K . E . v a n S l u i s TOTAL T LARYNGECTOMY o t Exploring voice outcomes and functional issues a l L a r y n g e c t o m Klaske Elisabeth van Sluis y Total laryngectomy Exploring voice outcomes and functional issues 00000 -17x24_BNW.indd 1 22-10-20 14:23 Published by Ridderprint | www.ridderprint.nl Cover design: Femke Zandberg ISBN: 978-94-6416-238-7 Copyright c 2020 Klaske Elisabeth van Sluis. All rights reserved. 00000 -17x24_BNW.indd 2 22-10-20 14:23 Total laryngectomy Exploring voice outcomes and functional issues ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus prof. dr. ir. K.I.J. Maex ten overstaan van een door het College voor Promoties ingestelde commissie, in het openbaar te verdedigen in de Aula der Universiteit op woensdag 16 december 2020, te 14.00 uur door Klaske Elisabeth van Sluis geboren te Leeuwarden 00000 -17x24_BNW.indd 3 22-10-20 14:23 Promotiecommissie: Promotores: Prof. dr. M.W.M. van den Brekel Universiteit van Amsterdam Prof. dr. P.P.G. Boersma Universiteit van Amsterdam Copromotores: Dr. L. van der Molen Universiteit van Amsterdam Dr. R.J.J.H. van Son Universiteit van Amsterdam Overige leden: Prof. dr. E. Gerrits Universiteit Utrecht Prof. dr. G. Van Nuffelen Universiteit Antwerpen Prof. dr. J.C.M. van Weert Universiteit van Amsterdam Prof. dr. J.E. Rispens Universiteit van Amsterdam Prof. dr. I.M. Verdonck-de Leeuw Vrije Universiteit Amsterdam Prof. dr. A.J.M. Balm Universiteit van Amsterdam Faculteit der Geesteswetenschappen Het Nederlands Kanker Instituut heeft een financiële bijdrage ontvangen van Atos Medical AB (Hörby, Zweden), wat bijdraagt aan de bestaande infrastruc- tuur van de afdeling hoofd-halsoncologie en -chirurgie om kwaliteit van leven onderzoek mogelijk te maken. Het drukken van dit proefschrift werd mede mogelijk gemaakt door steun van Castor EDC, ChipSoft, Meditop Medical Products B.V., Atos Medical B.V., Science Plus Group, Pro Education, de Nederlandse Vereniging voor Logopedie en Foniatrie, Logoscientia, Prof. dr. Eelco Huizinga Stichting en de Patiënten- vereniging Hoofd-Hals. 00000 -17x24_BNW.indd 4 22-10-20 14:23 Draai met de zon mee zodanig dat je de warmte in je hart kan blijven voelen Patiënt na hoofd-halskanker 00000 -17x24_BNW.indd 5 22-10-20 14:23 00000 -17x24_BNW.indd 6 22-10-20 14:23 Contents AuthorContributions............................ 1 1 General introduction 5 1.1Introduction............................. 5 1.2HeadandNeckCancer....................... 6 1.3Functionsofthelarynx...................... 6 1.4Totallaryngectomy......................... 6 1.5 Speech rehabilitation after total laryngectomy . 8 1.5.1 Tracheoesophageal speech . 8 1.5.2 Esophagealspeech..................... 8 1.5.3 Electrolarynx speech . 10 1.5.4 Functional issues following total laryngectomy . 10 1.6 Multidimensional analysis of voice and speech . 11 1.6.1 Perceptualanalysis..................... 11 1.6.2 Acousticanalysis...................... 12 1.6.3 Patient-reported outcome measures . 12 1.7 Aims and scope of this thesis . 13 2 Objective and subjective voice outcomes after total laryngec- tomy: a systematic review 19 2.1Introduction............................. 20 2.2Materialsandmethods....................... 21 2.3Results................................ 23 2.3.1 Acousticoutcomes..................... 28 2.3.2 Perceptual outcomes . 32 2.3.3 Patient-reported outcome . 34 2.3.4 Summaryofresults..................... 35 2.4Discussion.............................. 36 2.5Conclusions............................. 38 2.5.1 Compliance with ethical standards . 39 00000 -17x24_BNW.indd 7 22-10-20 14:23 viii 3 Multidimensional evaluation of voice outcomes following total laryngectomy: a prospective multicenter cohort study 47 3.1Introduction............................. 48 3.2Methods............................... 49 3.2.1 Studydesign........................ 49 3.2.2 Demographics and oncological history . 50 3.2.3 Acousticanalysis...................... 50 3.2.4 Statistical analysis . 51 3.3Results................................ 52 3.3.1 Studysample........................ 52 3.3.2 General course of self-reported outcomes and acoustic voicequality........................ 53 3.3.3 Correlations between outcome measurements . 56 3.3.4 Predictors of voice outcome . 56 3.4Discussion.............................. 56 3.4.1 Strengths and limitations . 57 3.4.2 Recommendations for clinical practice and future research 58 3.5Conclusion............................. 59 4 The acoustic contrast between the Dutch consonants /t/ and /d/ is reduced in tracheoesophageal speech 71 4.1Introduction............................. 71 4.2Methods............................... 72 4.2.1 Participants......................... 72 4.2.2 Datacollection....................... 73 4.2.3 Acousticanalysis...................... 73 4.2.4 Statistical analysis . 73 4.3Results................................ 74 4.4Discussion.............................. 76 4.5Conclusions............................. 77 4.6Acknowledgements......................... 78 5 Long-term stability of tracheoesophageal voices 81 5.1Introduction............................. 81 5.2Speechandmethods........................ 82 5.2.1 Speakers and recordings . 82 5.2.2 Perceptual evaluation . 83 5.2.3 Automatic evaluation . 84 5.3Results................................ 84 5.3.1 Experiment1........................ 85 5.3.2 Experiment2........................ 85 5.3.3 Consistency between recordings . 87 5.4Discussion.............................. 87 5.5Conclusions............................. 89 5.6Acknowledgements......................... 89 00000 -17x24_BNW.indd 8 22-10-20 14:23 ix 6 Interaction of functional and participation issues on quality of life after total laryngectomy 93 6.1Introduction............................. 94 6.2Materialsandmethods....................... 95 6.2.1 Questionnaire........................ 95 6.2.2 Statistical analysis . 95 6.2.3 Grouping of respondents . 96 6.2.4 Grouping of questions . 96 6.2.5 Average number of reported experienced issues per theme 97 6.3Results................................ 99 6.3.1 Respondents........................ 99 6.3.2 r-QoLrating........................ 99 6.3.3 Average number of reported experienced issues per theme 100 6.3.4 Correlations between r-QoL rating and themes . 100 6.4Discussion.............................. 104 6.5Conclusion............................. 105 6.6Acknowledgments.......................... 106 6.7AppendixA............................. 106 7 Expiratory muscle strength training in patients after total la- ryngectomy; a feasibility pilot study 113 7.1Introduction............................. 114 7.2MaterialsandMethods....................... 115 7.2.1 Expiratory muscle strength training and adjustment to use after total laryngectomy . 115 7.2.2 Emst study training protocol . 116 7.2.3 Feasibility, safety, and compliance . 117 7.2.4 Objective and subjective outcome measures . 117 7.2.5 Statistical analysis . 118 7.3Results................................ 119 7.3.1 Feasibility, safety, and compliance . 119 7.3.2 Objective and subjective outcome measures . 121 7.4Discussion.............................. 122 7.5Conclusion............................. 124 7.6Acknowledgements......................... 124 8 Women’s perspective on life after total laryngectomy: a quali- tative study 129 8.1Whatthispaperadds....................... 130 8.1.1 What is already known on the subject? . 130 8.1.2 What this paper adds to existing knowledge . 130 8.1.3 What are potential or actual clinical impications of this work?............................ 131 8.2Introduction............................. 131 8.3Methods............................... 132 00000 -17x24_BNW.indd 9 22-10-20 14:23 x 8.4Results................................ 135 8.4.1 Disease and treatment as a turning point . 135 8.4.2 Returning to everyday activities . 137 8.4.3 Persistent vulnerability . 140 8.5Discussion.............................. 141 8.5.1 Recommendations for clinical practice . 144 8.6Conclusions............................. 145 8.7Acknowledgements......................... 145 9 General discussion 149 9.1Voiceandspeechoutcomes.................... 149 9.1.1 Summary of the findings . 149 9.1.2 Measuring voice and speech outcomes after total laryn- gectomy........................... 151 9.2 Functional issues and well-being after total laryngectomy - Sec- tion2 ................................ 154 9.2.1 Summary of the findings . 154 9.3 Future research perspectives . 156 9.4 Clinical recommendations . 157 9.4.1 Pre-treatment counselling and tailored rehabilitation . 157 9.4.2 Offering speech rehabilitation . 158 Summary................................... 161 9.1Englishsummary.......................... 161 9.2Dutchsummary........................... 165 Abouttheauthor............................... 171 Dankwoord.................................. 173 00000 -17x24_BNW.indd 10 22-10-20 14:23 Author Contributions Abbreviations of contributing authors Klaske E. van Sluis KvS Rob J.J.H. van Son RvS Lisette van der Molen LvdM Michiel W.M. van den Brekel MvdB Paul P.G. Boersma PB Frans J.M. Hilgers FH Patrick A. Bhairosing PAB Anthony J. McGuinness AM Carsten E. Palme CP Daniel Novakovic DN Danielle Stone DS Lydia Natsis LN Emma Charters EC Kelly Jones KJ Richard Dirven RD Marijn Kapitein MK Maartje Leemans ML Anne F. Kornman AK Wim G. Groen WG Bari Hoffman-Ruddy BH Martijn M. Stuiver MS Gili Yaron GY Chapter 1 Manuscript preparation KvS Manuscript editing and review RvS,