van Sluis Klaske E, van der Molen Lisette, van Son Rob J J H, Hilgers Frans J M, Bhairosing Patrick A, van den Brekel Michiel W M
Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands.
Eur Arch Otorhinolaryngol. 2018 Jan;275(1):11-26. doi: 10.1007/s00405-017-4790-6. Epub 2017 Oct 31.
Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL).
A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers.
Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes.
Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered.
食管发音（ES）、气管食管发音（TES）和/或电子喉发音（ELS）是全喉切除术后（TL）常用的三种言语康复方法。
对文献进行系统综述，以评估ES、TES、ELS与健康受试者在声学、感知和患者报告结局方面的比较结果。
纳入26篇文章。在大多数研究中，方法学质量较低。很可能存在纳入偏倚，许多研究仅纳入了表现出色的受试者。在声学参数、基频、最长发声时间和强度方面，与ES相比，TES的结局显著更好。在感知方面，TES的语音质量和可懂度评分显著优于ES和ELS。在患者报告结局方面，没有一个言语康复组报告有明显更好的结果。
关于TL术后言语结局的研究设计存在缺陷，证据水平薄弱。迫切需要标准化测量工具来评估替代语音受试者。根据声学和感知结局，TES是较好的言语康复方法。TL术后所有受试者组均报告有一定程度的嗓音障碍。护理人员的认知以及医疗保健和保险系统的差异在可提供的言语康复选择中发挥作用。
