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Functional speech outcomes after laryngectomy and pharyngolaryngectomy
M J McAuliffe1, E C Ward, L Bassett
1Department of Speech Pathology and Audiology, The University of Queensland, St Lucia, Australia.
Archives of Otolaryngology--Head & Neck Surgery
|June 23, 2000
Summary
Patients undergoing total laryngectomy or pharyngolaryngectomy with free jejunal reconstruction can achieve functional tracheoesophageal speech. While pharyngolaryngectomy patients had lower intelligibility and voice quality, both groups reported high satisfaction and well-being.
Area of Science:
- Otolaryngology
- Speech-Language Pathology
- Reconstructive Surgery
Background:
- Total laryngectomy and pharyngolaryngectomy are surgical procedures that can significantly impact speech.
- Tracheoesophageal speech (TES) is a common voice rehabilitation method following these surgeries.
- Free jejunal interposition is a reconstructive technique used after pharyngolaryngectomy.
Purpose of the Study:
- To compare functional speech outcomes between patients who underwent total laryngectomy versus pharyngolaryngectomy.
- To evaluate voice quality, intelligibility, and patient-reported satisfaction and well-being in both groups using TES.
- To determine the effectiveness of TES as a primary communication mode after these extensive head and neck surgeries.
Main Methods:
- A group comparison design was employed in an adult acute tertiary care hospital setting.
- Thirty patients post-total laryngectomy and 13 post-pharyngolaryngectomy (with free jejunal reconstruction) were included.
- Speech intelligibility, voice quality, TES use, satisfaction, disability, handicap, and well-being were assessed and compared between groups.
Main Results:
- Pharyngolaryngectomy patients demonstrated reduced functional intelligibility (P<.05) and poorer voice quality (P<.01).
- Higher levels of perceived voice disability were reported in the pharyngolaryngectomy group (P<.05).
- No significant difference was found in the proportion of successful TES users; both groups reported low handicap and high well-being.
Conclusions:
- Functional, effective, and satisfactory tracheoesophageal speech is achievable after both total laryngectomy and pharyngolaryngectomy with free jejunal reconstruction.
- Despite objective differences in voice quality and intelligibility, patient-reported outcomes are positive in both surgical groups.
- TES serves as a viable and satisfactory communication method for patients following extensive oncologic surgery of the larynx and pharynx.