title: Defining the stenotic post-laryngectomy tracheostoma and its impact on the quality of life in laryngectomees: development and validation of a stoma function questionnaire.
abstract: OBJECTIVE
  The aims of this study were to identify if: (i) size of stoma contributes to quality of life (QoL) in laryngectomees; (ii) stoma size has an impact on routine stoma care and function; and (iii) an optimal stoma size exists below which patients experience stoma problems.
  
  
  METHODS
  Cross-sectional study of laryngectomees.
  
  
  METHODS
  Two tertiary care centres.
  
  
  METHODS
  Fifty-seven patients who had undergone total laryngectomy one to five years ago and using tracheo-oesophageal speech as their primary communication means.
  
  
  METHODS
  Three main measures were studied: 1 a new study specific questionnaire designed to assess problems with function and care of the end tracheosto- ma; 2 QoL as assessed by the head and neck QoL instrument; 3 a precision custom designed sizer to measure the minimum stoma diameter.
  
  
  RESULTS
  The final study-specific questionnaire contained four items assessing different aspects of stomal function. From raw total scores an overall stomal score was generated. The stoma score was moderately correlated to emotion and speech domains in head and neck Quality of Life questionnaire, indicating that different concepts were being measured. The mean minimum stoma diameter was 15.9 +/- 2.9 mm. There was a significant increase in the area under the receiver operating characteristic curve beyond a threshold value of > or 15 mm; smaller sizes were associated with a poorer stoma score (Mann-Whitney test, P < 0.001). No patient found the stoma sizer use distressing.
  
  
  CONCLUSIONS
  Size of stoma significantly contributes to QoL in laryngectomees and stomas with minimum diameters of 14 mm or less are associated with adverse effects on routine stoma function. The study-specific stoma function questionnaire appears to be a useful instrument.
authors.affiliation: Department of Otolaryngology, Head-Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK. vinidh.paleri@ncl.ac.uk
authors.forename: V
authors.initials: V
authors.lastname: Paleri
authors.forename: R G
authors.initials: RG
authors.lastname: Wight
authors.forename: S
authors.initials: S
authors.lastname: Owen
authors.forename: A
authors.initials: A
authors.lastname: Hurren
authors.forename: F W
authors.initials: FW
authors.lastname: Stafford
mesh_terms: D019540:Area Under Curve; D003147:Communication Disorders / Q000209:etiology / Q000534:rehabilitation; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000534:rehabilitation / Q000556:secondary / Q000601:surgery; D007825:Laryngectomy; D007831:Larynx, Artificial; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery; D010611:Pharyngectomy; D011446:Prospective Studies; D011474:Prosthesis Design; D011788:Quality of Life; D012372:ROC Curve; D015203:Reproducibility of Results; D012107:Research Design; D018434:Sickness Impact Profile; D013072:Speech, Esophageal; D011795:Surveys and Questionnaires; D014139:Tracheostomy; D016896:Treatment Outcome; D006113:United Kingdom