Sarin Vanita, Chatterjee Arpita
Department of Otorhinolaryngology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India.
Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3739-3749. doi: 10.1007/s12070-023-04072-x. Epub 2023 Jul 20.
The association of voice disorders in laryngeal cancers has been studied extensively; however Dysphonia associated with chemo-radiation in non laryngeal Head and Neck cancer (HNC) is a new area of practice in voice clinics. This study thus aimed to evaluate the efficacy of voice rehabilitation among non-laryngeal HNC survivors who were treated with curative RadioTherapy (RT)/Chemoradiotherapy (CRT) in adjunct with or without surgery. This tertiary institutional assessor blinded quasi experimental study after inclusion and exclusion criteria consisted of a study cohort of 128 patients who within 1-3 months of completion of treatment for HNC reported to the laryngology clinic for voice complaints and throat discomfort. All patients underwent documentation of laryngeal endoscopic imaging, acoustics assessment, Aronson's Laryngeal Palpatory Method (LPM) and Voice Handicap Index (VHI). Thereafter they were subjected to Vocal Rehabilitation Therapy (VRT) which constituted of Manual circumlaryngeal therapy, SOVTE, and vocal hygiene program. Re-evaluation of the vocal parameters was done at 6 weeks and 3 months from the start of the VRT. All parameters were significantly altered at 6 weeks and 3 months follow-up. Post VRT the videolaryngoscopic findings showed reduction in abnormal supraglottic MTPs with subsequent good approximation of true cords and reduction of involvement of supralaryngeal activities. The Dysphonia Severity Index (DSI) impairment levels and VHI scores showed significant improvement from the baseline to both at 6 weeks and 3 months of VRT ( < 0.001). DSI and VHI scores even showed significant improvement between 6 weeks to 3 months of therapy. There was highly significant correlation of VRT with/without surgery, with CRT and in non-smokers at 6 weeks and 3 months of VRT. In non-laryngeal head and neck malignancies, VRT offered as early as within 1-3 months of completion of treatment of HNC ameliorates surgical and chemo-radiation induced Muscle Tension Dysphonia.
喉癌患者声音障碍的相关性已得到广泛研究；然而，非喉头颈癌（HNC）中与放化疗相关的发声困难是嗓音诊所一个新的业务领域。因此，本研究旨在评估接受根治性放射治疗（RT）/同步放化疗（CRT）联合或不联合手术治疗的非喉HNC幸存者的嗓音康复效果。这项三级机构评估者设盲的准实验研究，在纳入和排除标准确定后，研究队列包括128例患者，这些患者在完成HNC治疗后的1 - 3个月内，因声音问题和咽喉不适到喉科门诊就诊。所有患者均接受了喉镜内镜成像记录、声学评估、阿隆森喉触诊法（LPM）和嗓音障碍指数（VHI）评估。此后，他们接受了嗓音康复治疗（VRT），包括手动环甲膜治疗、SOVTE和嗓音卫生计划。在VRT开始后的6周和3个月对嗓音参数进行重新评估。在6周和3个月的随访中，所有参数均有显著变化。VRT后，电子喉镜检查结果显示声门上肌紧张性发音障碍异常减少，随后声带良好闭合，喉上活动受累减少。发声困难严重程度指数（DSI）损伤水平和VHI评分从基线到VRT的6周和3个月均有显著改善（<0.001）。DSI和VHI评分在治疗的6周和3个月之间也有显著改善。在VRT的6周和3个月时，无论是否手术、是否接受CRT以及非吸烟者，VRT均有高度显著相关性。在非喉头颈恶性肿瘤中，VRT早在HNC治疗完成后的1 - 3个月内进行，可改善手术和放化疗引起的肌肉紧张性发声困难。
