Figure - available from: Laryngoscope Investigative Otolaryngology
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Distribution of the self‐reported rating of overall health and independence (the score of 0 is the worst imaginable situation, the score of 10 is the best imaginable situation). Due to rounding off, the sum does not add to 100%
Source publication
Objective
Total laryngectomy (TL) leads to lifelong physical changes which can lead to functional and participation issues. To assess the relationship between self‐reported quality of life and functional and participation issues, a large international online questionnaire was used.
Method
A questionnaire was sent out to 8119 recipients of whom 170...
Citations
... However, the current HMEs do not provide sufficient physiological upper airway function. Thus, patients using HMEs still suffer from respiratory symptoms such as coughing and increased sputum production [5]. Furthermore, adverse events such as skin disorders due to adhesives may occur, leading to reduced adherence [6]. ...
... Laryngeal cancer represents 30% of head and neck cancers and 2% of malignant tumors. Despite progress in surgical and medical techniques, total laryngectomy is still today the operation of choice in the case of advanced forms of laryngeal cancer or in the case of salvage surgery [1][2][3][4][5][6]. ...
Background: Permanent tracheostomy because of total laryngectomy surgery entails significant consequences for patients regarding respiratory physiopathology, such as the loss of the filtering, humidifying, and heating of air by the nose. The use of special stomal filters can provide adequate protection of the tracheal–bronchopulmonary system with a reduction in respiratory pathologies. In fact, in most cases, laryngectomy patients are first cigarette smokers who for this reason also already have respiratory diseases such as chronic obstructive pulmonary disease (COPD). Despite the availability of tracheal filters, as reported in the literature, patients often tend to limit their use due to reported breathing difficulties, especially in conditions of intense breathing. Methods: The objective of this clinical study was to evaluate the most suitable stomal filter for laryngectomy patients during physical activity. The filters studied were an INHEALTH device (Blom-Singer SpeakFree HME); two ATOS devices (Provox® Life™ Energy HME and Provox® Life™ Home HME); and an FAHL device (Laryvox HME Sport). Results: For this purpose, the performances of 31 laryngectomy patients, subjected to medium–high physical effort, were analyzed through a standardized pneumological test, the Six Minute Walking Test (6MWT), which involves a sustained walk lasting six minutes, with an evaluation of heart rate, oxygen saturation, and meters traveled every 60 s; furthermore, we examined two subjective indices, namely, the basal and final dyspnea index and the initial and final muscular fatigue index. Conclusions: The multidisciplinary approach of the laryngectomee patient must also take pulmonary rehabilitation into consideration. It is the task of the medical team and speech therapy support to help the patient in the correct choice of HME filters taking into account daily needs.
... Despite progress in surgical and medical techniques, total laryngectomy is still today the operation of choice in the case of advanced forms of laryngeal cancer or in the case of salvage surgery. [1][2][3][4][5][6] The creation of a permanent stoma has profound psychological and physical consequences on the patient. [7] 2 The loss of vocal ability, a devastating experience for the relational life of the laryngectomee patient. ...
Background: Permanent tracheostomy because of total laryngectomy surgery entails great conse-quences for the patient regarding respiratory physiopathology such as the filtering, humidifying, and heating function of the air by the nose is lost. The use of special stomal filters can determine adequate protection of the trachea-broncho-pulmonary system with a reduction in respiratory pathologies. In fact, in most cases laryngectomee patients are first cigarette smokers who for this reason already have also respiratory diseases such as chronic obstructive pulmonary disease (COPD). Despite the availability of tracheal filters, multiple times, as reported in the literature, the patient tends to limit their use due to reported breathing difficulties, especially in conditions of intense breathing. Methods: The objective of this clinical study was to evaluate the most suitable stomal filter for the laryngectomee patient during physical activity. The filters studied were an INHEALTH device (Blom-Singer SpeakFree HME); two ATOS devices (Provox® Life™ Energy HME and Provox® Life™ Home HME); and an FAHL device (Laryvox HME Sport). Results: For this purpose, the performances of 31 laryngectomee patients, subjected to medi-um-high physical effort, were analyzed through a standardized pneumological test, the Six Minute Walking Test (6MWT) which involves a sustained walk lasting six minutes, with evaluation , every 60 seconds, heart rate, oxygen saturation and meters travelled; furthermore, it examines two sub-jective indices, namely, the basal and final dyspnea index and the initial and final muscular fatigue index.
... and a median VAS score of 78 (95%CI 73-84) at the EQ-5D-5L [33]. This relatively high level of QOL is in accordance with the earlier reports [54]. [31,32]. ...
The aims of this exploratory study and clinical phase II trial were to assess the specific nature and extent of dysphagia in laryngectomized patients with self-reported dysphagia, and its rehabilitation potential using the novel Swallowing Exercise Aid (SEA 2.0). Twenty laryngectomized patients participated in a six-week exercise program with the SEA 2.0. Exercises consisted of Chin Tuck Against Resistance (CTAR), Jaw Opening Against Resistance (JOAR), and Effortful Swallow Against Resistance, conducted three times per day. Swallowing was assessed at baseline (T0), six (T1) and 14 (T2) weeks, consisting of patient-reported outcomes, BMI, videofluoroscopy, swallowing capacity, and muscle strength measurements. Dysphagia significantly impacts quality of life, with impaired swallowing speed and bolus propulsion as main reported issues. Subjective dysphagia parameters, swallowing capacity, and pharyngeal residue clearance were reduced, but BMI was normal. Muscle and tongue strength were within normal ranges. All participants managed to use the SEA 2.0. Adherence was 95%. At T1, subjective swallowing parameters (MDADI and EAT-10) showed clinically relevant improvements. Objectively, CTAR and JOAR strength increased with 27.4 and 20.1 Newton, respectively. Also, swallowing capacity (from 2.4 g/s to 3.8 g/s) and pharyngeal residue clearance improved. At T2, results were slightly lower than at T1, but still better than at baseline. Dysphagia in laryngectomized patients affects quality of life, but swallowing can be improved with a six-week rehabilitation program using the novel SEA 2.0. Adherence was excellent and several subjective and objective swallowing parameters improved.
... Further, and as mentioned previously, how any given component of the TE voice signal is weighted, either favorably or unfavorably, in the context of other features inherent to that sample must always be carefully considered. This must also be considered within the context of how the speaker's new alaryngeal voice influences social functioning and interpersonal interaction [38][39][40]. With this concern in mind, our acoustic method may serve to distinguish TE speakers and provide for improved classification methods when coupled with auditory-perceptual data provided by listeners [21]. ...
Introduction: This study pursued two objectives: (1) to determine the potential association between listener (n = 51) judgments of 20 male tracheoesophageal speaker samples for two auditory-perceptual dimensions of voice, overall severity (OS) and listener comfort (LC); and (2) to assess the temporal and spectral acoustic correlates for these auditory-perceptual dimensions. Methodology: Three separate correlation analyses were performed to evaluate the association between OS and LC. First, scores of OS and LC from all listeners were pooled together, and then the correlation between OS and LC was computed. Second, scores of OS and LC were averaged over all listeners to derive a single estimate of OS and LC for each TE speaker sample; the correlation between the average OS and LC was then computed. Third, listener-to-listener variability in the association between OS and LC was evaluated by computing the correlation between OS and LC scores from each listener across all TE samples. Finally, two stepwise multiple regression models were created to relate the average LC score to spectral and temporal variation in the acoustic signal. Results: While the pooled OS and LC scores had a moderate positive correlation (r = 0.66, p < 0.00001), the averaged OS and LC exhibited a near perfect positive correlation (r = 0.99, p < 0.00001). The significant differences between the pooled and averaged scores were explained by significant listener-to-listener variability in the association between OS and LC. OS and LC scores from 5 listeners had non-significant correlations, 10 had moderate correlations (r < 0.7), 35 listeners had high correlations (0.7 < r < 0.9), and 1 listener had a very high correlation (r < 0.9 < 1). Finally, the acoustic models created based on the spectral and temporal variations in the signal were able to account for 87.7% and 61.8% of variation in the average LC score. Conclusions: The strong correlations between OS and LC suggest that LC may, in fact, provide a more comprehensive auditory-perceptual surrogate for the voice quality of TE speakers. Although OS and LC are distinct conceptual dimensions, LC appears to have the advantage of assessing the social impact and potential communication disability that may exist in interactions between TE speakers and listeners.
... The average demographic characteristics of the patients were in line with the features of the TL patients in other studies. Leemans et al., 2020) According to the survey of a large sample of TLs respondents, about 80% were aged more than 60 years, 60% were retired, and a male-to-female ratio of 5 was reported.24 ...
... Journal of New Findings in Health and Educational Sciences (IJHES), 1(4):[13][14][15][16][17][18][19][20][21][22][23] 2023 ...
Introduction: Total laryngectomy (TL) is a procedure that severely affects the patient's quality of life. This study determined the prevalence of general health and affective disorders as an often neglected aspect of cancer care in patients following TL. Methods: This is a cross-sectional case-control study. We enrolled 80 participants into two groups; male patients who had undergone TL due to advanced squamous cell laryngeal cancer from 1 to 3 years ago (n=45) and a control group of healthy individuals (n=35). The DASS-21 and SF-36 questionnaires were used to evaluate participants' affective disorders and general health, respectively. Data were analyzed using SPSS, and a p-value <0.05 was considered significant. Results: The mean age of the patients and control group were 57.9±7.7 and 55.4±8.7 years, respectively (p=0.338). The mean scores of general health status were significantly lower in TL patients than in the control group (84.9±13.1 vs. 94.9±8.4, respectively, p=0.011), and the mean scores of overall affective disorders were higher in TL patients than in the control group (40.8±25.1 vs. 26.7±19.0, respectively, p=0.009). Also, we found a significant positive relationship between the prevalence of affective disorders and patients' age (r= 0.46, p=0.004). But there was no correlation between other demographic variables, affective disorders, and general health status. Conclusions: Significant high status of depression and anxiety and lower general health state were seen in TL patients compared with the control group. To enhance patients' quality of life, supporting patients before and after surgery is recommended.
... It has been noted that low speech intelligibility is associated with reduced conversations and social activity [41]. Conversely, the ability to participate in meaningful and social activities is a significant factor for the patient's QoL [42]. Our study reinforces the findings from a narrative review synthesising the potential impact on patients' QoL across all communication options [12] after TL. ...
Purpose
Total laryngectomy followed by radiotherapy is a life-preserving treatment for patients with locally advanced laryngeal cancer. This study explored how persons who had undergone total laryngectomy perceived themselves as cancer survivors in the follow-up phase.
Methods
A descriptive phenomenological approach was adopted. We employed a purposive sampling strategy to collect data through interviews at the otorhinolaryngology outpatient clinics of two research hospitals in northern Italy. The interviews were transcribed verbatim and analysed, following the seven analytical steps of Colaizzi’s descriptive analysis.
Results
The final sample included 19 patients. The following main themes were identified: (i) accepting a life with the “without” to survive; (ii) feeling unpleasant emotions; (iii) getting the hang of communication again; and (iv) reclaiming one’s role. Together, they highlight the lived experiences of laryngectomised patients during the follow-up phase and how they perceived themselves as cancer survivors.
Conclusion
Laryngectomised patients are a uniquely vulnerable population. This study provides insights into how surgical procedures change and affect their lives over time to improve care models, patient education, and support systems. Survivors must be adequately prepared to transition from treatment and return to the community. This preparation should begin before treatment is started. Functional education, accurate information, and psychological support must be arranged and provided before surgery. Regarding the post-treatment phase, it is essential to support voice rehabilitation and peer support, and improve the family network, to ensure these patients’ reintegration into society and social recognition.
... 5,6 These airway problems significantly influence sleep, social contacts and quality of life. 7 Stoma cloth covers (bibs) and heat and moisture exchangers have been developed to restore some of these lost functions. Bibs are worn in front of the stoma. ...
Objective
After laryngectomy, the breathing resistance of heat and moisture exchangers may limit exercise capacity. Breathing gas analysis during cardiopulmonary exercise testing is not possible using regular masks. This study tested the feasibility of cardiopulmonary exercise testing with a heat and moisture exchanger in situ, using an in-house designed connector. Additionally, we explored the effect of different heat and moisture exchanger resistances on exercise capacity in this group.
Methods
Ten participants underwent two cardiopulmonary exercise tests using their daily life heat and moisture exchanger (0.3 hPa or 0.6 hPa) and one specifically developed for activity (0.15 hPa). Heat and moisture exchanger order was randomised and blinded.
Results
All participants completed both tests. No (serious) adverse events occurred. Only four subjects reached a respiratory exchange ratio of more than 1.1 in at least one test. Maximum exercise levels using heat and moisture exchangers with different resistances did not differ.
Conclusion
Cardiopulmonary exercise testing in laryngectomees with a heat and moisture exchanger is feasible; however, the protocol does not seem appropriate to reach this group's maximal exercise capacity. Lowering heat and moisture exchanger resistance does not increase exercise capacity in this sample.
... The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Although the percentage of patients who undergo total laryngectomy has decreased over the years in favor of conservative surgery, total laryngectomy remains a devastating event due to the impact on daily life [3][4][5][6]. Total laryngectomy is a radical method reserved for the treatment of advanced laryngeal carcinoma or as a salvage therapy. ...
Background:
Total laryngectomy is an operation that involves numerous problems for the patient, especially in daily life: loss of the fact, loss of voice, evident scars and persistence of the tracheostoma. Much is known about rehabilitation programs involving the voice, swallowing, shoulder girdle rehabilitation; less explored is the field of sport and sports rehabilitation in the laryngectomized patient.
Methods:
We conduced systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in order to evaluate the possibilities of practicing sports for the patient after total laryngectomy.
Results:
From an initial search of 4191 papers, we have come to include six papers for this literature review. We have also reported one of our clinical cases referring to a laryngectomized patient who swims competitively at an amateur level even after surgery with a particular device. The purpose of this work is to understand the role and importance of sport in rehabilitation and the possibilities that a frail patient like the laryngectomized patient has in practicing sport. Surely the best results are obtained in subjects who practiced sports before surgery.
Conclusion:
It is evident that sport is important in the psychological and motor recovery of the laryngectomized patient. There is still a lack of clear rehabilitation protocols, especially for water sports, which allow all laryngectomized patients to return to sports. We believe that early resumption of physical activity makes the experience of the disease less dramatic.
... [15][16][17][18][19] Despite these benefits, a large variation in adherence (35%-77%) has been reported, 18,20,21 and even in cases of full adherence (HME .20 hours per day) pulmonary issues are still present, negatively affecting daily life. 5,[9][10][11][22][23][24][25][26][27][28][29] Currently available HMEs do not yet provide levels of humidification identical to those provided by the nose, and further improvements are needed. Problems associated with available adhesives, such as skin irritation, 30,31 poor seal, and different shapes and morphologies of tracheostomas, 8,32,33 have been described as additional reasons for reduced adherence. ...
Objective
To evaluate the effects of new devices—heat and moisture exchangers (HMEs) and adhesives—on pulmonary symptoms, subject adherence, quality of life, dermatologic symptoms, and patient satisfaction after laryngectomy.
Study Design
Prospective crossover study.
Setting
Between December 2020 and April 2021, 40 patients were enrolled who had undergone laryngectomy, routinely used HMEs and adhesive, and were followed in our Department of Otolaryngology–Head and Neck Surgery.
Methods
Patients were allocated into group A (new products) or group B (usual care) for 6 weeks. Then the 2 groups reversed, and each patient acted as his or her own control. Patients kept a diary and cough tally sheet. At baseline and after each 6-week period, 2 questionnaires were administered: EQ-5D (European Quality of Life–5 Dimensions) and CASA-Q (Cough and Sputum Assessment Questionnaire).
Results
Six weeks of using new products resulted in the following effects for both groups: (1) a significant reduction in daily forced expectoration and dry coughs, (2) a significant improvement in all domains of the CASA-Q, (3) an increase in adherence to HME use, (4) a significant reduction in shortness of breath and skin irritation, and (5) significantly better scores in the anxiety/depression domain of the EQ-5D.
Conclusion
Achieving this reduction in patients who were already highly adherent to HME use is clinically relevant and underscores the importance of using better-performing HMEs that can compensate for the humidification deficit. Improving pulmonary symptomatology could reduce patient restrictions in daily life and avoidance of social activity, with a consequent positive effect on quality of life.
