Thomas L, Jones T M, Tandon S, Carding P, Lowe D, Rogers S
Alderhey Hospital, Liverpool, UK.
Clin Otolaryngol. 2009 Feb;34(1):34-42. doi: 10.1111/j.1749-4486.2008.01830.x.
Radical treatment of oropharyngeal cancer can have significant impact on speech & voice outcomes.
(i) To assess the extent of speech & voice handicap in disease-free survivors of oropharyngeal squamous cell cancer. (ii) To assess the validity of the speech domain of UWQOL as a screening tool. (iii) To identify clinical characteristics associated with worse speech/voice outcome.
Cross-sectional survey.
University Hospital Aintree, a university teaching hospital and tertiary referral centre.
All who were treated for oropharyngeal cancer between 1 January 1999 and 31 May 2005, were alive, disease free and willing to participate.
Three patient-based questionnaires: University of Washington Quality of Life (UWQOL), voice handicap index (VHI) and voice related quality of life (VRQOL). Three expert-based assessments: GRBAS rating, speech intelligibility and dysarthria rating.
Sixty-six per cent of patients participated. Median VHI score (29) & VRQOL score (15) imply mild to moderate voice impairment. 20% of patients had severe handicap (VHI score >60). Forty-eight per cent had normal voice ratings. Speech was normal in 26%, mildly impaired in 62% and significantly impaired in 12% patients (UWQOL). Correlation between UW-QOL speech domain with speech intelligibility rating was 0.52 (P < 0.001). There were clear demarcations between UW-QOL scores of 30, 70 and 100 on the voice questionnaires. Adverse speech and voice function were associated with tumour stage, radiotherapy (RT) & free-flap surgery.
Voice & speech impairment is prevalent in >70% of oropharyngeal cancer patients. There is moderate correlation between UWQOL speech domain and speech intelligibility assessment & voice tools making it a quick and easy screening instrument. The main clinical correlates associated with adverse patient and observer rated speech and voice outcomes were tumour stage, RT and free-flap reconstruction.
口咽癌的根治性治疗会对言语和嗓音结果产生重大影响。
（i）评估口咽鳞状细胞癌无病生存者的言语和嗓音障碍程度。（ii）评估UWQOL言语领域作为筛查工具的有效性。（iii）确定与较差言语/嗓音结果相关的临床特征。
横断面调查。
阿intree大学医院，一所大学教学医院和三级转诊中心。
所有在1999年1月1日至2005年5月31日期间接受口咽癌治疗、存活、无病且愿意参与的患者。
三份基于患者的问卷：华盛顿大学生活质量问卷（UWQOL）、嗓音障碍指数（VHI）和嗓音相关生活质量问卷（VRQOL）。三项基于专家的评估：GRBAS评分、言语清晰度和构音障碍评分。
66%的患者参与。VHI评分中位数（29）和VRQOL评分中位数（15）表明存在轻度至中度嗓音障碍。20%的患者有严重障碍（VHI评分>60）。48%的患者嗓音评级正常。26%的患者言语正常，62%的患者轻度受损。在言语方面，12%的患者严重受损（UWQOL）。UW-QOL言语领域与言语清晰度评级之间的相关性为0.52（P<0.001）。在嗓音问卷上，UW-QOL得分30、70和100之间有明显界限。不良的言语和嗓音功能与肿瘤分期、放疗（RT）和游离皮瓣手术有关。
超过70%的口咽癌患者存在嗓音和言语障碍。UWQOL言语领域与言语清晰度评估及嗓音工具之间存在中度相关性，使其成为一种快速简便的筛查工具。与患者和观察者评定的不良言语和嗓音结果相关的主要临床因素是肿瘤分期、放疗和游离皮瓣重建。
