Routine Use of Nasendoscopy to Enhance the Speech and Language Therapist’s Decision-Making Process in Surgical Voice Restoration

Abstract

Objective. To discover whether the routine use of nasendoscopy adds to the speech and language therapist’s (SLT’s) clinical judgment.

Study Design. A prospective quasi-experimental study.

Setting. Outpatient and inpatient settings in a cancer center.

Subjects and Methods. All laryngectomees who met the inclusion/exclusion criteria were assessed by means of a questionnaire, clinical checks, and nasendoscopy. Comparison of data was undertaken.

Results. A total of 50 reviews were conducted over the 4-month data collection period. Nasendoscopy was successfully performed on 45 occasions. In 31 episodes, additional information was gained by conducting the nasendoscopy assessment following the SLT’s clinical assessment. In 22 patients, the presence of granulation or excess tissues interfering with valve placement was identified through the use of nasendoscopy, and in 2 of these patients, action was required to prevent accidental closure of the tracheoesophageal fistula (difficulties that were not identified on clinical examination alone).

Conclusions. Nasendoscopy assessment is a relatively quick, inexpensive, and accessible tool that is well tolerated by patients. Its use helps to identify patients who are at potential risk of complications with voice prosthesis changes and even at risk of accidental closure of the tracheoesophageal fistula through the presence of granulation tissue at the posterior end of the tract. With the use of routine nasendoscopy, these patients can be identified and reviewed more regularly to monitor and manage these problems accordingly. Nasendoscopy warrants consideration as a routine component of review appointments for patients who have undergone surgical voice restoration.