Vlastarakos Petros V, Georgantis Ilias, Nikolopoulos Thomas P, Delidis Alexandros
Department of ENT, MITERA Hospital, Athens, Greece.
Department of ENT, Attikon University Hospital, Athens, Greece.
Int Arch Otorhinolaryngol. 2021 Aug 13;26(3):e310-e313. doi: 10.1055/s-0041-1730454. eCollection 2022 Jul.
Early glottic cancer (EGC) is associated with a high cure rate. Hence, patients and physicians also focus on the impact of the proposed treatment on the speaking function of the preserved larynx. The present study assessed the impact of single-modality treatment (transoral laser microsurgery [TLM], or radiotherapy) or combination therapy for EGC on postinterventional voicing and explored factors which might explain the related perceptions. A total of 108 patients filled in the voice handicap index 10 questionnaire, 1 and 2 years postinterventionally. Non-parametric tests were used for the respective statistical analyses. Sixty-four patients were treated with TLM, 15 with radiotherapy, and 29 with both modalities. Transoral microsurgery and radiotherapy were associated with postinterventional dysphonia, which attenuated between the first and second postintervention year ( = 0.000). No association between sociodemographic parameters and the attenuation of postinterventional dysphonia was identified for either treatment modality. Transoral microsurgery and radiotherapy resulted in comparable postinterventional voicing, in the first ( = 0.940) and second ( = 0.196) postintervention years. The addition of TLM to radiotherapy resulted in worse voice quality in the second, compared with the first postintervention year ( = 0.000), demonstrating a detrimental effect on speech intelligibility in noise ( = 0.000). Single therapy should be favored over the combination of TLM and radiotherapy for EGC in terms of retaining better postinterventional voice quality. Postinterventional dysphonia should be taken into account, during preinterventional counseling, as it may exert leverage on the quality of patients' lives. Patients and physicians should acknowledge the optimal time of voice function return, which seems to be extending up to two years posttreatment.
早期声门癌（EGC）的治愈率较高。因此，患者和医生也关注所提议的治疗对保留喉的发声功能的影响。本研究评估了EGC的单模态治疗（经口激光显微手术[TLM]或放射治疗）或联合治疗对介入后发声的影响，并探讨了可能解释相关认知的因素。共有108名患者在介入后1年和2年填写了嗓音障碍指数10问卷。采用非参数检验进行各自的统计分析。64名患者接受了TLM治疗，15名接受了放射治疗，29名接受了两种治疗方式。经口显微手术和放射治疗与介入后发音困难有关，这种情况在介入后的第一年到第二年有所减轻（P = 0.000）。对于任何一种治疗方式，均未发现社会人口统计学参数与介入后发音困难的减轻之间存在关联。经口显微手术和放射治疗在介入后的第一年（P = 0.940）和第二年（P = 0.196）产生了相当的介入后发声效果。与介入后的第一年相比，在放射治疗中加入TLM导致第二年的嗓音质量更差（P = 0.000），表明对噪声中的言语可懂度有不利影响（P = 0.000）。就保留更好的介入后嗓音质量而言，对于EGC，单一疗法应优于TLM与放射治疗的联合。在介入前咨询期间应考虑介入后发音困难，因为它可能会对患者的生活质量产生影响。患者和医生应认识到嗓音功能恢复的最佳时间，似乎可延长至治疗后两年。
