Effects of Finding the Speech-Language Pathologist Likeable on Postlaryngectomy Speech Intelligibility Outcomes.

INTRODUCTION: Speech-language pathologists (SLPs) work with patients after total laryngectomy (TL) to regain verbal communication. The influence of the quality of the therapeutic relationship on the success of TL voice rehabilitation in terms of speech intelligibility is not known. Finding each other likeable is an important factor in establishing and maintaining interpersonal relationships in everyday life. The fit of therapist and client is relevant to the therapeutic relationship. The purpose of this study therefore was to assess the association between the degree of SLPs' likeability ratings and postlaryngectomy speech intelligibility. METHODS: In a multicentre prospective cohort study, participants rated their SLPs' likeability after finishing TL rehabilitation. Speech intelligibility was measured objectively with the Post-Laryngectomy Telephone Intelligibility Test and subjectively with the Questionnaire for Adjustment after Laryngectomy. The association of SLPs' likeability with speech intelligibility was analysed using hierarchical logistic regression, expressed with odds ratios (OR) with corresponding 95% confidence intervals (CI). RESULTS: Altogether 124 patients from 13 institutions participated. The degree of finding the SLP likeable was not significantly associated with objective speech intelligibility (OR 1.30; 95% CI 0.78-2.18; p = 0.32) or subjective speech intelligibility (OR 1.01; 95% CI 0.60-1.72; p = 0.96) after controlling for age, sex and education factors. DISCUSSION/CONCLUSION: In this patient cohort, there was no evidence for an association between ratings of SLPs' likeability and speech intelligibility outcomes after rehabilitation. Future studies could consider the use of alternative instruments for measuring likeability.

Multicenter prospective study on the use and outcome of rehabilitation after total laryngectomy in Germany.

BACKGROUND: The purpose of this study was to assess the use and outcome of rehabilitation after total laryngectomy in Germany. METHODS: We enrolled patients who were scheduled for total laryngectomy, approached them again after surgery, after 3 months and 1 year. Patients completed questionnaires and were interviewed. RESULTS: Of 309 participants, 14% had not received any rehabilitation. Reasons for nonuse were primarily ongoing treatment and poor health. Users of rehabilitation had 4 times the odds of attaining any ability to speak compared to nonusers (odds ratio 3.8, P = .02). The main aim of rehabilitation from the perspective of the users was speech rehabilitation, mentioned by 71% before starting rehabilitation. This was also what most users (27%) found the most helpful part of rehabilitation. CONCLUSIONS: Patients are interested in attending rehabilitation. They especially want to improve their speech capacity, which indeed is better among users of rehabilitation than in those without.

Fish embryo tests with Danio rerio as a tool to evaluate surface water and sediment quality in rivers influenced by wastewater treatment plants using different treatment technologies.

In order to evaluate surface water and the sediment quality of rivers connected to wastewater treatment plants (WWTPs) with different treatment technologies, fish embryo tests (FET) with Danio rerio were conducted using native water and sediment samples collected upstream and downstream of four WWTPs in Southern Germany. Two of these WWTPs are connected to the Schussen River, a tributary of Lake Constance, and use a sand filter with final water purification by flocculation. The two others are located on the rivers Schmiecha and Eyach in the area of the Swabian Alb and were equipped with a powdered activated carbon stage 20 years ago, which was originally aimed at reducing the release of stains from the textile industry. Several endpoints of embryo toxicity including mortality, malformations, reduced hatching rate, and heart rate were investigated at defined time points of embryonic development. Higher embryotoxic potentials were found in water and sediments collected downstream of the WWTPs equipped with sand filtration than in the sample obtained downstream of both WWTPs upgraded with a powdered activated carbon stage.

Quality of life before and after total laryngectomy: results of a multicenter prospective cohort study.

BACKGROUND: The purpose of this study was to determine what quality of life (QOL) areas improve and deteriorate during the first year after total laryngectomy and to identify predictors of these changes. METHODS: One hundred seventy-four patients completed the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires before laryngectomy, n = 133 before discharge from hospital, n = 110 at the end of rehabilitation, and n = 86 1 year after laryngectomy. Multivariate regression analysis was performed to estimate the effect of potential predictors on QOL. RESULTS: Areas that did not recover to baseline level were physical functioning, role functioning, social functioning, fatigue, dyspnea, appetite loss, financial difficulties, senses, speech, and social contact, whereas global health status, coughing, and weight improved. There was no evidence for predicting effects of age, sex, education, and tumor site. Tumor stage, recurrent disease, radiotherapy, and mental health did display predicting effects. Smoking status before the treatment had marginally significant effects. CONCLUSION: QOL decreases initially after laryngectomy; some QOL areas recover slowly over the course of the year after surgery, and some remain significantly worse than at baseline.

Speech rehabilitation during the first year after total laryngectomy.

BACKGROUND: Gaining a new voice is one of the major aims after total laryngectomy. The objective of this study was to describe the process and results of speech rehabilitation during the first year after surgery. METHODS: Speech intelligibility was measured 6 months (n = 273) and 1 year (n = 225) after total laryngectomy. RESULTS: Objective (23.4 to 47.5 points, p < .0001) and subjective (51.6 to 64.7 points, p < .0001) speech intelligibility improved between 6 months and 1 year after total laryngectomy. Patients who used tracheoesophageal puncture (TEP) had the best results in speech intelligibility 6 months and 1 year after total laryngectomy. In all, 12% of the patients who used TEP initially no longer used it 1 year later. Patients who had received rehabilitation had better objective speech intelligibility than those who did not. CONCLUSIONS: Speech improves considerably between 6 months and 1 year after total laryngectomy. Nonattendance of rehabilitation is associated with a worse functional outcome in speech rehabilitation.

Motivation as a predictor of speech intelligibility after total laryngectomy.

BACKGROUND: It has often been argued that if patients' success with speech rehabilitation after laryngectomy is limited, it is the result of lacking motivation on their part. This project investigated the role of motivation in speech rehabilitation. METHODS: In a multicenter prospective cohort study, 141 laryngectomees were interviewed at the beginning of rehabilitation and 1 year after laryngectomy. Speech intelligibility was measured with a standardized test, and patients self-assessed their own motivation shortly after the surgery. Logistic regression, adjusted for several theory-based confounding factors, was used to assess the impact of motivation on speech intelligibility. RESULTS: Speech intelligibility 1 year after laryngectomy was not significantly associated with the level of motivation at the beginning of rehabilitation (odds ratio [OR], 1.3; 95% confidence interval [CI], 0.7-2.3; p = .43) after adjusting for the effect of potential confounders (implantation of a voice prosthesis, patient's cognitive abilities, frustration tolerance, physical functioning, and type of rehabilitation). CONCLUSIONS: Motivation is not a strong predictor of speech intelligibility 1 year after laryngectomy.

Clinical relevance of quality-of-life data in laryngectomized patients.

OBJECTIVES/HYPOTHESIS: Statistically significant differences in health-related quality of life (HRQL) are not always clinically relevant. It is also plausible that patients perceive other changes to be relevant than health professionals do. The objective of this study was to find thresholds for HRQL that laryngectomees consider to be clinically relevant 1 year after surgery, (i.e., the level of HRQL that patients rate as satisfactory). A second aim was to investigate how many laryngectomized patients reached those targets. STUDY DESIGN: Multicenter cross-sectional study. METHODS: A total of 28 patients 1 year following laryngectomy and 24 healthcare professionals (HCPs) defined target values for the QLQ-C30 and QLQ-H&N35. In another sample of 157 laryngectomized patients 1 year following laryngectomy, we determined what percentage of patients reached these thresholds. RESULTS: Patients are the most accepting of sensory impairments (56.5), coughing (53.6), and dyspnea (44.0), whereas constipation (9.1) and nausea/vomiting (10.7) were rated as being the most troublesome symptoms. HCPs assessed more of the studied complaints as being tolerable than patients did, especially in psychosocial domains. Between 34.5% (senses) and 86.5% (constipation) of the reference group hit the predefined targets at different scales. CONCLUSIONS: Symptoms caused by disease are easier for patients to live with than more general nonspecific symptoms. Taking into account that some adverse effects of disease or therapy are partially irreversible, target values additional to changes of HRQL can be helpful when interpreting data.

[Psychological morbidity in spouses of laryngectomized cancer patients: factors related to the probability of its occurrence]. / Psychische Morbidität bei Partnern kehlkopfloser Karzinompatienten: Womit hängt die Auftrittswahrscheinlichkeit zusammen?

In a multicenter cross-sectional study of 106 spouses of laryngectomized patients differences between spouses with a mental disorder and spouses without were analyzed. The probability of occurrence was mainly related to relationship factors: Spouses, who reported a better quality of their relationship with the patient (OR=0.77; 95% CI: 0.631-0.939; p=0.010), whose sexual desire was not diminished in response to their partner's disease (OR=0.077; 95% CI: 0.011-0.527; p=0.009) and who had no problems in dealing with the tracheostomy (OR=0.062; 95% CI: 0.006-0.619; p=0.018) presented a mental disorder less frequently. The cross-sectional nature of this study does not allow conclusions regarding causality. The results should be reappraised in a longitudinal study. However, the findings suggest that patients with laryngectomy and their families should be also offered couple interventions besides individual counseling.

Screening for mental disorders in laryngeal cancer patients: a comparison of 6 methods.

OBJECTIVES: The aim of this study was to determine how accurate mental distress screening instruments are in identifying psychological sequelae in ambulatory laryngeal cancer patients who have undergone surgery. METHODS: Two-hundred and fifty subjects were tested for mental disorders according to the guidelines defined in the Diagnostic Statistical Manual of Psychological Illnesses, Version 4. Screening instruments tested were: the 'Hospital Anxiety and Depression Scale' (HADS), the subscale 'Emotional Functioning' of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), the 'Hornheider Fragebogen' (HFB), and a single-item visual analogues scale (VAS). Accuracy was assessed by calculating the sensitivity rates, specificity rates, and areas under the curve from the receiver operating characteristic curves. RESULTS: The relative frequency of mental disorders was 19.8%. All of the screening instruments tested were found to be highly accurate. The best levels of sensitivity and specificity were associated with the total score of the HADS. CONCLUSIONS: These results confirm that a significant minority of laryngeal cancer patients suffer from severe mental distress, and that accurate screening for clinically significant mental disorders is possible using any of the instruments evaluated here.