Clinical Publications of Interest 2025-01
Rehabilitation of dysphagia and voice problems following total laryngectomy
The main objectives of this study were to assess participants’ satisfaction with rehabilitation following total laryngectomy (TL) and to explore potential associations between dysphagia, voice problems, and other explanatory variables using multivariate analyses. This cross-sectional population-based questionnaire study involved 172 Danish and Swedish participants who had TL between 2000 and 2015. They completed questionnaires assessing their satisfaction with the rehabilitation services provided. The results showed that while a majority were satisfied with the help from their local hospital (85%) and municipality (75%), a significant number reported not receiving any vocal (22%), swallow (78%), or olfactory rehabilitation (65%). Participants also reported high satisfaction with the assistance provided for Provox voice prosthesis replacement, with 77% rating it as good or excellent. The mean scores for dysphagia-specific quality of life (MDADI) and voice-related quality of life (V-RQOL) were 77.5 and 62.8, respectively. Additionally, 16% and 20% of participants showed signs of depression and anxiety. Multivariate analysis revealed that dysphagia was associated with more voice problems, higher depression and anxiety scores, and being treated in Denmark versus Sweden. Voice problems were also linked to more dysphagia and higher depression scores. In conclusion, the study found that while most participants were satisfied with the rehabilitation they received, a significant number reported not having undergone any dysphagia or olfactory rehabilitation. The tight link between voice problems, dysphagia, and depression suggests that medical personnel should be vigilant about the psychological effects of TL. There is a need for additional centralization of rehabilitation.
Primary mode of communication for people with total laryngectomy in the UK: a cross-sectional survey
Post-surgery, people with total laryngectomy (PTL) often prefer surgical voice restoration (SVR) for communication due to its potential for better voice quality, intelligibility, patient acceptability, and quality of life. In the UK, SVR is routinely offered to all eligible PTL. The objective of the study was to report on the rate of SVR usage in the UK and to investigate the factors that influence its uptake among PTL. The study was conducted as a national multi-centre audit over a six-month period, focusing on the primary communication methods used by PTL. The main results indicated that out of 1196 PTL, 71% used SVR as their primary mode of communication. Factors such as sex, employment status, and time elapsed since laryngectomy were found to be significantly associated with SVR usage. Specifically, males and those who were employed were more likely to use SVR, and PTL who were further post-laryngectomy were also more likely to use SVR. In conclusion, the study provides a benchmark for the current status of SVR usage across the UK, highlighting that a significant majority of PTL use SVR as their primary communication method. The findings suggest that SVR is a preferred method of communication rehabilitation, especially among males, employed individuals, and those who are longer post-surgery.
Oncological and functional outcome after laryngectomy for laryngeal and hypopharyngeal cancer: a population-based analysis in Germany from 2001 to 2020
Total laryngectomy is a key treatment option for patients with advanced laryngeal and hypopharyngeal cancer. However, there is an ongoing discussion about whether definitive radiochemotherapy might be a better alternative. This underscores the importance of evaluating both treatment strategies, considering not only overall survival (OS), but also the long-term functional outcomes such as voice and swallowing function. This population-based analysis examines the long-term outcomes of laryngectomy in patients with laryngeal or hypopharyngeal cancer. The study included 617 patients over a 20-year period and aimed to identify prognostic factors affecting OS, percutaneous endoscopic gastrostomy (PEG) dependency, and speech rehabilitation via voice prosthesis (VP). The main outcomes showed that the median OS was 131 months, where stage IV disease and laryngectomy for recurrent disease were identified as independent factors for lower OS. Additionally, 23.7% of patients required a PEG, and 74.7% received a VP for speech rehabilitation. The median time to PEG removal was 7 months, and postoperative aspiration needing treatment was an independent risk factor for later definitive VP removal. In conclusion, the study suggests that laryngectomy remains an important treatment option for advanced laryngeal and hypopharyngeal cancer, with long-term dependency on nutrition via PEG being a significant issue, while the use of VP is a stable long-term measure for voice rehabilitation.
Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer with Intractable Aspiration
Dysphagia and intractable aspiration are complications for survivors of head and neck cancer (HNC), leading to significant morbidity and impacting quality of life. Traditional treatments often fail to address the profound dysphagia experienced by these patients. Functional laryngectomy (FL) is presented as a potential intervention to mitigate these issues by improving swallowing function and overall well-being. This cohort study aims to evaluate how FL impacts self-reported perceptions of voice, swallowing, oral intake, quality of life (QoL), and mood in HNC survivors dealing with severe dysphagia and persistent aspiration. The cohort study involved 20 patients with profound swallowing dysfunction. Following FL, significant improvements were observed across various parameters. Voice quality showed a notable enhancement, with the Voice Handicap Index (VHI) score improving from 63.6 to 39.7 at six months post-FL, which was statistically significant with a large effect size (η² = 0.42; 95% CI, 0.19-0.56). Swallowing function also improved significantly, as indicated by the Eating Assessment Tool (EAT-10) score decreasing from 33.2 to 8.3 (η2 = 0.72; 95% CI, 0.54-0.80). Additionally, 63% of patients who were dependent on feeding tubes were able to discontinue their use within six months, and 85% of patients successfully utilized a tracheoesophageal voice prosthesis for communication. Quality of life measured with the Functional Assessment of Cancer Therapy – Head & Neck (FACT-H&N) showed significant improvement, and mood states using the Profile of Mood States (POMS) test were enhanced. In conclusion, FL may enhance voice, swallowing, functional oral intake, QoL, and mood in HNC survivors with severe dysphagia and intractable aspiration.
Swallowing after total laryngectomy surgery: where are we after 150 years?
Total laryngectomy (TL), which involves the removal of the larynx, necessitates significant adjustments in swallowing mechanics due to the anatomical changes. The review aims to evaluate the effects of total laryngectomy on swallowing, emphasizing the role of high-resolution manometry and Endoluminal Functional Lumen Imaging Probe (EndoFLIP) in diagnosing swallow dysfunction, and to identify the impact of esophageal issues on post-surgery dysphagia. Additionally, it seeks to explore effective treatments for improving swallowing function after laryngectomy. EndoFLIP is a minimally invasive technology used to measure the shape and compliance of the upper esophageal sphincter. The main results indicate that dysphagia is a common issue post-TL, with a prevalence between 35% and 89%. The review then identifies additional risk factors that can influence the likelihood of swallowing difficulties, such as the type of treatment received, prior radiation therapy, and the extent of surgical reconstruction. Common causes of dysphagia post-laryngectomy are explored, with a focus on issues like stricture formation, esophageal dysmotility, and the effects of radiation therapy. Manometry provides a precise evaluation of the causes of dysphagia and any esophageal issues, while EndoFLIP is particularly helpful in identifying strictures and understanding upper esophageal sphincter dysfunction. The role of speech-language pathologists (SLPs) is highlighted, emphasizing their importance in the evaluation and management of dysphagia through evidence-based practices and critical thinking. In conclusion, the article provides a comprehensive overview of the challenges and considerations in swallowing function after TL. It highlights the complexity of the issue and the need for individualized assessment and management strategies to address dysphagia in this patient population.
Oral Care in Head and Neck Radiotherapy: Proposal for an Oral Hygiene Protocol
This literature review addresses the significant challenge of managing oral health in patients undergoing radiotherapy for head and neck cancers. Radiotherapy, while effective in treating cancer, often leads to adverse effects in the oral cavity, necessitating a comprehensive approach to oral hygiene. The objective of the literature review was to propose a detailed oral hygiene protocol tailored for patients receiving head and neck radiotherapy. This protocol aims to mitigate the side effects of radiotherapy, such as mucositis, candidiasis, xerostomia, trismus, fibrosis, and changes in the oral biofilm, which can severely impact a patient’s quality of life. The literature review included a total of 15 articles from 1998 to 2023. The main results indicated that a multidimensional approach is required to manage the complex oral side effects of radiotherapy. The proposed protocol emphasizes the importance of both home-based and professional dental care. It includes specific recommendations for oral hygiene devices, the use of fluoride and chlorhexidine, and the management of acute and late-onset complications. The protocol also highlights the role of patient education and motivation in maintaining oral health during and after radiotherapy. In conclusion, the literature review provides a structured oral hygiene protocol that can be integrated into the care plan of head and neck cancer patients undergoing radiotherapy. The protocol is based on a comprehensive literature review and analysis of existing studies on the side effects of radiotherapy and their management. However, the authors emphasize the need for further research to validate its effectiveness.
Disclaimer:
The content of the journal articles is the opinion of the article authors and does not necessarily reflect the opinion of Atos Medical AB nor any of its subsidiaries. By providing this material it is not implied that the articles nor its authors are endorsing Atos Medical AB or Atos Medical AB products. Nothing in this material should be construed as Atos Medical AB providing medical or other advice, making any recommendations or claims, and is purely for informational purposes. It should not be relied on, in any way, to be used by clinicians as the basis for any decision or action, as to prescription or medical treatment. When making prescribing or treatment decisions, clinicians should always refer to the specific labeling information approved for the country or region of practice.
LitAlert summaries of journal articles are not exhaustive. For full content, please see the actual publication. Suggestions and requests to: clinicalaffairs@atosmedical.com.
Atos Learning Institute offers a wide range of learning solutions, including local market classroom-based training and customized learning programs, virtual instructor-led training and blended learning. The institute has a team of experienced trainers and experts who design and deliver the training programs and partner with subject matter experts.
Share
Save to my content
