ASSESSING VOCAL FUNCTION AFTER CHEMORADIATION FOR ADVANCED LARYNGEAL CARCINOMA

Objective: To identify objective parameters that could serve as valid indicators of vocal function in evaluating patients treated at multipl e centers for head and neck cancer. Design: Objective measures of voic e were validated against functional outcome measures of voice and comm unication. Setting: A multidisciplinary university-based ambulatory he ad and neck cancer clinic. Subjects: Fifteen patients at varying postt reatment intervals after chemoradiation therapy for head and neck canc er and 5 volunteers with no cancer but with a history of heavy smoking and drinking. Main Outcome Measures: Acoustic and aerodynamic paramet ers were measured in patients with head and neck cancer after treatmen t with combined chemotherapy and irradiation and in control subjects. Communicative function was assessed by perceptual assessment of record ed voice samples, by a clinician-based communication score, and by pat ient self-rating of voice and communication. Results: Both perceptual analysis and communication score were concordant with patient self-rat ing of voice and communication ability. Acoustic measures were abnorma l in patients, and jitter scores correlated with listener ratings of p erceived voice quality. However, acoustic measures did not relate to c ommunication function, as assessed by either the patient or the clinic ian. Laryngeal resistance demonstrated a significant correlation with both patient and observer assessments of voice quality and communicati on function. Laryngeal resistance was on average twice as high in pati ents who complained of voice fatigue, but this difference was not stat istically significant. Conclusions: Laryngeal resistance, determined d uring standardized phonation, is a reliable objective parameter of voc al function after chemoradiation therapy for head and neck cancer. A s tandardized clinician-based communication scale holds promise as a use ful tool. Acoustic measures reflect the sound of the voice but not the ability to communicate effectively.