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OBJECTIVE: To assess the endotracheal temperature and humidity and clinical effects of 2 models of a new heat and moisture exchanger (HME): Rplus, which has regular breathing resistance, and Lplus, which has lower breathing resistance. METHODS: We measured endotracheal temperature and humidity in 10 laryngectomized patients, for 10 min each, with and without the HMEs. We sequentially tested 4 HME models (all Atos Medical, Hörby, Sweden), in randomized order: Rplus, Lplus, Provox Normal (the HME we regularly use and which we considered the reference HME), and Stomvent (an older HME model). We also assessed the short-term clinical and practical effects of the Rplus and Lplus in a prospective 3-week trial with 13 laryngectomized patients. RESULTS: Rplus and Lplus had better humidification than Provox Normal (6.8 mg H2O/L, 4.3 mg H2O/L, and 3.7 mg H2O/L, respectively, P < .001), and no significant temperature difference. During the 3-week study period, 7 of the 13 patients reported noticeably lower mucus production with Rplus and Lplus. CONCLUSIONS: Rplus and Lplus had better heating and humidification than Provox Normal. Although Stomvent also performed well, its design is less convenient for laryngectomized patients. Further HME improvement is still warranted and should focus on improving the HME's heating capacity. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Perceptual judgments and patients’ perception of voice and speech after concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer. Study Design: Prospective clinical trial. Methods: A standard Dutch text and a diadochokinetic task were recorded. Expert listeners rated voice and speech quality (based on Grade, Roughness, Breathiness, Asthenia, and Strain), articulation (overall, [p], [t], [k]), and comparative mean opinion scores of voice and speech at three assessment points calculated. A structured study-specific questionnaire evaluated patients’ perception pretreatment (N=55), at 10-week (N=49) and 1-year posttreatment (N=37). Results: At 10 weeks, perceptual voice quality is significantly affected. The parameters overall voice quality (mean, −0.24; P =0.008), strain (mean, −0.12; P =0.012), nasality (mean, −0.08; P =0.009), roughness (mean, −0.22; P =0.001), and pitch (mean, −0.03; P =0.041) improved over time but not beyond baseline levels, except for asthenia at 1-year posttreatment (voice is less asthenic than at baseline; mean, +0.20; P =0.03). Perceptual analyses of articulation showed no significant differences. Patients judge their voice quality as good (score, 18/20) at all assessment points, but at 1-year posttreatment, most of them (70%) judge their “voice not as it used to be.” In the 1-year versus 10-week posttreatment comparison, the larynx-hypopharynx tumor group was more strained, whereas nonlarynx tumor voices were judged less strained (mean, −0.33 and +0.07, respectively; P =0.031). Patients’ perceived changes in voice and speech quality at 10-week post- versus pretreatment correlate weakly with expert judgments. Conclusion: Overall, perceptual CCRT effects on voice and speech seem to peak at 10-week posttreatment but level off at 1-year posttreatment. However, at that assessment point, most patients still perceive their voice as different from baseline. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Perceptual judgments and patients’ perception of voice and speech after concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer. Study Design: Prospective clinical trial. Methods: A standard Dutch text and a diadochokinetic task were recorded. Expert listeners rated voice and speech quality (based on Grade, Roughness, Breathiness, Asthenia, and Strain), articulation (overall, [p], [t], [k]), and comparative mean opinion scores of voice and speech at three assessment points calculated. A structured study-specific questionnaire evaluated patients’ perception pretreatment (N=55), at 10-week (N=49) and 1-year posttreatment (N=37). Results: At 10 weeks, perceptual voice quality is significantly affected. The parameters overall voice quality (mean, −0.24; P =0.008), strain (mean, −0.12; P =0.012), nasality (mean, −0.08; P =0.009), roughness (mean, −0.22; P =0.001), and pitch (mean, −0.03; P =0.041) improved over time but not beyond baseline levels, except for asthenia at 1-year posttreatment (voice is less asthenic than at baseline; mean, +0.20; P =0.03). Perceptual analyses of articulation showed no significant differences. Patients judge their voice quality as good (score, 18/20) at all assessment points, but at 1-year posttreatment, most of them (70%) judge their “voice not as it used to be.” In the 1-year versus 10-week posttreatment comparison, the larynx-hypopharynx tumor group was more strained, whereas nonlarynx tumor voices were judged less strained (mean, −0.33 and +0.07, respectively; P =0.031). Patients’ perceived changes in voice and speech quality at 10-week post- versus pretreatment correlate weakly with expert judgments. Conclusion: Overall, perceptual CCRT effects on voice and speech seem to peak at 10-week posttreatment but level off at 1-year posttreatment. However, at that assessment point, most patients still perceive their voice as different from baseline. [Copyright &y& Elsevier]