Klaske van Sluis

48 3.1. Introduction ear Mixed Effect model confirmed Time as a significant factor in predicting AVQI score ( p ≤ .001), as well as perceptual rated voice quality by the clini- cian ( p =.015) and patient-reported perceptual rated voice quality ( p =.002). No statistical significance was found in VHI-10 scores over time. Conclusions: Successful tracheoesophageal speech was achieved in most par- ticipants, some had to rely on augmentative alternative communication meth- ods. Patient reported outcomes indicate acceptance of the condition and suffi- cient coping on the long term. However, acoustic rated voice quality is abnormal at all post-surgery time-points. AVQI proved to be a useful instrument to evalu- ate tracheoesophageal speech. There is a need for validation and determination of cut-off values for VHI-10 and AVQI for use in tracheoesophageal speech. 3.1 Introduction One of the most important rehabilitation goals after total laryngectomy is voice rehabilitation. To compensate for the loss of voice, patients ideally rehabilitate speech with a voice prosthesis, so called tracheoesophageal speech [1–3]. If this is not possible, alternative communication methods include esophageal speech, electrolarynx speech, or augmentative alternative communication. Successful tracheoesophageal speech after laryngectomy is not guaranteed as outcomes in intelligibility, voice quality, and experienced voice handicap varying vary strongly between laryngectomized patients. To evaluate voice outcomes, it is recommended to use multi-dimensional analysis which combines objective and subjective outcome measures [4]. Voice recordings of connected speech and sustained phonation can be used to objec- tively measure voice outcomes with acoustic analysis, focusing on pitch, pertur- bation, and harmonics-to-noise ratio. The Acoustic Voice Quality Index (AVQI) is a widely used measure reflecting a number of acoustic outcomes in one score [5, 6]. Subjective measures, on the other hand, include clinician and patient rated perceptual evaluation of voice and speech, and Patient Reported Out- come Measures (PROMs) assessing Quality of Life (QoL) and speech related QoL. Little is known about the course of voice outcomes in the first year after surgery [2]. Present studies, prospectively assessing the course of QoL and re- ported voice problems, demonstrated that, in the long term, health related QoL and speech related QoL improve post-surgery compared to pre-laryngectomy [7–12]. Before laryngectomy QoL is often lower compared to reference standard due to initial organ preservation treatment or by the tumour itself [7, 8]. Im- mediately after laryngectomy QoL scores drop even further. The following year after surgery some patients recover back to baseline whilst some do not recover [7, 8]. For longitudinal QoL studies there is a significant selection bias, as pa- tients whose health problems prevent their participation through the duration of the study, are often excluded from study analysis, which may result in over