Functional outcomes following nonsurgical treatment for advanced-stage laryngeal carcinoma.
OBJECTIVE
Objectives were 1) to provide comprehensive evaluations of functional outcomes using perceptual and objective measures of patients treated nonsurgically for stages III and IV laryngeal squamous cell carcinoma and 2) to propose a standard battery of tests that can be used for appraising functional outcomes in this patient population.


METHODS
Retrospective study of 14 patients.


METHODS
Perceptual measures of voice were obtained using blinded expert listener impression ratings and a validated quality of life questionnaire (Voice Handicap Index). Objective data included acoustic, speech aerodynamic, and videostroboscopic evaluations. Patients were also assessed relative to stability of the airway, secretion control, and ability to tolerate oral diet without aspiration symptoms.


RESULTS
Patients demonstrated functional but abnormal voice, speech, and swallowing abilities after treatment. More specifically, patients were judged to have moderately deviant biomechanical findings on videostroboscopy that did not improve with longer time intervals after treatment. These findings helped to explain the moderately abnormal acoustic and aerodynamic measurements revealing high values for jitter, shimmer, noise, airflow, glottal resistance, and subglottal pressures and substantially lower than normal maximum phonation times. Expert listeners were in agreement with the objective findings. However, patients rated themselves as only mildly impaired with regard to the emotional, physical, and functional handicapping effects of treatment, difficulties that were judged to improve with longer time intervals after treatment. Swallowing function showed a trend toward improvement for patients with time intervals of more than 12 months since completion of therapy.


CONCLUSIONS
Patients demonstrated variable degrees of laryngeal dysfunction as evidenced by perceptual and objective measures. Patients rated themselves to be only mildly handicapped with regard to voice quality. A methodology and battery of tests are proposed to help standardize outcome data collection for this patient population.
Meleca
Robert J
RJ
Department of Otolaryngology, Wayne State University School of Medicine and the Detroit Medical Center, Detroit, Michigan, USA. rmeleca@med.wayne.edu
Dworkin
James Paul
JP
Kewson
Danny T
DT
Stachler
Robert J
RJ
Hill
Samuel L
SL
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000628:therapy*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013061:Speech Acoustics; D011795:Surveys and Questionnaires; D014832:Voice Disorders / Q000175:diagnosis / Q000209:etiology