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From January 1988 to December 1990, 186 patients with laryngeal cancer or hypopharyngeal cancer underwent total laryngectomy in our hospital. We studied voice restoration in 110 of these patients by means of a direct interview method at the end of 1991. Seventy-six cases were excluded because of death (70) or being lost to follow-up (6). About 80% of the patients (89/110) attended esophageal speech classes, with a success rate of 78% (69/89). Seventy-four percent (51/69) had no problems with daily oral communication using esophageal speech. Neither radiation therapy nor post operative pharyngocutaneous fistula formation influenced the success rate. Neither did the site of the primary tumor in the larynx or hypopharynx exert an influence, although patients with laryngeal cancer were superior to those with hypopharyngeal cancer in terms of the quality of esophageal speech. It was found that age was the most important factor. Patients below 60 years old had a 90% success rate, between 60 and 75 the rate was 60% and above 75 it was only 10%. Unfortunately, 15% (17/110) of the laryngectomized patients used a pen and pad alone. Most were too old to attend esophageal speech classes.
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