喉癌患者喉部分切除术后的嗓音声学分析

目的 探讨喉癌患者喉部分切除术术式、喉功能重建方法与术后嗓音质量的关系。方法 采用Dr．Speech嗓音分析软件，对116例不同术式喉部分切除术患者分别于术后1、2年进行发声功能测试，对测得的基频微扰（jitter）、振幅微扰（shimmer）、标准化噪声能量（NNE）进行比较分析，判断受试者嗓音质量。结果 所测得的声学参数jitter、shimmer、NNE值，以喉声门上水平部分切除术组最低，嗓音质量相对最好（P〈0．01）；喉次全切除术组最高，嗓音质量相对最差（P〈0．01）。声带切除术组和声带癌激光切除术组与其它各组比较，其差异均有显著统计学意义（P〈0．05或0．01），但这两组间比较，差异无统计学意义。各组术后嗓音质量效果从好到差依次为：喉声门上水平部分切除术组、声带切除术组、声带癌激光切除术组、喉垂直部分切除术组、喉额侧部分切除术组、喉次全切除术组。结论 喉癌患者喉部分切除术后，发声功能的恢复与手术方式及重建方法密切相关，其中，喉声门上水平部分切除术组术后嗓音质量相对最佳，喉次全切除术组术后相对最差。     

Voice quality after endoscopic laser surgery and radiotherapy for early glottic cancer: objective measurements emphasizing the Voice Handicap Index

We analyzed the functional outcome and self-evaluation of the voice of patients with T1 glottic carcinoma treated with endoscopic laser surgery and radiotherapy. We performed an objective voice evaluation, as well as a physical, emotional and functional well being assessment of 19 patients treated with laser surgery and 18 patients treated with radiotherapy. Voice quality is affected both by surgery and radiotherapy. Voice parameters only show differences in the maximum phonation time between both treatments. Results in the Voice Handicap Index show that radiotherapy has less effect on patient voice quality perception. There is a reduced impact on the patient’s perception of voice quality after radiotherapy, despite there being no significant differences in vocal quality between radiotherapy and laser cordectomy.     

Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis

OBJECTIVES: Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP). Both are less destructive than total arytenoidectomy and have distinct theoretical advantages for voice preservation, but they have never been compared. METHODS: The records of patients with BVFP treated with TC or MA were reviewed; information regarding the outcome measures of tracheotomy decannulation, dysphagia, Voice Handicap Index score, voice intensity, clinical course, and preoperative and postoperative voice quality was obtained. RESULTS: Seventeen patients were available for evaluation (11 with TC, 6 with MA). All 6 patients with a preoperative tracheotomy were decannulated. Four patients in the MA group and 2 in the TC group had an increase in their postoperative Voice Handicap Index score. Two of the patients in the MA group had a decrease in phonatory sound pressure level of 3 dB, and 1 in the TC group had a decrease of 2 dB sound pressure level. Patient self-report of airway status following TC or MA showed that 62.5% (10 of 16) were significantly better and 25% (4 of 16) were somewhat better. Blinded audio perceptual analysis comparing preoperative and postoperative voice quality showed no difference between the MA and TC groups. A swallowing quality-of-life instrument confirmed a lack of swallowing difficulties postoperatively. CONCLUSIONS: Both TC and MA are good treatment options for BVFP, with a low incidence of complications in postoperative voice or of swallowing difficulties and a consistent improvement of laryngeal airway restriction symptoms.     

Larynx cancer: quality of life and voice after treatment

IntroductionTreatments for patients with laryngeal cancer often have an impact on physical, social, and psychological functions.ObjectiveTo evaluate quality of life and voice in patients treated for advanced laryngeal cancer through surgery or exclusive chemoradiation.MethodsRetrospective cohort study with 30 patients free from disease: ten total laryngectomy patients without production of esophageal speech (ES); ten total laryngectomy patients with tracheoesophageal speech (TES), and ten with laryngeal speech. Quality of life was measured by SF-36, Voice-Related Quality of Life (V-RQOL), and Voice Handicap Index (VHI) protocols, applied on the same day.ResultsThe SF-36 showed that patients who received exclusive chemoradiotherapy had better quality of life than the TES and ES groups. The V-RQOL showed that the voice-related quality of life was lower in the ES group. In the VHI, the ES group showed higher scores for overall, emotional, functional, and organic VHI.DiscussionQuality of life and voice in patients treated with chemoradiotherapy was better than in patients treated surgically.ConclusionThe type of medical treatment used in patients with laryngeal cancer can bring changes in quality of life and voice.     

Multidimensional assessment of female tracheoesophageal prosthetic speech

Objective: The objective of this study was to undertake a multidimensional assessment of female tracheoesophageal prosthetic speech. Study Design: A cross‐sectional cohort study. Setting: Head and Neck Unit in a tertiary oncology referral centre. Patients: Ten female and 10 male total laryngectomy patients with no signs of recurrence and using voice prosthesis were compared to 10 normal female speakers. Intervention(s): Electroglottographic and acoustic analysis of voice parameters for both sustained vowel /i/ and connected speech, perceptual evaluation using GRBAS (with 2 experienced raters) and questionnaire assessment using the University of Washington Quality of Life and the Voice Handicap Index. Statistical analysis was done using the Statistical Package for Social Sciences, (v. 14, SPSS Inc., Chicago III). Results: Median age of the female larygectomy patiemts was 65 years (range: 41‐81), that of male laryngectomees was 66.5 years (range: 40‐79) and that of the normal female subjects was 47.5 years (range: 35‐72). All electroglottographic, acoustic parameters and GRBAS ratings of the female laryngectomy patients were significantly worse as compared with the normal female subjects. The median fundamental frequency (111.8 Hz) was comparable to male tracheoesophageal speakers (115.8 Hz). Mean composite University of Washington Quality of Life score and overall Voice Handicap Index score was 79.3(12.5) and 47.5(27.6) for the female laryngectomy patients and for the males was 81.2 (9.6) and 39.4(18.7). Conclusions: Gender frequency differences as seen in normal subjects are lost following a laryngectomy operation as evidenced by electroglottographic and perceptual data. Although the quality of life scores are comparable to the male tracheoesophageal speakers, they exhibit a greater voice handicap as compared to their male counterparts.     

Laser resection of T1a glottic carcinomas: results and postoperative voice quality

OBJECTIVES: To calculate recurrence, mortality and complication rates and evaluate postoperative voice quality after laser resection of T(1a) glottic carcinoma. MATERIAL AND METHODS: Since 1995 we have treated 118 patients with a T(1a) glottic carcinoma with laser surgery. In order to evaluate postoperative voice quality, patients who were alive and free of recurrence were sent the Voice Handicap Index (VHI) questionnaire containing 30 questions concerning how their voice affects their daily life physically, emotionally and socially. RESULTS: Twelve patients (10%) had a local recurrence and received further treatment, either a second laser treatment, radiotherapy or a total laryngectomy. One patient (0.84%) died due to the laryngeal cancer. Ninety-nine patients were sent the VHI questionnaire and 94 of the completed questionnaires were included in the study and analyzed. The mean total score was 13.2, with mean subscores of 6.5 (physical), 4.1 (functional) and 2.5 (emotional). CONCLUSIONS: The results indicate that these patients as a group do not consider that their voice has a negative impact on their daily life. Good surgical technique is essential to obtain a good functional result. The laser strength should be kept low and the surgical margins small in order to minimize scarring and vocal cord stiffness.     

Posterior cordectomy. Our experience

ObjectiveSeveral surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral cord palsy. We performed a retrospective study of our experience in posterior cordectomy with a laser CO₂, analysing the improvement of dyspnoea and voice quality after surgery.MethodsThis was a retrospective study of 13 cases (9 female, 4 male). The age range was 25-79 years. Iatrogenic post-thyroidectomy (4 cases) was the most common aetiology of bilateral laryngeal palsy in our study.We assessed the subjective improvement of respiratory function and voice quality after laser surgery using the Spanish adaptation of the Voice Handicap Index (VHI).ResultsDyspnoea improved in all patients. Two cases had a worsening of dyspnoea in the immediate postoperative period and one case was successfully solved with a new surgical intervention.After surgery, most of patients suffered from mild or middle dysphonia.ConclusionsThe posterior cordectomy is an easy, safe and effective treatment for dyspnoea secondary to bilateral laryngeal palsy, maintaining acceptable voice quality.     

Valoración de la calidad vocal tras el tratamiento del carcinoma faringolaríngeo avanzado en un protocolo de preservación de órgano

Introduction and objectivesAdvanced laryngeal and pharyngeal cancer, as well as methods to treat them, have a direct impact on voice function, speech communication and deglutition. Such alterations in function can influence employability and general quality of life.Patients and methodsTo characterise the vocal status of the patients treated with an organ-preservation protocol, we report the voice outcomes of 17 patients who were alive and disease free at the time of the survey, with a minimum follow-up of 6 months, after a combination of radiotherapy and chemotherapy to treat advanced cancer. Objective voice assessment by means of spectrographic analysis, the GRBAS perceptual analysis system and the Voice Handicap Index was the methodology followed, which we suggest could be used in future large-scale investigations.ResultsNormal or slightly dysphonic voices were observed in 5 patients (29.4%) and moderate/severe in 12 (70.6%). Spectrographically, the 17 samples were classified as normal in 4 cases (23.4%), Grade I in 3 cases (17.6%), Grade II in 3 (17.6%), Grade III in 4 (23.5%) and Grade IV in 2 (11.7%). The Voice Handicap Index questionnaire, which was completed by the patients themselves, gave normal results in all the patients except for 4 (23.5%).ConclusionsThe voice acoustic analysis of this series shows that the damage related to the organ-preservation protocol displays a relatively wide range of voice function outcomes. To characterise the vocal status of these patients reliably, we propose using homogeneous instruments (spectrography, GRBAS scale, Maximum Phonation Time and Voice Handicap Index) in future meta-analyses.     

Voice outcome following thyroplasty in patients with cancer-related vocal fold paralysis

Medialization laryngoplasty restores voice in patients with unilateral laryngeal paralysis. Of question was whether patients with vocal fold paralysis resulting from cancer or its treatment had as good a post-operative voice result as patients with vocal fold paralysis of benign etiology. The purpose of the present study was to compare post-operative perceptual, acoustic, aerodynamic, and quality of life data in these two patient groups. Twenty-eight patients with vocal fold paralysis secondary to malignancy or its treatment were age and gender-matched with patients with paralysis resulting from benign origin. Pre- and post-operative perceptual judgments of pitch, loudness and quality were rated independently by two speech–language pathologists. A digital audiotape of the patient's voice was analyzed using Soundscope software. Fundamental frequency, conversational intensity and perturbation were evaluated. Glottal flow rates in propositional speech, phonation times and extent of pitch and loudness ranges were also measured. Three quality of life surveys, the Short Form-36 general health survey, the Voice Handicap Index, and the Voice Outcomes Study were administered. Results of voice testing indicated that perceptual, acoustic and aerodynamic data were significantly improved 3 months after thyroplasty in all patients regardless of whether they had a history of cancer. Quality of life data, however, distinguished the two groups. In particular, the general health measure found a significant difference in physical functioning and overall vitality, although satisfaction with improved voice was equally appreciated in both patient groups. Of clinical significance is that though general health may differ, patients with cancer-related laryngeal paralysis can expect to have as good a voice outcome following thyroplasty as patients with paralysis of benign etiology.     

早期声门癌经口激光显微手术患者获较高语音基频

目的评估早期声门癌患者治疗后嗓音特征和生活质量的长期疗效。研究设计回顾性分析台湾一家医学中心的患者资料。方法42例声门癌患者接受放疗（radiation therapy，RT）或经口激光显微手术（transoral laser microsurgery，TLM）治疗12个月后评估其嗓音和生活质量。结果24例患者接受RT，18例患者接受TLM。两组患者无听力学和空气动力学差异，对于男性患者仅有发音基频的差异。在癌症治疗——头颈调查的功能性评估中，TLM治疗组比RT治疗组能更好地交流，但无嗓音质量和强度的差异。同样，这两组在嗓音障碍指数10（VHI-10）评估中也没有显著性差异。结论接受TLM治疗的男性患者比接受RT治疗组的男性患者。具有较高的发音基频。对于早期声门癌患者，无论是接受TLM治疗，还是接受RT治疗，嗓音相关的生活质量是相似的：但是接受TLM治疗患者具有更好的交流能力。     

Laser resection of T1a glottic carcinomas: results and postoperative voice quality

Objectives—To calculate recurrence, mortality and complication rates and evaluate postoperative voice quality after laser resection of T_1a glottic carcinoma.

Material and Methods—Since 1995 we have treated 118 patients with a T_1a glottic carcinoma with laser surgery. In order to evaluate postoperative voice quality, patients who were alive and free of recurrence were sent the Voice Handicap Index (VHI) questionnaire containing 30 questions concerning how their voice affects their daily life physically, emotionally and socially.

Results—Twelve patients (10%) had a local recurrence and received further treatment, either a second laser treatment, radiotherapy or a total laryngectomy. One patient (0.84%) died due to the laryngeal cancer. Ninety-nine patients were sent the VHI questionnaire and 94 of the completed questionnaires were included in the study and analyzed. The mean total score was 13.2, with mean subscores of 6.5 (physical), 4.1 (functional) and 2.5 (emotional).

Conclusions—The results indicate that these patients as a group do not consider that their voice has a negative impact on their daily life. Good surgical technique is essential to obtain a good functional result. The laser strength should be kept low and the surgical margins small in order to minimize scarring and vocal cord stiffness.     

Endolaryngeal cordectomy using cold instruments for treatment of T1 glottic cancers

In the treatment of early-stage glottic cancers, radiotherapy and surgery have similar success rates. In our department, we have been using cold instruments coupled with surgical microscope and/or telescopes for several years in treatment of early stage glottic cancers. Our aims were, to present our experience with endolaryngeal resection of T1 glottic cancers with cold instruments coupled with surgical microscope and telescopes, to present our oncological results, to discuss the advantages of endolaryngeal cordectomy over open cordectomy or RT and to discuss whether laser is obligatory for this approach or not.Our study includes retrospective analysis of 38 patients with T1 glottic cancer, who have been treated with endolaryngeal surgery as the primary treatment. The median follow-up was 24 months. The most commonly performed procedure was type-II cordectomy (38.5%). Overall survival rate was 94.7%, while the disease-specific survival rate was 100%. Local recurrences occurred in two patients at 8th and 11th months, postoperatively. In the first patient, type-Vc cordectomy and in the second type-Va cordectomy had been performed. Both patients with recurrences could be salvaged by fronto-lateral laryngectomy, and are still alive in their 38th and 6th months following salvage surgery. Therefore, the local control rate and larynx preservation rate with endolaryngeal cordectomy were 94.7 and 100%, respectively, in this study group. All patients had a voice quality sufficient for communicating easily over telephone. We believe that lasers are not obligatory to perform endolaryngeal cordectomy for treatment of T1 glottic cancers, as the same oncological and similar functional outcomes may be achieved with the traditional cold instruments.     

Voice,speech, and swallowing outcomes in laser-treated laryngeal cancer

OBJECTIVE: To describe preliminary voice, speech, and swallowing outcomes in patients treated by endoscopic laser excision of laryngeal cancer with or without adjuvant radiation therapy. STUDY DESIGN: Retrospective review. METHODS: Seventeen surgically treated patients (five T2 glottic and 12 clinically staged T2 supraglottic squamous cell carcinomas) participated in the study. Self-ratings of voice (Voice Handicap Index) and swallowing (M. D. Anderson Dysphagia Inventory) were completed, as well as independent auditory-perceptual ratings of voice and speech recordings. RESULTS: Although no significant difference between Voice Handicap Index, M. D. Anderson Dysphagia Inventory, and listener ratings was identified based on tumor site and irradiation status, there was a trend toward poorer outcomes in patients who received adjuvant radiation therapy. Whereas the patients having supraglottic cancer tended to report better voice but poorer swallowing outcomes, the glottic cancer group displayed the opposite pattern. Severity on Voice Handicap Index correlated significantly with listener severity ratings of speech, suggesting that the patients' perception of their voice handicap was similar to the listeners' judgments of their speech severity. CONCLUSIONS: The results suggest the following trends: 1) Adjuvant radiation therapy was associated with poorer outcomes for voice, speech, and swallowing and may be associated with more impairment than surgery alone and 2) poorer outcomes on voice and swallowing were observed for the glottic and supraglottic cancer groups, respectively. To bolster these preliminary findings, additional outcomes studies in patients treated with conservation therapy are needed.     

Quality of life and voice handicap of laryngectomees using tracheoesophageal substitute voice

BACKGROUND: Health-related quality of life (QoL) and subjective health have become popular constructs for the evaluation of both efficacy and efficiency of diagnostic and therapeutic procedures in medicine. QoL is considered a multidimensional construct encompassing physical, mental and social facets of life. It is an accepted outcome parameter not only in international classification systems such as ICIDH and ICF, but as well in clinical guidelines and disease management programs. Measuring quality of life allows for comparison of different diseases though it certainly lacks disease specific aspects. Thus, it has to be assumed that in patients with distinct functional deficits QoL cannot cover all aspects that are important for the individual patient. This study focuses on laryngectomies and their self-evaluation of post-laryngectomy speech. It is well known that these patients experience a decreased QoL compared to patients after partial laryngectomy or healthy persons. In this study, the impact of voice restoration on the laryngectomies' QoL was evaluated. PATIENTS AND METHODS: In 20 male laryngectomies aged 62 +/- 8 years, relations between QoL and voice handicap were evaluated using two instruments as proposed in the international literature, i. e. the Short-Form Health Survey (SF-36) and the Voice Handicap Index (VHI). All patients had successfully been using tracheoesophageal substitute voice for at least one year. Complete data sets were available from all patients. Data were analysed using Microsoft Excel and Sigma Plot, Jandel Corp. software packages. RESULTS: Results of both the SF-36 and the VHI reveal wide interindividual ranges. There are statistically significant correlations (p < 0.05) between the SF-36's scales General Health and Vitality and the VHI, whereas no correlations were found between social and psychological scales and the voice handicap. DISCUSSION: Wide ranges of the data obtained reveal that obviously both health related quality of life and voice handicap are not affected in a group specific way. So, both tests are of clinical value to depict individual aspects of wellbeing after laryngectomy. The combination of VHI and SF-36 illuminates correlations between general and special subjective aspects. Strikingly, the laryngectomies' social and psychological status is not related to their voice handicap. Data allow for conclusion that laryngectomies' substitute voice problems do not affect social aspects of quality of life in a disease specific way, at least as long as voice restoration was successful at all.     

Voice rehabilitation after laryngectomy with the Provox voice prosthesis in South Africa

A study was undertaken to determine whether the Provox voice prosthesis provides good voice rehabilitation following a total laryngectomy in the urban, suburban and rural populations served by a tertiary referral hospital in South Africa. Between 1995 and 1999, a cohort of 128 patients at Tygerberg Hospital was rehabilitated with the Provox voice prosthesis after laryngectomy. In 104 patients primary placement of the prosthesis was done at the time of the laryngectomy. Mean device life and adverse events were determined. Voice quality was assessed subjectively in 104 patients and objectively in 26 patients. The mean device life was 303 days and adverse events occurred in 16 patients. Subjectively, 77 of 104 patients had a good voice, and objectively 22 of 26 patients had good voice intelligibility. The Provox voice prosthesis provides good voice rehabilitation following total laryngectomy, with minimal complications, in the population served by Tygerberg Hospital.     

Clinical outcome of early glottic carcinoma in Serbia

Objective

Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, laser cordectomy, and radiotherapy. The aim of the study was to conduct comprehensive study to evaluate oncological and functional results of different treatment modalities for Tis and T1 glottic carcinoma, identify prognostic factors for the outcome of treatment and decide where we stand in applying worldwide standards of early glottic carcinoma treatment.

Methods

Prospective study was conducted on 221 patients treated with Tis and T1 glottic carcinoma from 1998 to 2003 (72 patients were treated endoscopically with CO₂ laser, 75 patients with cordectomy through laryngofissure and 74 with radiotherapy), with follow-up period from 38 to 107 months. Important demographic and clinical variables were analyzed. Voice quality after the treatment was assessed using multidimensional voice analysis.

Results

Comparing oncological results of three modalities of treatment, there were no significant differences. Functional results of treatment were better after laser cordectomy and primary radiotherapy than following the open cordectomy. Five-year survival rate was almost identical in all three groups of patients, and important prognostic factors for survival were age and histological grade of the tumor.

Conclusion

Considering that the choice of treatment in our country is also greatly influenced by other paramedical factors, such as distance from treatment facility, reliability of follow-up, significant time delay of radiotherapy because of small number of radiology centers and strong patients’ surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.     

Breathing and voice quality after surgical treatment for bilateral vocal cord paralysis

OBJECTIVE: To evaluate long-term results of surgical treatment for bilateral vocal cord paralysis using objective and subjective measures of breathing and voice quality. DESIGN: Prospective cross-sectional case series. SETTING: Tertiary care otolaryngology and speech pathology referral center. PATIENTS: Ten patients with bilateral vocal cord paralysis who underwent surgical treatment between October 1996 and May 2006 at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Würzburg, were examined at a mean of 27.2 months after surgery. MAIN OUTCOME MEASURES: Glottal area, voice range profile, Voice Handicap Index, pulmonary function test results, G?ttingen Hoarseness Diagram, microlaryngostroboscopic findings, chronic respiratory disease questionnaire, and European Organization for Research and the Treatment of Cancer quality-of-life questionnaire, including the head and neck module. RESULTS: Residual recurrent nerve function was seen in 9 of 10 patients. Pulmonary data varied widely and did not correlate with the size of the glottal area. Quality of life, subjective dyspnea, and physical functioning correlated with expiratory airflow measures. Voice range was reduced in all patients. High breathiness and reduced maximum phonation time led to increased Voice Handicap Index scores. CONCLUSIONS: Microlaryngostroboscopic findings did not necessarily correlate with subjective dyspnea and vocal complaints. Reduction of inspiratory speaking efforts and acquisition of special breathing techniques improve airflow stability and effectiveness of respiration, leading to enhanced quality of life.     

Functional outcomes after supracricoid laryngectomy

OBJECTIVES: Local control and 5-year survival rates are similar for patients undergoing total laryngectomy and supracricoid laryngectomy for the treatment of advanced-stage laryngeal carcinoma. However, comprehensive studies of functional outcomes after supracricoid laryngectomy are lacking. STUDY DESIGN: Cohort study. METHODS: This investigation provides objective voice laboratory data, skilled listener impressions of voice samples, swallowing evaluations, and patient self-perceptions of speech ability obtained from 10 supracricoid laryngectomees. RESULTS: Results demonstrated variable acoustic and speech aerodynamic disturbances, hoarse-breathy vocal quality, and speech dysfluency. Patients' self-perceptions of voice revealed severe dysphonia that induced certain emotional, physical, and functional setbacks. However, blinded judges rated these individuals as possessing intelligible speech and communication skills. All patients demonstrated premature spillage of the bolus and varying degrees of laryngeal penetration, aspiration, and retention during swallowing studies. However, each patient used a compensatory strategy to protect the airway. Voice and swallowing abilities appeared to depend on the mobility of the arytenoid cartilages, base of tongue action, and residual supraglottic tissue for the creation of a competent neoglottal sphincter complex that vibrated during phonation efforts and protected the airway during deglutition. CONCLUSIONS: Supracricoid laryngectomy avoids the potential complications, limitations, and emotional problems associated with a permanent tracheostoma. All patients demonstrated intelligible voice and effective swallowing function postoperatively, supporting supracricoid laryngectomy as a suitable alternative surgical approach to the total laryngectomy in select patients.     

Cricohyoidoepiglottopexy vs near-total laryngectomy with epiglottic reconstruction in the treatment of early glottic carcinoma

OBJECTIVE: To compare functional and oncological outcomes of cricohyoidoepiglottopexy (CHEP) and near-total laryngectomy with epiglottic reconstruction (NTLER) techniques in early glottic carcinoma. DESIGN: Case series, clinical study. SETTING: Two tertiary care referral centers. PATIENTS: Seventeen patients with T1b glottic squamous cell carcinoma were treated with CHEP and 21 were treated with NTLER. MAIN OUTCOME MEASURES: Fundamental frequency, maximum phonation time, maximum phonation intensity, Voice Handicap Index, and GRBAS (grade, roughness, breathiness, asthenia, and strain) scale were used to evaluate voice. Nasogastric tube removal times and late postoperative aspiration scales were used to evaluate swallowing ability. RESULTS: Fundamental frequency (P=.78), maximum phonation time (P=.44), and maximum phonation intensity (P=.94) measurements were not significantly different in the 2 groups. There was also no significant difference in mean Voice Handicap Index score (P=.62), mean decannulation time (P=.25), time to nasogastric tube removal (P=.12), or clinical grades of late postoperative aspiration (P=.87) between the 2 groups. The mean Voice Handicap Index score was 55.58 in the CHEP group and 52.78 in the NTLER group. According to the GBRAS scale, overall voice quality was moderately altered in both groups. All patients were successfully decannulated. In the CHEP and NTLER groups, the mean decannulation times were 27 and 20 days, respectively, and the nasogastric tubes were removed after an average of 23 and 17 days. The overall (Kaplan-Meier) survival rate was 94% in the patients who underwent CHEP and 90% in the patients who underwent NTLER (P=.76). The disease-free survival rates were 100% and 76% in the CHEP and NTLER groups, respectively (P=.07). CONCLUSIONS: Functional and oncological results appear to be similar with both treatment methods. If open surgery is planned, the choice between these procedures mainly depends on the experience and preference of the surgeon.     

Treatment responsiveness of the Singing Voice Handicap Index

Objectives/Hypothesis: To examine the responsiveness of the previously validated Singing Voice Handicap Index (SVHI) to treatment related changes in patients' singing voice. Study Design: Prospective. Methods: Thirty singing patients at a tertiary voice clinic prospectively completed the Voice Handicap Index and SVHI at their initial presentation, pretreatment, and posttreatment. Results: Patients had lower SVHI scores posttherapy compared with the initial SVHI scores (P ≤ .001, paired t-test). The change in SVHI scores from initial to posttreatment evaluation was greater than the change from initial to pretreatment evaluation (P < .001, paired t-test). The Spearman correlation of the Voice Handicap Index difference with the SVHI difference before and after treatment was 0.71 (P < .001). Conclusion: The SVHI measures changes in patients' singing vocal health status resulting from treatment and the change correlates with that of other validated instruments.