Management of Dysphonia After Radiation Therapy

Villari, Craig R.; Courey, Mark S.

doi:10.1016/j.otc.2015.04.006

Cited by 12 publications

(10 citation statements)

References 42 publications

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“…Fibrosis leads to reduced tissue viscosity, which reduces the normal vibratory patterns that are required for normal voice. These tissue changes make long-term rehabilitation difficult 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients are taught to maintain adequate systemic hydration to maximise vocal function during and after radiation treatment. Local hydration using environmental humidification or steam inhalation is also beneficial 17 . Voice therapy focuses on helping the patient produce voice without using inefficient compensatory behaviours such as increased laryngeal strain and supraglottic constriction 2 .…”

Section: Discussionmentioning

confidence: 99%

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Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers

Sreenivas

Sreedharan

Narayan

et al. 2021

Acta Otorhinolaryngol Ital

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Objective. This study evaluated the effect of voice intervention in patients who received chemoradiation to the neck for non-laryngeal head and neck malignancies. Methods. Twenty individuals with non-laryngeal malignancies of the head and neck who received chemoradiation were divided by block randomisation into an intervention group that received voice rehabilitation and a control group without rehabilitation. All patients underwent acoustic analysis, perceptual and subjective analysis of voice before the commencement of chemoradiotherapy and at 1, 3 and 6 months after chemoradiotherapy. Results. In both groups, all parameters were significantly altered at one month followup except for fundamental frequency (females in control group and males in intervention group). In the intervention group, all parameters returned to pretreatment levels (no statistical differences) at 6 months. In the control group, all except for a few subjective parameters (grade, breathiness and asthenia) remained significantly altered at 6 months compared to the levels before radiotherapy. Conclusions. In non-laryngeal head and neck malignancies, voice rehabilitation offered at 1 month after treatment ameliorates chemoradiation-induced dysphonia within 6 months. KEY WORDS: chemoradiation, non-laryngeal head and neck cancer, voice handicap index, dysphonia RIASSUNTO Obiettivo. Questo studio mira a valutare l'effetto della riabilitazione vocale in pazienti sottoposti a chemiradioterapia per tumori maligni della testa e del collo non laringei. Metodi. Venti individui con neoplasie non laringee della testa e del collo che hanno effettuato trattamento chemioradioterapico sono stati divisi per randomizzazione in due gruppi:un gruppo ha ricevuto la riabilitazione vocale e un gruppo di controllo senza riabilitazione. Tutti i pazienti sono stati sottoposti ad analisi acustica, analisi percettiva e soggettiva della voce prima dell'inizio della chemio radioterapia e a tre e sei mesi dopo la chemio radioterapia. Risultati. In entrambi i gruppi, tutti i parametri sono stati alterati in modo significativo a un mese di follow-up ad eccezione della frequenza fondamentale (femmine nel gruppo di controllo e maschi nel gruppo di intervento). Nel gruppo sottoposto a riabilitazione, tutti i parametri sono tornati ai livelli di pretrattamento (nessuna differenza statistica) a 6 mesi di follow-up. Nel gruppo di controllo, tutti tranne alcuni parametri soggettivi (grado, respiro affannoso e astenia) sono rimasti significativamente alterati a 6 mesi, rispetto ai livelli precedenti alla radioterapia. Conclusioni. Nei tumori maligni della testa e del collo non laringei, la riabilitazione vocale offerta un mese dopo il trattamento migliora la disfonia entro sei mesi.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers

Sreenivas

Sreedharan

Narayan

et al. 2021

Acta Otorhinolaryngol Ital

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“…Generally, surgery in a previously radiated surgical field is challenging, time consuming, and poses a higher rate of complications. Radiation alters tissue vascularity and promotes fibrosis, which may result in slow recovery, uncontrolled postoperative infections, chondritis/chondronecrosis, ischemic damage to the nearby poorly vascularized mucosa, and implant extrusion.…”

Section: Introductionmentioning

confidence: 99%

“…However, there are no published objective studies to support these arguments. Nevertheless, evidence to support any surgical treatment for dysphonia in radiated patients is limited as well . Recent evidence sheds more light on the safety of LFS in the radiated larynx.…”

Section: Introductionmentioning

confidence: 99%

Is laryngeal framework surgery safe in the radiated larynx?

2016

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“…A recent review of laryngeal cancer management reports speech-language pathology intervention to be the primary and most successful treatment modality for voice rehabilitation after laryngeal cancer treated with radiotherapy (Villari & Courey, 2015). Despite this, other authors report that patients, post cancer treatment, perceive little need for voice therapy .…”

Section: Discussionmentioning

confidence: 99%

Laryngeal cancer management: Voice, communication and quality of life outcomes following non-surgical treatment

Bergström¹

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Organ-preservation treatments, such as radiotherapy + chemotherapy ([C]RT), are used to manage laryngeal cancer with the dual aim of achieving cancer cure, whilst enabling preservation of the larynx for improved functional outcomes post treatment. Research, however, has shown that organ-preservation is not synonymous with function-preservation. It is now recognised that vocal impairments often remain after organ-preservation treatment and that a return to normal voice function does not occur for all patients. Consequently, further research is needed to investigate the varying sequelae of laryngeal cancer management, specifically the impact on function and quality of life (QOL) over time, and the efficacy of rehabilitation. Positive benefits following rehabilitation have been reported within the greater head and neck cancer (HNC) population, however, research specifically exploring laryngeal cancer management, impact on voice function, communication, QOL and patient well-being is comparatively sparse. Hence, the aims of the current thesis are to (1) investigate voice function, communication and QOL for patients treated with (C)RT, and (2) examine the impact of voice rehabilitation on function, patient perceptions and psychological well-being. The first three studies of this thesis (Chapters 2-4) address the first aim, while studies 4 and 5 (Chapters 5-6) address the second. Data used in the current thesis were derived from (a) a large, randomised controlled trial (RCT), (b) a normative cohort, (c) a community listener group, and (d) speech-language pathology (SLP) clinicians. The first study (Chapter 2) investigates the potential impact of laryngeal biopsy on voice outcomes in a pilot group of 15 patients, and a matched control cohort (n=15). Voice outcomes were collected via voice recordings for both groups with the patient group undergoing recordings pre and post biopsy. No significant difference was observed pre-post biopsy, however examination of individual data suggested that multiple punch biopsies may negatively impact functional outcomes. Although the biopsy is a necessary component of cancer diagnosis, this pilot study concluded that type of biopsy may influence functional outcomes and that this is in an area requiring further research. Chapter 3 presents a longitudinal study investigating voice characteristics, communication and QOL outcomes for a cohort of patients (n=40) who received radiotherapy for laryngeal cancer. Voice function, patient reported communication and QOL outcomes were recorded pre treatment, then again at 1, 6 and 12 months post treatment. Results indicated that patients with laryngeal cancer demonstrated impaired and/or reduced perceptual, acoustic, patient reported communication and QOL outcomes pre radiotherapy, which persisted up to 12 months post. Results also documented patterns of change during the 12 month follow-up period. The implications for the nature and timing of voice rehabilitation are discussed.

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Management of Dysphonia After Radiation Therapy

Cited by 12 publications

References 42 publications

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers

Is laryngeal framework surgery safe in the radiated larynx?

Laryngeal cancer management: Voice, communication and quality of life outcomes following non-surgical treatment

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