Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 51, Num. 4, 2005, pp. 258-259

Journal of Postgraduate Medicine, Vol. 51, No. 4, October-December, 2005, pp. 258-259

Expert's Comments

Patients' experience with voice prostheses

Schuster M

Department of Phoniatrics and Pedaudiology, University Hospital, Erlangen
Correspondence Address: Shuster M, Department of Phoniatrics and Pedaudiology, University Hospital, Erlangen, Germany, E-mail: maria.schuster@phoni.imed.uni-erlangen.de

Code Number: jp05095

Related article:jp05094

Laryngectomy leads to several structural and functional limitations such as hyposmia, swallowing problems and coughing and mucus production due to breathing through a tracheostoma. In addition, laryngectomy means loss of voice and therefore considerable restriction of communication. Voice restoration and protection of the airways nowadays are an integral part of therapy. There are different methods of voice restoration. Tracheo-esophageal substitute voice has been shown to be the most similar to normal voice and is therefore preferred. Patients using tracheo-esophageal voice are mostly equipped with a voice prosthesis preventing aspiration but leading exhaled air into the esophagus by a one-way valve system. Patients who use voice prosthesis or other devices need to have special knowledge or abilities to maintain their functioning.

The article presents a questionnaire that has been designed to acquire more information about laryngectomees′ knowledge and experience. The authors report the results of the questionnaire: patients′ handling and satisfaction with voice prostheses, heat and moisture systems and free-hands devices for the tracheostoma, substitute voice quality and quality-of-life. They divide the questionnaire′s issues into device-related, substitute voice-related, stoma-related divisions and ask for functionional and subjective limitations. Considering every day′s experience with laryngectomees a lot of questions seem to be too abstract to be well understood by patients. Comparing this new questionnaire to established questionnaires it lacks descriptive questions that prevent from ambiguity. This could explain some results that vary considerably from other publications. It seems fairly exceptional that leakage while drinking occurred in more than half of all patients during the last 7 days before they answered the questionnaire. The authors should consider possible distorsional effects of the approach and data collection. Statistical results are therefore questionable.

Some issues that are part of the presented questionnaire have already been published and also validated. For example quality-of-life evaluations of laryngectomees, objective voice outcome and subjective voice outcome using standardized questionnaires such as the EORTC, the SF-36, VHI, or VRQOL.

The presented questionnaire lacks precision and validation. However, parts of it could be used for clinical and scientific purposes to complete information about specific issues concerning laryngectomies using voice prosthesis and other devices. Functional and subjective limitations of the patients should rather be evaluated by existing standardized questionnaires. The questionnaire presented in this paper is not yet useful and needs revision.

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