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. 2021 Apr;41(2):131-141.
doi: 10.14639/0392-100X-N0977.

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers

Athulya Sreenivas  1 , Suja Sreedharan  1 , Manisha Narayan  1 , Radish Kumar Balasubramanium  2 , Pu Prakash Saxena  3 , Sourjya Banerjee  3 , Deviprasad Dosamane  1 , Vijendra Shenoy  1 , M Panduranga Kamath  1
Affiliations

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers

Athulya Sreenivas et al. Acta Otorhinolaryngol Ital. 2021 Apr.

Abstract
in English, Italian

Objective: This study evaluated the effect of voice intervention in patients who received chemoradiation to the neck for non-laryngeal head and neck malignancies.

Methods: Twenty individuals with non-laryngeal malignancies of the head and neck who received chemoradiation were divided by block randomisation into an intervention group that received voice rehabilitation and a control group without rehabilitation. All patients underwent acoustic analysis, perceptual and subjective analysis of voice before the commencement of chemoradiotherapy and at 1, 3 and 6 months after chemoradiotherapy.

Results: In both groups, all parameters were significantly altered at one month follow-up except for fundamental frequency (females in control group and males in intervention group). In the intervention group, all parameters returned to pretreatment levels (no statistical differences) at 6 months. In the control group, all except for a few subjective parameters (grade, breathiness and asthenia) remained significantly altered at 6 months compared to the levels before radiotherapy.

Conclusions: In non-laryngeal head and neck malignancies, voice rehabilitation offered at 1 month after treatment ameliorates chemoradiation-induced dysphonia within 6 months.

Gli effetti della riabilitazione vocale dopo chemioradioterapia per i tumori testa e collo non laringei.

Obiettivo: Questo studio mira a valutare l’effetto della riabilitazione vocale in pazienti sottoposti a chemiradioterapia per tumori maligni della testa e del collo non laringei.

Metodi: Venti individui con neoplasie non laringee della testa e del collo che hanno effettuato trattamento chemioradioterapico sono stati divisi per randomizzazione in due gruppi: un gruppo ha ricevuto la riabilitazione vocale e un gruppo di controllo senza riabilitazione. Tutti i pazienti sono stati sottoposti ad analisi acustica, analisi percettiva e soggettiva della voce prima dell’inizio della chemio radioterapia e a tre e sei mesi dopo la chemio radioterapia.

Risultati: In entrambi i gruppi, tutti i parametri sono stati alterati in modo significativo a un mese di follow-up ad eccezione della frequenza fondamentale (femmine nel gruppo di controllo e maschi nel gruppo di intervento). Nel gruppo sottoposto a riabilitazione, tutti i parametri sono tornati ai livelli di pretrattamento (nessuna differenza statistica) a 6 mesi di follow-up. Nel gruppo di controllo, tutti tranne alcuni parametri soggettivi (grado, respiro affannoso e astenia) sono rimasti significativamente alterati a 6 mesi, rispetto ai livelli precedenti alla radioterapia.

Conclusioni: Nei tumori maligni della testa e del collo non laringei, la riabilitazione vocale offerta un mese dopo il trattamento migliora la disfonia entro sei mesi.

Keywords: chemoradiation; dysphonia; non-laryngeal head and neck cancer; voice handicap index.

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Conflict of interest statement

Conflict of interest

Figures

Figure 1.
Figure 1.
Box plots representing F0 Fundamental frequency (for males and females) and shimmer (Shim) in the control and study group at 6 month post-chemoradiotherapy.
Figure 2.
Figure 2.
Box plots showing the acoustic parameters Jitter (Jitt), noise harmonic ratio (NHR) and Soft Phonation Index (SPI) in the control and intervention groups at 6 months post-chemoradiotherapy.
Figure 3.
Figure 3.
Bar diagram showing the proportion of patients with 0 (normal), 1 (mild) and 2 (moderate) severity of changes in perceptual evaluation of patients using GRBAS scores (grade, roughness, asthenia, breathiness and strain) at 6 months post chemo radiotherapy in control and intervention groups.
Figura 4.
Figura 4.
Box plot showing Voice Handicap Index (VHI) in the control and intervention groups at 6 months post-chemoradiotherapy.
Figura 5.
Figura 5.
Graph depicting the trend in Voice Handicap Index (VHI) between the intervention and control group before radiotherapy, and at 1, 3 and 6 months after radiotherapy.
See this image and copyright information in PMC

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