Klaske van Sluis

150 9.1. Voice and speech outcomes tomy. Nevertheless, values for acoustic, perceptual, and speech related quality of life (QoL) are abnormal compared to healthy laryngeal speakers. Tracheoe- sophageal speech has favourable outcomes on acoustic features as fundamental frequency, loudness and maximum phonation time. For both tracheoesophageal speech and esophageal speech the sound source is the PE-segment. In tracheoe- sophageal speech, the mucosal vibrations of the neoglottis are driven by the lungs. It is likely that this pulmonary air stream leads to more fluency, longer phonation time and louder speech, resulting in a better acoustic and percep- tual outcome. For electrolarynx speech it is not relevant to perform acoustic analysis, since fundamental frequency and loudness are mechanically produced. Results in speech-related QoL were variable between the different speech re- habilitation methods that are offered. There are only few studies which compare different groups of speakers and within these studies different instruments are used. Several of them have only included excellent speakers, which leads to an inclusion bias. As a consequence, we had to conclude that in all three groups of speakers abnormality is observed in their reported speech-related QoL. Train- ing period and satisfaction of the reached result might be of influence in the reported handicap. It is the case that, esophageal speakers have to train for a long period, most patients need six months to accomplish intelligible and flu- ent speech. Therefore, when they are evaluated after this training period they are proud and satisfied with their accomplishment. In contrast, electrolarynx speech is mostly possible in one session, although intelligibility issues occur. The training period for tracheoesophageal speech differs from a few sessions up to several months of training with a speech language pathologist (SLP). The amount of needed training and level of succes might have an influence on reported speech- related QoL. Prospective evaluation of voice outcomes In Chapter 3 we prospectively evaluated voice and speech outcomes from be- fore up to one-year post-laryngectomy. This study has been conducted over two countries and five hospitals; all patients who were admitted to total laryngec- tomy in the study time frame have been approached for inclusion. Aiming to overcome an inclusion bias by only including excellent speakers, we chose to prospectively assess patients over time. The study shows the variation between speakers. Voice outcomes decrease from pre- to post-surgery, which is seen in the AVQI scores and perceptual outcomes. Voice rehabilitation is insufficient in most participants who decease within the first year following surgery. This means that they often have no verbal communication method in the palliative stage of their life. Nevertheless, the study participants who were included in the study at one year post-surgery do reach acceptable tracheoesophageal speech, this was the case in 20 of the 22 included participants at the 12 months post- surgery assessment acquired tracheoesophageal speech. This is also reflected in the speech-related QoL outcomes, and overall reported QoL, which improves in the long term.