Klaske van Sluis

94 6.1. Introduction Results: This study showed that more functional and participation issues and a lower r-QoL are reported in the group of younger respondents (<60 years), women, and respondents who have had the TL procedure less than 2 years ago. The issue themes “experienced limitations in daily activities” and “avoiding social activities” are related to r-QoL. Most participants report “pul- monary issues,” and these issues have a strong correlation with most other themes. Conclusion: The ability to participate in meaningful and social activities is a major factor in r-QoL. Due to the frequency and strong correlations of pulmonary issues with other issue themes, pulmonary issues might be an un- derlying cause of many other issues. 6.1 Introduction A total laryngectomy (TL) leads to lifelong changes in physical, psychological and social functioning, severely impacting the patients’ normal daily function- ing and quality of life. First of all, due to the removal of the larynx, one of the immediate consequences is that the patient loses his ability of laryngeal speech. The fact that patients now breathe through a tracheostoma instead of their nose or mouth can lead to pulmonary problems, such as coughing, dys- pnea, excessive mucus production, forced expectoration, and stoma cleaning [1–6]. A total laryngectomy can also lead to other functional problems such as difficulties in swallowing, olfaction, sleeping difficulties, fatigue, and pain in throat and neck [4, 6, 7]. The functional consequences of the TL procedure also impact the patient’s self-image, which can lead to psychological problems such as anxiety and de- pression [4, 5, 8, 9], and reduced sexuality [7, 10–12]. Lastly, due to the visible scarring and difficulties with communication it can lead to worsened social interactions and participation [4, 5, 7, 13]. To help total laryngectomized patients rehabilitate their lost functions, in particular their pulmonary condition and speech, multiple medical devices have been developed in the last few decades. The most important medical devices include the voice prosthesis, and the Heat and Moisture Exchanger (HME) with various fixation methods. It has been proven that HMEs reduce pulmonary issues, such as coughing and mucus production, and improve other related functional issues such as voice and sleeping [14–18]. To restore speech and voice, tracheoesophageal speech generated with the help of a voice prosthesis has become the ‘gold standard’ in the many parts of the world [19]. To ensure an optimal rehabilitation and quality of life for each patient, an understanding of possible consequences of the TL procedure and the correlation of self-reported participation and functional issues can provide a unique insight. Atos Medical AB (Malmö, Sweden), with help of ReD Associates (Copenhagen, Denmark), a strategy consultancy company, recently send out a questionnaire