell transplantation: a multicenter prospective study by thes Gruppo Italiano Trapianto di Midollo Osseo. J Psychosoc Oncol 2023; 41:687-703. [PMID: 36825453 DOI: 10.1080/07347332.2023.2181722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE Depressive disorders are the most common manifestation of psychological distress in allogenic hematopoietic stem cell transplantation. Few studies have yet investigated the relationship between therapeutic educational interventions and outcomes in these patients with specific attention to those related to mental health. Aim of this study was to understand how much educational intervention can represent a protective factor in preventing psycho-emotional distress-related issues in this setting. DESIGN A prospective observational study of a multicenter cohort was conducted. PARTICIPANTS Adult patients undergoing allogeneic hematopoietic stem cell transplantation. METHODS A pre-transplant therapeutic educational programme was offered to a cohort of adult patients undergoing allo-HSCT recruited in ten transplant centers of the GITMO network between May 2018 and January 2019. Depression, Anxiety and Stress scale was used to collect data on psycho-emotional distress at admission (T0), at the day of transplant (T1) and at discharge (T2). Descriptive data were collected and reported, and comparative analyses were done among patients who were compliant with the pre-transplant educational intervention and those who did not (for any reason). FINDINGS A cohort of 133 allo-HSCT patients was observed. In patients who did not receive pre-transplant educational intervention, higher levels of depression at admission (p = 0.01) and at the day of transplant (p = 0.03), higher levels of anxiety (p = 0.01 and p = 0.01 respectively) as well as higher levels of stress (p < 0.01 and p = 0.01) were observed. Problem solving and "face to face" interview were the best methods to provide education to patients. Those who received pre-transplant education through "face-to-face" interview reported significant low levels of depression during the whole hospital stay period (p < 0.01; p = 0.01; p = 0.01) and less anxiety and stress at admission (p < 0.05 and p = 0.01 respectively). Depression was more represented in female than male participants at T0 (16.5% vs 9.0%; p = 0.01), while among T0 and T2 the males had a significant higher increasing of depression than females (p = 0.03). CONCLUSION Our study demonstrated that pretreatment therapeutic educational programs with specific learning modalities can be effective in limiting the potential risk of developing moderate-to-severe anxiety-depressive states and stress symptoms related to allo-HSCT. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Further studies are needed to confirm our results and to understand whether containing psycho-emotional distress can have any relationship with medium- and long-term post-transplant complications.
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Affiliation(s)
- Marco Cioce
- Department UOC SITRA, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ivan Borrelli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorella Cappucciati
- U.O. Ematologia e Centro Trapianti, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Manuela Giori
- Terapia Onco-Ematologica Intensiva Trapianto CSE, A.O.U San Luigi Gonzaga Regione Gonzole 10, Orbassano (TO), Italy
| | - Giorgia Gobbi
- SC Ematologia Trapianto Midollo, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Patrizia Mabilia
- U.O.C. di Ematologia e Trapianto Emopoietico A.O.R.N, San Giuseppe Moscati, Avellino, Italy
| | - Mauro Marsullo
- Trapianti di midollo osseo, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Chiara Prendin
- U.O. Ematologia, Azienda Ulss 8 "Berica", Ospedale San Bortolo, Vicenza, Italy
| | - Letteria Russo
- Hemato-Oncology and Radiotherapy Department, Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, RC, Italy
| | | | - Maurizio Zega
- Department UOC SITRA, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Sica
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Bacigalupo
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Vezio Savoia
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Celli
- Faculty of Medicine and Psychology, Università "La Sapienza", Rome, Italy
| | - Paola Garau
- Department UOC SITRA, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicola Serra
- Biostatistic Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS of Reggio, Emilia, Italy
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10
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Longobardi Y, Galli J, Di Cesare T, D'Alatri L, Settimi S, Mele D, Bussu F, Parrilla C. Optimizing Pulmonary Outcomes After Total Laryngectomy: Crossover Study on New Heat and Moisture Exchangers. Otolaryngol Head Neck Surg 2022; 167:929-940. [PMID: 35316144 DOI: 10.1177/01945998221086200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the effects of new devices-heat and moisture exchangers (HMEs) and adhesives-on pulmonary symptoms, subject adherence, quality of life, dermatologic symptoms, and patient satisfaction after laryngectomy. STUDY DESIGN Prospective crossover study. SETTING Between December 2020 and April 2021, 40 patients were enrolled who had undergone laryngectomy, routinely used HMEs and adhesive, and were followed in our Department of Otolaryngology-Head and Neck Surgery. METHODS Patients were allocated into group A (new products) or group B (usual care) for 6 weeks. Then the 2 groups reversed, and each patient acted as his or her own control. Patients kept a diary and cough tally sheet. At baseline and after each 6-week period, 2 questionnaires were administered: EQ-5D (European Quality of Life-5 Dimensions) and CASA-Q (Cough and Sputum Assessment Questionnaire). RESULTS Six weeks of using new products resulted in the following effects for both groups: (1) a significant reduction in daily forced expectoration and dry coughs, (2) a significant improvement in all domains of the CASA-Q, (3) an increase in adherence to HME use, (4) a significant reduction in shortness of breath and skin irritation, and (5) significantly better scores in the anxiety/depression domain of the EQ-5D. CONCLUSION Achieving this reduction in patients who were already highly adherent to HME use is clinically relevant and underscores the importance of using better-performing HMEs that can compensate for the humidification deficit. Improving pulmonary symptomatology could reduce patient restrictions in daily life and avoidance of social activity, with a consequent positive effect on quality of life.
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Affiliation(s)
- Ylenia Longobardi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Tiziana Di Cesare
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Lucia D'Alatri
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Stefano Settimi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Dario Mele
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Rome, Italy
| | - Claudio Parrilla
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma-Università Cattolica del Sacro Cuore, Milan, Italy
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11
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Zheng L, Luo Z, Wang H, Liu S, Li X, Peng D, Liu Y, Ye S, Lu Y, Chen J, Mei Z, Wei L, Qian Y, Lin X, Xu C. Effectiveness of a nurse-led coaching of self-care agency intervention for elderly patients with total laryngectomy: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e061238. [PMID: 36008060 PMCID: PMC9422826 DOI: 10.1136/bmjopen-2022-061238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Due to functional defects and structural destruction after total laryngectomy, patients experienced the poor quality of life, especially for elderly. The barriers to accessing self-care in elderly patients were considered to result from complex and multifaceted interactions of biologic and social factors. Therefore, specific efforts to improve elderly patients' quality of life are needed. The purpose of our study is to verify nurse-led coaching of elderly patient self-care approaches, which can reduce logistic burden of patients and obtain the successful functional rehabilitation ultimately. METHODS AND ANALYSIS Elderly patients (n=60) scheduled for total laryngectomy will be randomly divided into the intervention group and the control group. Patients in the control group received routinely nursing during hospitalisation and thereby at home after discharge received conventional family care without regular supervision of nurses. Patients in the intervention group will receive a series of self-care intervention based on the transtheoretical model during hospitalisation. During home after discharge, nurses will additionally evaluate and supervise the self-care effect of patients. The two groups of patients' self-care agency, self-efficacy, quality of life and nutritional status will be recorded separately at different time points. Primary outcome is the improvement of patients' self-care agency, and secondary outcome is the improvements of patients' self-efficacy, quality of life, nutritional states and 3-month unplanned readmission rate. ETHICS AND DISSEMINATION The Ethics Committee of Hubei Cancer Hospital has approved this protocol (KYLLBA2020006). The findings of the trial will be disseminated through peer-reviewed journals, national or international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100043731.
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Affiliation(s)
- Liyuan Zheng
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Luo
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huifen Wang
- Department of Nursing, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu'e Liu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Li
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danxia Peng
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Liu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sanxia Ye
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchen Lu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Chen
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhidan Mei
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lai Wei
- Department of Radiotherapy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Qian
- Department of Thoracic Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Lin
- Department of Thoracic Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Xu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Martins de Sousa M, Matos R, Vilarinho H, Santos M, Silveira H. Voice rehabilitation with voice prosthesis: Long term results, complications and risk factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:219-224. [PMID: 35908815 DOI: 10.1016/j.otoeng.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite the advances in surgical and non-surgical organ preservation treatments, total laryngectomy (TL) remains the most effective treatment in advanced larynx cancer and as salvage procedure in chemoradiation failure. One of the most devastating sequel after TL is loss of voice. Voice prosthesis (VP) is currently the preferred choice for voice rehabilitation. The purpose of this study is to identify VP complications, its lifespan and factors that influence the longevity of the VP. METHODS We performed a retrospective study at a Tertiary University Hospital. Medical records of patients that underwent total laryngectomy, between January 1st of 2008 and 31st of December of 2017 were analyzed. RESULTS Of the 84 patients that underwent laryngectomy, 60 had VP. The average age at the time of surgery 60.2 years old and there was a male preponderance (57:3). The mean lifespan of the prosthesis was 7.53 months. Leakage through the prosthesis was the most common reason for replacement of the prosthesis, followed by leakage around the prosthesis. Follow up time and manual suture were associated with prosthesis replacement. There was no significant relationship between the staging, tumor location or adjuvant radiotherapy and number of prosthesis replacement or its lifespan. CONCLUSIONS Rehabilitation after TL is of major importance to improve quality of life after surgery. Tracheoesophageal puncture with voice prosthesis is a safe procedure for vocal rehabilitation and was performed in the majority of patients in our study. Follow-up time and type of suture were the main determinants of the lifespan of the prosthesis.
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Affiliation(s)
- Mafalda Martins de Sousa
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Surgery and Physiology - Unit of Otorhinolaryngology - Faculty of Medicine, Porto University, Porto, Portugal.
| | - Ricardo Matos
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Surgery and Physiology - Unit of Otorhinolaryngology - Faculty of Medicine, Porto University, Porto, Portugal
| | - Helena Vilarinho
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Helena Silveira
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Surgery and Physiology - Unit of Otorhinolaryngology - Faculty of Medicine, Porto University, Porto, Portugal
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13
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Martins de Sousa M, Matos R, Vilarinho H, Santos M, Silveira H. Voice rehabilitation with voice prosthesis: Long term results, complications and risk factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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D'Alatri L, Longobardi Y, Parrilla C, Crudo F, Oliveto G, Mari G, Marchese MR, Passali GC, Ausili Cefaro C, Paludetti G, Galli J. Long-term voice outcomes and quality of life after open partial horizontal laryngectomy type II vs. total laryngectomy: A cross-sectional study. Clin Otolaryngol 2022; 47:464-470. [PMID: 35231162 DOI: 10.1111/coa.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/09/2021] [Accepted: 02/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aim to analyse long-term voice outcomes and quality of life (QoL) in patients undergoing open partial horizontal laryngectomy type II (OPHL type II) and to compare them to those obtained by patients undergoing total laryngectomy (TL) with voice prosthesis (VP). DESIGN Cross-sectional cohort study. SETTING Patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). PARTICIPANTS Forty-five patients were enrolled and divided into two groups: OPHL group and TL group. MAIN OUTCOMES MEASURES Acoustic analysis, maximum phonation time, INFV0 scale, I-SECEL, UW-QoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. RESULTS Voices of patients undergoing OPHL Type II were worse than those of laryngectomised patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the social domain of QoL were higher in OPHL group. CONCLUSIONS Open partial horizontal laryngectomy Type II allows an acceptable voice recovery and a satisfactory QoL.
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Affiliation(s)
- Lucia D'Alatri
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ylenia Longobardi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Claudio Parrilla
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Fabrizio Crudo
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma, Italy
| | - Giuseppe Oliveto
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma, Italy
| | - Giorgia Mari
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Raffaella Marchese
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giulio Cesare Passali
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carolina Ausili Cefaro
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
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15
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Parrilla C, Longobardi Y, Paludetti G, Marenda ME, D'Alatri L, Bussu F, Scarano E, Galli J. A one-year time frame for voice prosthesis management. What should the physician expect? Is it an overrated job? ACTA ACUST UNITED AC 2021; 40:270-276. [PMID: 33100338 PMCID: PMC7586190 DOI: 10.14639/0392-100x-n0587] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/24/2020] [Indexed: 11/23/2022]
Abstract
Management of late complications represents the main reason for reluctance in using voice prosthesis rehabilitation. The aim of this paper is to report our experience by describing the one-year management of a large cohort of patients in order to clarify how demanding management is in terms of burden on clinicians. Between June 2017 and June 2018, each access made at the Otolaryngology Clinic of our Institute for issues related to prosthesis by 70 laryngectomised patients rehabilitated by voice prosthesis was registered in a specific database. A review of the data provided information on the incidence, management and outcomes of adverse events encountered during the selected time frame. In addition, a T test was used to evaluate the differences between irradiated and non-irradiated patients and between primary and secondary tracheo-oesophageal-puncture. Leakage through the prosthesis was the most common cause for access (51.86%). The median number of accesses per patient per year was 3.47. The speech therapist autonomously managed 18.1% of accesses. The median number of accesses per patient per year needing a physician was 2.84. The median lifetime of the prosthesis was 4.85 months. Radiotherapy or modality (primary or secondary) of the puncture did not influence the number of accesses per year or the prosthesis lifetime. This retrospective analysis of results highlighted the most frequent issues and the most effective measures to deal with them, which allowed us to define a systematic algorithm to standardise and ease long-term outpatient management.
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Affiliation(s)
- Claudio Parrilla
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Ylenia Longobardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Maria Elisabetta Marenda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Lucia D'Alatri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Francesco Bussu
- Otolaryngology Division AOU, Sassari, Italy.,Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Emanuele Scarano
- Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
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Parrilla C, Almadori A, Longobardi Y, Lattanzi W, Salgarello M, Almadori G. Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution? Cells 2021; 10:cells10071695. [PMID: 34359865 PMCID: PMC8305158 DOI: 10.3390/cells10071695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023] Open
Abstract
Autologous tissue-assisted regenerative procedures have been considered effective to close different types of fistula, including the leakage around tracheoesophageal puncture. The aim of this study was to retrospectively review 10 years of lipotransfer for persistent periprosthetic leakage in laryngectomized patients with voice prosthesis. Clinical records of patients who experienced periprosthetic leakage from December 2009 to December 2019 were reviewed. Patients receiving fat grafting were included. The leakage around the prosthesis was assessed with a methylene blue test. Twenty patients experiencing tracheoesophageal fistula enlargement were treated with fat grafting. At the one-month follow-up, all patients were considered improved with no leakage observed. At six months, a single injection was sufficient to solve 75% of cases (n 15), whereas 25% (n 5) required a second procedure. The overall success rate was 80% (n 16). Results remained stable for a follow-up of 5.54 ± 3.97 years. Fat grafting performed around the voice prosthesis, thanks to its volumetric and regenerative properties, is a valid and lasting option to solve persistent periprosthetic leakage.
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Affiliation(s)
- Claudio Parrilla
- Otolaryngology Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.P.); (Y.L.); (G.A.)
| | - Aurora Almadori
- Plastic Surgery Unit, Department of Women’s and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College of London, London NW3 2QG, UK
- Correspondence:
| | - Ylenia Longobardi
- Otolaryngology Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.P.); (Y.L.); (G.A.)
| | - Wanda Lattanzi
- Applied Biology Unit, Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marzia Salgarello
- Plastic Surgery Unit, Department of Women’s and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giovanni Almadori
- Otolaryngology Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.P.); (Y.L.); (G.A.)
- Head & Neck Oncologic Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Longobardi Y, Savoia V, Parrilla C, Marchese MR, Morra L, Mari G, Degni E, D’Alatri L. Pre-operative speech-language pathology counselling in patients undergoing total laryngectomy: A pilot randomized clinical trial. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Parrilla C, Longobardi Y, Galli J, Rigante M, Paludetti G, Bussu F, Scarano E. Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm. Otolaryngol Head Neck Surg 2021; 165:446-454. [PMID: 33400627 DOI: 10.1177/0194599820983343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Periprosthetic leakage represents the most demanding long-term complication in the voice prosthesis rehabilitation. The aim of this article is to discuss the various causes of periprosthetic leakage and to propose a systematic management algorithm. STUDY DESIGN Retrospective cohort study. SETTING Otolaryngology clinic of the University Polyclinic A. Gemelli-IRCCS Foundation. METHODS The study included 115 patients with voice prosthesis who were treated from December 2014 to December 2019. All patients who experienced periprosthetic leakage were treated with the same step-by-step therapeutic approach until it was successful. Incidence, management, and success rate of every attempt are analyzed and discussed. RESULTS Periprosthetic leakage was reported 330 times by 82 patients in 1374 clinic accesses. Radiotherapy, timing of tracheoesophageal puncture, and type of total laryngectomy (primary or salvage) did not influence the incidence of periprosthetic leakage. Salvage total laryngectomy increases the risk of more clinically relevant leakages. CONCLUSION By using a systematic algorithm with a step-by-step standardized approach, periprosthetic leakage management could become a less treacherous issue.
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Affiliation(s)
- Claudio Parrilla
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Jacopo Galli
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Mario Rigante
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Impact of Educational Interventions on Psychological Distress During Allogeneic Hematopoietic Stem Cell Transplantation: A Randomised Study. Mediterr J Hematol Infect Dis 2020; 12:e2020067. [PMID: 32952978 PMCID: PMC7485479 DOI: 10.4084/mjhid.2020.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background Physical and psychological factors, like wrong attitudes and behaviours, can negatively influence the health outcomes of the patients receiving allogeneic hematopoietic stem cell transplantation (AHSCT). Educational interventions aiming to improve knowledge on side effects, risks, complications and preventive behaviour can reduce psychological distress, and improve quality of life (QoL). We aimed to compare a standard approach with therapeutic patient education (TPE) to analyse the impact on AHSCT patients’ QoL, psychological distress and knowledge of AHSCT side effects, risks complications and preventive behaviour. Material and methods A prospective interventional study was conducted analysing data of 36 patients who received one of two different educational approaches, which were a standard approach (not-exposed) or TPE (exposed). Results In the exposed group QoL improved 14 days after transplantation (42.2 vs 25.6; p<0.03) and at time of discharge (36.6 vs 54.4; p<0.005). Anxiety and depression were better controlled in the exposed group, both at hospitalisation and discharge (anxiety: 48.1 vs 53.2; 46.4 vs 51.6. p<0.04; depression: 49 vs 55.3; 48 vs 54.3, p<0.03). Knowledge of AHSCT risks and complications improved in exposed patients, both at admission (10.1/15 vs 8/15 correct answers; p<0.01) and discharge (10.7/15 vs 8.8/15 correct answer; p<0.03). Conclusions The TPE for AHSCT patients improved knowledge, reduced anxiety and depression, which consequently increasing QoL. Therefore, we recommend our approach to further engage patients in the treatment plan, which should specifically take place prior to AHSCT initiation.
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Longobardi Y, Galli J, D'Alatri L, Savoia V, Mari G, Rigante M, Passali GC, Bussu F, Parrilla C. Patients With Voice Prosthesis Rehabilitation During the COVID-19 Pandemic: Analyzing the Effectiveness of Remote Triage and Management. Otolaryngol Head Neck Surg 2020; 164:277-284. [PMID: 32746738 PMCID: PMC7404089 DOI: 10.1177/0194599820948043] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To describe a remote approach used with patients with voice prosthesis after
laryngectomy during the COVID-19 pandemic and the resulting clinical
outcomes in terms of voice prosthesis complications management, oncological
monitoring, and psychophysical well-being. Study Design Prospective cohort study. Setting Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS
Foundation. Subjects and Methods All patients with voice prosthesis who underwent laryngectomy followed by our
institute were offered enrollment. Patients who agreed to participate were
interviewed to inquire about the nature of the need and to plan a video call
with the appropriate clinician. Before and 1 week after the clinician’s
call, patients were tested with the Hospital Anxiety and Depression Scale.
Degrees of satisfaction were investigated with a visual analog scale. A
comparison between those who accepted and refused telematic support was
carried out to identify factors that influence patient interest in
teleservice. Results Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23
(62.16%) of 37 cases, the video call was sufficient to manage the problem.
In the remaining 14 cases (37.83%), an outpatient visit was necessary.
Participants who refused telematic support had a significantly shorter time
interval from the last ear, nose, and throat visit than patients who
accepted (57.95 vs 96.14 days, P = .03). Video-called
patients showed significantly decreased levels of anxiety and depression
(mean Hospital Anxiety and Depression Scale total score pre– vs post–video
call: 13.97 vs. 10.23, P < .0001) and reported high
levels of satisfaction about the service. Conclusion Remote approach may be a viable support in the management of patients with
voice prosthesis rehabilitation.
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Affiliation(s)
- Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Jacopo Galli
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vezio Savoia
- Servizio di Psicologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgia Mari
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Mario Rigante
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giulio Cesare Passali
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Bussu
- ENT Division, Azienda Ospedaliero Universitaria, Sassari, Italia
| | - Claudio Parrilla
- Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Allegra E, La Mantia I, Bianco MR, Drago GD, Le Fosse MC, Azzolina A, Grillo C, Saita V. Verbal performance of total laryngectomized patients rehabilitated with esophageal speech and tracheoesophageal speech: impacts on patient quality of life. Psychol Res Behav Manag 2019; 12:675-681. [PMID: 31616193 PMCID: PMC6699587 DOI: 10.2147/prbm.s212793] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/18/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Total laryngectomy has important psychophysical and social consequences for patients’ quality of life because of the functional changes resulting from the removal of the larynx. Voice deprivation is perhaps the most relevant limiting factor in social relationships, increasing feelings of solitude and tending to drive individuals into social isolation. Multiple voice rehabilitation methods after total laryngectomy are available. This study aimed to determine the acoustic quality of the rehabilitated voice achieved with esophageal speech (ES) and tracheoesophageal speech (TES), and acoustic quality impacts on patients’ perceptions of their quality of life. Materials and methods The patient inclusion criterion was the completion of a speech rehabilitation course with ES or TES at least 6 months after total laryngectomy. The voice acoustic analysis was carried out automatically by using the Multidimensional Voice Program. The following parameters were extracted: fundamental frequency (F0), Jitter% (Jitt), Shimmer% (Shim), and noise-to-harmonic ratio (NHR). Subjective voice evaluation was performed by using the following questionnaires: Voice Handicap Index (VHI), Voice-related Quality of Life (V-RQOL), and Voice Performance Questionnaire (VPQ). Results The acoustic analysis showed a difference between ES and TES patients on all acoustic parameters; this difference was significant for F0 (133.09±2.4 and 119±3.3, respectively; p<0.001), NHR (0.43±0.21 and 0.31±0.14, respectively; p=0.02), and maximum phonation time (2.02±038 s and 10.64±0.28 s, respectively; p=0.01. Regarding patient-related outcomes, TES correlated with better total scores compared with ES; however, the differences in the total scores on the VHI (p=0.09), V-RQOL (p=0.39), and VPQ (p=0.52) were not statistically significant. Conclusion The rehabilitation of laryngectomized patients must be addressed by a multidisciplinary team that considers the personalities, personal needs, and relational conditions of individual patients in order to determine and apply the phonatory rehabilitation method most suitable for achieving a better quality of life.
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Affiliation(s)
- Eugenia Allegra
- Otolaryngology, Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Ignazio La Mantia
- Otolaryngology, "G.F Ingrassia" Department, University of Catania, Catania, Italy
| | - Maria Rita Bianco
- Otolaryngology, Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | | | - Alfio Azzolina
- Otolaryngology Unit, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Calogero Grillo
- Otolaryngology, "G.F Ingrassia" Department, University of Catania, Catania, Italy
| | - Vincenzo Saita
- Otolaryngology Unit, Cannizzaro Hospital, University of Catania, Catania, Italy
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