Rehabilitation of dysphagia and voice problems following total laryngectomy

OBJECTIVE: Determine participants' satisfaction with rehabilitation following total laryngectomy (TL) and investigate associations between dysphagia, voice problems, and possible explanatory variables.

METHODS: 172 Danish and Swedish participants having received a TL 1.6-18.1 years ago for laryngeal/hypopharyngeal cancer answered a questionnaire regarding satisfaction with rehabilitation following TL and the V-RQOL, MDADI, and HADS questionnaires.

RESULTS: 85% and 75% were satisfied with the help received from their local hospital and municipality, respectively. 22%, 78%, and 65% indicated having not received any vocal, swallow, or olfactory rehabilitation, respectively. MDADI mean score was 77.5, V-RQOL was 62.8 and the HADS questionnaire indicated that possible depression or anxiety was present in 16% and 20% of participants, respectively. Multivariate analysis found the following variables to be associated with dysphagia; more voice problems, higher depression score, higher anxiety score, and being treated and rehabilitated in Denmark vs. in Sweden. Furthermore, multivariate analysis found the following variables to be associated with voice problems; more problems with dysphagia and higher depression score.

CONCLUSION: We found that the majority of participants were satisfied with the received rehabilitation but that a large proportion reported having no dysphagia or olfactory rehabilitation. We found that voice problems, dysphagia, and depression after TL are tightly linked, and therefore suggest that medical personnel in contact with TL patients should be aware of possible psychological late effects. We found that being treated and rehabilitated in Sweden, vs. in Denmark, was associated with a better swallow outcome and we suggest additional centralization of rehabilitation in especially Denmark.