title: Questionnaire analysis of the swallowing-related outcomes following total laryngectomy.
abstract: OBJECTIVE
  To determine the effects of a total laryngectomy on the swallow and subsequent quality of life in head and neck cancer patients.
  
  
  METHODS
  Cross-sectional single centre cohort study.
  
  
  METHODS
  Head and Neck Oncology Unit, Tertiary Referral Unit.
  
  
  METHODS
  Sixty-two patients who underwent total laryngectomy at our centre participated in the study.
  
  
  METHODS
  Subjects were stratified by age, sex, tumour stage, other procedures such as myotomy and nerve re-implantation. Pharyngectomy, glossectomy, flap reconstruction, neck dissection and previous radio- and chemotherapy were also assessed to see if they affected swallow and subsequent quality of life. Main outcome was measured using the MD Anderson Dysphagia Inventory questionnaire.
  
  
  RESULTS
  Responses were received from 46 males and 16 females (response rate of 80.5%) with a mean age of 64.7 years (SD 9.4). Median follow-up in patients was 90 months (range 1-276). The mean MD Anderson Dysphagia Inventory total score in our series of patients was 77.7 (SD 16.6). MD Anderson Dysphagia Inventory global score was 79.4 (SD 22.6), Emotional score was 77.7 (SD 17.8), Functional score 81.3 (SD 15.9) and Physical score was 74.1(SD 18). Statistically significant differences were seen between the emotional scores of glossectomised and non-glossectomised patients (Mann Whitney, P = 0.04). No significant correlation was seen between the subscale scores and the remaining treatment variables such as age, gender, site, tumour stage, myotomy, nerve implantation, radiotherapy, reconstruction and major complications.
  
  
  CONCLUSIONS
  This questionnaire study is the largest of its type to assess the swallow of patients who have undergone laryngectomy at a single centre. The overall result confirmed that most patients had a subjectively good swallow. Only glossectomy and the method of PE segment closure were shown to significantly affect swallowing outcomes following surgery. We recommend further work especially prospective studies pre and post surgery using this or similarly validated instruments to fully assess swallow in the laryngectomy population.
authors.affiliation: Head and Neck Unit, Royal Marsden Hospital, London. rehan.kazi@rmh.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Kazi
authors.forename: V
authors.initials: V
authors.lastname: Prasad
authors.forename: R
authors.initials: R
authors.lastname: Venkitaraman
authors.forename: C M
authors.initials: CM
authors.lastname: Nutting
authors.forename: P
authors.initials: P
authors.lastname: Clarke
authors.forename: P
authors.initials: P
authors.lastname: Rhys-Evans
authors.forename: K J
authors.initials: KJ
authors.lastname: Harrington
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires