Voice handicap evaluation after supracricoid partial laryngectomy

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Abstract
Objectives: To gather information on the vocal and professional impact of supracricoid partial laryngectomy (SCPL). Study Design: Collection of quality of life data more than 12 months postsurgery, including expert‐rated patient voice assessment (GRBAS [grade, roughness, breathiness, asthenia, strain] scale), self voice assessment, Voice Handicap Index (VHI), and socioprofessional data. Patients: Sixty‐four patients were evaluated after SCPL. The surgical procedure had been conducted for initial stage T1b or T2 glottic carcinoma. All patients had no recurrence, were decanulated, and did not have any swallowing impairment. Thirty‐three patients were less than 60 years old and were professionally active at the time of surgery. The mean age was 48.5 years old (42–59 years old). Fifteen patients were working in the communications sector, so use of their voice was obligatory. Professional impact and VHI measurements were evaluated. Results: For patients with professional activities before surgery, 15/33 (45%) continued their activities, whereas 55% had to withdraw from or modify these activities. For patients with communications activities, 6/15 (40%) continued their activities, 4 (26.6%) adapted, and 5 (33.3%) withdrew from their professional activities. The mean VHI value was 51.2. The mean VHI values according to the dysphonic grade (1, 2, and 3) were 36.3, 50.7, and 52.9, respectively. The mean VHI values were 45.6, 58.6, and 53.2, respectively, for patients who pursued their professional activities, withdrew from or adapted their activities, and had no professional activities. Correlations were obtained between VHI and the dysphonic grade (P = .043), cessation of professional activities (P = .034), and the time elapsed since surgery (P = .046). VHI emotional and physical subscale scores were significantly higher for patients who had withdrawn from their professional activities or adapted them. Conclusions: Supracricoid partial laryngectomy can have a marked social and professional impact. Many patients have to withdraw from professional activities in which vocal involvement is essential. The potential postsurgical social voice impact should be taken into consideration before proposing this surgery, and it is essential to estimate the possible impacts of the vocal handicap according to the patient's professional or other activities. Laryngoscope, 2009