Qualitative Voice Analysis in Patients With Head and Neck Cancer Using the Provox Voice Prosthesis

No methods have been established for evaluating successful shunt phonation and voice quality in patients after laryngectomy. In this study, we investigated whether acoustic analysis using smoothed cepstral peak prominence (CPPS) is useful for objectively evaluating shunt phonation using a voice prosthesis after laryngectomy. We examined the evaluation method for shunt phonation, conditions for obtaining good phonation, and practical methods for postoperative rehabilitation.

We evaluated 11 patients who used Provox voice prosthesis and underwent laryngectomy for head and neck cancer treatment at our facility between April 2021 and March 2024. We examined CPPS, age at the time of Provox insertion, sex, primary lesion, presence or absence of skin flap, type of skin flap, timing of Provox placement, maximum phonation time, Vocal Fatigue Index (VFI), Voice Handicap Index, and extent of tumor resection.

The median age was 67 years (range: 58-85 years), and the male-female ratio was 10:1. The primary diseases were laryngeal cancer in six cases and hypopharyngeal cancer in five cases. All five cases of hypopharyngeal cancer underwent flap reconstruction, with four cases undergoing free jejunum reconstruction and one case undergoing pectoralis major myocutaneous flap reconstruction. CPPS 16.8 (13.8-24.6) was analyzable for all cases and was significantly correlated with VFI (r = -0.72, p = 0.01).

CPPS is a useful evaluation item in shunt phonation, while VFI is a useful evaluation item that is easily assessed in daily clinical practice. Therefore, to implement effective voice rehabilitation, rehabilitation should be implemented while using these combined multiple evaluation methods.