Embargoed until May 11, 2001
Contact: Kenneth S. Satterfield760-776-8502 (5/11-5/16) 703- 519-1563[email protected]
Radiotherapy Given for Non-Laryngeal Head and Neck TumoursMay Lead to Significant Voice Dysfunction
Palm Desert, CA -- The larynx, responsible for the generation of voice, can be subject to high doses of radiotherapy (RT), both in the presence and absence of disease. Patients undergo irradiation of the larynx when glottic tumors are present. The larynx also receives wide-field radiotherapy when such treatment is administered to the upper-aerodigestive system for non-laryngeal tumors of the head and neck region.
Good voice quality is achieved when RT is provided for early-stage laryngeal tumors. However, early research suggests that significant vocal dysfunction occurs to patients undergoing wide-field radiotherapy (RT) for non-laryngeal tumors of the head and neck, especially when compared to comparable age and gender-matched controls.
Whether these changes could be attributed to irradiation of the normal larynx or irradiation of the entire upper aerodigestive tract has been an issue of debate. Now, a new study from Canada suggests that wide-field head and neck radiotherapy adversely affects voice, even when compared to patients receiving laryngeal RT. Essentially, radiotherapy affects the extralaryngeal upper aerodigestive tract and soft tissues leading to vocal dysfunction. Accordingly, a new direction for speech therapists
may be appropriate for treating these patients.
The authors of the study, Vocal Function following Radiation for Non-Laryngeal versus LaryngealTumours of the Head and Neck are Keven Fung MD and J. Yoo MD FRCS(C), both from the Department of Otolaryngology, London Health Sciences Centre, and H. A. Leeper PhD, from the School of Communication Sciences and Disorders, Elborn College, all with the University of Western Ontario, London, Ontario, Canada. Their findings were presented on May 15, 2001, at the 104th meeting of the Triological Society, held in Palm Desert, CA.
Methodology: Vocal function was assessed in a comprehensive manner. Microanalytical and macroanalytical acoustic analyses, aerodynamic measurements, and videostroboscopy were performed on vowel production data. In addition, the Voice Handicap Index was administered for self- assessment of voice quality. All subjects were male, smokers, and greater than 12 months post- radiotherapy. Patients were grouped according to site of tumour -- laryngeal or non-laryngeal.
Results: Seventeen patients with non-laryngeal tumours and 13 patients with early laryngeal (glottic) tumours were evaluated. Microanalytical acoustic parameters were worse for 75 percent (six of eight) of the acoustic measures of vowel production in the non-laryngeal group. These include jitter, relative amplitude perturbation, amplitude perturbation quotient, normalized noise energy, pitch amplitude and spectral flatness ratio. Macroanalytical acoustic analyses revealed no difference in fundamental frequency but numerically smaller phonational frequency range in the non-laryngeal group. Allaerodynamic measures, including mean phonation time, mean airflow and vocal fold diadochokinetic rate were decreased in the non-laryngeal group. Videostroboscopy demonstrated increased supraglottic (area above the larynx) activity in the non-laryngeal group. Voice handicap scores were also significantly greater in the non-laryngeal group.
Conclusions: Patients undergoing radiotherapy for non-laryngeal tumours should be aware of the possible voice dysfunction that may occur. Post-treatment therapy should include, as necessary, speech therapy to address any significant changes in the voice function.
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Editor's Note: Address reprint requests to: J. Yoo MD, Department of Otolaryngology, London HealthSciences Centre, Victoria Campus, 800 Commissioners Road East, London, Ontario, N6A 5A5,Canada. PHONE: (519) 685-8300 EXT# 58457, FAX: (519) 685-8185, E-MAIL: [email protected]
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