According to epidemiological data, age is one of the main risk factors for cancer development, a finding that points to an increase in cancer incidence with gains in life expectancy. 76% of our patients were males, with mean age of 64 years. Besides genetic factors, smoking and alcohol use increase the chances of head and neck cancer, with squamous cell carcinoma as the predominant histological type. In our sample, 64% were former smokers and 32% former alcohol users, with 44% present alcohol users. Mean alcohol and tobacco use time was 40 years, with 4 doses and 15 cigarettes a day, on average.
Recent studies have shown good results with organ preservation approaches that use radiochemotherapy. Although survival time is not affected, laryngeal function is not always preserved, as state Hirsch et al [10]. In our study, radiochemotherapy was used in 56% of the subjects, followed by radiotherapy alone in 44%. A 7000 Gy dose was applied to 64%, with a 5000 Gy fossa dose in 81%. Treatment was curative in 88%.
We chose to use a combination of objective and subjective measurements, according to Leeper et al [11]. Those authors concluded that, although subjective measurements of voice quality are important, objective measurements are necessary to assess subtle voice changes with time.
According to Behrman, Abramson and Myssiorek [12], 80% of prospectively studied patients had changes in their voice quality 1 year after radiotherapy. 40% of our patients still complained of hoarseness, and 56% of throat clearing, even 3 years after treatment.
Carrara-de Angelis et al. [13] concluded that of 15 patients who had received radiochemotherapy for laryngeal cancer, 33% had adequate voice quality or mild dysphonia, 40% moderate dysphonia, and 27% severe dysphonia. In a study of patients treated for glottic tumor, Caminero et al. [14] reported that 11% had normal voices, 44% had mild dysphonia, 28% had moderate dysphonia, and 17% had severe dysphonia. Those authors also reported VHI results that were close to normal. Our results were slightly better, with the following characteristic voices: hoarse (76%), hoarse-breathing (12%), rough (20%), and crepitating (16%). On the GIRBAS scale, 24% had normal voice, 40% mild dysphonia, and 36% moderate dysphonia.
Our study showed that although most subjects had mild physical, functional and emotional handicaps, several aspects of communication were impaired.
The communication problems identified in our study were: moderate difficulty to be understood, need to repeat what had been said, poor voice quality, need to make an effort to speak, and difficulty to socialize (embarrassment to speak and feeling of incompetence when speaking).
Voice quality was associated with speech rehabilitation in our study. The same finding was reported by Van Gogh et al. [15], who concluded that speech therapy was effective for patients complaining of voice impairment after treatment for early glottic carcinoma. Improvement was significant with VHI analysis, and was also confirmed through the objective voice parameters assessed.