Quality of Life in Patients Submitted to Total Laryngectomy Ana Pereira da Silva, Telma Feliciano, Susana Vaz Freitas, Sara Esteves, and Cecı´lia Almeida e Sousa, Porto, Portugal Summary: Background. Laryngeal carcinoma accounts for about 80 000 deaths annually worldwide. Despite its aggressiveness, total laryngectomy (TL) is a treatment option with curative intent. This article aims to evaluate its impact on these patients quality of life (QoL). Material and Methods. Thirty-four patients who underwent TL with bilateral neck dissection between 2003 and 2012 responded to the European Organization for Research and Treatment of Cancer QoL Core Questionnaire, the Self-Evaluation of Communication Experiences after Laryngeal Cancer Questionnaire, and the Hospital Anxiety and Depression Scale. Results. Data revealed that QoL is lower in these patients compared with general population. Regarding alaryngeal speech modalities, esophageal speech is associated with a significantly higher physical functional capacity. Conclusions. TL results in a permanent disability with decreased functional capacity and psychological distress. Close monitoring of these patients and investing in speech rehabilitation are essential to preserve their QoL. Key Words: Laryngectomy–Quality of life–Alaryngeal speech. INTRODUCTION Worldwide incidence of laryngeal carcinoma is estimated in 130 000 new cases per year, and it is responsible for about 80 000 deaths annually. 1 Glottic, supraglottic, and subglottic cancers represent approximately two-thirds, one-third, and 2% of laryngeal cancers, respectively. 2 Hypopharyngeal carci- noma with laryngeal involvement is less common, with about a quarter of the incidence, but usually has a worse prognosis. 3 The major risk factor for the development of the larynx or hy- popharynx carcinoma is tobacco use and, when associated with the intake of alcohol, a strong synergistic effect is created. 4 Other identified potential risk factors include infection with hu- man papillomavirus and continuous exposure to paint, diesel, fumes, asbestos, or radiation, which can be responsible for a small part of these carcinomas. The larynx is responsible for three vital functions: the main- tenance of airway patency, occlusion of the airway during the pharyngeal phase of swallowing and voice production. Laryn- geal and hypopharyngeal malignant tumors may affect the different physiological functions of the larynx, depending on their size and location. Patients with tumors of the glottic larynx commonly present with hoarseness and thereby can be diag- nosed at an early stage. Conversely, patients with hypopharyng- eal and supraglottic or subglottic laryngeal tumors, due to later symptom onset, are usually diagnosed with locally advanced disease and a higher incidence of lymph node metastases. The primary aim of treatment was survival of the patients with the best possible functional outcome. This may include single modality therapy or various combinations of surgery, radiation therapy, and/or chemotherapy. In early stage disease, both radi- ation therapy and laryngeal preservation surgery can cure a high proportion of patients with laryngeal carcinoma. 5 Observational studies showed that the 5-year disease-specific survival rate was 90% for stage I disease and 80% for stage II disease. 6 In patients with locoregionally advanced disease, despite che- moradiotherapy’s wide use, surgery still retains a role as an alter- native approach to functional organ preservation. Total laryngectomy (TL) may be more appropriate for selected patients with advanced laryngeal and hypopharyngeal cancer and in pa- tients who are not candidates for chemoradiotherapy. 7,8 This surgery is also frequently necessary as a salvage procedure in relapsing or persistent disease after chemoradiotherapy. 9 Although TL is a straightforward surgical procedure that can eradicate tumors confined to the cartilaginous boundaries of the larynx, it results in physical and functional changes. The loss of the natural voice and the stigma of a permanent stoma can affect these patients emotional well-being and some of the most basic functions of life, including breathing, swallowing, and communication. 10,11 Speech alteration is a major contributor to reduced quality of life (QoL) after TL. Options for rehabilitation of speech commu- nication include esophageal speech (ES), tracheoesophageal speech (TES), and the use of an electrolarynx. 12 ES production requires the injection of air into an esophageal reservoir and its release through the vibratory pharyngoesophageal segment, a skill often difficult to acquire. In TES, the use of a tracheoesopha- geal prosthesis placed through the tracheoesophageal wall allows pulmonary air to be shunted into the esophagus where it can be released through the pharyngoesophageal segment. The electro- larynx is a battery-powered device that provides a mechanical vi- bration source that is transmitted through the external tissues of the neck or cheek or delivered intraorally via a plastic tube. 12 QoL was defined by the World Health Organization as the ‘‘individual’s perceptions of their position in life, in the context of the culture and value systems in which they live, and in rela- tion to their goals, expectations, standards, and concerns.’’ 13 It is generally agreed that there is no ideal measure to assess QoL and that this is a dynamic concept with many variables involving objective and subjective characteristics. Accepted for publication September 3, 2014. This article was presented at the second Congress of the Iberoamerican Academy of Otolaryngology on May 2013 at Porto, Portugal. From the Otorhinolaryngology Department, Centro Hospitalar do Porto, Porto, Portugal. Address correspondence and reprint requests to Ana Pereira da Silva, Otorhinolaryn- gology Department, Centro Hospitalar do Porto, Largo Abel Salazar 4000, Porto, Portugal. E-mail: anacostapsilva@gmail.com Journal of Voice, Vol. -, No. -, pp. 1-7 0892-1997/$36.00 Ó 2014 The Voice Foundation http://dx.doi.org/10.1016/j.jvoice.2014.09.002