title: Practice of laryngectomy rehabilitation interventions: a perspective from Europe/the Netherlands.
abstract: OBJECTIVE
  Total laryngectomy rehabilitation (TLR) in Europe is not uniform, with quite some differences in approach and infrastructure between various countries. In, for example, the Netherlands, Switzerland, Scandinavia, and more recently also in the UK, head and neck cancer (HNC) treatment and rehabilitation shows a high level of centralization in dedicated HNC centres. In other European countries, the level of centralization is lower, with more patients treated in low-volume hospitals. This article focusses on the situation in the Netherlands and, where applicable, will discuss the regional variations in Europe.
  
  
  RESULTS
  Prosthetic surgical voice restoration (PSVR) presently is the method of choice in Europe, and use of oesophageal and electrolarynx voice has moved to the background. In most European countries (except the UK and Ireland), PSVR is physician driven, with an indispensable role for speech-language pathologists and increasingly for oncology nurses. Indwelling voice prostheses are mostly preferred, also because these devices can be implanted at the time of trachea-oesophageal puncture. Pulmonary rehabilitation is achieved with heat and moisture exchangers, which, based on extensive clinical and basic physiology research, are considered an obligatory therapy measure. In addition to PSVR, also issues such as smoking cessation, dysphagia/swallowing rehabilitation, and olfaction/taste rehabilitation are discussed. Especially, the latter has shown great progress over the last decade and is another example of increasing implementation of evidence-based practice in TLR.
  
  
  CONCLUSIONS
  TLR has shown considerable progress over the last decades, and through the intensified collaboration between all clinicians involved, significantly has improved vocal, pulmonary, and olfactory rehabilitation after total laryngectomy.
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam Centre for Language and Communication, University of Amsterdam, Amsterdam, the Netherlands. l.vd.molen@nki.nl
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Molen
authors.forename: Anne F
authors.initials: AF
authors.lastname: Kornman
authors.forename: Merel N
authors.initials: MN
authors.lastname: Latenstein
authors.forename: Michiel W M
authors.initials: MW
authors.lastname: van den Brekel
authors.forename: Frans J M
authors.initials: FJ
authors.lastname: Hilgers
mesh_terms: D001037:Aphasia / Q000534:rehabilitation; D005060:Europe; D006801:Humans; D007348:Insurance, Health; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial; D008171:Lung Diseases / Q000534:rehabilitation; D009426:Netherlands; D000857:Olfaction Disorders / Q000534:rehabilitation; D010348:Patient Care Team; D011183:Postoperative Complications; D011474:Prosthesis Design; D016540:Smoking Cessation; D013651:Taste Disorders / Q000534:rehabilitation