VOCAL FUNCTION EXERCISES AND VOCAL HYGIENE COMBINED TREATMENT APPROACH AS A METHOD OF IMPROVING VOICE QUALITY IN IRRADIATED PATIENTS FOR LARYNGEAL CANCERS

IGNAZIO LA MANTIA¹, FRANCESCO CUPIDO², CLAUDIO ANDALORO³

¹Department of Medical Sciences, Surgical and Advanced Technologies, University of Catania, Catania, Italy - ²Department of Surgical and Oncological Disciplines, University of Palermo, Palermo, Italy - ³Ear Nose and Throat Unit, Santa Marta e Santa Venera Hospital, Acireale, Catania, Italy

Introduction: Despite the negative effects of radiation therapy on voice quality is well documented in literature few studies have focused on the efficacy of voice therapy in the irradiated laryngeal cancers population. The purpose of this study was to investi- gate the efficacy of an evidence-based voice therapy, known as Vocal Function Exercises (VFE) in a combined approach with Vocal Hygiene (VH) in improving vocal function in patients who have been irradiated for laryngeal cancers and compared to the results of VH alone treatment.

Materials and methods: A prospective, randomized and controlled study involved patients with primary laryngeal cancer treated with curatively intended radiotherapy. Study group (10 patients) was treated with VFE+VH approach and control group (9 patients) was treated with a VH alone therapy; both interventions started one month following radiotherapy completion and lasted for 6 weeks. Voice Handicap Index (VHI) scores, laryngeal stroboscopy, high-speed laryngeal imaging, acoustic analysis, aerodyna- mic analysis, auditory-perceptual measures through the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) rating scale and impact on Health-Related Quality of Life (HRQL) through the EORTC Quality of Life Questionnaire Head and Neck module (EORTC QLQ-H&N35) were evaluated at baseline and post-intervention.

Results: VFE+VH combined approach shows better and statistically significant improvement after vocal intervention when compared to VH alone group for VHI (p=0.023), GRBAS (p=0.038), MPT (p<0.001), jitter (p=0.015), NMWA (p=0.011), NGG (p=0.026) and EORTC QLQ-H&N35 (p=0.047).

Conclusions: The current investigation demonstrated that the VFE+VH combined approach was effective in improving the vocal function in irradiated patients with laryngeal cancers.