Assessment of Voice Handicap in Total Laryngectomy Patients at Kenyatta National Hospital

Abstract

Background Surgical treatment for advanced laryngeal cancer entails total laryngectomy and an initial loss of voice. This has an expected negative impact on quality of life as patients lose their main mode of communication. Objective: The study determined the level of voice handicap in laryngectomees. Study Setting: The study was carried out at the Kenyatta National Hospital Ear Nose and Throat department clinic. Methodology: This was a cross sectional descriptive study of 44 participants who had undergone total laryngectomy at least three months prior to the study and were recruited using convenience sampling technique. Participants completed a demographic and clinical data questionnaire and the Voice Handicap Index (VHI) Questionnaire. The VHI scores were calculated and correlation analysis was done with a statistical significance set at < 0.05 at 95%confidence interval. The independent sample T-test, Chi-square test and ANOVA test were used for this analysis. Results: There were 44 participants in the study, 42(95.5%) were male and 2(4.5%) were female with an age range of 36 to 73 years. The total VHI mean was 17.95. Thirty-nine patients (89%) had a mild, while 2 (4.5%) had a moderate and 3 (6.9%) had a severe handicap. The total subdomain means were 7.9 for physical, 4.9 for functional and 5.2 for emotional domains. The majority of the patients 32 (72.7%) used whispering and had VHI mean of 19.6, while 10(22.7%) used an electrolarynx and had a VHI of 13.6 and 4.5% used tracheoesophageal prosthesis with a VHI of 13. There was no statistically significant difference in total or subdomain VHI across all three methods of rehabilitation. Conclusion and Recommendations: This study demonstrates that most of our laryngectomees have a mild voice handicap. Even though it was not statistically significant, VHI was worse in those using whispering than those using electrolarynx and tracheoesophageal prosthesis. We recommend surgical voice rehabilitation to be used after laryngectomy as it is the gold standard and gives better handicap scores.