Alaryngeal Communication Effectiveness And Long-term Quality Of Life

Background: Primary or salvage total laryngectomy is a surgical procedure used to treat patients with advanced-stage larynx and hypopharynx cancer. The resultant alaryngeal communication is usually considered unsatisfactory and a profound impairment. Objectives: The purpose of this study was to evaluate the efficacy of alaryngeal communication after total laryngectomy and its association with long-term quality of life evaluation. Material and Methods: 82 patients with squamous cell carcinoma of the larynx and hypopharynx underwent a total laryngectomy associated or not with irradiation therapy. The type of alaryngeal communication was 18 (21.9%) tracheoesophageal voice, 12 (14.6%) esophageal speech, 11 (13.4%) electrolarynx and 41 (50%) non-vocal. Communication effectiveness was judged according perceptual, acoustic and temporal parameters. The European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) was used to measure quality of life. Results: Tracheoesophageal voice was considered good in 13 cases (72.2%), moderate in 4 (22.2%) and poor in 1 (5.6%); esophageal speech, good in 2 (16.7%), moderate in 8 (66.6%) and poor in 2 (16.7%); electrolarynx, good in 1 (9.1%), moderate in 9 (81.8%) and poor in 1 (9.1%); non-vocal communication, 100% poor. Total range of QLQ score varied from 8.3 to 100 (median, 75). Total QLQ scores were not associated with the effectiveness of communication (p=0.2512). Conclusion: Tracheoesophageal voice was more effective than esophageal speech or electrolarynx, but surprisingly alaryngeal communication was not considered by the patients essential to maintain or improve longterm quality of life.