Laryngectomised patients with voice prostheses : Influence of supra-esophageal reflux on voice quality and quality of life.

摘要

INTRODUCTION: We conducted a prospective study to assess the influence of supra-esophageal reflux on voice quality and quality of life in patients who had undergone laryngectomy and prosthetic voice rehabilitation. PATIENTS AND METHODS: We investigated 60 laryngectomised patients using 24-h dual-probe pH monitoring before and 6 months after oral anti-reflux treatment with proton pump inhibitors (PPIs). Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30. Voice quality was quantified using the voice handicap index (VHI10). Quality of life and voice quality parameters were then correlated with the severity of reflux disease. RESULTS: Patients with physiological reflux area index (RAI) scores had a mean VHI10 score of 46.4 (+/-11.4). VHI scores were found to increase to up to 64.1 (+/-9.6) with reflux severity (p=0.025). Total quality of life scores ranged from 115.8 (+/-24.7) in patients with physiological RAI scores to 131.0 (+/-33.1) in patients with highly pathological RAI scores (p=0.007). After 6 months of treatment with PPIs, VHI scores improved to a total score of 57.5 (+/-20.6, p=0.003). Quality of life scores improved to 123.3 (+/-29.0, p=0.045). CONCLUSION: Supra-esophageal reflux influences voice quality and quality of life in laryngectomised patients with voice prostheses. This can be explained, for example, by an increased incidence of periprosthetic leakage, the presence of edema in the pharyngo-esophageal segment (where speech is produced), and general reflux symptoms. Rigorous treatment with anti-reflux medications leads to an improvement in reflux parameters that can be assessed objectively (RAI) and in correlated quality of life and voice quality parameters. For this reason, we recommend rigorous oral treatment with PPIs in laryngectomised patients with a confirmed diagnosis of supra-esophageal reflux.