European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 6, pp 1573–1583 | Cite as

Voice rehabilitation for laryngeal cancer after radiotherapy: a systematic review and meta-analysis

  • Mahoko TaitoEmail author
  • Shunsuke Taito
  • Masahiro Banno
  • Takashi Fujiwara
  • Hitoshi Okamura
  • Hiraku Tsujimoto
  • Yuki Kataoka
  • Yasushi Tsujimoto
Review Article



We aimed to determine whether voice rehabilitation after radiotherapy improves the quality of life (QOL), voice function, and self-rated voice function in patients with laryngeal cancer.


We searched CENTRAL, MEDLINE, EMBASE, PEDro, and World Health Organization International Clinical Trials Registry Platform for randomized controlled trials published between inception and October 2018. The primary outcome was QOL, adverse events and mortality. Secondary outcomes included voice function and self-rated voice function. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation approach.


Three trials (enrolling 122 patients) compared voice rehabilitation to usual care or no intervention after radiotherapy. Voice rehabilitation did not significantly improve any QOL scores. Data on adverse events and mortality were not available in any of the trials. Voice rehabilitation did not improve any voice function scores, such as jitter (mean difference: – 0.48 [– 1.27 to 0.32]), shimmer (mean difference: – 0.04 [– 0.27 to 0.19]), maximum phonation time (mean difference: 1.54 [– 1.13 to 4.22]), and the grade, roughness, breathiness, asthenia, and strain scale (mean difference: – 0.39 [– 2.59 to 1.80]). Voice rehabilitation also did not improve the voice handicap index, which was used as a self-rated voice function score (mean difference: 5.54 [– 2.07 to 13.16]). The certainty of the evidence was graded as low for primary and secondary outcomes.


Voice rehabilitation for patients with laryngeal cancer after radiotherapy might not improve QOL, voice function, and self-rated voice function. Pre-specified voice rehabilitation programs may not be necessary for all patients with laryngeal cancer after radiotherapy.


Laryngeal cancer Radiotherapy Voice rehabilitation Quality of life Systematic review 



We thank Lisa Tuomi, Therese Karlsson (Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg), Caterina Finzia (Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital), and Vrushali Angadi (Division of Communication Sciences and Disorders, University of Kentucky), for providing us with additional information regarding their studies. We would like to thank Editage ( for English language editing.


The authors received no specific funding for this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they do not have any conflicts of interest.

Supplementary material

405_2019_5452_MOESM1_ESM.doc (64 kb)
Supplementary file1 (DOC 64 kb)
405_2019_5452_MOESM2_ESM.docx (17 kb)
Supplementary file2 (DOCX 16 kb)
405_2019_5452_MOESM3_ESM.docx (18 kb)
Supplementary file3 (DOCX 17 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NursingHiroshima University HospitalHiroshimaJapan
  2. 2.Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
  3. 3.Division of Rehabilitation, Department of Clinical Practice and SupportHiroshima University HospitalHiroshimaJapan
  4. 4.Department of PsychiatrySeichiryo HospitalAichiJapan
  5. 5.Department of PsychiatryNagoya University Graduate School of MedicineAichiJapan
  6. 6.Department of Otolaryngology Head and Neck SurgeryKurashiki Central HospitalOkayamaJapan
  7. 7.Hospital Care Research UnitHyogo Prefectural Amagasaki General Medical CenterHyogoJapan
  8. 8.Department of Respiratory MedicineHyogo Prefectural Amagasaki General Medical CenterHyogoJapan
  9. 9.Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
  10. 10.Department of Nephrology and DialysisKyoritsu HospitalHyogoJapan

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