Department of Head and Neck Oncology & Surgery, The Netherlands Cancer Institute, Plesmanlaan, Amsterdam, The Netherlands.
J Voice. 2012 Sep;26(5):664.e25-33. doi: 10.1016/j.jvoice.2011.08.016. Epub 2011 Dec 29.
Perceptual judgments and patients' perception of voice and speech after concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer.
Prospective clinical trial.
A standard Dutch text and a diadochokinetic task were recorded. Expert listeners rated voice and speech quality (based on Grade, Roughness, Breathiness, Asthenia, and Strain), articulation (overall, [p], [t], [k]), and comparative mean opinion scores of voice and speech at three assessment points calculated. A structured study-specific questionnaire evaluated patients' perception pretreatment (N=55), at 10-week (N=49) and 1-year posttreatment (N=37).
At 10 weeks, perceptual voice quality is significantly affected. The parameters overall voice quality (mean, -0.24; P=0.008), strain (mean, -0.12; P=0.012), nasality (mean, -0.08; P=0.009), roughness (mean, -0.22; P=0.001), and pitch (mean, -0.03; P=0.041) improved over time but not beyond baseline levels, except for asthenia at 1-year posttreatment (voice is less asthenic than at baseline; mean, +0.20; P=0.03). Perceptual analyses of articulation showed no significant differences. Patients judge their voice quality as good (score, 18/20) at all assessment points, but at 1-year posttreatment, most of them (70%) judge their "voice not as it used to be." In the 1-year versus 10-week posttreatment comparison, the larynx-hypopharynx tumor group was more strained, whereas nonlarynx tumor voices were judged less strained (mean, -0.33 and +0.07, respectively; P=0.031). Patients' perceived changes in voice and speech quality at 10-week post- versus pretreatment correlate weakly with expert judgments.
Overall, perceptual CCRT effects on voice and speech seem to peak at 10-week posttreatment but level off at 1-year posttreatment. However, at that assessment point, most patients still perceive their voice as different from baseline.
评估头颈部癌症患者接受同期放化疗（CCRT）后嗓音和言语的感知判断和患者感知。
前瞻性临床试验。
记录标准荷兰语文本和双音节词测试。由专家听众根据等级、粗糙度、呼吸音、乏力和紧张度对嗓音和言语质量进行评分，并在三个评估点计算言语和嗓音的综合平均意见评分。一份结构特定的研究调查问卷在治疗前（N=55）、10 周时（N=49）和 1 年时（N=37）评估患者的感知。
10 周时，嗓音感知质量受到明显影响。总体嗓音质量（平均，-0.24；P=0.008）、紧张度（平均，-0.12；P=0.012）、鼻音度（平均，-0.08；P=0.009）、粗糙度（平均，-0.22；P=0.001）和音调（平均，-0.03；P=0.041）参数随时间改善，但未超过基线水平，除 1 年后的乏力外（嗓音比基线时更乏力；平均，+0.20；P=0.03）。发音感知分析未显示出显著差异。患者在所有评估点都认为自己的嗓音质量良好（评分，18/20），但在 1 年后，大多数人（70%）认为自己的“嗓音不再像以前那样”。在 1 年与 10 周的比较中，喉下咽肿瘤组的嗓音更紧张，而非喉肿瘤的嗓音则被认为不那么紧张（平均，-0.33 和+0.07，分别；P=0.031）。患者在 10 周时嗓音和言语质量感知的变化与专家判断的相关性较弱。
总体而言，CCRT 对嗓音和言语的感知影响似乎在治疗后 10 周达到高峰，然后在 1 年后趋于稳定。然而，在该评估点，大多数患者仍认为自己的嗓音与基线时不同。
