Tracheoesophageal speech: predictors of success and social validity ratings

The purpose of this study was to examine long-term success rates and predictors of success for patients who had undergone either primary or secondary tracheoesophageal puncture. An additional aim was to compare judgments of communication effectiveness made by a speech-language pathologist with those made by the patient or significant other.

Thirty-six laryngectomees were initially rated on a 5-point functional communication scale. These ratings resulted in the formation of two distinct groups that were identified as "successful" and "unsuccessful." The groups were compared on the basis of age at time of surgery and 10 categorical variables that have been implicated in the success or failure of tracheoesophageal puncture surgery.

Results indicated that nearly two thirds of the patients had successful communication at an average of approximately 4 years posttracheoesophageal puncture. For the 13 patients judged as "unsuccessful," reduced vision, limited arm/hand movement, and history of radiotherapy were found in significantly greater numbers. When communication profile ratings made by a speech-language pathologist were compared with those made by the patient or significant other (P/SO), approximately one-third varied by at least "1" scale value, with the vast majority resulting in comparatively higher ratings by the speech-language pathologist.

The findings of this study are in general agreement with previously published success rates for tracheoesophageal puncture and attest to the long-term nature of these success rates in a majority of patients. Additional investigation is necessary to identify factors that may contribute to discrepancies between clinician expectations and those of the patient or significant other.