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      The impact of vocal rehabilitation on quality of life and voice handicap in patients with total laryngectomy

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          Abstract

          Background:

          Health-related quality of life (HRQL) and voice handicap index (VHI) of laryngectomies seem to be relevant regarding voice rehabilitation. The aim of this study is to assess the impact on HRQL and VHI of laryngectomies, following voice rehabilitation.

          Materials and Methods:

          A retrospective study done at the Ear, Nose, and Throat Department of the Emergency County Hospital. Sixty-five laryngectomees were included in this study, of which 62 of them underwent voice rehabilitation. Voice handicap and QOL were assessed using the QOL questionnaires developed by the European Organisation for Research and Treatment of Cancer (EORTC); variables used were functional scales (physical, role, cognitive, emotional, and social), symptom scales (fatigue, pain, and nausea and vomiting), global QOL scale (pain, swallowing, senses, speech, social eating, social contact, and sexuality), and the functional, physical, and emotional aspects of the voice handicap (one-way ANOVA test).

          Results:

          The mean age of the patients was 59.22 (standard deviation = 9.00) years. A total of 26 (40%) patients had moderate VHI (between 31 and 60) and 39 (60%) patients had severe VHI (higher than 61). Results of the HRQL questionnaires showed that patients who underwent speech therapy obtained better scores in most scales ( P = 0.000). Patients with esophageal voice had a high score for functional scales compared with or without other voice rehabilitation methods ( P = 0.07), and the VHI score for transesophageal prosthesis was improved after an adjustment period. The global health status and VHI scores showed a statistically significant correlation between speaker groups.

          Conclusion:

          The EORTC and the VHI questionnaires offer more information regarding life after laryngectomy.

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          Most cited references24

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          Validation of the EORTC QLQ-C30 and EORTC QLQ-H&N35 in patients with laryngeal cancer after surgery.

          The aim of this study was to test the validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (QLQ-C30) and Head and Neck Module (QLQ-H&N35) for patients who have undergone surgery due to laryngeal cancer.
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            An endoscopic technique for restoration of voice after laryngectomy.

            Reports of restoration of voice after total laryngectomy include diversion of exhaled pulmonary air though planned or spontaneous fistulae with a variety of modified tracheal cannulas and valves. Limitations of these techniques include aspiration, scar closure of the shunts, wound complications, and failure to achieve voice consistently. We report a two-year experience with an endoscopic method using a unique valved prosthesis eliminating complicated surgical reconstructions, aspiration, and stenosis. Fifty-four of 60 patients (90%) achieved fluent voices with one deglutition problem. Radiation therapy preceded voice restoration in 63% of the patients and radical neck dissection in 72%. The endoscopic procedure, hospitalization and period of speech therapy are short and constitute a cost-effective voice rehabilitation program. The results of this simple method and lack of complications are encouraging.
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              A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy.

              Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance in the last 10 years. Several reliable voice prostheses have been developed and used successfully. Priorities for further development of the methods and instruments for prosthetic voice rehabilitation have led to the design of a low-resistance, self-retaining voice prosthesis (Provox) and an adapted replacement method. The results obtained in 79 patients are described. In vivo airflow resistance ranged from 1.0 to 3.8 kPa (mean = 1.9 kPa). Speech quality was good in 91% of the patients. The self-retaining properties of the prosthesis appeared to be satisfactory. The average device-life was more than 5 months. Replacement of the prosthesis with a new disposable guide wire was done quickly as an outpatient procedure. Maintenance of the prosthesis by the patient was simple. The new low-resistance, self-retaining Provox voice prosthesis and the modified replacement method appeared to further improve the results of prosthetic voice rehabilitation after total laryngectomy.
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                Author and article information

                Journal
                J Res Med Sci
                J Res Med Sci
                JRMS
                Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
                Medknow Publications & Media Pvt Ltd (India )
                1735-1995
                1735-7136
                2016
                26 December 2016
                : 21
                : 127
                Affiliations
                [1]Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
                [1 ]Department of Otorhinolaryngology, Emergency County Hospital, Cluj-Napoca, Romania
                [2 ]Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
                Author notes
                Address for correspondence: Dr. Magdalena Chirilă, Iuliu Hatieganu University of Medicine and Pharmacy, 13 Emil Isaac, 400023, Cluj-Napoca, Romania. E-mail: chirila_magda@ 123456yahoo.com
                Article
                JRMS-21-127
                10.4103/1735-1995.196609
                5348966
                2dd10c9d-29a0-46d5-ba39-42b9c31e0004
                Copyright: © 2016 Journal of Research in Medical Sciences

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 12 April 2016
                : 13 July 2016
                : 09 August 2016
                Categories
                Original Article

                Medicine
                quality of life,voice handicap index,voice rehabilitation
                Medicine
                quality of life, voice handicap index, voice rehabilitation

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