Ramya S Patel1, Tiffany Mohr2, Christine Hartman3, Carol Stach2, Andrew G Sikora1,4, Jose P Zevallos5, Vlad C Sandulache1,4. 1. 1 Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA. 2. 2 Speech and Language Pathology, Department of Veterans Affairs, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. 3. 3 Houston VA Health Services Research and Development Center, Department of Veterans Affairs, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. 4. 4 Otolaryngology Head and Neck Surgery Service, Department of Veterans Affairs, Michael E. DeBakey VA Medical Center, Houston, Texas, USA. 5. 5 Department of Otolaryngology Head and Neck Surgery, Washington University, St. Louis, Missouri, USA.
Abstract
OBJECTIVES: Veterans have an increased risk of laryngeal cancer, yet their oncologic and functional outcomes remain understudied. We sought to determine the longitudinal impact of tracheoesophageal puncture and voice prosthesis on quality-of-life measures in veterans following total laryngectomy (TL). METHODS: We performed a cross-sectional analysis of TL patients (n = 68) treated at the Michael E. DeBakey Veterans Affairs Medical Center using the Voice Handicap Index (VHI), MD Anderson Dysphagia Index (MDADI), and University of Washington Quality of Life Index (UW-QOL). RESULTS: Using tracheoesophageal (TE) speech was associated with significantly better VHI, MDADI, and UW-QOL scores compared to other forms of communication. The association between TE speech use on VHI, MDADI, and UQ-QOL persisted even when the analysis was limited to patients with >5-year follow-up and was maintained on multivariate analysis that accounted for a history of radiation and laryngectomy for recurrent laryngeal cancer. CONCLUSIONS: Using tracheoesophageal speech after total laryngectomy is associated with durable improvements in quality of life and functional outcomes in veterans. Tracheoesophageal voice restoration should be attempted whenever technically feasible in patients that meet the complex psychosocial and physical requirements to appropriately utilize TE speech.
OBJECTIVES: Veterans have an increased risk of laryngeal cancer, yet their oncologic and functional outcomes remain understudied. We sought to determine the longitudinal impact of tracheoesophageal puncture and voice prosthesis on quality-of-life measures in veterans following total laryngectomy (TL). METHODS: We performed a cross-sectional analysis of TLpatients (n = 68) treated at the Michael E. DeBakey Veterans Affairs Medical Center using the Voice Handicap Index (VHI), MD Anderson Dysphagia Index (MDADI), and University of Washington Quality of Life Index (UW-QOL). RESULTS: Using tracheoesophageal (TE) speech was associated with significantly better VHI, MDADI, and UW-QOL scores compared to other forms of communication. The association between TE speech use on VHI, MDADI, and UQ-QOL persisted even when the analysis was limited to patients with >5-year follow-up and was maintained on multivariate analysis that accounted for a history of radiation and laryngectomy for recurrent laryngeal cancer. CONCLUSIONS: Using tracheoesophageal speech after total laryngectomy is associated with durable improvements in quality of life and functional outcomes in veterans. Tracheoesophageal voice restoration should be attempted whenever technically feasible in patients that meet the complex psychosocial and physical requirements to appropriately utilize TE speech.
Entities:
Keywords:
total laryngectomy; tracheoesophageal prosthesis; veterans