Voice quality after laser cordectomy and vertical hemilaryngectomy

Available online 27 December 2011

Peer review under responsibility of Alexandria University Faculty of Medicine.

Figures & data

Table 1 Shows auditory perceptual assessment (APA) of the patients at first visit and follow up visit.

Auditory perceptual assessment (APA)	Unilateral cordectomy group A	Bilateral cordectomy group B	Vertical hemilaryngectomy group C	Total
Intensity
Excessive	3	5	2	10
Decreased or aphonic	1	2	3	6
Average	2	2	0	4
Overall grade of voice change
1	0	1	1	2
2	2	2	2	6
3	3	4	3	10
Strained
1	1	1	0	2
2	0	3	2	5
3	3	3	3	9
Leaky
1	1	1	0	2
2	0	3	2	5
3	2	2	3	7
Roughness
1	0	0	0	0
2	3	0	3	6
3	3	3	4	10
Vocal fry	3	1	5	9
Voice break	4	3	5	12

Table 2 Multidimensional voice profile for studied patients and control.

	Patients (group A, B & C) (n = 20)	Normal (group D) (n = 13)	z-value	p
Frequency measures
Fo	159.29 ± 57.95	118.5 ± 23.11	−0.84	.005
Fhi	228.46 ± 137.52	124.94 ± 24.95	−3.28	.003
Flo	111.54 ± 38.53	112.33 ± 22.57	−0.63	.531
STD	25.76 ± 34.35	1.57 ± 0.57	−3.87	.000
PFR	12.25 ± 10.42	3.00 ± 1.41	−3.87	.001
Tremor analysis measures
Fftr	4.14 ± 2.75	4.14 ± 2.45	−0.57	.567
Fatr	4.81 ± 5.37	2.73 ± 0.815	−0.05	.962
FTRI	1.57 ± 1.76	0.53 ± 0.23	−1.30	.194
ATRI	7.57 ± 7.63	3.75 ± 2.66	−1.56	.118
Frequency perturbation measures
Jita	312.09 ± 221.39	77.44 ± 27.16	−4.05	.000
Jitt	5.19 ± 3.47	0.89 ± 0.42	−4.31	.000
RAP	2.99 ± 1.96	0.534 ± 0.268	−4.31	.000
PPQ	3.34 ± 2. 37	0.516 ± 2.45	−4.31	.000
sPPQ	6.44 ± 7.34	0.86 ± 2.77	−4.44	.000
vFo	13.65 ± 15.09	1.35 ± 0.45	−3.91	.000
Amplitude perturbation measures
ShdB	1.22 ± .90	0.27 ± 0.097	−4.24	.000
Shim	13.65 ± 9.49	3.12 ± 1.18	−4.22	.000
APQ	9.80 ± 7.17	2.47 ± 0.81	−4.42	.000
sAPQ	12.06 ± 7.50	4.37 ± 1.35	−3.72	.000
vAm	19.66 ± 9.66	12.00 ± 5.40	−2.72	.018
Noise related parameters
NHR	0.31 ± 0.245	0.15 ± 0.21	−2.20	.028
VTI	0.13 ± 0.17	0.05 ± 0.04	−1.37	.169
SPI	26.38 ± 16.36	35.13 ± 25.43	−1.10	.269
Voice break, voiceless segments and subharmonic measures
DVB	42.76 ± 172.79	0 ± 0	−2.46	.014
DSH	4.79 ± 6.61	0 ± 0	−2.55	.011
DUV	30.36 ± 38.57	0.09 ± 0.32	−3.30	.001
NVB	1.65 ± 3.06	0 ± 0	−317	.002
NSH	2.66 ± 5.07	0 ± 0	−2.41	.016
NUV	14.55 ± 26.16	0.77 ± 0.28	−2.84	.004

Significant p ⩽ .05.

Table 3 Aerodynamic changes for patients and normal.

	Patient (n = 20)	Control (n = 13)	z-value	p
Vital capacity	2.84 ± 1.60	3.67 ± 1.06	−1.46	.145
MPT	9.64 ± 5.47	17.15 ± 4.58	−3.14	.002
Phonatory quotient	0.44 ± 0.36	0.22 ± 0.86	−1.41	.159
Phonatory flow rate	0.93 ± 1.21	0.32 ± 0.27	−1.83	.069
Phonatory SPL	84.46 ± 9.63	77.29 ± 13.29	−1.21	.224
Mean air pressure	9.28 ± 5.32	7.25 ± 3.16	−0.08	.934
Phonatory efficiency	0.411 ± 0.77	118.20 ± 127.19	−1.74	.000
Phonatory resistance	17.07 ± 6.69	51.26 ± 54.05	−4.24	.049

Significant p ⩽ .05.

Table 4 Multidimensional voice profile and aerodynamic measures for vertical hemilaryngectomy and laser cordectomy.

	Vertical hemilaryngectomy (group C) (n = 8)	Laser cordectomy (n = 13) group A & B	z-value	p
Frequency measures
Fo	181.10 ± 72.60	148.32 ± 40.60	1.93	0.185
Fhi	243.89 ± 160.01	211.38 ± 101.83	0.26	0.617
STD	27.16 ± 39.17	21.23 ± 28.60	0.08	0.778
PFR	10.65 ± 8.57	11.40 ± 11.10	0.59	0.453
Frequency perturbation measures
Jita	366.03 ± 297.16	346.13 ± 253.33	0.05	0.818
Jitt	5.57 ± 3.21	4.88 ± 3.60	0.51	0.485
RAP	3.17 ± 1.73	2.84 ± 2.07	1.30	0.271
PPQ	3.47 ± 2.15	3.68 ± 2.87	2.26	0.153
sPPQ	6.55 ± 7.53	7.30 ± 9.63	0.54	0.474
vFo	12.15 ± 11.71	9.84 ± 13.60	0.60	0.809
Amplitude perturbation measures
ShdB	1.28 ± 0.83	4.11 ± 9.95	3.07	0.099
Shim	14.13 ± 8.84	11.83 ± 9.12	0.63	0.439
APQ	9.92 ± 7.00	10.28 ± 8.69	1.56	0.230
sAPQ	10.81 ± 6.45	13.69 ± 9.37	1.80	0.198
vAm	19.68 ± 8.10	17.61 ± 11.85	2.13	0.164
Noise related parameters
NHR	0.31 ± 0.21	0.27 ± 0.24	0.27	0.608
Voice break, voiceless segments and subharmonic measures
DVB	13.28 ± 22.05	2.72 ± 6.44	6.58	0.021
DSH	10.00 ± 7.22	1.58 ± 3.33	3.57	0.076
DUV	30.28 ± 42.02	31.12 ± 40.00	0.03	0.860
NVB	3.37 ± 4.41	0.50 ± 0.53	29.19	0.000
NSH	6.37 ± 6.80	0.60 ± 1.96	13.93	0.002
NUV	17.62 ± 29.61	10.80 ± 15.14	0.67	0.426
Aerodynamic changes parameters
MPT	8.75 ± 4.79	11.11 ± 6.07	0.68	0.456
Phonatory efficiency	0.13 ± 0.123	0.45 ± 1.10	−0.26	0.126
Phonatory resistance	17.26 ± 5.32	16.92 ± 7.13	−1.21	0.007

Significant p ⩽ .05.

Table 5 Multidimensional voice profile aerodynamic measures for unilateral and bilateral cordectomy.

	Unilateral laser cordectomy group A (n = 7)	Bilateral laser cordectomy group B (n = 5)	p
Frequency measures
Fo	146.771 ± 47.84	141.94 ± 41.17	.866
Fhi	188.16 ± 93.46	260.21 ± 149.26	.167
STD	19.94 ± 32.24	31.68 ± 35.3	.084
PFR	9.00 ± 10.26	17.2 ± 14.34	.053
Frequency perturbation measures
Jita	265.28 ± 215.39	475.76 ± 289.79	.057
Jitt	4.00 ± 3.81	6.23 ± 3.64	.124
RAP	2.37 ± 2.22	3.59 ± 2.09	.489
PPQ	2.52 ± 2.54	3.96 ± 2.85	.271
sPPQ	3.88 ± 4.37	9.84 ± 10.122	.567
vFo	10.9 ± 15.09	19.91 ± 20.82	.809
Amplitude perturbation measures
ShdB	0.98 ± 1.10	1.45 ± 0.823	.132
Shim	10.76 ± 11.6	17.74 ± 6.76	.542
APQ	8.05 ± 7.95	12.06 ± 7.23	.561
sAPQ	11.12 ± 8.27	15.36 ± 8.36	.187
vAm	18.71 ± 10.14	22.07 ± 12.87	.178
Noise related parameters
NHR	0.23 ± 0.22	0.43 ± 0.34	.067
Voice break, voiceless segments and Subharmonic measures
DVB	2.94 ± 7.79	1.68 ± 1.72	.145
DSH	1.13 ± 2.98	1.58 ± 3.53	.802
DUV	24.47 ± 40.62	38.76 ± 36.69	.357
NVB	0.28 ± 0.49	0.80 ± 0.48	.011
NSH	0.00 ± 0.00	1.2 ± 2.68	.237
NUV	0.43 ± 0.77	29.4 ± 32.76	.024
Aerodynamic parameters
MPT	11.17 ± 6.46	8.25 ± 5.34	.157
Phonatory efficiency	0.83 ± 1.11	0.09 ± 0.87	.055
Phonatory resistance	17.06 ± 9.41	16.85 ± 5.13	.167

Significant p ⩽ .05

Table 6 Multidimensional voice profile and aerodynamic analysis pre and posttherapy and at initial visit and reevaluation for patients who did not receive voice therapy.

	Therapy (n = 8)			No therapy (n = 5)
	Prevoicetherapy	Postvoicetherapy	p	Initial visit	Reevaluation	p
Frequency measures
Fo	149.49 ± 25.47	138.81 ± 54.67	.484	165.83 ± 72.60	199.35 ± 58.73	.715
Fhi	244.14 ± 110.04	164.13 ± 85.62	.036	218.015 ± 157.04	247.43 ± 39.75	.715
STD	25.57 ± 30.225	23.65 ± 47.03	.463	52.07 ± 38.17	32.59 ± 45.34	.715
PFR	14.25 ± 12.39	6.75 ± 7.21	.018	10.92 ± 9.22	7.50 ± 4.95	.593
Frequency perturbation measures
Jita	365.4 ± 286.40	182.28 ± 153.93	.069	276.51 ± 206.77	354.85 ± 271.35	.144
Jitt	6.12 ± 3.68	2.79 ± 1.83	.012	4.59 ± 3.34	3.94 ± 2.09	.715
RAP	3.62 ± 2.12	1.65 ± 1.07	.012	2.58 ± 1.81	2.56 ± 2.47	.715
PPQ	3.78 ± 2.18	1.76 ± 1.27	.018	3.07 ± 2.25	2.45 ± 1.31	.593
sPPQ	7.75 ± 8.43	3.17 ± 4.36	.069	5.56 ± 6.77	2.80 ± 1.89	.715
vFo	16.94 ± 18.57	8.49 ± 16.47	.208	11.46 ± 12.68	5.45 ± 3.43	.715
Amplitude perturbation measures
ShdB	1.42 ± 1.06	0.67 ± 0.29	.063	1.08 ± 0.80	0.99 ± 1.01	.715
Shim	15.12 ± 11.09	7.68 ± 3.29	.093	12.58 ± 8.54	10.99 ± 11.51	.715
APQ	10.57 ± 7.34	5.53 ± 2.46	.050	9.29 ± 7.34	7.96 ± 8.18	.715
sAPQ	13.13 ± 7.79	6.80 ± 2.22	.036	11.34 ± 7.56	8.63 ± 7.20	.715
vAm	18.84 ± 9.83	14.96 ± 2.89	.401	20.67 ± 9.91	22.22 ± 18	.465
Noise related parameters
NHR	0.36 ± 0.29	0.19 ± 0.13	.042	0.27 ± 0.21	0.22 ± 0.18	.465
Voice break, voiceless segments and subharmonic measures
DVB	42.51 ± 44.09	0.49 ± 1.13	.273	68.84 ± 22.87	65.34 ± 33.00	.317
DSH	0.62 ± 0.52	3.68 ± 4.9	.893	5.04 ± 6.60	6.00 ± 6.44	.317
DUV	3.28 ± 6.45	6.93 ± 13.36	.043	22.27 ± 33.96	25.75 ± 43.88	.465
NVB	27.12 ± 36.74	0.125 ± 0.353	.046	2.33 ± 3.84	0.25 ± 0.50	1.00
NSH	0.625 ± 1.78	0.625 ± 1.78	.285	2.30 ± 4.36	3.20 ± 3.60	.180
NUV	0.00 ± 13.30	0.00 ± 13.30	.115	6.17 ± 11.48	18.50 ± 35.03	.465
Aerodynamic parameters
MPT	8.75 ± 4.34	12.22 ± 3.93	.059	10.83 ± 6.97	10.00 ± 5.77	.317
Phonatory efficiency	0.67 ± 0.95	276.9 ± 128.3	.028	0.05 ± 0.04	22.91 ± 2.30	.285
Phonatory resistance	16.8 ± 5.20	24.41 ± 32.33	.027	18.46 ± 8.84	27.45 ± 33.59	.180

Significant p ⩽ .05

Table 7 Mean values of acoustic and aerodynamic parameters of posttherapy in the three surgical groups and the control.

	Normal (group D) (n = 13)	Unilateral cordectomy (n = 3)	p	Bilateral cordectomy (n = 3)	p	Vertical hemilaryngectomy (n = 2)	p
Frequency measures
Fo	118.5 ± 23.11	166.11 ± 66.02	.199	218.37 ± 79.82	.012	135.38 ± 64.90	.897
Fhi	124.94 ± 24.95	144.37 ± 36.95	.915	265.63 ± 112.50	.009	189.64 ± 130.60	.251
STD	1.57 ± 0.57	26.89 ± 48.45	.351	43.48 ± 65.94	.098	11.45 ± 8.38	.929
PFR	3.00 ± 1.41	3.00 ± 2.53	.982	10.33 ± 11.85	.035	8.50 ± 4.20	.087
Frequency perturbation measures
Jita	77.44 ± 27.16	145.87 ± 100.47	.623	166.28 ± 68.00	.576	403.35 ± 283.57	.000
Jitt	0.89 ± 0.42	1.80 ± 0.97	.294	3.40 ± 1.66	.004	4.71 ± 1.99	.000
RAP	0.53 ± 0.27	1.05 ± 0.57	.351	2.07 ± 1.02	.004	2.56 ± 2.47	.080
PPQ	0.516 ± 2.45	1.09 ± 0.62	.950	2.22 ± 1.30	.010	2.93 ± 1.30	.000
sPPQ	0.86 ± 2.77	1.34 ± 0.36	.950	5.61 ± 7.07	.010	3.28 ± 1.75	.185
vFo	1.35 ± 0.45	2.20 ± 0.41	.996	18.05 ± 26.92	.016	6.15 ± 3.02	.675
Amplitude perturbation measures
ShdB	0.27 ± 0.097	0.35 ± 0.18	.936	0.87 ± 0.13	.025	1.25 ± 0.80	.000
Shim	3.12 ± 1.18	3.95 ± 2.00	.961	9.77 ± 1.47	.030	10.99 ± 11.51	.000
APQ	2.47 ± 0.81	2.91 ± 1.37	.984	6.91 ± 1.32	.046	10.20 ± 6.55	.000
sAPQ	4.37 ± 1.35	4.24 ± 1.64	.999	7.89 ± 1.53	.085	11.01 ± 5.19	.000
vAm	12.00 ± 5.40	11.87 ± 2.70	.100	15.87 ± 1.99	.544	23.39 ± 7.15	.002
Noise related parameters
NHR	0.15 ± 0.21	0.12 ± 0.03	.100	0.27 ± 0.20	.079	0.26 ± 0.15	.052
Voice break, voiceless segments and subharmonic measures
DVB	0.00 ± 0.00	0.00 ± 0.00	.100	0.64 ± 1.43	1.00	0.19 ± 0.38	.939
DSH	0.00 ± 0.00	0.70 ± 1.56	.100	7.5 ± 6.50	.000	1.16 ± 2.01	.799
DUV	0.09 ± 0.32	0.00 ± 0.00	.100	15.83 ± 20.24	.404	27.74 ± 42.49	.030
NVB	0.00 ± 0.00	0.00 ± 0.00	.100	0.00 ± 0.00	1.00	0.50 ± 0.58	.002
NSH	0.00 ± 0.00	0.00 ± 0.00	.100	1.67 ± 2.89	.023	0.00 ± 0.00	1.00
NUV	0.77 ± 0.28	0.60 ± 1.34	.100	13.67 ± 13.61	.291	27.50 ± 32.26	.004
Aerodynamic changes parameters
MPT	17.15 ± 4.58	12.00 ± 3.46	.127	9.33 ± 5.13	.044	10.00 ± 5.77	.038
Phonatory efficiency	118.20 ± 127.19	36.32 ± 47.80	.429	20.40 ± 10.00	.377	36.35 ± 10.60	.521
Phonatory resistance	51.26 ± 54.05	0.89 ± 0.36	.147	1.43 ± 0.89	.224	0.79 ± 0.67	.216