Addressing an unmet need in oncology patients: rehabilitation of upper aerodigestive tract function

Abstract

Background: Laryngeal dysfunction in the oncology population is common and may detract from quality of life (QoL) due to vocal restriction and aspiration. Therapies to address this complex issue have not been explored to date. We examined the outcomes among oncology patients treated with a minimally invasive office-based surgical approach for the rehabilitation of laryngeal dysfunction.

Patients and methods: A retrospective analysis was carried out of oncology patients referred for laryngeal dysfunction. Patients who underwent minimally invasive injection laryngoplasty (IL) were selected. Subjective outcome measures, objective voice analysis parameters, and swallowing studies were annotated.

Results: Sixty-one patients underwent IL for the management of laryngeal dysfunction. Lung cancer was the most common cancer diagnosis (39.3%), and 52% of patients had thoracic malignancies. All patients had a self-reported improvement in vocal function with a single injection, and 55 patients (90%) reported lasting effects at 3 months. In patients with pre- and postoperative voice analysis, phonatory function increased from 5.0 to 10.5 s, more than twofold improvement compared with baseline functioning. Seventy-one percent of patients who aspirated before injection no longer required a modified diet. There were no major complications.

Conclusions: Interventions to improve the QoL in oncology patients continue to evolve. We report significant improvements in both subjective and objective measures of laryngeal function after IL for vocal fold dysfunction that are both immediate and sustained. We conclude that IL is a safe and efficacious procedure for the treatment of laryngeal dysfunction in oncology patients, resulting in palliation and improved QoL.

Figure 1.

Distribution of treated patients based upon primary oncological diagnosis.

Figure 2.

Representative laryngoscopic findings before and after injection laryngoplasty in a patient with metastatic lung cancer and a right vocal cord paralysis. Top, pre- and postinjection images demonstrating adequacy of airway diameter during respiration and vocal cord abduction. Bottom, images obtained before and after injection (right vocal cord) during phonation. Complete glottic closure is evident, with excellent voice outcome and complete airway protection.

Figure 3.

Objective voice analysis demonstrates an increase in phonatory function by 100% after injection laryngoplasty (paired samples t-test, P < 0.001).