Ocena oviranosti v govorni komunikaciji po laringektomiji

Ojsteršek Slapšak, Alma Lea (author), Hočevar Boltežar, Irena (mentor)

Rak grla ali spodnjega žrela je huda bolezen, ki obolelemu popolnoma spremeni življenje. Ker je bolezen mnogokrat odkrita v napredovalnem stadiju, je za preživetje pogosto nujno potrebna laringektomija tj. popolna odstranitev grla. S tem bolnik ostane brez organa, ki je ključen za tvorbo glasu in za govor. Morda se to na začetku ob vseh ostalih pridruženih težavah in boju za preživetje ne zdi toliko pomembno, dolgoročno pa je ravno izguba sposobnosti govora največja ovira v nadaljnjem življenju laringektomiranih bolnikov. V teoretičnem delu naloge je opisana pogostnost raka grla in spodnjega žrela v Sloveniji, vzroki za nastanek in kako bolezen prepoznamo. Zdravljenje rak grla in spodnjega žrela je lahko kirurško, obsevalno ali s kemoterapijo. Posledice kirurškega zdravljenja, laringektomije, so spremenjen vzorec kašljanja, pihanja, dihanja na traheostomo, zmanjšana zmožnost vohanja, okušanja ter ne nazadnje nezmožnost oz. spremenjen način tvorbe glasu. Da čim bolj zmanjšamo negativni vpliv teh posledic na življenje po zdravljenju raka grla oziroma spodnjega žrela, moramo bolniku zagotoviti celostno rehabilitacijo. Pri govorni rehabilitaciji laringektomiranih bonikov ima logoped bistveno vlogo. V sodobnem času poznamo več načinov govorne rehabilitacije po laringektomiji, to so ezofagealni govor (EG), traheoezofagealni govor (TEG) in uporaba elektrolarinksa oz. umetnega grla (UG). Kateri način je najprimernejši za posameznega bolnika, je odvisno od vrste dejavnikov, predvsem od njegovih posebnosti, želja, obsežnosti operacije in od stališča zdravstvene stroke glede govorne rehabilitacije. Slovenski strokovnjaki so veliki zagovorniki EG, rezultati raziskav o načinu govorne rehabilitacije po laringektomiji v preteklih letih so pokazali, da se večina laringektomiranih oseb sporazumeva na ta način. Medtem pa je v tujini najbolj razširjen način sporazumevanja TEG in EG skorajda niti ne učijo več. Za ugotavljanje vpliva kakovost glasu na kakovost življenja bolnikov je v svetu najpogosteje v uporabi vprašalnik Voice Handicap Index (VHI), tudi za oceno oviranosti pri sporazumevanju laringektomiranih oseb. Namen magistrske naloge je z vprašalnikom VHI ugotoviti, kateri način sporazumevanja za slovenske bolnike po laringektomiji predstavlja najmanjšo oviranost v govorni komunikaciji in kateri spremljajoči dejavniki še vplivajo na višjo stopnjo oviranosti. Raziskavo sem izvedla na vzorcu 255 članov Društva laringektomiranih Slovenije, analizirala sem njihove odgovore in pridobljene rezultate primerjala s strokovno literaturo. Rezultati so pokazali, da kar 75,2% laringektomiranih uporablja ezofagealni govor, 8,3% jih uporablja traheoezofagealni govor, elektrolarinks uporablja 7,4% govorcev in 9,1% jih uporablja druge načine sporazumevanja, kot so pisanje, šepet, kretnja. Na celotnem vprašalniku VHI so najnižji povprečni rezultat in s tem najmanjšo oviranost dosegli uporabniki EG. Statistično pomembne razlike med različnimi načini govorne rehabilitacije glede oviranosti zaradi glasu nisem odkrila. Izkazalo se je, da imajo vsi laringektomirani najbolj prizadeto funkcionalno področje. Medtem ko so uporabniki elektrolarinksa pokazali najmanj prizadeto fizično področje vprašalnika, so bili uporabniki vseh ostalih načinov sporazumevanja najmanj prizadeti na emocionalnem področju. S časom, ki je minil od operacije, se rezultati vprašalnika VHI izboljšujejo, kar pomeni, da se oviranost z leti zmanjšuje, vendar korelacija ni statistično pomembna. Anketiranci, ki živijo sami, so na celotnem vprašalniku dosegli nižje povprečne rezultate kot tisti, ki živijo v skupnem gospodinjstvu. Na funkcionalnem delu vprašalnika je bila razlika med skupinama statistično pomembna (p = 0,017). Primerjava oviranosti v govorni komunikaciji med bolniki z rakom grla in rakom žrela je pokazala, da sta skupni rezultat VHI ter fizični del malenkost boljša pri osebah z rakom grla, ostala podtesta pa sta pokazala minimalno slabši rezultat. Nobena razlika statistično ni bila pomembna. Vpliva razsežnejše operacije na večjo oviranost pri komunikaciji zaradi govora nisem potrdila, saj so bile razlike v rezultatih med laringektomiranimi in tistimi z obsežnejšo operacijo (dodatno še odstranitev dela žrela ali celo uporaba presadka za kritje manjka tkiva) minimalne. Prav tako nisem potrdila vpliva sočasnega zdravljenja s kemoterapijo. Samo na funkcionalnem delu vprašalnika je skupina, ki je bila pred ali po laringektomiji zdravljena z obsevanjem, dosegla boljši rezultat kot skupina, ki ni bila obsevana. Na fizičnem, emocionalnem in pri skupnih rezultatih je skupina, ki je bila obsevana, izkazala večjo oviranost v govorni komunikaciji. Na fizičnem delu vprašalnika je bila ta razlika statistično pomembna (p = 0,043). Med starostjo in rezultati na vprašalniku VHI sem odkrila pozitivno korelacijo, kar pomeni, da oviranost v govorni komunikaciji s starostjo anketirancev narašča. Vendar je povezanost statistično pomembna le na emocionalnem delu (p = 0,049). Rezultati kažejo, da so moški bolj ovirani v govorni komunikaciji kot ženske. Razlika med spolom je na funkcionalnem delu in pri skupnem rezultatu statistično pomembna (p = 0,029).

• Language: Unknown
• Keywords: rak grla in žrela
• Work type: Not categorized
• Organization: PEF - Faculty of Education
• Year: 2015
• PID: 20.500.12556/RUL-72749
• COBISS.SI-ID: 10728521
• Publication date in RUL: 30.09.2015

Secondary language

• Language: Unknown
• Title: Handicap assessment in speech communication after laryngectomy

Abstract

Laryngeal or hypopharyngeal cancer is a severe disease that changes completely the life of an affected individual. Because the disease is often diagnosed in its advanced stage, the laryngectomy, i.e. the complete removal of the larynx, is often urgently necessary to ensure survival. The procedure leaves the patient without the organ that is crucial for the formation of voice and speech. In the beginning, this might not seem very important due to all the other associated problems and struggle for survival, but over a lengthy period of time it is the loss of speech ability that is the greatest obstacle in the life of laryngectomized patients. The theoretical part of the thesis describes the incidence of laryngeal and hypopharyngeal cancer in Slovenia, its etiology and means to recognize it. Laryngeal and hypopharyngeal cancer can be treated surgically, with radiotherapy or chemotherapy. The consequences of surgical treatment, laryngectomy, include changed pattern of coughing, blowing and breathing through a tracheostomy tube, the reduced ability to smell and taste and also the inability or changes in the formation of voice. We must ensure an integrated concept of rehabilitation for a patient after throat or lower pharynx cancer treatment to minimize the previously mentioned negative effects on their life. A speech and language therapist has a crucial role in speech rehabilitation of the laryngectomized patients. In modern times, there are several methods of speech rehabilitation after laryngectomy; these include: esophageal speech (ES), tracheoesophageal speech (TES) and use of electrolarynx / artificial larynx (AL). To ensure which method is the most suitable for an individual patient, we need to take into account various factors, especially patient's peculiarities, wishes, scale of operation and the position of medical profession on speech rehabilitation. Slovenian experts are great supporters of ES; the results of various research in recent years on the methods of speech rehabilitation after laryngectomy have shown that ES is the most commonly used method of communication by the laryngectomized patients. However, the most common method of communication abroad is TES as ES is almost never taught anymore. The most commonly used questionnaire to determine the impact of voice quality on the quality of patients' life in the world is Voice Handicap Index (VHI), which is also used to assess the degree of disability in communication of the laryngectomized patients. The purpose of this master's thesis is to determine with VHI questionnaire which method of communication represents the minimum disability in speech communication and which concomitant factors have an additional impact on the higher level of disability for a laryngectomized Slovenian patient. The research was conducted on a sample of 255 members of the Slovenian Association of the Laryngectomized. I analyzed their responses and compared the obtained results with the relevant scientific literature. The results showed that as many as 75.2% of the laryngectomized use esophageal speech, 8.3% use tracheoesophageal speech, electrolarynx is used by the 7.4% and 9.1% use other methods of communication, such as writing, whisper, gestures. The lowest average result on the entire VHI questionnaire and consequently the lowest level of disability was reached by the ES users. The statistically significant difference between various methods of speech rehabilitation in connection to the voice-connected disability was not discovered. The functional part was the most affected by all the laryngectomized patients. While the physical area of the questionnaire was the least affected by the electrolarynx users, the users of other methods of communications were the least affected in the emotional part. As time from the operation progressed, the results of a VHI questionnaire started to improve, which means that the disability decreases with age, but the correlation is not statistically significant. The questionnaire participants who live alone achieved lower average results in the whole questionnaire in comparison to those who live in a shared household. The difference between groups was statistically significant in the functional part (p = 0,017). The comparison of disability in speech communication between patients with throat and lower pharynx cancer has revealed that the overall results of VHI and physical part are slightly better in people with throat cancer; other subtests have revealed minimally lower results. These differences were not statistically significant. The impact of a more extensive operation on the increased disability with communication due to speech was not confirmed as there was minimal difference with the results between the laryngectomized and those that underwent a more extensive operation (additional removal of pharynx or even use of grant to cover the missing tissue). Moreover, I also did not confirm the impact of concomitant treatment with chemotherapy. The group that was treated with radiation prior or post laryngectomy achieved better results only in the functional part of the questionnaire in comparison to the group that did not undergo radiation therapy. The group that was treated with radiation proved greater disability in speech communication in the physical and emotional part and in the overall results of the questionnaire. The difference was statistically significant in the physical part of the questionnaire (p = 0,043). The positive correlation between the age and the results was discovered in the questionnaire, which means that the disability in speech communication of the participants is increasing with age. However, the correlation is statistically significant only in the emotional part (p = 0,049). The results show us that men are more impaired in speech communication than women. The gender difference is statistically significant in the functional part and in the overall results (p = 0,029).

• Keywords: laryngeal and hypopharyngeal cancer