PREDICTING POSTLARYNGECTOMY VOICE OUTCOME IN AN ERA OF PRIMARY TRACHEOESOPHAGEAL FISTULIZATION - A RETROSPECTIVE EVALUATION

Objectives: Not all laryngectomees appear to have the same potential t o develop functional spoken communication. Our goal was to evaluate vo ice outcome in different functional subgroups of laryngectomees and to identify physical and demographic factors associated with success and failure to achieve functional spoken communication. Design: Retrospec tive chart review. Setting: Surgery was performed at a tertiary care h ospital. Multidisciplinary follow-up was conducted at weekly head and neck clinics held at the associated regional cancer centre. Voice reha bilitation procedures took place in both settings. Patients: Sixty-fou r consecutive patients who had undergone total laryngectomy during the era of primary tracheoesophageal fistulization (TEF) at this facility . Patients were subdivided into four groups according to whether they had undergone primary TEF, or whether this had been contraindicated by locoregional factors or TEF candidacy/performance status, or both. In terventions: Primary TEF was performed whenever technically feasible a nd traditional TEF candidacy criteria were met. Voice rehabilitation p rocedures were initiated prior to discharge. Outcome Measures: A judge ment of voice outcome was assigned based on documentation on at least one of three patient treatment records by a physician or speech-langua ge pathologist that a patient had demonstrated functional spoken commu nication within the clinical setting. Results: Forty-five of 64 patien ts (70%) achieved functional spoken communication. Six laryngectomized subgroups were ultimately identified and characterized. Voice outcome varied considerably between these subgroups. Prelaryngectomy communic ation status and age emerged as predictors of voice outcome. Conclusio ns: Voice outcome is related to several factors present prior to or at laryngectomy. Different combinations of such factors create various p ostlaryngectomy recovery streams for which voice outcome may be predic ted more specifically.