Klaske van Sluis

38 2.5. Conclusions be taken into account when offering speech rehabilitation. Medical problems such as neurological disorders, causing a lack of dexterity or trainability, can hamper any rehabilitation technique and influence the choice. Societal partic- ipation, which includes family life and employment status also plays a role in patients’ preference for a speech rehabilitation method. Table 2.6: Aspects of the three speech rehabilitation methods with regards to required equipment, costs and dependence on healthcare system [1, 48, 53, 59– 62] Esophageal speech (ES) Tracheoesophageal Speech (TES) Electrolarynx speech (ELS) Mechanical or prosthetic device required No Yes Yes Hand occupied during voicing No Yes/no, some patients are able to use an automatic speaking valve Yes Dependence on speech language pathologist (SLP) Yes, nowadays fewer SLP’s have knowledge of providing ES ther- apy Yes, knowledge of voice pros- thesis equipment and TES re- habilitation is required Yes Duration of the therapeu- tic process to functional speech Training time, mostly concerns several months Useful speech is mostly achieved within five training sessions Useful speech is mostly achieved within five training sessions Financial implications No material costs. More therapeutic costs during often prolonged training period. Material costs, higher than ES and ELS. Potential reim- bursement issues. Lower ther- apeutic costs that ES, compa- rable to ELS. Material costs, lower than TES. Lower ther- apeutic costs that ES, comparable to TES. Overall success achieving useable speech Low success rate High success rate High success rate Besides voice quality, physical capacity, emotional well-being and social functioning are also affecting general quality of life in TL patients [63, 64]. Poor general condition is negatively associated with successful voice rehabili- tation [65]. Additionally, the extent of the surgery pays a role, e.g. in case of a pharyngolaryngectomy even more functional speech problems and reduced quality of life is reported [66]. 2.5 Conclusions This systematic review consists of 26 studies reporting on multidimensional voice outcomes after total laryngectomy. Only three of these studies could be rated with a low risk of bias. This number is insufficient to draw firm conclu- sions. Most studies were rated with a unclear risk of bias because of flaws in patient selection and methodology. For acoustic outcomes, tracheoesophageal speech (TES) seems to be more