Klaske van Sluis

34 2.3. Results group of ES combined with ELS, and therefore, this study is not presented in Table 2.4. TES scored significant better on intelligibility when communicating with strangers in a situation where there was no face-to-face contact [36]. One study [46] found that for TES, fricative consonants had the highest number of confusions. Whereas in ES, nasals caused the highest number of confusions [46]. There was no significant difference with regards to intelligibility found between ES and TES [46]. 2.3.3 Patient-reported outcome In Table 2.4 patient-reported outcomes (PROs) for the included studies are presented. Comparative results for the different speaker groups are shown. Pre- defined outcome variables, which were formulated in the research question but not reported in the included studies, will not be discussed. This concerns the EORTC QLQ-H&N35, and EORTCQLQ-C30. None of the studies compared PROs on voice quality of healthy speakers with alaryngeal speakers. Therefore, only comparative outcomes of the speech rehabilitation methods can be shown. Voice Handicap Index The Voice Handicap Index (VHI) was used in six studies [30, 39, 41, 50, 51, 53] ( n =296). Four level B studies [39, 41, 50, 53] used the full version of the VHI. Two studies, including the level A rated study of Eadie et al. [30], used the ten item version of the VHI [30, 51]. In two studies [41, 50] no mean outcomes per speaker group were reported, only number of speakers per severity level were reported. One study [39] compared TES to a group of speakers using other, non-surgical voice restoration methods (EL, ES, mouthing, and writing). In the present review, this comparison of TES with a heterogeneous group of speakers was not taken into account (TES n =35 compared to non-surgical voice restoration n =27) [39]. One study [51], reports significant better vocal functioning for ES compared to the groups of TES and ELS [51] (Table 4). In the level A rated study of Eadie et al. [30] no differences were found between TES and ELS. Although the scores of TES were slightly better, these differences were not significant (Table 4) [30]. Additionally, three level B rated studies [41, 50, 53] did not find any significant differences between groups. In one study [41] ES and TES both reported a slight or moderate perceived voice handicap. In another study [50] ES, TES and ELS reported a moderately perceived voice handicap, and no group differences were found. Furthermore, the study of Tiple et al. [53], did not find any significant differences between ES, TES and ELS. According to this study, however having no communication method available at all leads to a significantly worse VHI score compared to having ES as communication option [53].