[Quality of life evaluation after total laryngectomy: interests and limits in speech therapy]

In order to improve the speech therapy process after total laryngectomy (TL), an "ecological" approach of the rehabilitation of the TL has been used to adapt our technique to the appropriate situation of each patient (according to his expectations, his needs, etc...), and therefore to ensure the success of the training of an substitution voice.

Patients were evaluated with auto-evaluation scales: EORTC QLQ C30 dealing with common aspects affecting all patients with cancer, EORTC QLQ H&N 35 dealing with characteristics more particular of cancers of head and neck and a scale of vocal handicap (VHI) to be able to compare quality of life and felt vocal handicap. We completed this study by a perceptive evaluation with the I(I)NFVo scale corresponding to the GRBAS for non-laryngeal voices.

37 subjects, 31 men (84%), 6 women (16%). average age: 60 years. 9 subjects implanted with a tracheo-oesophageal prosthesis (24%). Average post-operative period: 5 years.

The quality of life among patients with TL is relatively well preserved, the principal complaint being in the social field. Neither the age, the sex, the post-operative period, nor the use of a tracheo-oesophageal voice (TOV) instead of an oro-oesophageal voice (OOV) seem to have an influence on the quality of life of the questioned patients. The results with the VHI show that only the post-operative period influences the vocal handicap. As for the perceptive analysis, only the postoperative period and the use of the TOV influence the scores.

This study enabled us to note the absence of correlation between the quality of life, the vocal handicap, and the perceptive quality of the non-laryngeal voice. These scales are complementary tools and can constitute an invaluable help in the treatment of the TL thanks to simple methods (self-evaluation), which are standardized, reproducible, with an aim of assessment at the beginning or at the end of treatment, or to control and follow-up.