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Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx

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Abstract

Purpose

To characterize outcomes of total laryngectomy for the dysfunctional larynx after radiation.

Methods

Retrospective case series of all subjects who underwent total laryngectomy for the irradiated dysfunctional larynx between 2000 and 2018 at an NCI-designated comprehensive cancer center at a single tertiary care academic medical center. Main outcomes included enteral tube feeding dependency, functional tracheoesophageal speech, and number and timing of postoperative pharyngeal dilations.

Results

Median time from radiation to laryngectomy was 2.8 years (range 0.5–27 years). Functional outcomes were analyzed for the 32 patients with 1-year follow-up. Preoperatively, 81% required at least partial enteral tube feeding, as compared to 34% 1-year postoperatively (p = 0.0003). At 1 year, 81% had achieved functional tracheoesophageal speech, which was associated with cricopharyngeal myotomy (p = 0.04, HR 0.04, 95% CI 0.002–0.949). There were 34% of subjects who required at least one pharyngeal dilation for stricture by 1 year postoperatively. Over half (60%) of the cohort were dilated over the study period.

Conclusions

Laryngectomy for the dysfunctional larynx improves speech and swallowing outcomes in many patients. Cricopharyngeal myotomy is associated with improved postoperative voice. While the need for enteral feeding is decreased, persistent postoperative swallowing dysfunction is common. Careful patient selection and education regarding functional expectations are paramount.

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Author information

Author notes

  1. Andrew J. Rosko and Matthew E. Spector contributed equally.

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA

    Janice L. Farlow, Anna Hardenbergh, Teresa Lyden, J. Chad Brenner, Andrew G. Shuman, Steven B. Chinn, Chaz L. Stucken, Kelly M. Malloy, Jeffrey S. Moyer, Keith A. Casper, Mark E. P. Prince, Carol R. Bradford, Gregory T. Wolf, Andrew J. Rosko & Matthew E. Spector

  2. Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA, 98517, USA

    Andrew C. Birkeland

  3. Department of Otolaryngology, University of Toronto, Toronto, ON, Canada

    Douglas B. Chepeha

Authors
  1. Janice L. Farlow
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  2. Andrew C. Birkeland
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  3. Anna Hardenbergh
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  4. Teresa Lyden
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  5. J. Chad Brenner
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  6. Andrew G. Shuman
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  7. Steven B. Chinn
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  8. Chaz L. Stucken
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  9. Kelly M. Malloy
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  10. Jeffrey S. Moyer
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  11. Keith A. Casper
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  12. Mark E. P. Prince
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  13. Carol R. Bradford
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  14. Gregory T. Wolf
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  15. Douglas B. Chepeha
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  16. Andrew J. Rosko
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  17. Matthew E. Spector
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Corresponding authors

Correspondence to Andrew J. Rosko or Matthew E. Spector.

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Ethical standards

This study was performed in accordance with the ethical standards of the University of Michigan’s Institutional Review Board (HUM00081554) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was deemed not applicable. There was no funding for this study, and the authors have no conflicts of interest to disclose.

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Farlow, J.L., Birkeland, A.C., Hardenbergh, A. et al. Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx. Eur Arch Otorhinolaryngol 277, 1459–1465 (2020). https://doi.org/10.1007/s00405-020-05809-y

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  • DOI: https://doi.org/10.1007/s00405-020-05809-y

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