Emily C Deane1, Harman Parhar1, Linda Rammage1,2, Amanda Hu3, Donald W Anderson1. 1. Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC, V5Z1M9, Canada. 2. School of Audiology & Speech Sciences, University of British Columbia, Vancouver, Canada. 3. Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC, V5Z1M9, Canada. amanda.hu@vch.ca.
Abstract
BACKGROUND: Gastric pull-up is a reconstructive option for circumferential defects after resection of advanced laryngopharyngeal malignancy. Voice loss is expected and vocal rehabilitation remains a challenge. Our study objectives were to investigate the feasibility of secondary tracheoesophageal puncture following gastric pull-up and to analyze voice outcomes. METHODS: This was a prospective cohort study of patients with advanced laryngopharyngeal malignancies who underwent gastric pull-up and secondary tracheoesophageal puncture between 1988 and 2017 at a tertiary-care academic institution. Objective acoustic measures included fundamental frequency and vocal intensity. Perceptual analysis was performed using voice recordings ("Rainbow Passage") randomly presented in a blinded fashion to four clinicians using the validated GRBAS scale. Speech intelligibility was assessed in a blinded fashion using a validated 7-point scale. Additionally, the Voice Handicap Index-10 was administered as a validated patient self-reporting tool. RESULTS: Ten patients (7 male, 3 female) were included, all of whom preferentially used tracheoesophageal puncture for communication. These patients had abnormal median fundamental frequency of 250 (interquartile range (IQR) 214-265) Hz and a limited median vocal intensity of 65.8 (IQR 64.1-68.3) dB. Perceptual analysis (GRBAS) revealed a median 'moderate' degree of impairment [grade 2 (IQR 2-3), roughness 2 (IQR 2-3), breathiness 3 (IQR 2-3), asthenia 2 (IQR 1-2), strain 2 (IQR 1-2)] as did median intelligibility scores [median 5 (IQR 4-7)]. Most patients self-reported an abnormal voice handicap-10 [median 26.5 (IQR 22.8-35.0)]. CONCLUSION: Secondary tracheoesophageal puncture is a safe and feasible option for voice rehabilitation after gastric pull-up. Although analyses demonstrated moderate subjective and objective impairment, tracheoesophageal puncture provided patients with a self-reported means of functional verbal communication and was their preferred method of communication.
BACKGROUND: Gastric pull-up is a reconstructive option for circumferential defects after resection of advanced laryngopharyngeal malignancy. Voice loss is expected and vocal rehabilitation remains a challenge. Our study objectives were to investigate the feasibility of secondary tracheoesophageal puncture following gastric pull-up and to analyze voice outcomes. METHODS: This was a prospective cohort study of patients with advanced laryngopharyngeal malignancies who underwent gastric pull-up and secondary tracheoesophageal puncture between 1988 and 2017 at a tertiary-care academic institution. Objective acoustic measures included fundamental frequency and vocal intensity. Perceptual analysis was performed using voice recordings ("Rainbow Passage") randomly presented in a blinded fashion to four clinicians using the validated GRBAS scale. Speech intelligibility was assessed in a blinded fashion using a validated 7-point scale. Additionally, the Voice Handicap Index-10 was administered as a validated patient self-reporting tool. RESULTS: Ten patients (7 male, 3 female) were included, all of whom preferentially used tracheoesophageal puncture for communication. These patients had abnormal median fundamental frequency of 250 (interquartile range (IQR) 214-265) Hz and a limited median vocal intensity of 65.8 (IQR 64.1-68.3) dB. Perceptual analysis (GRBAS) revealed a median 'moderate' degree of impairment [grade 2 (IQR 2-3), roughness 2 (IQR 2-3), breathiness 3 (IQR 2-3), asthenia 2 (IQR 1-2), strain 2 (IQR 1-2)] as did median intelligibility scores [median 5 (IQR 4-7)]. Most patients self-reported an abnormal voice handicap-10 [median 26.5 (IQR 22.8-35.0)]. CONCLUSION: Secondary tracheoesophageal puncture is a safe and feasible option for voice rehabilitation after gastric pull-up. Although analyses demonstrated moderate subjective and objective impairment, tracheoesophageal puncture provided patients with a self-reported means of functional verbal communication and was their preferred method of communication.
Entities:
Keywords:
Gastric pull-up; Laryngopharyngoesophagectomy; Quality of life; Voice
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