Preoperative and Postoperative Speech Therapy
Evidence based medicine has not quite reached the field of pre- and post-operative speech therapy. Spontaneous healing of the vocal folds after surgery using standardized microphonosurgical techniques is the key to voice restoration. Pre- and post-operati
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Preoperative and Postoperative Speech Therapy Niels Rasmussen and Frederik G. Dikkers
Core Messages
›› Evidence based medicine has not quite reached ›› ›› ›› ››
the field of pre- and post-operative speech therapy. Spontaneous healing of the vocal folds after surgery using standardized microphonosurgical techniques is the key to voice restoration. Pre- and post-operative speech therapy should be tailored to the nature of the vocal fold pathology. Precise, truely objective measures of the quality of speech are warranted. Better definitions of and precise goals for speech therapy are desirable.
This chapter on preoperative and postoperative speech therapy builds on European experience and pertinent international literature. The organization and application of speech therapy for patients undergoing phonosurgery varies widely across Europe. The aim of the present section is to describe these variations, their background, the arguments, and the causes for this diversity. Areas needing further research are identified. A proposal is provided based on this information to guide phonosurgeons to the most efficient use of speech therapy in relation to phonosurgery.
N. Rasmussen (*) Department of Otolaryngology, 2100 Copenhagen, Rigshospitalet, Denmark e-mail: [email protected]
18.1 History of Preoperative and Postoperative Speech Therapy The classic article of Bouchayer and Cornut in 1992 [1] simply stated that pre- and postoperative speech therapy for all laryngeal conditions was indispensable. However, until recently there have been no randomized controlled studies to support this contention.
18.2 Organization of Speech Therapy The organization of health care varies considerably across Europe. In some countries or areas of the same country, speech therapists are employed by the national health care system and work intimately with the phonosurgeon in the examination and treatment of the patients. In other countries or areas of the same country, speech therapists are employed by the Ministry of Education and are only involved in the examination and treatment on the demand of the phonosurgeon. This also applies for countries where speech therapists work exclusively in private practice.
18.3 Educational Programs There are several schools of speech therapy. The effect of these various treatments for the same entity has not been validated. A major reason for this is that the personality and personal skills of the speech therapist appear to be important. For details concerning specific methods of speech therapy, one is advised to read specific literature.
M. Remacle, H. E. Eckel (eds.), Surgery of Larynx and Trachea, DOI: 10.1007/978-3-540-79136-2_18, © Springer-Verlag Berlin Heidelberg 2010
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18.4 Evidence for the Effect of Speech Therapy Preoperatively and Postoperatively Evidence for the effect of speech therapy pre- and postoperatively is sparse. In 2006, van Gogh and colleagues [2] showed that there is a beneficial effect of voice therapy in patients treated for early glottic carcinoma, but
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