Klaske van Sluis

Summary 9.1 English summary Total laryngectomy Exploring voice outcomes and functional issues In Chapter 1 a general introduction to head and neck cancer is provided. Total laryngectomy as a treatment modality is introduced, as well as the con- sequences of this procedure regarding voice, speech and quality of life. A total laryngectomy leads to physiological changes and the functional problems. To rehabilitate speech, three main substitute voice methods are available: tra- cheoesophageal speech, esophageal speech, and electrolarynx speech. These substitute voice methods are described and the functioning of these methods is illustrated. To evaluate voice and speech, a multi-dimensional evaluation is recommended; which entails acoustic evaluation, perceptual evaluation, and patient-reported evaluation. The need for dedicated studies to investigate voice outcomes and functional issues after total laryngectomy is stated. In Chapter 2 a systematic literature review evaluating comparative acous- tic, perceptual, and patient-reported outcomes for esophageal speech, tracheoe- sophageal speech, and electrolarynx speech in comparison with healthy speakers is presented. We have performed a systematic search in several databases, fol- lowed by a selection process, twenty-six articles are included. In most studies, methodological quality was low. It is likely that in many studies an inclusion bias is present, studies report including only exceptional speakers. When com- paring the different groups of speakers, statistically significant better outcomes are reported for tracheoesophageal speakers compared to esophageal speakers for the acoustic parameters, fundamental frequency, maximum phonation time, and intensity. In studies presenting auditory-perceptual outcomes, tracheoe- sophageal speech is rated with a better voice quality and intelligibility com- pared to esophageal speech and electrolarynx speech. For self-reported voice