Multidimensional evaluation of voice outcomes following total laryngectomy: a prospective multicenter cohort study

K.E. van Sluis, R.J.J.H. van Son, L. van der Molen, A.J. MCGuinness, C.E. Palme, D. Novakovic, D. Stone, L. Natsis, E. Charters, K. Jones, R. Dirven, M.W.M. van den Brekel

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The purpose of this study is to assess the general course of acoustic, patient rated, and clinician-rated voice outcomes from pre- up to 12 months post total laryngectomy.

Patients admitted to a total laryngectomy in five participating hospitals in Australia and The Netherlands were included. Assessments took place at pre-, 3 months, 6 months, and 12 months post-surgery. Voice outcomes are evaluated with the Acoustic Voice Quality Index (AVQI), perceptual scales, and patient-reported outcome measures including VHI-10 and EQ-5D-5L. Statistical analyses include descriptive statistics, t tests (pre- to 6 months post-surgery), Linear Mixed Effect models.

The study included 43 participants. A significant worsening of AVQI is seen from pre- to post-surgery evaluated with t test (p < 0.001). The Linear Mixed Effect model confirmed Time as a significant factor in predicting AVQI score (p ≤ 0.001), as well as perceptual rated voice quality by the clinician (p = 0.015) and patient-reported perceptual rated voice quality (p = 0.002). No statistical significance was found in VHI-10 scores over time.

Successful TE-speech was achieved in most participants, some had to rely on augmentative alternative communication methods. Patient-reported outcomes indicate acceptance of the condition and sufficient coping in the long term. However, acoustic rated voice quality is abnormal at all post-surgery time-points. AVQI proved to be a useful instrument to evaluate TE-speech. There is a need for validation and determination of cut-off values for VHI-10 and AVQI for use in TE-speech.
Original languageEnglish
Pages (from-to)1209–1222
Number of pages14
JournalEuropean Archives of Oto-Rhino-Laryngology
Issue number4
Early online date21 Jul 2020
Publication statusPublished - Apr 2021


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