Self-expression and identity after total laryngectomy: Implications for support.

OBJECTIVE: To explore how individuals with a laryngectomy (IWL) from diverse backgrounds make meaning and adjust to the physical and functional changes from a total laryngectomy. To examine the extent primary supporters (PS) and health professionals (HP) are able to support IWL with the psychosocial and existential challenges rendered by a surgery that significantly impacts a person's talking, breathing, swallowing, and appearance. METHODS: A constructivist grounded theory approach and symbolic interactionism were used to guide data collection and analysis. Semi-structured interviewing occurred. RESULTS: Twenty-eight participants (12 IWL, 9 PS, and 7 HP) were interviewed. The findings suggest that IWL experience significant change to their self-identity and there is evidence of a range of passive and active reframing patterns (destabilised, resigned, resolute, and transformed). The loss of self-expression included changes to communicative participation, personal style, food preferences, and social roles. Short and longer-term supports appear to influence outcomes but are often ill-equipped to manage the psychosocial needs of IWL. CONCLUSIONS: Loss of self-expression after total laryngectomy influences self-identity and adjustment. How individuals reframe their identity appears to be tied with how they view their disabilities and disfigurement. These perceptions also appear to be influenced by the reactions of others and the support available. Further resourcing, education, and training are needed so that PS and HP can provide holistic care.

Social support and substitute voice acquisition on psychological adjustment among patients after laryngectomy.

The objective is to clarify whether social support and acquisition of alternative voice enhance the psychological adjustment of laryngectomized patients and which part of the psychological adjustment structure would be influenced by social support. We contacted 1445 patients enrolled in a patient association using mail surveys and 679 patients agreed to participate in the study. The survey items included age, sex, occupation, post-surgery duration, communication method, psychological adjustment (by the Nottingham Adjustment Scale Japanese Laryngectomy Version: NAS-J-L), and the formal support (by Hospital Patient Satisfaction Questionnaire-25: HPSQ-25). Social support and communication methods were added to the three-tier structural model of psychological adjustment shown in our previous study, and a covariance structure analysis was conducted. Formal/informal supports and acquisition of alternative voice influence only the "recognition of oneself as voluntary agent", the first tier of the three-tier structure of psychological adjustment. The results suggest that social support and acquisition of alternative voice may enhance the recognition of oneself as voluntary agent and promote the psychological adjustment.

La voz del laringectomizado: incapacidad, percepción y análisis acústico / Laryngectomized voice rehabilitation: handicap, perception and acoustic analysis

Los pacientes laringectomizados tienen una limitación muy importante al perder la función vocal. La rehabilitación de la voz se realiza por erigmofonía o prótesis fonatoria. Ambos procedimientos son útiles pero tienen diferencias evidentes en la calidad vocal obtenida. Objetivo. Determinar cómo es percibida la voz rehabilitada con ambos procedimientos por los pacientes y observadores, completando el estudio con su análisis acústico. Material y método. Pacientes laringectomizados (n = 18) con voz rehabilitada con erigmofonía (n = 10) y prótesis fonatoria (n = 8). Estudio por medio de VHI-30, análisis acústico (F0, TMF, HNR, «speech-rate», intensidad y espectrograma) y evaluación perceptual (GRBAS y CAPE-V). Resultados. El VHI-30 presenta valores similares en ambos tipos de voz rehabilitada. El análisis acústico muestra diferencias importantes entre ambos tipos de voces, siendo los valores obtenidos con prótesis fonatoria más parecidos a los de la voz laríngea. La evaluación perceptual indica mayor grado de afectación en la voz erigmofónica que en la prótesis fonatoria. No se observa relación significativa entre lo percibido por los pacientes con ambos tipos de voces rehabilitadas y lo valorado por el observador. Los estudios acústicos y perceptuales muestran valores más próximos a la normalidad en la voz de prótesis fonatoria (AU)

Laryngectomized patients have a very important limitation when they lose the vocal function. Voice rehabilitation is fulfilled by means of the esophageal voice or by means of a phonatory prosthesis. Both methods are useful but they have evident differences concerning the vocal quality obtained. Objective. Determine how rehabilitated voice is perceived with both methods by patients and observers, completing the study with its acoustic analysis. Material and method. Laryngectomized patients (n = 18) with rehabilitated voice by means of esophageal voice (n = 10) and phonatory prosthesis (n = 8). A study was made through the VHI-30, acoustic analysis (F0, TMF,HNR, «speech rate», intensity and spectrogram) and perceptual evaluation (GRBAS and CAPE-V). Results. VHI-30 displays similar values in both types of rehabilitated voice. The acoustic analysis shows differences between both types of rehabilitated voices and the usual laryngeal voice. The perceptual study presents a higher degree of affectation on the esophageal voice than on the PF one. There is no relation between what the patient perceives and what the observer values. The acoustic and perceptual studies show closer values to normality in the phonatory prosthesis voice (AU)

How do voice restoration methods affect the psychological status of patients after total laryngectomy?

OBJECTIVE: This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients. METHODS: The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically. RESULTS: Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary. CONCLUSION: Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

Tracheoesophageal voice after total laryngopharyngectomy reconstruction: Jejunum versus radial forearm free flap.

OBJECTIVE/HYPOTHESIS: Tracheoesophageal (TE) voice restoration after laryngopharyngectomy with jejunal (Jej) flap and radial forearm flap (RFF) reconstruction has been successfully completed and studied for both techniques, but no direct comparisons exist. We undertook this study to directly compare TE voice in patients with total laryngopharyngectomy (TLP) reconstruction using the Jej and the RFF in a comprehensive and rigorous manner. STUDY DESIGN: Retrospective cohort study. METHODS: Forty patients after total laryngectomy or TLP were grouped by pharyngeal closure method: 18 primary closure (STL), 10 jejunal flap (TLP-Jej), and 12 radial forearm flap (TLP-RFF). Voice recordings underwent objective acoustic analysis and blinded subjective assessment by trained and naïve listeners. Quality-of-life (QOL) assessments were obtained in all subjects using general health, disease-specific, and voice-specific survey tools. RESULTS: All studies groups had similar demographics. Acoustic analysis demonstrated no differences in fundamental frequency or intensity levels. Subjective assessment demonstrated statistically significant inferior voice function of the reconstructed patients (TLP-Jej and TLP-RFF) compared to STL subjects for nearly all parameters tested by both naïve and trained listeners. No differences were noted between TLP-Jej and TLP-RFF subjects for any of the parameters evaluated. Overall, trained listeners assessed TE voice more favorably compared to naïve listeners in a significant manner. The three QOL surveys revealed no significant differences between TLP-Jej and TLP-RFF subjects. CONCLUSION: Tracheoesophageal voice in TLP-Jej and TLP-RFF subjects was equivalent but inferior to STL subjects. Reconstructed subjects had no differences in general, disease-specific, and voice-specific quality of life. LEVEL OF EVIDENCE: 2b.

Quality of life in patients submitted to total laryngectomy.

BACKGROUND: Laryngeal carcinoma accounts for about 80 000 deaths annually worldwide. Despite its aggressiveness, total laryngectomy (TL) is a treatment option with curative intent. This article aims to evaluate its impact on these patients quality of life (QoL). MATERIAL AND METHODS: Thirty-four patients who underwent TL with bilateral neck dissection between 2003 and 2012 responded to the European Organization for Research and Treatment of Cancer QoL Core Questionnaire, the Self-Evaluation of Communication Experiences after Laryngeal Cancer Questionnaire, and the Hospital Anxiety and Depression Scale. RESULTS: Data revealed that QoL is lower in these patients compared with general population. Regarding alaryngeal speech modalities, esophageal speech is associated with a significantly higher physical functional capacity. CONCLUSIONS: TL results in a permanent disability with decreased functional capacity and psychological distress. Close monitoring of these patients and investing in speech rehabilitation are essential to preserve their QoL.

Examining the construct validity of the V-RQOL in speakers who use alaryngeal voice.

PURPOSE: The construct validity of the Voice-Related Quality of Life (V-RQOL; Hogikyan & Sethuraman, 1999) measure was evaluated in a sample of 109 individuals who have undergone total laryngectomy. METHOD: A principal components factor analysis was performed on participant responses to the 10-question V-RQOL measure. RESULTS: Factor analysis of the V-RQOL in our alaryngeal sample confirmed the presence of two factors (physical and social-emotional), which is consistent with the identified domains in the current V-RQOL. However, the current data indicate that some of the questions proposed by the original authors of the V-RQOL (Questions 7 and 9) do not align with their proposed domains in this postlaryngectomy sample. CONCLUSION: The results indicate that some V-RQOL questions do not align with their proposed domains. Consequently, an alternative scoring algorithm may be warranted for alaryngeal populations, and the authors make suggestions for this change that are simple and efficient. Based on the findings of the present factor analysis, use of this modified scoring procedure may serve to increase the sensitivity of the V-RQOL for those who are laryngectomized and use alaryngeal methods of voice and speech. Consequently, the value and application of the V-RQOL may be expanded in the clinical setting.

Auditory-perceptual speech outcomes and quality of life after total laryngectomy.

OBJECTIVE: (1) To determine potential relationships between speech intelligibility, acceptability, and self-reported quality of life (QOL) after total laryngectomy and (2) to determine whether relationships are stronger when QOL is measured by a head and neck cancer-specific or discipline-specific QOL scale. STUDY DESIGN: Cross-sectional. SETTING: University-based laboratory and speech clinic. SUBJECTS AND METHODS: Twenty-five laryngectomized individuals completed disease-specific (University of Washington Quality of Life; UW-QOL) and discipline-specific (Voice Handicap Index-10; VHI-10) QOL scales. They also provided audio recordings that included the Sentence Intelligibility Test (SIT) and a reading passage. Thirty-three listeners transcribed the SIT sentences to yield intelligibility scores. Fifteen additional listeners judged speech acceptability of the reading passage using rating scales. RESULTS: The QOL scores were moderate across the UW-QOL physical (mean = 77.63) and social-emotional (mean = 78.02) subscales and the VHI-10 (mean = 17.91). Speech acceptability and intelligibility varied across the samples, with acceptability only moderately related to intelligibility (r = 0.41, P < .05). Relationships were weak between ratings of intelligibility and self-reported QOL (range, r = 0.00-0.22) and weak to moderate between acceptability with QOL (range, r = 0.01-0.46). The only statistically significant, but moderate, relationship was found between speech acceptability with the UW-QOL speech subscore (r = 0.46, P < .05). CONCLUSION: Listeners' ratings of speech acceptability and intelligibility were not strongly predictive of disease-specific or voice-related QOL, suggesting that listener-rated and patient-reported outcomes are complementary.

Relación entre el aprendizaje de la voz erigmofónica y los niveles de ansiedad y de depresión en pacientes laringectomizados totales / No disponible

La pérdida de la voz laríngea es la principal consecuencia que sufren los laringectomizados totales, por lo que el aprendizaje de una nueva voz es el objetivo principal de la rehabilitación de estos pacientes. La voz erigmofónica es una de las posibilidades que tiene estos pacientes para recuperar la capacidad de comunicación oral de una manera natural. La laringectomía total se asocia a consecuencias psicológicas, como la ansiedad y la depresión, frecuentemente presentes en la enfermedad oncológica.En la investigación que presentamos, se hace referencia a la posible incidencia de algunas de las características de la voz erigmofónica sobre los niveles de ansiedad y de depresión de estos pacientes. Los cambios observados en estas respuestas en función de la percepción que tienen sobre su nueva voz, de los cambios experimentados en su aprendizaje, de la importancia que ha supuesto para ellos y si tienen impresión de habla correcta con las personas con las que se comunican. Se ha valorado la incidencia que ha supuesto el tiempo que les ha costado alcanzar un nivel mínimo de dominio de la voz erigmofónica necesaria para mantener comunicación oral. Los resultados obtenidos confirman la significación o valor predictivo de tres de las variables estudiadas: Las personas que perciben que han aprendido a hablar, que hablan bien y que hablan con cualquiera (no solo con familiares) están menos deprimidos. En el caso de la ansiedad no se encuentran efectos. Hemos elaborado un perfil del paciente que no disminuye su nivel de depresión después de haber adquirido la voz erigmofónica: considera que ha aprendido a hablar con dificultad, ya que le ha costado más de 6 meses; pero no se siente nada satisfecho con su nueva voz, tiene la impresión de no hablar correctamente, habla solamente con familiares y la pérdida de la voz le supuso un sentimiento de incapacidad. La laringectomía le afectó mucho psicológicamente, familiarmente, socialmente y laboralmente (está en paro). Se siente muy afectado físicamente, con molestias por el traqueostoma, dificultades en la respiración y dificultades para tragar alimentos. Es relativamente joven (54 años) y está viudo (AU)

The loss of laryngeal voice is the main consequence suffered by total laryngectomy, so learning a new voice is the main objective of the rehabilitation of these patients. Esophageal voice is one of the possibilities for patients to recover oral communication skills in a natural way. Total laryngectomy is associated with psychological consequences such as anxiety and depression often present in cancer disease. The present research is about the potential impact of some of the characteristics of the esophageal voice on levels of anxiety and depression in these patients. The observed changes in these responses in terms of perceptions about his new voice, the changes in their learning, the importance that has meant for them and if they have impression of correct speech and with whom they communicate. We evaluated the impact of time it took them to reach a minimum level of mastery of esophageal voice necessary to maintain oral communication. The results obtained confirm the significance or predictive value of three of the variables studied: People who perceive they have learned to speak, they speak well and speak with anyone (not just family) are less depressed. In the case of anxiety are no effects. We have developed a patient profile that does not diminish their level of depression after having acquired the voice erigmofónica: Consider who has learned to speak with difficulty, and that has cost more than 6 months, but does not feel at all satisfied with their new voice, has the impression of not speaking properly, speak only with family and lost his voice was a sense of incapacity. Laryngectomy psychologically affected him deeply, familiarly, socially and occupationally (is unemployed). He feels physically affected with discomfort for the tracheostoma, difficulty in breathing and swallowing difficulties. The patient is relatively young (54 years) and is a widower (AU)

[The role of sex in voice restoration and emotional functioning after laryngectomy]. / Die Rolle des Geschlechts bei stimmlicher Rehabilitation und emotionalem Befinden nach Laryngektomie.

BACKGROUND: Data on psychosocial factors of laryngectomized women is rare. All means of alaryngeal voice production sound male due to low fundamental frequency and roughness, which makes postlaryngectomy voice rehabilitation especially challenging to women. Aim of this study was to investigate whether women use alaryngeal speech more seldomly and therefore are more emotionally distressed. MATERIAL AND METHODS: In a cross-sectional multi-centred study 12 female and 138 male laryngectomees were interviewed. To identify risc factors on seldom use of alaryngeal speech and emotional functioning, logistic regression was used and odds ratios were adjusted to age, time since laryngectomy, physical functioning, social activity and feelings of stigmatization. RESULTS: Esophageal speech was used by 83% of the female and 57% of the male patients, prosthetic speech was used by 17% of the female and 20% of the male patients and electrolaryngeal speech was used by 17% of the female and 29% of the male patients. There was a higher risk for laryngectomees to be more emotionally distressed when feeling physically bad (OR=2,48; p=0,02) or having feelings of stigmatization (OR=3,94; p≤0,00). Besides more women tended to be socially active than men (83% vs. 54%; p=0,05). CONCLUSIONS: There was no influence of sex neither on use of alaryngeal speech nor on emotional functioning. Since there is evidence for a different psychosocial adjustment in laryngectomized men and women, more investigation including bigger sample sizes will be needed on this special issue.

[Voice-related quality of life vs. health-related quality of life after partial laryngectomy]. / Stimmbezogene und allgemeine gesundheitsbezogene Lebensqualität kehlkopfteilresezierter Patienten.

BACKGROUND: The assessment of the treatment results of laryngeal cancer includes subjective aspects. Two tools for assessment of the quality of life of patients after treatment of small laryngeal carcinoma were compared: The disease-unspecific short-form-36 health-survey (SF-36) and the specific voice-related-quality-of-life-questionnaire (V-RQOL). MATERIAL AND METHODS: Data of 65 patients after partial laryngeal resection was evaluated during regular out clinic examinations. RESULTS: The average V-RQOL total score was 70,0 ± 24,3. Similar results were achieved for the physically (68,2 ± 24,3) and for the emotional (72,5 ± 27,6) subscores of the V-RQOL-survey being lower than the cut-off for healthy voices, which is at 80 points. The SF-36-health survey score was 43,0 ± 10,7 for the physically subscore and 50,2 ± 9,1 for the emotional subscore. Both subscores were rated worse than the age-adjusted standard value for the SF-36. There is a moderate correlation between both questionnaires, which does not depend from the size of the laryngeal carcinoma (T1 or T2). CONCLUSION: The voice-related quality of life is part of the health-related quality of life next to other factors. An amelioration of voice-related quality of life thus should lead to better general, health-related quality of life.

Objective eye-gaze behaviour during face-to-face communication with proficient alaryngeal speakers: a preliminary study.

BACKGROUND: There is a large body of research demonstrating the impact of visual information on speaker intelligibility in both normal and disordered speaker populations. However, there is minimal information on which specific visual features listeners find salient during conversational discourse. AIMS: To investigate listeners' eye-gaze behaviour during face-to-face conversation with normal, laryngeal and proficient alaryngeal speakers. METHODS & PROCEDURES: Sixty participants individually participated in a 10-min conversation with one of four speakers (typical laryngeal, tracheoesophageal, oesophageal, electrolaryngeal; 15 participants randomly assigned to one mode of speech). All speakers were > 85% intelligible and were judged to be 'proficient' by two certified speech-language pathologists. Participants were fitted with a head-mounted eye-gaze tracking device (Mobile Eye, ASL) that calculated the region of interest and mean duration of eye-gaze. Self-reported gaze behaviour was also obtained following the conversation using a 10 cm visual analogue scale. OUTCOMES & RESULTS: While listening, participants viewed the lower facial region of the oesophageal speaker more than the normal or tracheoesophageal speaker. Results of non-hierarchical cluster analyses showed that while listening, the pattern of eye-gaze was predominantly directed at the lower face of the oesophageal and electrolaryngeal speaker and more evenly dispersed among the background, lower face, and eyes of the normal and tracheoesophageal speakers. Finally, results show a low correlation between self-reported eye-gaze behaviour and objective regions of interest data. CONCLUSIONS & IMPLICATIONS: Overall, results suggest similar eye-gaze behaviour when healthy controls converse with normal and tracheoesophageal speakers and that participants had significantly different eye-gaze patterns when conversing with an oesophageal speaker. Results are discussed in terms of existing eye-gaze data and its potential implications on auditory-visual speech perception.

Communication adjustment of patients with a laryngectomy in Turkey: analysis by type of surgery and mode of speech.

Previous studies have routinely shown that individuals with a laryngectomy (IWL) have a decreased quality of life (QoL). However, the questionnaires frequently used are not specifically designed for persons with laryngeal cancer and may not reflect the issues of most concern to IWL. The purpose of this study was to investigate (1) the overall communication adjustment of IWL in Turkey, (2) the differences in communication adjustment among types of surgery for the treatment of laryngeal cancer, and (3) the differences in communication adjustment among types of speech following treatment for laryngeal cancer. Fifty-two patients (50 males and two females) who underwent surgical treatment for laryngeal cancer (i.e. total, supraglottic, frontolateral, vertical, supracricoid) and were being seen for follow-up care were recruited from an ENT clinic in Bursa, Turkey. Patients were provided with a written translation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) which yielded information on three subscales (General, Environment, and Attitude) and a Total score. Kruskall-Wallis and Wilcoxon signed ranks nonparametric tests of significance showed that overall adjustment was within the well-adjusted range for all types of surgery and modes of speech with two exceptions: Mean scores for supracricoid laryngectomy with cricohyoidopexy (28.5) and esophageal speech (29.3) were both within the poorly adjusted range on the Environment subscale [lowest mean score = 8.7 (supraglottic)]. Total mean scores ranged from 19.8 (supraglottic) to 49.9 (esophageal speech). Mean scores of the General subscale ranged from 4.0 (electrolaryngeal speech) to 7.7 (tracheoesophageal speech). Mean scores of the Attitude subscale ranged from 6.2 (supraglottic) to 19 (electrolaryngeal). Results of the Kruskall-Wallis test also showed a significant difference between type of surgery for the Environment subscale (p = 0.003), the Attitude subscale (p = 0.039), and the Total score (p = 0.007). The results suggest that overall, IWL in Turkey are well-adjusted to their new voice. However, results also showed that certain conservation surgeries (i.e. supraglottic, frontolateral, vertical) yielded more favorable outcomes than either supracricoid laryngectomy or speech following total laryngectomy. This finding is most likely related to the amount of tissue preserved following conservation surgery, in particular the preservation of the vocal folds.

Satisfaction and quality of life in laryngectomees after voice prosthesis rehabilitation.

OBJECTIVE/HYPOTHESIS: The purpose of the study was to assess the satisfaction and quality of life in laryngectomees after vocal rehabilitation using voice prostheses. We evaluated the impact on quality of life between laryngectomees with voice prostheses, laryngectomees without them and healthy controls. METHODS: This was a prospective study on a sample of laryngectomees in an Italian university hospital. Our study population was composed of 42 patients who had previously undergone a total laryngectomy; in 24 of them, voice rehabilitation was obtained with a voice prosthesis device (group A), while 18 of them learned oesophageal voice (group B). The results were compared with a group of 25 healthy controls (group C). In order to investigate the quality of life, we administered the Short Form 36-Item Health Survey (SF-36) to the 3 groups. Moreover, self-satisfaction of the subjects in group A was assessed by single questions regarding their use of the voice prosthesis. RESULTS: A statistical difference in the SF-36 was detected for social functioning (SF) between groups A and B. Role physical, SF and role emotional were significantly better in group C than in group A. Group A stated they were very satisfied with voice quality while there were still some problems regarding prosthesis lifetime and communication at the telephone or in noisy environments. CONCLUSIONS: Voice prosthesis implantation in laryngectomees showed positive effects on patients' quality of life; however, there are still some negative aspects. At present, an early diagnosis of larynx cancer with a partial laryngectomy in order to preserve phonatory function is the gold standard.

A physician's experience as a cancer of the neck patient.

This manuscript presents my personal experiences as a physician undergoing several surgical procedures including radical neck surgery for removal of pyriform sinus squamous cell carcinoma. I am telling my personal story in hopes that health care providers will realize the difficult challenges that a patient diagnosed with cancer and undergoes extensive surgeries must face. Facing and living through the difficulties and tribulations of a post-laryngectomy patient has illustrated to me how dependent and helpless one can be after this surgery. Being unable to speak, eat, and breathe normally, while dealing with a potential fatal illness, makes the patient extremely vulnerable, both physically and emotionally. During this difficult and challenging time, a proficient, competent, compassionate and caring approach that understands what the patient is experiencing should be practiced.

Automatic evaluation of tracheoesophageal substitute voice: sustained vowel versus standard text.

OBJECTIVE: The Hoarseness Diagram, a program for voice quality analysis used in German-speaking countries, was compared with an automatic speech recognition system with a module for prosodic analysis. The latter computed prosodic features on the basis of a text recording. We examined whether voice analysis of sustained vowels and text analysis correlate in tracheoesophageal speakers. PATIENTS AND METHODS: Test speakers were 24 male laryngectomees with tracheoesophageal substitute speech, age 60.6 +/- 8.9 years. Each person read the German version of the text 'The North Wind and the Sun'. Additionally, five sustained vowels were recorded from each patient. The fundamental frequency (F(0)) detected by both programs was compared for all vowels. The correlation between the measures obtained by the Hoarseness Diagram and the features from the prosody module was computed. RESULTS: Both programs have problems in determining the F(0) of highly pathologic voices. Parameters like jitter, shimmer, F(0), and irregularity as computed by the Hoarseness Diagram from vowels show correlations of about -0.8 with prosodic features obtained from the text recordings. CONCLUSION: Voice properties can reliably be evaluated both on the basis of vowel and text recordings. Text analysis, however, also offers possibilities for the automatic evaluation of running speech since it realistically represents everyday speech.

Voice handicap and health-related quality of life in laryngectomees: assessments with the use of VHI and EORTC questionnaires.

AIMS: To investigate the Voice Handicap Index (VHI), the health-related quality of life (HRQL), and the correlations between VHI and HRQL in laryngectomees. METHODS: Forty-three laryngectomized persons participated (mean age 68;6 years, time since laryngectomy between 0;6 and 12 years). Evaluation of voice handicap was done with the VHI. HRQL was evaluated with questionnaires from the European Organization for Research and Treatment of Cancer, EORTC QLQ-C30 and EORTC QLQ-H&N35. RESULTS: VHI for the whole group demonstrated a moderate voice handicap, with a mean score of 48/120. The functional scales of EORTC QLQ-C30 resulted in scores on the same level as the normal population with the exception of a lower global quality of life scale (Global QOL). EORTC QLQ-H&N35 revealed problems with smell and taste, speech, coughing, xerostomia, and sexuality. VHI correlated significantly with the Global QOL, the functional scales, dyspnea, pain, nausea and financial difficulties (EORTC QLQ-C30). Significant correlations were also found between VHI and speech problems, social contact, pain from the head and neck area, sense problems, sexuality and social eating (EORTC QLQ-H&N35). CONCLUSION: The EORTC questionnaires in combination with the VHI questionnaire seem to capture most of the problems following laryngectomy, including voice problems.

Psychosocial determinants of successful voice rehabilitation after laryngectomy.

This study gives an overview of publications on factors that are associated with the outcome of voice rehabilitation after laryngectomy. A systematic literature review was conducted. Fifty-six manuscripts were analyzed regarding the parameters investigated, the number of participants included, the study designs used, the assessment instruments, and the results. A broad range of factors were considered to contribute to successful voice rehabilitation, whereby psychosocial attributes related to success are mentioned as often as medical and treatment-related characteristics. The results of the studies are mostly inconsistent. It can be concluded, however, that active communication behavior, employment status, type of alaryngeal speech and the general physical condition are associated with rehabilitation outcomes, whereas alcohol consumption is not. More comprehensive prospective studies are needed which analyze the impact of psychosocial factors with validated and standardized instruments. A large sample size would be necessary to calculate all possibly relevant factors and their interaction. Clinicians should be careful about considering their patients to be "unmotivated" if the rehabilitation fails; instead, they should encourage them to communicate actively and take part in social activities.

[Relevance of psychosocial factors in speech rehabilitation after laryngectomy]. / Bedeutung psychosozialer Faktoren bei der Stimmrehabilitation nach Laryngektomie.

BACKGROUND: Often it is assumed that psychosocial and sociodemographic factors cause the success of voice rehabilitation after laryngectomy. Aim of this study was to analyze the association between these parameters. METHODS: Based on tumor registries of six ENT-clinics all patients were surveyed, who were laryngectomized in the years before (N = 190). Success of voice rehabilitation has been assessed as speech intelligibility measured with the postlaryngectomy-telephone-intelligibility-test. For the assessment of the psychosocial parameters validated and standardized instruments were used if possible. Statistical analysis was done by multiple logistic regression analysis. RESULTS: Low speech intelligibility is associated with reduced conversations (OR 0.970) and social activity (OR 1.049). Patients are more likely to talk with esophageal voice when their motivation for learning the new voice was high (OR 7.835) and when they assessed their speech therapist as important for their motivation (OR 4.794). The risk to communicate merely by whispering is higher when patients live together with a partner (OR 5.293), when they talk seldomly (OR 1.017) and when they are not very active in social contexts (OR 0.966). CONCLUSIONS: Psychosocial factors can only partly explain how voice rehabilitation after laryngectomy becomes a success. Speech intelligibility is associated with active communication behaviour, whereas the use of an esophageal voice is correlated with motivation. It seems that the gaining of tracheoesophageal puncture voice is independent of psychosocial factors.