Assessing vocal function after chemoradiation for advanced laryngeal carcinoma
G. E. Woodson, C. A. Rosen, T. Murry, R. Madasu, F. Wong, A. Hengesteg and K. T. Robbins
Department of Otolaryngology, University of Tennessee, Memphis, USA.
OBJECTIVE: To identify objective parameters that could serve as valid
indicators of vocal function in evaluating patients treated at multiple
centers for head and neck cancer. DESIGN: Objective measures of voice were
validated against functional outcome measures of voice and communication.
SETTING: A multidisciplinary university-based ambulatory head and neck
cancer clinic. SUBJECTS: Fifteen patients at varying posttreatment
intervals after chemoradiation therapy for head and neck cancer and 5
volunteers with no cancer but with a history of heavy smoking and drinking.
MAIN OUTCOME MEASURES: Acoustic and aerodynamic parameters were measured in
patients with head and neck cancer after treatment with combined
chemotherapy and irradiation and in control subjects. Communicative
function was assessed by perceptual assessment of recorded voice samples,
by a clinician-based communication score, and by patient self-rating of
voice and communication. RESULTS: Both perceptual analysis and
communication score were concordant with patient self-rating of voice and
communication ability. Acoustic measures were abnormal in patients, and
jitter scores correlated with listener ratings of perceived voice quality.
However, acoustic measures did not relate to communication function, as
assessed by either the patient or the clinician. Laryngeal resistance
demonstrated a significant correlation with both patient and observer
assessments of voice quality and communication function. Laryngeal
resistance was on average twice as high in patients who complained of voice
fatigue, but this difference was not statistically significant.
CONCLUSIONS: Laryngeal resistance, determined during standardized
phonation, is a reliable objective parameter of vocal function after
chemoradiation therapy for head and neck cancer. A standardized
clinician-based communication scale holds promise as a useful tool.
Acoustic measures reflect the sound of the voice but not the ability to
communicate effectively.
