| Several p rojects on the treatment and rehabilitation of head and neck cancer patients have been carried out or are ongoing at the department. The leitmotiv in these various projects is functional outcome in relation to health-related quality of life. The main aim is to improve diagnosis, treatment and rehabilitation. Regarding early glottic cancer, an assessment protocol on voice quality and voice-related quality of life was developed. For approximately half of the patients after treatment for early glottic cancer voice quality appeared to be deviant with clear consequences in daily life. A voice screening questionnaire was developed and validated, which proved to be feasible in clinical practice and a randomized prospective study on voice therapy revealed a clear beneficial effect for patients with voice complaints after treatment. Regarding advanced larynx cancer, the European BIOMED Pegasus project, coordinated at our Department revealed that it is feasible to perform multicentre speech rehabilitation assessment as well as standardised speech assessment in different languages. Within the scope of this project, a robust acoustic voice analysis programme was developed and validated. Female laryngectomees and laryngectomees with a hypotone pharyngoesophageal segment tend to have severe problems accepting their often weak and low-pitched tracheoesophageal shunt voice. Prototypes of a sound-producing shunt valve were tested in a clinical study on 20 laryngectomized patients. Speech assessment, including evaluation of speech quality, communicative suitability, and intelligibility, and registration of aerodynamic and acoustic voice parameters, revealed speech improvement. Low-pitched and noisy vibration of the PE segment, additionally to the sound of the prosthesis, was the main problem in the non-successful patients. Speech and swallowing function after surgical treatment for advanced oral and oropharyngeal tumours is dependent on the motility of dynamic structures in the oral cavity and oropharynx. Reconstruction by free flaps such as the radial forearm flap have become the preferred method of reconstruction for larger defects because of reliable reconstruction and because of improved functional characteristics of dynamic structures such as the tongue and pharynx. In a retrospective study on 100 patients after composite resection and microvascular soft tissue transfer, comorbidity as graded by the ACE-27 test, proved to be a strong predictor for complications. In a longitudinal prospective study on a cohort of 80 patients revealed that 65% of the patients reported speech problems 6 months after treatment, which was confirmed by objective speech analyses; 84% of the patients reported swallowing problems and dysphagia aspiration occurred frequently. Speech and swallowing impairment appeared to be clearly related to eating in public and social contacts (EORTC QLQ H&N35) and to overall health-related quality of life and emotional functioning (EORTC QLQ-C30). Currrently, research is focussing on more detailed speech and swallowing outcome measures including oral physiological function, acoustical formant analyses, swallowing imaging techniques, and speech and swallowing related quality of life questionnaires. |
