{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:41:00Z","timestamp":1787665260875,"version":"build-2736575974"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec id=\"ab-ooi240004-4\"><jats:title>Importance<\/jats:title><jats:p>Late effects of head and neck cancer (HNC) treatment include profound dysphagia, chronic aspiration, and death. Functional laryngectomy (FL) can improve patient survival and quality of life (QoL); however, removing a failing larynx for a noncancer reason is a difficult decision. Data regarding the ability of FL to improve self-perceptions of voice, swallowing, and QOL in survivors of HNC with intractable aspiration are inconclusive.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240004-5\"><jats:title>Objective<\/jats:title><jats:p>To investigate the association of FL with changes in self-reported perceptions of voice, swallowing, oral intake, QoL, and mood in survivors of HNC experiencing profound dysphagia and intractable aspiration.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240004-6\"><jats:title>Design, Settings, and Participants<\/jats:title><jats:p>This cohort study was conducted at a single academic institution and included survivors of HNC with profound swallowing dysfunction and intractable aspiration who underwent FL from July 2016 through March 2022. Of the initial 22 patients enrolled, 2 patients (15%) died of aspiration pneumonia before receiving FL. Data analyses were performed from July 2016 through March 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240004-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Self-reported measures of voice using the VHI (30-item Voice Handicap Index), swallowing using the EAT-10 (10-item Eating Assessment Tool), functional oral intake scale using the FOIS (Functional Oral Intake Scale), and quality of life using the FACT-H&amp;amp;amp;N (Functional Assessment of Cancer Therapy\u2212Head &amp;amp;amp; Neck) were assessed before FL and at 1, 3, and 6 months after FL. Mood states were evaluated using the POMS (Profile of Mood States, second edition), before FL and at 6 months after FL.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240004-8\"><jats:title>Results<\/jats:title><jats:p>The study analyses included 20 patients (mean [SD] age, 72.4 (7.0) years; 19 [95%] males and 1 [5%] female) who underwent FL and had complete data across all time points. Among these, 12 patients (60%) had received chemoradiation for oropharyngeal, 7 (35%) for laryngeal, or 1 (5%) for nasopharyngeal cancer. The mean (SD) time from completion of oncologic treatment to FL was 15.5 (5.5) years. Mean (SD) score on the EAT-10 improved from 33.2 (7.4) to 23.1 (10.8) at 1 month; 12.1 (9.1) at 3 months; and 8.3 (7.4) at 6 months, with a large effect size (\u03b7<jats:sup>2<\/jats:sup>\u2009=\u20090.72; 95% CI, 0.54-0.80). Mean (SD) score on the FOIS improved from 2.0 (1.5) to 2.9 (1.7) at 1 month; 4.8 (2.5) at 3 months; and 5.2 (1.7) at 6 months, with a large effect size (\u03b7<jats:sup>2<\/jats:sup>\u2009=\u20090.6; 95% CI, 0.38-0.71). Improvement in oral intake was achieved in 19 patients (95%), and feeding tubes were removed in 10 of 16 patients (63%) who were feeding tube\u2212dependent; 6 patients (27%) continued to require supplemental tube feedings. Mean (SD) score on the VHI improved from 63.6 (34.0) to 86.9 (33.7) at 1 month; 71.3 (36.1) at 3 months; and 39.7 (26.9) at 6 months, with a large effect size (\u03b7<jats:sup>2<\/jats:sup>\u2009=\u20090.42; 95% CI, 0.19-0.56). Seventeen patients (85%) were able to use a tracheoesophageal voice prosthesis for alaryngeal communication. Mean (SD) score on the FACT-H&amp;amp;amp;N improved from 86.2 (17.8) to 93.6 (18.4) at 1 month; 109.0 (18.4) at 3 months; and 121.0 (16.8) at 6 months, with a large effect size (\u03b7<jats:sup>2<\/jats:sup>\u2009=\u20090.64; 95% CI, 0.42-0.74). Mean (SD) score on the POMS improved from 58.9 (13.2) at baseline to 44.5 (9.9) at 6 months, with a large effect size (Cohen <jats:italic>d<\/jats:italic>\u2009=\u20091.04; 95% CI, 0.48-1.57). None of the patients experienced major complications of FL; 1 patient (5%) had a postoperative pharyngocutaneous fistula.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240004-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The findings of this cohort study indicate that FL was associated with marked improvements in self-perception of voice and swallowing, functional oral intake, QoL, and mood state among survivors of HNC. These findings can serve as a framework for FL counseling among HNC survivors experiencing profound dysphagia and intractable aspiration.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.0049","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T16:35:46Z","timestamp":1709829346000},"page":"335","source":"Crossref","is-referenced-by-count":12,"title":["Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer With Intractable Aspiration"],"prefix":"10.1001","volume":"150","author":[{"given":"Lisa","family":"Evangelista","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nogah","family":"Nativ-Zeltzer","sequence":"additional","affiliation":[{"name":"Department of Communication Disorders, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Bewley","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C.","family":"Birkeland","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Abouyared","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Cates","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head & Neck Surgery, University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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