Quality of Life with Voice Prosthesis after Total Laryngectomy

Document Type : Original


1 Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo (PA) Italy.

2 ENT and Maxillo-Facial Clinic, IRCSS – Casa Sollievo Della Sofferenza – San Giovanni Rotondo, Foggia (FG), Italy.


The loss of voice after total laryngectomy is one of the main impairments in personal and social life. In order to prevent potential psycho-social consequences in the patient and his family, the restoration of phonatory function is the main objective of post-laryngectomy rehabilitation. The aim of this study was to assess quality of life in patients who received prosthetic voice after total laryngectomy.
Materials and Methods:
Over a one-year period, 51 patients with voice prostheses after total laryngectomy were recruited. 32 patients (62.74%) were administered radiation therapy and 9 patients (17.64%) underwent to surgical reconstruction with flaps. Each patient was administered the VHI-10 and V-RQOL self-assessment questionnaires.
The study showed that vocal restoration with voice prosthesis allows patients to recover a significant degree of quality of life after total laryngectomy. The average score on the V-RQOL questionnaire was 75.9 and on the VHI-10 questionnaire was 13.5. It has not been shown a statistically significant correlation between quality of life after tracheoesophageal prosthesis and radiation therapy, chemotherapy or reconstruction flaps. Younger patients showed, on average, a higher score at V-RQOL. These results allow to state that, after prosthetic rehabilitation, at least 75% of patients experienced an increase in quality of life. Moreover, the prosthetic technique (primary vs secondary) does not affect the long-term outcome and radiotherapy, chemotherapy or reconstruction flaps are not absolute contraindications to rehabilitation with voice prosthesis.
After total laryngectomy, rehabilitation with tracheoesophageal prosthesis is a satisfactory choice to restore the patient’s ability to communicate verbally.


  1. Salturk Z, Arslanoglu A, Ozdemir E, Yildirim G, Aydoğdu İ, Kumral TL et al. How do voice restoration methods affect the psychological status of patients after total laryngectomy? HNO, 2016; 64: 163-168.
  2. Dragicevic D, Jovic RM, Kljajic V, Vlaski L,   Savović S Comparison of Voice Handicap Index in Patients with Esophageal and Tracheoesophageal Speech after Total Laryngectomy. Folia Phoniatr Logop, 2019; 1-7.
  3. Scherl C, Kauffels J, Schutzenberger A, Dollinger M, Bohr C, Dürr S et al. Secondary Tracheoesophageal Puncture After Laryngectomy Increases Compli-  cations with Shunt and Voice Prosthesis. The Laryngoscope, 2020.
  4. Chaves AD, Pernambuco LA, Balata PM, Santos VS, de Lima LM,   de Souza SR et al. Limits on quality of life in communication after total laryngectomy. Int Arch Otorhinolaryngol, 2012; 16: 482-491.
  5. Attieh AY, Searl J, Shahaltough NH, Wreikat MM, Lundy S Voice restoration following total laryngectomy by tracheoesophageal prosthesis: Effect on patients’ quality of life and voice handicap in Jordan. Health Qual Life Outcomes 2008; 6:26.
  6. Polat B, Orhan KS, Kesimli MC, Gorgulu Y, Ulusan M, Deger K   The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy. Eur Arch Otorhinolaryngol 2015; 272: 34-31.
  7. van Sluis KE, van der Molen L, van Son RJJH, Hilgers FJM, Bhairosing PA, van den Brekel MWM. Objective and subjective voice outcomes after total laryngectomy: a systematic review. Eur Arch Otorhinolaryngol. 2018 Jan;275(1):11-26.
  8. Neto JCB, Dedivitis RA, Aires FT, Pfann RZ, Cernea CR Comparison between Primary and Secondary Tracheoesophageal Puncture Prosthesis: A Systematic Review. ORL, 2017; 79: 222-229.
  9. Summers L. Social and quality of life impact using a voice prosthesis after laryngectomy.  [Miscellaneous Article].  Curr Opin Otolaryngol Head Neck Surg. 2017;25(3):188-194.
  10. Clancy K, Lujian JS, Xia T, Zender C, Maronian N Outcomes of tracheoesophageal puncture in twice-radiated patients. Am J Otolaryngol, 2019; 40: 1-4.
  11. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope. 2004 Sep; 114(9): 1549-56.
  12. Hogikyan ND, Sethuraman G. Validation of an instrument to measure Voice-Related Quality of Life (V-RQOL). J Voice. 1999;13(4):557–569.
  13. Luu K, Chang BA, Valenzuela D, Anderson D. Primary versus secondary tracheoesophageal puncture for voice rehabilitation in laryngectomy patients: A systematic review. Clinical Otolaryngology, 2018; 43: 1250-1259.
  14. Galli A, Giordano L, Biafora M, Tulli M. Voice prosthesis rehabilitation after total laryngectomy: are satisfaction and quality of life maintained over time? Acta Otorhinolaryngologica Italica, 2019; 39: 162-168.
  15. Shuxin Xi MSN. Effectiveness of voice rehabilitation on vocalisation in postlaryngectomy patients: a systematic review. Int J Evid Based Healthc 2010; 8: 256–258
  16. Verro B, Greco G, Chianetta E, Saraniti C. Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature. Int Arch Otorhinolaryngol, 2020.
  17. Patel RS, Mohr T, Hartman C, Stach C, Sikora AG, Zevallos JP et al. Tracheoesophageal Prosthesis use is associated with improved overall Quality of Life in Veterans with Laryngeal Cancer. Ann Otol Rhinol Laryngol. 2018 Jul;127(7):421-428.
  18. Saraniti C, Montana F, Chianetta E, Greco G, Verro B. Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and disease local control on a cohort of 153 patients. Braz J Otorhinolaryngol. 2020.
  19. Eadie TL, Day AM, Sawin DE, Lamvik K, Doyle PC Auditory-perceptual speech outcomes and quality of life after total laryngectomy. Otolaryngol Head Neck Surg 2013;148(1):82–8.
  20. Varghese BT, Mathew A, Sebastian P, Iype EM,  Vijay A  Comparison of quality of life between voice rehabilitated and non-rehabilitated laryngectomies in a developing world community. Acta Otolaryngol 2011; 131(3):310-5.
  21. Rossi VC, Fernandes FL, Ferreira MA, Bento LR, Pereira PS, Chone CT  Larynx cancer: quality of life and voice after treatment. Braz J Otorhinolaryngol. 2014; 80:403-.
  22. Weinstein GS, El-Sawy MM, Ruiz C, Dooley P, Chalian A, El-Sayed MM, Goldberg A  Laryngeal preservation with supracricoid partial laryngectomy results in improved quality of life when compared with total laryngectomy. Laryngoscope. 2001 Feb; 111(2): 191-9.
  23. Hogikyan ND, Wodchis WP, Terrell JE, Bradford CR, Esclamado RM. Voice-related quality of life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis. J Voice. 2000 Sep;14(3):378-86.
  24. Kupfer RA, Hogikyan EM, Hogikyan ND. Establishment of a normative database for the Voice-Related Quality of Life (V-RQOL) measure. J Voice. 2014 Jul;28(4):449-51.
  25. Arffa RE, Krishna P, Gartner-Schmidt J, Rosen CA. Normative values for the Voice Handicap Index-10. J Voice. 2012 Jul;26(4):462-5
  26. Miyoshi M, Fukuhara T, Kataoka H, Hagino H. Relationship between quality of life instruments and phonatory function in tracheoesophageal speech with voice prosthesis. Int J Clin Oncol. 2016 Apr; 21(2):402-408.
  27. Kazi R, De Cordova J, Singh A, Venkitaraman R, Nutting CM, Clarke P, et al. Voice-related Quality of Life in laryngectomees: assessment using the VHI and V-RQOL symptom scales. J Voice. 2007 Nov; 21(6): 728-734.
  28. Portone CR, Hapner ER, McGregor L, Otto K, Johns MM 3rd. Correlation of the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure(V-RQOL).J Voice.2007 Nov;21(6):723-27.
  29. Peterson JF, Lansaat L, Timmermans AJ, van der Noort V, Hilgers FJM, van den Brekel MWM Post laryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13-year period. Head Neck, 2019; 41(3): 623-631.
  30. Saraniti C, Speciale R, Santangelo M, Massaro N, Maniaci A, Gallina S et al. Functional outcomes after supracricoid modified partial laryngectomy. J Biol Regul Homeost Agents. 2019 Nov-Dec;33(6): 1903-1907.
  31. Chakravarty PD, McMurran AEL, Banigo A, Shakeel M, Ah-See KW. Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis. J Laryngol Amp Otol 2018; 132(1): 14–21.