title: Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures? An e-tool-based analysis.
abstract: OBJECTIVE
  The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Head and Neck Oncology Unit, Tertiary Referral Centre.
  
  
  METHODS
  Forty-two patients following total laryngectomy.
  
  
  METHODS
  Videofluoroscopy using an e-tool (JRuler).
  
  
  METHODS
  Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables.
  
  
  RESULTS
  Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters.
  
  
  CONCLUSIONS
  Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality.
authors.affiliation: Head and Neck Unit, Royal Marsden Hospital, The Institute of Cancer Research, London, UK. rehan.kazi@rmh.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Kazi
authors.forename: A
authors.initials: A
authors.lastname: Singh
authors.forename: G P J
authors.initials: GP
authors.lastname: Mullan
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: D003430:Cross-Sectional Studies; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D007825:Laryngectomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013071:Speech, Alaryngeal / Q000379:methods; D013072:Speech, Esophageal; D014741:Video Recording / Q000295:instrumentation*; D014832:Voice Disorders / Q000175:diagnosis* / Q000453:epidemiology; D014833:Voice Quality