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Objective: To document accurately the tracheo-oesophageal party wall thickness (PWT) intra-operatively in patients undergoing total laryngectomy and to correlate it with constitutional parameters like height, weight, body mass index (BMI), age, and gender. Also, to correlate PWT with the length of tract (LOT), that is prosthesis size, as measured using the standard valve length measuring device provided by the manufacturers., Methods: Twenty-eight patients of carcinoma larynx, following removal of the diseased larynx had their tracheo-oesophageal PWT measured using a special custom-designed and calibrated external (or outside) calliper and a primary trachea-oesophageal puncture (TOP) was made and inserted 10-14 days postoperative with an appropriately sized Blom-Singer(R) indwelling voice prosthesis., Results: The mean PWT was 3.1 mm. PWT showed significant correlation with the weight of the patients (P = 0.006). There was no significant correlation between PWT and height, BMI, age or gender of the study group. The average LOT was found to be 4.8 mm (SD 1.5). There was a significant correlation (P = 0.009) between PWT and initial LOT, with the most commonly used prosthesis sizes being 4-6 mm., Conclusions: The study shows that Indian patients with a thin party wall require a smaller prosthesis size and it is advisable to measure the PWT intra-operatively. Tracheo-oesophageal PWT in laryngectomised patients in India: implications for surgical voice restoration.

Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage laryngeal carcinoma around the world. The loss of natural voice is very often traumatic for the total laryngectomy patient, presenting lifelong challenges for communication in a world that relies heavily on verbal communication. Functional rehabilitation of these patients has long been one of the major challenges facing clinicians, but it is only in the last three decades that the emphasis on restoration of function and quality of life has become almost as important as cure and survival. Although voice restoration for alaryngeal speakers can be attained with any of 3 speech options - esophageal speech, electrolarynx and surgical voice restoration (SVR) using a valve the SVR technique has today become the preferred method and 'gold standard.' Successful tracheo-esophageal voice restoration in laryngectomy patients can be very rewarding, and patients are no longer condemned to silence while they await the results of their cancer treatments. They can face the challenges of life with the knowledge that a near-normal quality of life is very much possible.

Purpose: To conduct prospective electroglottographic analyses of voice outcomes after radical chemoradiotherapy for locally advanced laryngopharyngeal cancers and to compare them with patients who have undergone total laryngectomy (TL)., Patients and Methods: Twenty-one patients (19 male, 2 female, median age [range] 65 [50-85] years) with Stage III/IV laryngopharyngeal cancer received induction chemotherapy followed by radical chemoradiotherapy. Electroglottography, using the sustained vowel /i/ and connected speech, was performed before treatment and 1, 6, and 12 months after treatment. In addition, single voice recordings were taken from 21 patients (16 male, 5 female, aged 65 [50-84] years) who had undergone TL and surgical voice restoration and from 21 normal controls (18 male, 3 female, aged 65 [33-80] years)., Results: Before treatment the vocal measures for the chemoradiotherapy patients were significantly different from normal controls in jitter (p = 0.02), maximum phonation time (MPT) (p = 0.001), and words per minute (WPM) (p = 0.01). At 12 months after treatment MPT and WPM had normalized, but jitter and normalized noise energy were significantly worse than in normal controls. Comparison of voice outcomes at 12 months for chemoradiotherapy patients revealed superiority over the TL group in all parameters except MPT (18.2 s vs. 10.4 s, p = 0.06). Analysis of the recovery of voice up to 12 months after treatment revealed progressive improvement in most electroglottographic measures., Conclusions: This prospective study demonstrates significantly better outcome for patients treated with chemoradiotherapy as compared with TL. Progressive normalization of many voice parameters occurs over the 12 months following chemoradiotherapy.

The objective of this study was to assess the difference in voice quality as defined by acoustical analysis using sustained vowel in laryngectomized patients in comparison with normal volunteers. This was designed as a retrospective single center cohort study. An adult tertiary referral unit formed the setting of this study. Fifty patients (40 males) who underwent total laryngectomy and 31 normal volunteers (18 male) participated. Group comparisons with the first three formant frequencies (F1, F2, and F3) using linear predictive coding (LPC) (Laryngograph Ltd, London, UK) was performed. The existence of any significant difference of F1, F2, and F3 between the two groups using the sustained vowel /i/ and the effects of other factors namely, tumor stage (T), chemoradiotherapy, pharyngectomy, cricothyroid myotomy, closure of pharyngoesophageal segment, and postoperative complication were analyzed. Formant frequencies F1, F2, and F3 were significantly different in male laryngectomees compared to controls: F1 (P<0.001, Mann-Whitney U test), F2 (P<0.001, Student's t test), and F3 (P=0.008, Student's t test). There was no significant difference between females in both groups for all three formant frequencies. Chemoradiotherapy and postoperative complications (pharyngocutaneous fistula) caused a significantly lower formant F1 in men, but showed little effect in F2 and F3. Laryngectomized males produced significantly higher formant frequencies, F1, F2, and F3, compared to normal volunteers, and this is consistent with literature. Chemoradiotherapy and postoperative complications significantly influenced the formant scores in the laryngectomee population. This study shows that robust and reliable data could be obtained using electroglottography and LPC in normal volunteers and laryngectomees using a sustained vowel.

Aim: To obtain information about valved speech and related issues in patients who have undergone total laryngectomy with the help of a new structured questionnaire on voice prosthesis., Settings and Design: A questionnaire-based pilot study set at a tertiary referral head and neck cancer unit., Materials and Methods: Twenty-five patients using voice prostheses, who showed no signs of recurrence after having undergone total laryngectomy were interviewed with the help of a questionnaire that assessed issues such as voice quality, valve maintenance, leakage, quality of life, humidification and hands-free system over the preceding seven days. The data was analyzed using non-parametric tests (Mann-Whitney and Spearman rank)., Results: Twenty-five patients (16 males) with a median age of 65 years (IQ range: 59-70 years) had been using the prosthesis for a median of 6 years (IQ range: 5-10 years). The majority of the patients (n=20) were fully informed about their valve size and diameter and most were able to remove and replace their own prosthesis. Fourteen patients (60%) had leakage-related issues. Women were less satisfied with their voice quality as compared to men. Overall, there appeared to be an improvement in quality of life with the use of the voice prosthesis., Conclusions: The subjects were fairly well informed about their valve and experienced a high level of satisfaction with their voice. This questionnaire serves as a valuable tool for monitoring voice rehabilitation in patients who have undergone laryngectomy.

Summary: To optimize tracheoesophageal (TO) speech after total laryngectomy, it is vital to have a robust tool of assessment to help investigate deficiencies, document changes, and facilitate therapy. We sought to evaluate and validate electroglottography (EGG) as an important tool in the multidimensional assessment of TO speech. This study is a cross-sectional study of the largest cohort of TO speakers treated by a single surgeon. A second group of normal laryngeal speakers served as a control group. EGG analysis of both groups using connected speech and sustained vowels was performed. Two trained expert raters undertook perceptual evaluation using two accepted scales. EGG measures were then analyzed for correlation with treatment variables. A separate correlation analysis was performed to identify EGG measures that may be associated with perceptual dimensions. Our data from EGG analysis are similar to data obtained from conventional acoustic signal analysis of TO speakers. Sustained vowel and connected speech parameters were poorer in TO speakers than in normal laryngeal speakers. In perceptual evaluation, only grade (G) of the GRBAS scale and Overall Voice Quality appeared reproducible and reliable. T stage, pharyngeal reconstruction and method of closure, cricopharyngeal myotomy, and postoperative complications appear to be correlated with the EGG measures. Five voice measures—jitter, shimmer, average frequency, normalized noise energy, and irregularity—correlated well with the key dimensions of perceptual assessment. EGG is an important assessment tool of TO speech, and can now be reliably used in a clinical setting. [Copyright &y& Elsevier]

Twenty-seven total laryngectomy patients (19 males and 8 females) and 18 normal control subjects (10 males and 8 females) were subjected to electroglottography-based single voice recordings using sustained vowels and connected speech. The results showed poorer values and larger variability for all the voice measures for the total laryngectomy patients (TO speech) as compared to that of normal subjects. There were statistically significant differences (p<0.05) for all study parameters between the TO and normal speech. This study shows that robust and reliable data can be obtained using electroglottography in laryngectomees with both a sustained vowel and connected speech. Using these parameters, TO speech is significantly different from normal speech and is highly variable. This methodology has enormous potential for further investigations in laryngectomees and other patients with head and neck cancer. [ABSTRACT FROM AUTHOR]