An objective assessment of voice production after radiation therapy for stage I squamous cell carcinoma of the glottis

Long-Term Laryngeal Function and Quality of Life Following Treatment of Early Glottic Cancer: A Meta-Analysis

OBJECTIVE

To review the literature concerning long-term functional outcomes and quality of life (QoL) in patients undergoing transoral laser microsurgery (TLM) versus radiotherapy (RT) for early glottic cancer.

DATA SOURCES

A systematic search was conducted across PubMed, Scopus, and Cochrane Library from inception until April 2024.

REVIEW METHODS

Articles considered were primary studies directly comparing the 2 treatment modalities in a population of T1 and T2 glottic cancer. Interest outcomes were patient report outcome measures (PROMs) of vocal function and QoL, clinician-reported measures, and acoustic analyses parameters.

RESULTS

There was no significant difference between TLM and RT in grade, roughness, breathiness, asthenia, strain (relative risk, 1.11; 95% confidence interval [CI], 0.60-2.07; I2 = 90.96; P < .001), Voice Handicap Inventory-30 scores (standardized mean difference [SME] 0.51; 95% CI, -0.04-1.07; I2 = 89.72; P < .001), or fundamental frequency (SME 0.56; 95% CI, -0.14-1.25; I2 = 91.12; P < .001). The TLM group had significantly better performance with regards to jitter (SME 0.54; 95% CI, 0.08-1.00; I2 = 79.42; P < .001) and shimmer (SME 0.53; 95% CI, 0.11-0.95; I2 = 74.94; P < .001). The risk of bias was assessed to be serious.

CONCLUSION

The findings suggest comparable long-term PROMs between TLM and RT in the treatment of early glottic carcinoma, with TLM showing better acoustic analysis outcomes. However, the available evidence remains scarce, of high heterogeneity, and at risk of bias. A direct comparison between TLM and RT through large randomized controlled trials is needed to provide more substantial evidence to determine the optimum treatment.

Multimodal Evaluation of Voice Outcome in Early Glottic Cancers Treated With Definitive Radiotherapy

BACKGROUND/AIM

We employed a multimodal evaluation of voice outcome (MEVO) model to assess long-term voice outcome in early glottic cancer (EGC) patients treated with primary radiotherapy (RT). The model consisted of objective and subjective vocal evaluation during follow-up, by a dedicated Speech Pathologist and Speech Therapist.

PATIENTS AND METHODS

MEVO methodology includes Self-perception Voice Handicap Index (VHI-30), evaluation of parameters Grade (G), Roughness (R), Breathiness (B), Asthenia (A) and Strain (S) according to GRBAS scale, objective analysis and aerodynamics using the PRAAT software and laryngeal evaluation with videostroboscope (VS).

RESULTS

The MEVO methodology was described and tested on a sample of 10 EGCs submitted to definitive RT (total dose 66-70 Gy). Mean follow-up was 48.9 months (range=9-115). VHI was mild-moderate in 90% of patients; overall voice function (GRBAS) was normal-mildly impaired in 70% of patients; VS evaluation showed normal vocal cord motion in 90% of patients, but complete glottic closure in 60%. PRAAT scores confirmed these findings.

CONCLUSION

A multidimensional voice evaluation is time consuming, but useful to objectify vocal impact of radiotherapy. The MEVO model allowed to quantify vocal dysfunction, showing a good objective vocal outcome.

The Effect of Supraclavicular Radiotherapy on Acoustic Voice Quality Index (AVQI), Spectral Amplitude and Perturbation Values

OBJECTIVE

The Acoustic Voice Quality Index (AVQI), spectral amplitude, and voice perturbation parameters are objective assessment methods that are used in clinical settings and for research purposes. The aim of this study was to demonstrate the effect of supraclavicular RT on the physiology and function of the vocal fold.

METHODS

A total of 29 female patients were included in the study. The voices of the patients, who were diagnosed with breast cancer and underwent supraclavicular RT, were recorded before and after the treatment (1 and 6 months). AVQI, spectral amplitude (H1-H2, H1-A1, H1-A2, H1-A3) and acoustic analyses of the voice perturbation parameters were performed.

RESULTS

AVQI was significantly higher in the first month (P < 0.05). Of the voice perturbation parameters, shimmer was found to be significantly high in the first month (P < 0.05). However, not all spectral amplitude values showed a significant change (P > 0.05).

CONCLUSION

In this study, AVQI and shimmer values were found to be higher following the application of supraclavicular RT. These results showed that nonlaryngeal RT might cause changes in the acoustic values of the voice in the early stage.

Objective and self-evaluation voice analysis after transoral laser cordectomy and radiotherapy in T1a-T1b glottic cancer

Voice quality outcome becomes an important factor in the choice of the therapeutic option. The differences between radiotherapy and laser cordectomy have been extensively debated in the literature. We analyzed the vocal outcomes after carbon dioxide (CO₂) laser cordectomy and radiotherapy treatment for T1a-b early glottic cancer by means of objective and subjective voice evaluation. A retrospective study was performed on 56 cancer patients, 30 treated with cordectomy and 26 with radiotherapy. All patients underwent laser cordectomy which was performed under general anesthesia using a surgical microscope in laryngeal suspension. The laser we used was an Ultrapulse one, 10.6-μm wavelength, and a power setting of 2 to 4 W in an Ultrapulse mode was selected. Two different sets of data were recorded: (a) voice acoustic analysis (jitter, shimmer, fundamental frequency and noise/harmonic ratio) and (b) voice handicap index (VHI). Data collected were statistically analyzed using SPSS 20.0 for Windows. Jitter, shimmer, and signal-to-noise ratio were significantly altered in both glottic cancer patient groups as compared to the control group. On the contrary, no statistically significant alteration of the fundamental frequency was found in both treatment groups. Interestingly, jitter and shimmer values were significantly more compromised in transoral laser surgery patients as compared with radiotherapy-treated patients. The VHI was also significantly altered in both cancer patient groups as compared to the control group. More importantly, however, the self-evaluation voice analysis was not significantly different between the two treatment groups, contrary to what we observed for two of the four parameters measured in the objective voice analysis. Given the importance of the self-perception of the voice quality, no treatment can be considered superior from the patients' point of view. Therefore, we suggest that priority should be given to the endoscopic surgery, due to lower costs, lower morbidity, and shorter hospitalization.

A Multidimensional Study of Vocal Function Following Radiation Therapy for Laryngeal Cancers

Background:

Radiation therapy (XRT) has proven to be an effective curative modality in the treatment of laryngeal cancers. However, XRT also has deleterious effects on vocal function.

Aim:

To demonstrate the multidimensional nature of deficits in vocal function as a result of radiation therapy for laryngeal cancer.

Study Design:

Cohort study.

Methodology:

Vocal function parameters were chosen from the 5 domains of voice assessment to complete a multidimensional assessment battery. Adults irradiated (XRT group) for laryngeal cancers were compared to a control group of individuals with no history of head and neck cancers or radiation therapy. The control group was matched in age, sex, and pack years of smoking.

Results:

Eighteen participants were recruited for the study. The XRT group demonstrated significantly worse clinical values as compared to the control group across select parameters in the each of the 5 domains of voice assessment.

Discussion:

Radiation therapy for laryngeal cancers results in multidimensional deficits in vocal function. Notably, these deficits persist long term. In the present study sample, multidimensional deficits were persistent 2 to 7 years following completion of XRT. The observed multidimensional persistent vocal difficulties highlight the importance of vocal rehabilitation in the irradiated larynx cancer population.

Management of Dysphonia After Radiation Therapy

Radiation-induced dysphonia can develop after radiation for primary laryngeal cancer or when the larynx is in the radiation field for nonlaryngeal malignancy. The effects are dose dependent and lead to variable degrees of dysphonia in both short- and long-term follow-up. Rehabilitation of the irradiated larynx can prove frustrating but can be facilitated through behavioral, pharmacologic, or surgical interventions.

Practice of laryngectomy rehabilitation interventions: a perspective from Hong Kong

PURPOSE OF REVIEW

To review the current practice of rehabilitation for laryngectomees in Hong Kong.

RECENT FINDINGS

Factors affecting the quality of life of laryngectomees include their performance in speech restoration, the presence of complications of treatment, as well as the availability of psycho-social support. In Hong Kong, more than 90% of laryngectomees have speech restoration by various means, the commonest of which being tracheo-oesophageal puncture and electrolaryngeal speech. However, they face special problems in communication using the current alaryngeal speech modalities, as it is difficult to produce variation in tones, which is important to express different meanings in Cantonese. The responsibility of surgeons to follow-up patients after surgery and the practice of management of common complications after laryngectomy are also discussed. The New Voice Club of Hong Kong promotes self-help and mutual help between laryngectomees, with the aim of helping new members to regain normal speech and to re-integrate into society. Quality-of-life study in Hong Kong shows that although the mean global health score is satisfactory, the social functioning domain is most severely affected after surgery.

SUMMARY

Cantonese-speaking laryngectomees in Hong Kong are facing unique challenges in speech restoration and re-integration into society after surgery. Surgeons should take the leading role in the multidisciplinary management of these patients.

Voice outcomes for photoangiolytic KTP laser treatment of early glottic cancer

OBJECTIVES

Surgery and radiotherapy routinely provide high cure rates in treating early glottic cancer. Therefore, key metrics for success are optimal voice outcome and preservation of future cancer treatment options. Remarkably, there is a paucity of pretreatment versus posttreatment voice outcome data. Angiolytic KTP (potassium titanyl phosphate) laser treatment of early glottic cancer with ultranarrow margins was initiated to better preserve vocal function. Given that effective oncological results have been achieved, it was hypothesized that this approach would also result in improved posttreatment measures of vocal function that more closely approximate historical norms than pretreatment values.

METHODS

Pretreatment and posttreatment voice outcome data were obtained for 92 patients (64 with T1 cancer and 28 with T2 cancer) who underwent 532-nm KTP laser treatment of early glottic cancer in a study design in which each patient essentially served as his or her own control. The evaluations included objective measures (acoustic and aerodynamic) and patients' self-assessments of vocal function (Voice-Related Quality of Life; V-RQOL). A series of mixed analyses of variance were conducted for all vocal function measures, with tumor stage and depth of invasion as the between-subjects variables and time (presurgery versus postsurgery) as the within-subject variable.

RESULTS

There were statistically significant (p < or = 0.05) postoperative improvements for acoustic (perturbation and noise-to-harmonics ratio) and aerodynamic (subglottic pressure and vocal efficiency) measures of vocal function, as well as for V-RQOL assessment.

CONCLUSIONS

Comprehensive pretreatment and posttreatment voice measures in a large patient cohort demonstrated that the KTP laser significantly improved postoperative vocal function in patients with early glottic cancer. Furthermore, radiotherapy was preserved as an oncological treatment option.

Vocal characteristics in patients with type 2 diabetes mellitus

The objective of this study is to report the vocal characteristics of patients with type 2 diabetes mellitus in relation to disease duration, glycemic control, and neuropathy. This is a prospective study. The setting is institutional setting. A total of 82 patients were recruited for this study, and a healthy control group matched according to age and gender was recruited. Subjects underwent acoustic analysis and perceptual evaluation using the GRABS classification where G stands for grading, R for roughness, A for asthenia, B for breathiness, and S for straining using a scale of 0–3 where o stands for normal and three for severe deviation from normal. There was no significant difference in any of the acoustic variables between diabetic patients and control. There was no significant difference in the mean score of any of the perceptual evaluation parameters between diabetic patients and control, despite the fact that the mean scores were all higher in the diseased group except for roughness. When looking at subgroups, we see that diabetic patients with poor glycemic control and with neuropathy had significantly higher mean score for the G overall grade of the voice compared to controls with P values of 0.005 and 0.009, respectively. What is also worth noting is that diabetic patients with poor glycemic control had more straining compared to controls, P value 0.043. Patients with type 2 diabetes mellitus and poor glycemic control or neuropathy have a significant difference in the grade of their voice compared to controls.

Transoral laser microsurgery elevates fundamental frequency in early glottic cancer

OBJECTIVE

To evaluate the long-term voice characteristics and quality of life of early glottic cancer patients after definitive treatment.

STUDY DESIGN

Case series with chart review in a tertiary care medical center in Taiwan.

METHODS

Forty-two consecutive patients who received radiation therapy (RT) or transoral laser microsurgery (TLM) for early glottic cancer over 12 months were evaluated for voice laboratory data and quality-of-life measurements.

RESULTS

Twenty-four patients received RT, and 18 underwent TLM. There was no difference between the two groups on acoustic and aerodynamic voice measures except for modal fundamental frequency in males. In the Functional Assessment of Cancer Therapy-Head and Neck survey, the TLM group had better communication than the RT group, but there were no differences in voice quality and strength. There was also no significant difference in the Voice Handicap Index 10 evaluation.

CONCLUSIONS

Male patients who received TLM have higher modal fundamental frequency than male patients who received RT and norms. Voice-related life quality is similar in patients regardless of RT or TLM treatment for early glottic cancer, but those who receive TLM have better communication abilities than those who receive RT.

Pathologic effects of external-beam irradiation on human vocal folds

OBJECTIVES

We sought to better characterize pathologic changes that occur in the human vocal fold after radiotherapy for head and neck cancer.

METHODS

In a blinded, controlled study of archived tissue, we evaluated postirradiation salvage laryngectomy vocal fold tissue without evidence of malignant disease. Clinical and demographic patient data were collected. In a blinded fashion, irradiated tissue was compared to nonirradiated, benign control tissue. Histomorphometric analysis was used to assess muscle and collagen organization, superficial lamina propria (SLP) and vocal ligament thickness, vocalis muscle fiber area, collagen content, and hyaluronic acid content. Immunohistochemical analysis was used to assess the content of type I collagen, type IV collagen, vimentin, fibronectin, alpha-smooth muscle actin, matrix metalloproteinase 9, and laminin.

RESULTS

Twenty irradiated vocal folds were evaluated and compared to control specimens. Collagen and muscle disorganization was noted in the irradiated specimens. The SLP and vocal ligament thicknesses and the mean muscle fiber diameters did not differ significantly. The SLP fibronectin and the vocalis muscle and SLP collagen content were significantly increased in the irradiated vocal folds, and the SLP collagen content increased significantly with time between irradiation and resection. The laminin content of irradiated vocalis muscles was significantly decreased.

CONCLUSIONS

Radiotherapy results in significant vocal fold tissue changes. Having more precisely defined these changes, we plan continued investigation seeking targeted preventive and therapeutic interventions for improved vocal quality following radiotherapy.

Voice quality after organ-preservation therapy with definitive radiotherapy for laryngeal cancer

BACKGROUND

The purpose of this study was to analyze voice quality among patients treated by definitive radiotherapy for laryngeal cancer.

METHODS

Ten patients with laryngeal cancer who had completed radiotherapy were involved in this pilot study. A standardized protocol was administered assessing: (1) sustained vowel production following maximal inspiration, (2) sustained vowel production for a 7-second duration repeated 5 times, and (3) spontaneous speech for 10 seconds.

RESULTS

The acoustic parameters among patients with early-stage cancer were not statistically different from healthy age-corresponding controls, except for shimmer (0.20 vs 0.16 dB, ρ = 0.01) and maximum phonation duration (24.37 vs 30.10 seconds, ρ = 0.04). For patients with locally advanced cancer, differences with controls were observed with shimmer (2.29 vs 0.16 dB, ρ = 0.01), jitter (7.49% vs 1.04%, ρ = 0.01), harmonics-to-noise ratio (2.67 vs 9.22, ρ = 0.01), and maximum phonation duration (14.12 vs 30.10 seconds, ρ = 0.01).

CONCLUSIONS

Despite the subtle differences in voice quality that existed, radiotherapy as a curative treatment for laryngeal cancer allows maintenance of a functional voice.

Longitudinal analysis of voice quality in patients with early glottic cancer after transoral laser microsurgery

BACKGROUND

We conducted longitudinal voice evaluations in patients with early glottic cancer who underwent transoral laser microsurgery (TLM) to determine the time to stability.

METHODS

Twenty-five patients underwent TLM, including 13 limited cordectomies (type I and type II) and 12 extended cordectomies (type III to type IV). Multidimensional voice evaluations were performed before treatment and at 1, 3, 6, and 12 months after treatment.

RESULTS

Voice parameters of asthenicity, strain, mean airflow rate (MFR), voice handicap index (VHI)-functional, VHI-physical, and VHI-total scores improved in all patients. Most patients had improved 6 months after TLM. Patients with extended cordectomy showed higher breathiness, MFR, VHI-functional, and VHI-total scores. Healing was complete in all cases by 6 months and in a majority of cases (76%) by 3 months.

CONCLUSIONS

Voice quality achieved stability 6 months after TLM. Comparing treatment outcomes and surgical intervention are not recommended within 6 months of surgery.

Quality of voice after radiotherapy in early vocal cord cancer

Early glottic cancer (T1, T2N0M0), a disease of the voice box, mainly affects the voice. It can be effectively treated with both surgery and radiotherapy. Preservation of the voice while treating vocal cord cancer is not simply retaining the ability to vocalize. It is the determinant of choice of treatment and quality of life following curative management. Radiotherapy has resulted in excellent control rates with voice preservation and has been the standard of care for many decades. Several patient- (e.g., smoking, age, amount of talking during treatment), disease- (e.g., extent and site of lesion) and treatment- (e.g., radiation field size and dose, voice therapy) related factors adversely affect the quality of voice after radiotherapy. Several studies have evaluated voice quality either subjectively or objectively. Still, little is known about it. Voice quality after radiotherapy improves but does not reach the standard of the normal controls.

Voice and speech outcomes of chemoradiation for advanced head and neck cancer: a systematic review

Purpose of this review is to systematically assess the effects on voice and speech of advanced head and neck cancer and its treatment by means of chemoradiotherapy (CRT). The databases Medline, Embase and Cochrane were searched (1991-2009) for terms head and neck cancer, chemoradiation, voice and speech rehabilitation. Twenty articles met the inclusion criteria, whereof 14 reported on voice outcomes and 10 on speech. Within the selected 20 studies, 18 different tools were used for speech or voice evaluation. Most studies assessed their data by means of patient questionnaires. Four studies presented outcome measures in more than one dimension. Most studies summarised the outcomes of posttreatment data that were assessed at various points in time after treatment. Except for four studies, pre-treatment measurements were lacking. This and the fact that most studies combined the outcomes of patients with radiated laryngeal cancers with outcome data of non-laryngeal cancer patients impedes an interpretation in terms of the effects of radiation versus the effects of the disease itself on voice or speech. Overall, the studies indicated that voice and speech degenerated during CRT, improved again 1-2 months after treatment and exceeded pre-treatment levels after 1 year or longer. However, voice and speech measures do not show normal values before or after treatment. Given the large-ranged posttreatment data, missing baseline assessment and the lacking separation of tumour/radiation sites, there is an urgent need for structured standardised multi-dimensional speech and voice assessment protocols in patients with advanced head and neck cancer treated with CRT.

Risk factors for voice quality after radiotherapy for early glottic cancer

BACKGROUND AND PURPOSE

In the majority of patients irradiated for early glottic cancer an abnormal voice was reported. The purpose of the study was to determine the factors influencing voice quality after radiotherapy for T1 glottic cancer.

METHODS

The voices of 75 male patients irradiated for T1 glottic carcinoma were assessed subjectively and objectively by acoustic analyses and aerodynamic measurements. The laryngeal function and morphology were evaluated by videolaryngostroboscopy. The data on smoking habits, the associated diseases influencing voice quality, the extent of the tumor, the type of biopsy, and the irradiation technique were collected from the medical records. The data on the factors influencing voice quality were compared for patients with a normal/near-normal voice and those with a hoarse voice.

RESULTS

Voice quality was at least slightly abnormal in 94.7% and 81.3% of patients, when assessed perceptively and objectively, respectively. Smoking after the completed treatment, more severe morphologic alterations of the vocal folds, dryness of the throat, incomplete closure of the vocal folds and functional voice disorders expressed as supraglottic activity adversely influenced the voice quality. A good correlation between the perceptive voice assessment and the acoustic analyses was established.

CONCLUSIONS

After the successful irradiation for T1 glottic carcinoma, the great majority of the patients have at least a slightly hoarse voice. A better voice outcome could be achieved if radiotherapy was followed by the patient's cessation of smoking and the appropriate voice therapy.

Effects of chemoradiotherapy on voice and swallowing

PURPOSE OF REVIEW

Chemotherapy has been found to result in comparable survival rates to surgery for head and neck cancer. However, toxicity can often be worse after chemoradiotherapy, with impairment in voice, swallowing, nutrition, and quality of life. Investigators are attempting to modify radiotherapy treatment regimens to spare organs that have an impact on swallowing. This review will highlight voice and swallowing impairment seen after chemoradiotherapy, as well as treatment for voice and swallowing disorders in this population. Results of newer radiotherapy regimens will also be highlighted.

RECENT FINDINGS

Specific oropharyngeal swallowing motility disorders after chemoradiotherapy have been identified. Damage to specific structures has been correlated with specific pharyngeal phase swallow impairment. Swallowing function and quality of life have been examined over time, with improvement seen in both. Preventive/prophylactic swallow exercise programs have been encouraging. Chemoradiotherapy effects on voice have been identified in terms of acoustic, aerodynamic, and patient and clinician-rated perception of function. Improvement in voice has also been observed over time after chemoradiotherapy. Voice therapy has been found to have a positive impact on voice and perceptual measures in this population.

SUMMARY

Current studies show some improvement in swallow function after swallow and voice therapy in patients treated with chemoradiotherapy. Further, there is a suggestion of improved swallow function with sparing of organs with specific radiotherapy protocols. Future research needs to focus on specific voice and swallow treatment regimens in the head and neck cancer patient treated with chemoradiotherapy, specifically, timing, frequency, duration, and specific treatment types.

Voice outcomes after radiotherapy treatment for early glottic cancer: assessment using multidimensional tools

BACKGROUND

This is the first prospective study to use instrumental and both clinician- and client-rated auditory-perceptual measures to examine voice and voice-related quality of life changes in patients after curative radiotherapy for early glottic cancer.

METHOD

Thirty patients undergoing curative radiotherapy treatment for early glottic cancer completed the following: 3 voice tasks for acoustic, aerodynamic, and auditory-perceptual voice measures (therapist-rated); a patient self-report rating of voice quality; and a voice-related quality of life assessment before and 12 months after radiotherapy.

RESULTS

Patients' perceptions of their voice quality and their voice-related quality of life significantly improved posttreatment, as did acoustic, aerodynamic, and auditory-perceptual voice measures. Mean speaking fundamental frequency did not change significantly, although breathiness and strain in the voice recordings were demonstrably reduced.

CONCLUSION

In describing postradiotherapy voices in this study, pertinent measures of voice outcomes have been established, setting the benchmark for comparison in future cohort studies.

Photoangiolytic Laser Treatment of Early Glottic Cancer: A New Management Strategy

The 532 nm pulsed KTP (potassium titanyl phosphate) laser and the 585 nm pulsed dye laser (PDL) are photoangiolytic lasers that have been demonstrated to be effective for managing vocal fold dysplasia. The putative mechanism of action is selective photoangiolysis of the sublesional microcirculation. On the basis of this experience, early glottic cancers were treated by selectively targeting the intralesional and sublesional microvasculature. This approach was derived from Folkman's concepts of neoplastic growth resulting from tumor angiogenesis. Staged microlaryngeal treatment was adopted, because it facilitated optimal functional results, and was considered safe, because early glottic cancer rarely metastasizes. Furthermore, intercurrent disease during conventional incremental radiotherapy is typical in treating early glottic cancer. A pilot group of 22 patients with early glottic cancer (13 T1, 9 T2) were treated with a fiber-based angiolytic laser. Eleven of the 22 had unilateral disease and were entirely treated by laser photoangiolysis as a sole modality. Eleven of the 22 had bilateral disease; 5 of the 11 were treated entirely (bilaterally) by laser photoangiolysis, and 6 of the 11 only underwent laser treatment of the less involved vocal fold, with conventional resection being done on the dominant side of the cancer. The initial 8 of the 22 were treated with the PDL, and the latter 14 of the 22 were treated with the pulsed KTP laser. No patient has cancer presently, and none have undergone posttreatment radiotherapy or open surgery. The mean follow-up is 27 months, 13 of the 22 patients have at least 2 years of follow-up, and the first patient was treated just over 5 years ago. Objective measures of vocal function revealed that photoangiolytic treatment of early glottic cancer resulted in significant postoperative improvements despite the fact that half of the patients had bilateral disease. Angiolytic lasers effectively involuted early glottic cancer, with microsurgically directed nonionizing radiation of the dense neoplastic blood supply resulting in complete tumor regression. This approach is conceptually attractive, because it is repeatable, it preserves all conventional cancer treatment options, and it results in excellent vocal function by improving phonatory mucosal wave vibration. Observations from this investigation suggest that this new and novel cancer treatment strategy is effective; however, larger patient cohorts, longer follow-up, and multi-institutional confirmation will be necessary to establish incontrovertible oncological efficacy.

Photoangiolytic Laser Treatment of Early Glottic Cancer: A New Management Strategy

The 532 nm pulsed KTP (potassium titanyl phosphate) laser and the 585 nm pulsed dye laser (PDL) are photoangiolytic lasers that have been demonstrated to be effective for managing vocal fold dysplasia. The putative mechanism of action is selective photoangiolysis of the sublesional microcirculation. On the basis of this experience, early glottic cancers were treated by selectively targeting the intralesional and sublesional microvasculature. This approach was derived from Folkman's concepts of neoplastic growth resulting from tumor angiogenesis. Staged microlaryngeal treatment was adopted, because it facilitated optimal functional results, and was considered safe, because early glottic cancer rarely metastasizes. Furthermore, intercurrent disease during conventional incremental radiotherapy is typical in treating early glottic cancer. A pilot group of 22 patients with early glottic cancer (13 T1, 9 T2) were treated with a fiber-based angiolytic laser. Eleven of the 22 had unilateral disease and were entirely treated by laser photoangiolysis as a sole modality. Eleven of the 22 had bilateral disease; 5 of the 11 were treated entirely (bilaterally) by laser photoangiolysis, and 6 of the 11 only underwent laser treatment of the less involved vocal fold, with conventional resection being done on the dominant side of the cancer. The initial 8 of the 22 were treated with the PDL, and the latter 14 of the 22 were treated with the pulsed KTP laser. No patient has cancer presently, and none have undergone posttreatment radiotherapy or open surgery. The mean follow-up is 27 months, 13 of the 22 patients have at least 2 years of follow-up, and the first patient was treated just over 5 years ago. Objective measures of vocal function revealed that photoangiolytic treatment of early glottic cancer resulted in significant postoperative improvements despite the fact that half of the patients had bilateral disease. Angiolytic lasers effectively involuted early glottic cancer, with microsurgically directed nonionizing radiation of the dense neoplastic blood supply resulting in complete tumor regression. This approach is conceptually attractive, because it is repeatable, it preserves all conventional cancer treatment options, and it results in excellent vocal function by improving phonatory mucosal wave vibration. Observations from this investigation suggest that this new and novel cancer treatment strategy is effective; however, larger patient cohorts, longer follow-up, and multi-institutional confirmation will be necessary to establish incontrovertible oncological efficacy.

Acoustic voice analysis in different phonetic contexts after larynx radiotherapy for T1 vocal cord carcinoma

INTRODUCTION

Radiotherapy for early vocal cord carcinoma affects quality of voice. Nevertheless, most patients refer to having a high satisfaction level with their voice. The few acoustic studies on quality of voice have been performed only in prolonged vowel production, which is not a usual speech situation. The present study has been done with the aim of establishing which phonetic situations reflect a greater alteration in voice production related to irradiation.

MATERIAL AND METHODS

Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 non-irradiated subjects were included in a study of acoustic voice analysis. This analysis was performed one year after radiotherapy. Patients and control group voices were tape recorded in extended vowel production, oral reading of a standard paragraph, spontaneous speech and in a song. Acoustic analysis was performed by a Kay Elemetric's Computerized Speech Lab (model CSL #4300). Fundamental frequency, jitter, shimmer and harmonics-to-noise ratio were obtained in both groups. Statistical test: Lin concordance coefficient and Pearson's correlation coefficient, Student's t-test and ROC curves.

RESULTS

Concordance and correlation studies did not allow selection of any subgroup in acoustic parameters and different acoustic situations. Acoustic parameters had higher median values in irradiated patients. Student's t-test showed significant differences for fundamental frequency in sustained vowel production and spontaneous speech; for jitter there was statistical significance in all the acoustic situations and for shimmer in oral reading and song. Jitter showed a cut-off of 2.02% with a sensitivity of 89% and specificity of 97% in classifying irradiated and non-irradiated groups. The ROC curve for jitter correctly classified 94% of subjects into irradiated or non-irradiated groups.

CONCLUSIONS

The present study showed that jitter obtained from spontaneous speech was the most relevant parameter in discriminating voice in irradiated patients by acoustic analysis. Jitter in spontaneous speech is in need of more analysis in bigger series and in more advanced stages of larynx cancer as its relevance has been demonstrated.

Voice in early glottic cancer compared to benign voice pathology

The purpose of this study is to compare (Dutch) Voice Handicap Index (VHIvumc) scores from a selected group of patients with voice problems after treatment for early glottic cancer with patients with benign voice disorders and subjects from the normal population. The study included a group of 35 patients with voice problems after treatment for early glottic cancer and a group of 197 patients with benign voice disorders. Furthermore, VHI scores were collected from 123 subjects randomly chosen from the normal population. VHI reliability was high with high internal consistency and test-retest stability. VHI scores of glottic cancer patients were similar to those of patients with voice problems due to benign lesions. Both groups of patients were clearly deviant from the normal population. Within the normal population, 16% appeared to have not-normal voices. Based on ROC curves a cut-off score of 15 points was defined to identify patients with voice problems in daily life. A clinical relevant difference score of 10 points was defined to be used for individual patients and of 15 points to be used in study designs with groups. Patients with voice problems after treatment for early glottic cancer encounter the same amount of problems in daily life as the other voice-impaired patients. The VHI proved to be an adequate tool for baseline and effectiveness measurement of voice.

Vocal assessment in patients submited to CO2 laser cordectomy

Aim

To evaluate voice outcomes in patients with early glottic carcinoma treated by CO₂ laser cordectomy.

Method

15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO₂ laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group.

Results

Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to video-laryngo-stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. Conclusions: In spite of voice alterations in patients submitted to cordectomy by CO₂ laser, functional results are acceptable, with minimal repercussion in their quality of life. Avaliação da voz em pacientes submetidos à cordectomia com laser de CO₂.

Voice-related quality of life in T1 glottic cancer: irradiation versus endoscopic excision

OBJECTIVES

Several studies have explored posttreatment voice outcomes for early glottic cancer with varying results. To further clarify the voice-related quality of life (QOL) of T1 glottic cancer patients treated by external beam radiotherapy (EBRT) compared to endoscopic carbon dioxide laser excision (CLE), we performed a meta-analysis.

METHODS

We performed a meta-analysis review for the years 1966 to 2005 for the Voice Handicap Index (VHI), laryngeal cancer, voice outcome, voice quality, and quality of life. Studies in which the VHI was assessed at least 3 months after treatment for T1 glottic cancer were identified and analyzed by meta-analysis techniques.

RESULTS

Six studies with 208 patients (6 T1b and 202 T1a) treated with CLE and 91 patients (6 T1b and 85 T1a) treated with EBRT were identified. The posttreatment VHI scores were similar for the EBRT- and CLE-treated patients (p = .1, Wilcoxon rank sum test).

CONCLUSIONS

We conclude that CLE and EBRT provide comparable levels of voice handicap for patients with T1 glottic cancer.

The efficacy of voice therapy in patients after treatment for early glottic carcinoma

BACKGROUND

After treatment for early glottic carcinoma, a considerable number of patients end up with voice problems that interfere with daily life activities. The objective of this randomized and controlled study was to assess the efficacy of voice therapy in these patients.

METHODS

Of 177 patients, 6-120 months after treatment for early glottic carcinoma, 70 patients (40%) suffered from voice impairment based on a 5-item screening questionnaire. Approximately 60% of those 70 patients were not interested in participating in the current study. Twenty-three patients who were willing to participate were assigned randomly either to a voice therapy group (n = 12 patients) or to a control group (n = 11 patients). Multidimensional voice analyses (the self-reported Voice Handicap Index [VHI], acoustic and perceptual voice quality analysis, videolaryngostroboscopy, and the Voice Range Profile) were conducted twice: before and after voice therapy or with 3 months in between for the control group.

RESULTS

Statistical analyses of the difference in scores (postmeasurement minus premeasurement) showed significant voice improvement after voice therapy on the total VHI score, percent jitter, and noise-to-harmonics ratio in the voice signal and on the perceptual rating of vocal fry.

CONCLUSIONS

Voice therapy proved to be effective in patients who had voice problems after treatment for early glottic carcinoma. Improvement not only was noticed by the patients (VHI) but also was confirmed by objective voice parameters.

A screening questionnaire for voice problems after treatment of early glottic cancer

PURPOSE

After treatment for early glottic cancer, a considerable number of patients end up with voice problems interfering with daily life activities. A 5-item screening questionnaire was designed for detection of voice impairment. The purpose of this study is to assess psychometric properties of this questionnaire in clinical practice.

METHODS AND MATERIALS

The questionnaire was completed by 110 controls without voice complaints and 177 patients after radiotherapy or laser surgery for early glottic cancer.

RESULTS

Based on normative data of the controls, a score of 5 or less on at least 1 of the 5 questions was considered to state overall voice impairment. Reliability of the questionnaire proved to be good. Voice impairment was reported in 44% of the patients treated with radiotherapy vs. 29% of the patients treated with endoscopic laser surgery.

CONCLUSIONS

The questionnaire proved to be a reliable, valid, and feasible method to detect voice impairment in daily life. The questionnaire is easy to fill in, and interpretation is straightforward. It is useful for both radiation oncologists and otorhinolaryngologists in their follow-up of patients treated for early glottic cancer.

The impact of long-term botulinum toxin injections on symptom severity in patients with spasmodic dysphonia

Injection of botulinum toxin (BT) into the muscles of the larynx is an effective treatment for the symptoms of spasmodic dysphonia (SD). To date, however, there have been no studies that have used blinded raters to assess the efficacy of BT injections on overall symptom severity in a cohort of SD patients followed over a prolonged period. In this study, 102 subjects with SD were treated with serial BT injections for up to 2 years. Voice recordings were obtained at several time points during treatment and were played to a panel of expert and novice listeners who rated them based on overall symptom severity in a single-blind fashion. Subjects demonstrated significant improvement over baseline at all time points. In addition, patients showed a sustained responsiveness to therapy over time. These results provide support for the efficacy of serial BT injections for SD and suggest that successful treatment may depend, in part, on patients' early recognition of returning symptoms.

Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas

A cohort of 101 patients with previously untreated glottic cancer (15 Tis, 66 T1a, and 20 T1b) who underwent endoscopic CO2 laser excision between January 1995 and December 1997 was prospectively analyzed. The depth and extension of the excision were graded according to the European Laryngological Society Classification including 5 types of cordectomy. All patients were subsequently examined every 2 months for a period ranging from 30 to 66 months (mean, 48 months). The rates of 5-year overall survival, disease-free survival, ultimate local control with laser alone, and laryngeal preservation were 85%, 87%, 93%, and 95%, respectively. Sixty-nine patients underwent, at least 1 year after surgery, videolaryngostroboscopy combined with perceptual and objective evaluation of the voice, and spirometry. Acoustic parameters were compared with those obtained in a matched control group by Kruskal-Wallis test. No statistically significant difference was found (p > .05) between patients submitted to subepithelial (type I) and subligamental (type II) cordectomies and controls.

Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions

Phonomicrosurgery in performing artists has historically been approached with great trepidation, and vocal outcome data are sparse. The vocal liability of surgically disturbing the superficial lamina propria (SLP) and epithelium must be balanced with the inherent detrimental vocal effect of the lesion(s). A prospective investigation was performed on 185 performing artists who underwent phonomicrosurgical resection of 365 lesions: 201 nodules, 71 polyps, 66 varices and ectasias, 13 cysts, 8 keratotic lesions, 2 granulomas, 2 Reinke's edema, and 2 papillomas. Nearly all patients with SLP lesions reported improvement in their postsurgical vocal function. This subjective result was supported by objective acoustic and aerodynamic measures. All postsurgical objective vocal function measures fell within normal limits, including a few that displayed presurgical abnormalities. However, given the relative insensitivity of standard objective measures to assess higher-level vocal performance-related factors, it is even more noteworthy that 8 of 24 objective measures displayed statistically significant postsurgical improvements in vocal function. Such changes in objective measures mostly reflect overall enhancement in the efficiency of voice production. Phonomicrosurgical resection of vocal fold lesions in performing artists is enjoying an expanding role because of a variety of improvements in diagnostic assessment, surgical instrumentation and techniques, and specialized rehabilitation. Most of these lesions are the result of phonotrauma and arise within the SLP. Successful management depends on prudent patient selection and counseling, ultraprecise technique, and vigorqus vocal rehabilitation. Furthermore, an understanding of the vocal function and dysfunction of this high-performance population provides all otolaryngologists who manage laryngeal problems with valuable information that they can extrapolate for use in their practices.

Voice and treatment outcome from phonosurgical management of early glottic cancer

Phonosurgical management of early glottic cancer has evolved considerably, but objective vocal outcome data are sparse. A prospective clinical trial was done on 32 patients with unilateral cancer (T1a in 28 and T2a in 4) who underwent ultranarrow-margin resection; 15 had resection superficial to the vocal ligament, and 17 deep to it. The subepithelial infusion technique facilitated selection of these patients for the appropriate procedure. All are cancer-free without radiotherapy or open surgery. Involvement of the anterior commissure (22/32) or the vocal process (15/32) of the arytenoid cartilage did not influence local control. Nine of 17 patients had resection of paraglottic musculature, and all underwent medialization reconstruction by lipoinjection and/or Gore-Tex laryngoplasty. Eight of the 17 had resections deep to the vocal ligament, but without vocalis muscle, and 1 of the 8 underwent medialization. Posttreatment vocal function measures were obtained for all patients. A clear majority of the patients displayed normal values for average fundamental frequency (72%) during connected speech, and normal noise-to-harmonics ratio (75%) and average glottal airflow (91%) measures during sustained vowels. Smaller majorities of patients displayed normal values for average sound pressure level (SPL; 59%) during connected speech and for maximum ranges for fundamental frequency (56%) and SPL (59%). Fewer than half of the patients displayed normal values for sustained vowel measures of jitter (45%), shimmer (22%), and maximum phonation time (34%). Almost all patients had elevated subglottal pressures and reduced values for the ratio of SPL to subglottal pressure (vocal efficiency). There were significant improvements in a majority of patients for most vocal function measures after medialization reconstruction. Normal or near-normal conversation-level voices were achieved in most cases, regardless of the disease depth, by utilization of a spectrum of resection and reconstruction options. These favorable results are based on establishing aerodynamic glottal competency and preserving the layered microstructure of noncancerous glottal tissue.

Minimally invasive techniques for management of early glottic cancer

This article reviews management of early laryngeal squamous cell carcinoma with respect to current standards of practice and recent advances in minimally invasive endoscopic surgery, specifically highlighting powered instrumentation as an alternative to transoral laser resection of early glottic lesions. Limitations of the current staging system, controversy regarding management of lesions involving the anterior commissure, and the role of radiation therapy versus surgical management are also discussed with reference to current outcomes literature.

Swallowing and speech therapy after definitive treatment for laryngeal cancer

As the trend in laryngeal cancer treatment shifts towards organ-conservation surgeries and organ-preservation protocols, patients will more often retain anatomy vital to communication and swallowing. Despite a conservative approach, results of treatment may have debilitating effects. Rehabilitation efforts are directed towards a return to functional, if not normal, status. Although there are predictable trends in voice and swallowing disorders of patients with laryngeal cancer, posttreatment dysphonia and dysphagia are diverse in presentation. Considering the significant diversity of this population, speech pathologists should work closely with otolaryngologists to determine the most appropriate treatment for each patient. As this article demonstrates, voice and swallowing therapy are necessary components of the rehabilitation process following treatment for head and neck cancers. As always, treatment is tailored to the specific individual and based on information obtained during a thorough evaluation by a speech pathologist. Fortunately, with the help of voice and swallowing therapy, many patients return to functional communication and oral feeding.

Surgical voice rehabilitation after laser surgery for glottic carcinoma

Transoral laser surgery today is the mainstay of treatment for T1 and T2 glottic carcinoma. The vocal ability remains sufficient in the majority of patients. However, in some cases, a significant glottic gap may persist, leading to poor voice quality. We report a special technique of medialization thyroplasty using autologous cartilage specifically adapted for vocal rehabilitation after laser resection. Six patients with a significant glottic gap following laser surgery were treated. For vocal rehabilitation, a special medialization technique was performed. The superior rim of the thyroid cartilage of the resected side was exposed. A 1 x 2-cm piece of cartilage was harvested and reimplanted into a subperichondrial pouch created on the inner side of the thyroid cartilage. When phonation was optimal, this cartilaginous strut was sutured and/or glued in place. In all 6 cases, the vocal function improved significantly. The dysphonia index (0 = normal, 3 = aphonia), which includes objective parameters as well as expert voice ratings and the patient's perception, increased by 1.1 on average (range, 0.4 to 1.6). The results have been lasting. The established medialization techniques are of limited value in a larynx scarred by laser surgery. Injection augmentation is often futile because the tight scar tissue does not lend itself to augmentation. Implantation of nonorganic material may cause problems if revision surgery for tumor recurrence should become necessary or if the implant protrudes into the scarred endolarynx. The technique reported avoids these pitfalls and leads to voice quality improvement comparable to that of established medialization procedures.

Acoustical aspects of vocal function following radiotherapy for early T1a laryngeal cancer

We evaluated acoustic voice characteristics of 18 male patients undergoing radiotherapy. The subjects were seen for voice assessment preradiotherapy and at 1 month, 3 months, 6 months, and 1 year following radiotherapy. A multidimensional voice analysis computer program (IVANS, Avaaz Innovations, 1998) was employed to evaluate measures of traditional frequency and amplitude perturbation as well as time-based and linear prediction (LP) modeled "noise" parameters of the acoustic output in conjunction with perceptual judgments of overall vocal quality. The results indicate vocal deterioration of vocal function immediately following radiotherapy with gradual and significant improvement in acoustic and perceptual features over 9 to 12 months following the radiation treatment. Measures of glottal noise demonstrated higher sensitivity than frequency-based measures of voice perturbation, and with more consistent, less variable changes in acoustical voice output from the preradiation to the 12 month postradiation periods. Future research evaluating vowel type and acoustic perturbation measures with a larger sample of subjects over a longer time period seems warranted.

A comparison of radiation-induced and presbylaryngeal dysphonia

OBJECTIVE

The goal of this study was to assess voice after radiotherapy compared with patients with presbylaryngeal dysphonia.

STUDY DESIGN AND SETTING

Prospective assessment of 20 patients aged 60+ years who remained free of disease longer than 1 year after radiotherapy for T1 squamous cell carcinoma and retrospective review of 46 patients aged 60+ with presbylaryngeal dysphonia, conducted at a tertiary care, academic hospital. Assessment data included videostroboscopy, spectrography, voice range profile, and Voice Handicap Index.

RESULTS

Eighty percent of the radiotherapy patients reported a voice disorder. Acoustic data and functional measures reflected similar limitations and abnormalities for both groups. A high incidence of glottal gap in all patients may have been associated with increased mucosal stiffness in the radiotherapy group and vocal fold atrophy in the presbylaryngeal group.

CONCLUSION

Patient perception and functional outcome of voice were similar for both groups, despite differences in etiology of abnormal vocal fold vibratory behavior.

SIGNIFICANCE

Radiotherapy in older individuals may yield dysphonia that is no greater than that caused by normal aging.

Laser cordotomy versus radiotherapy: an objective cost analysis

This study presents a cost analysis of and comparison between laser cordotomy and external beam irradiation for the treatment of early glottic carcinoma. It compares the curative results of the two modalities from data of a retrospective study at my institution and a literature review of published cure rates. It also reviews the results of objective voice assessments in cases representing both treatments. The findings of this study indicate that the cure rates are equivalent and that voice quality obtained after laser cordotomy is comparable to that obtained after irradiation, yet the total cost of external beam radiotherapy is significantly higher than that of laser surgery. Hence, the findings of this study provide strong support for initially treating early glottic tumors with laser surgery.

Acoustic Analysis of Voice Quality with or without False Vocal Fold Displacement After Cordectomy

Conventional cordectomy by means of a laryngofissure is one of the therapeutic options for treatment of early glottic cancer. To improve the poor voice quality related to this kind of operation, many authors have developed different techniques to repair the mucosal defect. We analyzed voice quality acoustically and compared it after cordectomy alone and after cordectomy with the reconstruction of the vocal cord in a group of 14 patients affected by T1 glottic carcinoma. All the patients underwent postoperative speech therapy. Three patients who underwent cordectomy with reconstruction showed the presence of diplophonia, while two patients without reconstruction showed the presence of bitonality. The differences of the acoustic parameters (jitter, shimmer, harmonic-to-noise ratio) between the two groups of patients were not statistically significant. Reconstruction of the vocal cord does not seem to improve voice quality after cordectomy even in combination with postoperative speech therapy.

Acoustic analysis after radiotherapy in T1 vocal cord carcinoma: a new approach to the analysis of voice quality

PURPOSE

The study of acoustic voice parameters (fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio) in extended vowel production, oral reading of a standard paragraph, spontaneous speech and a song in irradiated patients for Tis-T1 vocal cord carcinoma.

METHODS AND MATERIALS

Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 nonirradiated subjects of the same age were included in a study of acoustic voice analysis. The control group had been rigorously selected for voice quality and the irradiated group had previous history of smoking in two-thirds of the cases and a vocal cord biopsy. Radiotherapy patients were treated with a 6MV Linac receiving a total dose of 66 Gy, 2 Gy/day, with median treatment areas of 28 cm(2). Acoustic voice analysis was performed 1 year after radiotherapy, the voice of patients in extended vowel production, oral reading of a standard paragraph, spontaneous speech, and in a song was tape registered and analyzed by a Kay Elemetric's Computerized Speech Lab (model CSL# 4300). Fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio were obtained in each case. Mann Whitney analysis was used for statistical tests.

RESULTS

The irradiated group presented higher values of fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio. Mann-Whitney analysis showed significant differences for fundamental frequency and jitter in vowel production, oral reading, spontaneous speech, and song. Shimmer only showed differences in vowel production and harmonics-to-noise ratio in oral reading and song.

CONCLUSIONS

In our study only fundamental frequency and jitter showed significant increased values to the control group in all the acoustic situations. Sustained vowel production showed the worst values of the acoustic parameters in comparison with the other acoustic situations. This study seems to suggest that more work should be done in this field.

Videolaryngostroboscopy following vertical partial laryngectomy

Phonation after partial laryngeal ablative surgery has not often been examined. Videolaryngostroboscopic recordings made after vertical partial laryngectomy (VPL) were retrospectively reviewed and correlated with patient historical and operative factors. Among VPL patients (n = 42), the most common site of vibration during phonation was the contralateral false vocal fold (17/42 patients or 40.5%), followed by the contralateral arytenoid mucosa (10/42 or 23.8%) and the contralateral true vocal fold (8/42 patients or 19.0%). There was no overall difference in vocal quality judgment with respect to site of vibration (ANOVA, p = .373). Vocal quality scores were similar with use of the pyriform mucosal flap versus other reconstructive methods (Student's t-test, p = .568). This study highlights the fact that reconstruction of a new vibratory source after VPL is important for voice production. Because VPL patients infrequently demonstrated true vocal fold vibration, alternative sites (ie, false vocal fold, arytenoid mucosa) must be considered as new phonatory sources after VPL.

Consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer: voice quality, vocal function, and vocal performance

PURPOSE

To assess consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer, by means of a multidimensional analysis protocol including voice quality, vocal function, and vocal performance measures.

METHODS AND MATERIALS

A total of 60 men treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers filled in questionnaires on vocal performance. Furthermore, perceptual analyses of voice quality and stroboscopic measures of vocal function were performed. There was a longitudinal group of 10 patients from whom data were collected before, as well as 6 months and 2 years after, radiation. Furthermore, data were collected on 5 separate groups of 10 patients each: before, 6 months after, 2 years after, 3-7 years after, and 7-10 years after radiation.

RESULTS

High correlations were found between self-ratings of vocal performance and several voice measures. Patients before radiotherapy experienced poor voice characteristics that improved 6 months to 10 years after treatment, and became comparable to vocal performance of control speakers in 50% of the patients. Following radiotherapy, deviant voice characteristics and consequences in daily life occurred significantly more often for patients in whom initial diagnosis consisted of stripping the vocal cord instead of biopsies and for patients who continued smoking after treatment.

CONCLUSION

Voice characteristics of patients diagnosed with early glottic cancer improved after radiotherapy, and became normal in half of our patients. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased deviant voice characteristics.