Patient Perspectives in Postlaryngectomy Communication Rehabilitation and Outcomes.

Abstract

Objective: To evaluate patient-reported outcomes in postlaryngectomy communication rehabilitation.

Study design: Cross-sectional survey study.

Setting: (a) Patients who underwent laryngectomy at a single institution and (b) members of the International Association of Laryngectomees (IAL).

Methods: We examined demographics, treatment history, speech rehabilitation methods and outcomes postlaryngectomy.

Results: A total of 157 participants responded to the survey (124 IAL; 33 institutional cohort). The most used primary methods of communication were tracheoesophageal puncture (TEP) 61.5%, electrolarynx (EL) 24.4%, and writing 9%. In all categories, except for communication in a noisy environment, alaryngeal voice was rated superior to aphonic communication (P < .05). Subset analysis of the alaryngeal voice cohort demonstrated higher communication efficacy for TEP compared to other modalities in all environments except for conversation with family and friends. Among TEP users, a history of a regional flap for reconstruction compared to free tissue transfer was associated with higher communication effectiveness scores (16.3 vs 10.6; P = .0085). Neither treatment modality (primary vs. salvage laryngectomy vs. radiation therapy) nor engagement in speech therapy impacted communication effectiveness scores for alaryngeal voice users.

Conclusion: Alaryngeal voice users reported higher efficacy of communication in most social contexts compared to aphonic communicators. Among alaryngeal voice users, TEP speech performed better in most social situations compared to an EL. Treatment characteristics including timing of surgery and radiation therapy were not associated with the ability to acquire alaryngeal voice, while the extent of resection and the type of reconstruction did show potential to impact voicing outcomes in patients who desire to pursue alaryngeal voicing techniques.