ORIGINAL ARTICLE Dysphagia Following a Total Laryngectomy: The Effect on Quality of Life, Functioning, and Psychological Well-Being Julia Maclean Æ Susan Cotton Æ Alison Perry Published online: 17 March 2009 Ó Springer Science+Business Media, LLC 2009 Abstract The aim of this study was to investigate the effect that dysphagia has on quality of life (QoL), func- tioning, and psychological well-being of people who have undergone a total laryngectomy. A questionnaire battery was sent to all members (N = 197) of the Laryngectomee Association of NSW, Australia. QoL and functioning were assessed using the World Health Organisation Quality of Life-Bref (WHOQoL-Bref) and the University of Wash- ington QoL (UW-QoL) measures. Psychological well- being was measured using the Depression Anxiety and Stress Scale (DASS). One hundred ten questionnaires (56%) were completed and returned. There were no sig- nificant differences in QoL, as measured by the WHOQoL- Bref, between those laryngectomees with and without dysphagia. Laryngectomees with dysphagia, however, had significantly impaired functioning and markedly reduced social participation as measured by the UW-QoL. Signifi- cantly higher levels of depression and anxiety were also documented in those laryngectomees who had dysphagia. Dysphagia may not necessarily determine QoL following a total laryngectomy. However, it may have a negative impact on functioning and on psychological well-being. Keywords Total laryngectomy Á Dysphagia Á Deglutition Á Deglutition disorders Á Quality of life Head and Neck (H&N) cancers encompass primary tumors arising from the larynx, pharynx, oral cavity, paranasal sinuses, and salivary glands [1]. These cancers arise in structurally complex areas that are required for critical functions, including respiration, speech, and swallowing [1]. Quality of life (QoL) and functioning are two impor- tant health domains to consider, alongside survival, when evaluating the success of H&N cancer treatments [1, 2]. To ensure accurate data are obtained, researchers must first differentiate between these domains. QoL is a complex, multidimensional concept, unique to each individual, and necessitates self-report [2]. QoL is affected by a range of physical and psychological charac- teristics, including emotional, physical, functional, social, financial, and spiritual components [2]. The World Health Organisation defines QoL as ‘‘an individual’s perceptions of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns’’ [3, p. 43]. More simplistically, this can be expressed as ‘‘reflecting a measure of the difference or ‘gap’ between one’s perceived reality and one’s expectations or wishes’’ [4, p. 895]. In health studies, there has been a shift away from measuring general QoL to more health-related quality of life (H- RQoL). This is a measure of the effect of a disease and its treatment on a patient’s perceived level of general well- being [1]. As with all outcomes, H-RQoL measures should be valid, reliable, sensitive, and, most importantly, clini- cally relevant to ensure that they are of use in determining and evaluating treatments [1]. J. Maclean (&) Cancer Care Centre, St. George Hospital, Short Street, Kogarah, NSW 2217, Australia e-mail: Julia.Maclean@sesiahs.health.nsw.gov.au S. Cotton Orygen Youth Health, Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia A. Perry School of Human Communication Sciences, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia 123 Dysphagia (2009) 24:314–321 DOI 10.1007/s00455-009-9209-0