Quality of life after conservative laryngeal surgery: a multidimensional method of evaluation

Abstract

Assessment of quality of life (QoL) and satisfaction with care are particularly important in the field of oncology. The definition of QoL and the requirements for its measurement are still a matter of debate, but it is generally accepted that QoL is a multidimensional concept involving three different domains: physical, psychological and social. The aim of this study was to test a simple, inexpensive, multidimensional method of QoL measurement, based both on patients' perception of clinical outcome and the quantitatively evaluated clinical outcome, equally weighted, in patients who underwent three different types of conservative laryngeal surgery: horizontal laryngectomy (HG), supraglottic laryngectomy (SL) and subtotal reconstructive laryngectomy (SRL). The following were carried out for each patient: subjective-objective evaluation of speech [computerized spectrographic analysis of fundamental frequency (FO), percentage of noise and intensity and logopedic evaluation of speech], evaluation of deglutition (videofluoroscopic parameters, and qualitative assessment) and evaluation of physical, social, emotional and functional well-being (Functional Assessment of Cancer Therapy, FACT-G, and modified University of Washington Quality of life Scale, UWQoL). Each assessment was given a score rating from one to three points. The overall evaluation of the qualitative and quantitative score for each field and for each type of laryngeal surgery shows that SL results in the best post-operative QoL. Although HG is less damaging and involves swifter functional recovery times, its slightly lower score is due to the poorer quality of speech. The analysis of the results obtained confirm the need to set up an evaluation protocol combining both the subjective perceptions of the patient, as well as the more objective evaluation of the functions that are impaired following surgery. The protocol described above, although limited by the low number of cases, was easy to carry out, inexpensive and applicable in relation to the various types of surgery that may compromise phonation and deglutition.

Multidimensional assessment of voice and speech after supracricoid laryngectomy with cricohyoidopexy

“…All other studies that included acoustic analysis of patients undergoing SCL, that we could identify, were performed without age-matched controls. 2,3,5,8,11 Most of the investigators reported that F0 decreased in patients with SCL, as we observed, 2,3,5,8 while some authors noted increased F0 values. 12 The values of shimmer and jitter in our study group were found to be increased, similar to the literature.…”

“…The acoustic parameters used for evaluating voice are F0, intensity, jitter, percentage jitter, shimmer and signal-to-noise ratio. [3][4][5]11 For acoustic and perceptual analysis, the mid-portion (3 sec) of the sustained /a/ vowel was used, as this method was reported to be the most appropriate. 5 Perturbation measures (in period and amplitude) and harmonicsto-noise computations have emerged as the most robust measures.…”

Evaluation of Voice Quality after Supraglottic Laryngectomy

“…[8][9][10] In addition, SL enables preservation of the glottis with acceptable functional outcomes. 8,9 Vigili et al 11 compared SL to horizontal glottectomy and supracricoid laryngectomy and reported that SL had superior results in terms of quality of life. Although studies have examined vocal outcomes following SL, 12,13 none have determined outcomes based on the extent of resection.…”

Morphological reconstruction of the neoepiglottis after hyo‐sub‐glosso‐epiglottectomy (anteriorly extended supraglottic laryngectomy)

“…1,3 In addition, patients often suffer from insufficient airway and/or poor quality of speech. 3,6,9,10 This tendency is significantly worsened when PC is applied to HSE. 3,6,9 Rademaker et al reported that patients who underwent PC after HSE required the average of 121 days before starting oral intake, and half of these patients were not free from the feeding tube.…”