Klaske van Sluis

General introduction 13 culties or handicaps which are experienced. Simple but effective assessment of the voice can be performed with a visual analogue scale of 100mm to obtain an impression of the voice quality, intelligibility and/or the impact the voice func- tioning has on performing everyday (social) activities. Different questionnaires have been developed that focus on voice functioning, e.g. the voice handicap index is a widely used questionnaire, which is available in a 30-item and a 10- item version [33, 34]. The questionnaire has been validated for use in laryngeal speakers experiencing voice problems but not specifically for total laryngectomy patients. 1.7 Aims and scope of this thesis In this PhD thesis I aim to investigate voice and speech outcomes as well as functional outcomes and functional consequences after total laryngectomy. The thesis is divided in two sections; the first section includes chapters 2 to 5 and presents outcomes on voice and speech after total laryngectomy. Chapter 2 presents a systematic literature review which was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for esophageal speech, tracheoesophageal speech, and electrolarynx speech in com- parison with healthy speakers. In Chapter 3 we report on our study which is unique in prospectively assessing the course of acoustic voice outcomes, re- ported voice problems, and quality of life in total laryngectomy patients from pre-laryngectomy up to one year post-surgery. In Chapter 4 an investigation of the acoustic changes of the consonants /t/ and /d/ in Dutch speaking indi- viduals before and after total laryngectomy is presented. Chapter 5 presents the outcomes of longitudinally collected voice recordings in individuals with a time range of seven to eighteen years, assessing if voice quality and intelli- gibility is stable on the long-term in tracheoesophageal speakers. The second section, covering Chapters 6 to 9, presents studies on functional issues, reha- bilitation strategies for pulmonary complaints and women-specific problems. Chapter 6 presents the results of a worldwide survey assessing functional and participation issues in a group of 1705 respondents with total laryngectomy. In Chapter 7 we report on the first Expiratory Muscle Strength Training we provided to patients after total laryngectomy which is aimed to reduce their pulmonary complaints. Chapter 8 describes the results of a qualitative study in which we interviewed female patients on their perspective of life after total laryngectomy. In Chapter 9 the results described in this thesis are discussed and recommendations for clinical practice and suggestions for future research are given. In Chapter 10 a summary of this thesis in Dutch and English is presented.