Singing after Total Laryngectomy | 237 10 Dear Editor-in-Chief, As recently pointed, in the European Annals of Otorhinolaryngology Head & Neck Diseases, 2023 is the 150th anniversary of the description of the total laryngectomy technique by Theodor Billroth1-3. We know, singing is not the first thing to think about after a total laryngectomy. This invasive surgery has life-changing consequences; patients must learn to speak, swallow and smell again. They often face psychological and social distress, decreased quality of life, and decreased respiratory function, might suffer from a hypo- or hypertonic voice and face less intelligible speech. With this letter, we would like to pay attention to the possibility and benefits of singing on respiratory function, voice quality, and quality of life. In our institute, the 56-year-old writer Willem Melchior, who is nowadays nine years disease-free, was diagnosed in 2012 with T2N0M0 glottic squamous cell carcinoma and treated with radiation therapy. In 2013, a local recurrence was noted, and a partial laryngectomy with the CO2 laser performed. In 2014, total laryngectomy became unavoidable and was performed. The surgeons performed a primary puncture and placed a Provox Vega® voice prosthesis during that same surgery. Our patient started voice rehabilitation on the 12th day post-surgery and could directly speak using tracheo-esophageal speech. After a couple of weeks, he wished to learn to speak without hands. After a few practice sessions, he was successful in handling and speaking with the Provox FreeHands HME®. Pre-surgery, one of his hobbies was singing and playing guitar. After his laryngectomy, he started singing again, created a Youtube Channel, and uploaded videos of himself singing Dutch songs and French chansons. He found that singing brings him joy. He pays attention to clear articulation, phrasing, and pausing during singing. Besides fun, he also has challenges to cope with. For instance, he has to choose songs that are not too fluctuating in tone. Also, he has to control the (air) pressure build-up because too high pressures loosen his adhesive with the consequences of air leakage. The FreeHands HME® allows him to play the acoustic guitar simultaneously, although he has to play it softly; otherwise, his voice is not audible. Singing after a total laryngectomy is not new. In 2013, Onofre et al.4 investigated singing as a 12-session therapy method and found that roughness, breathiness, and vocal extension all improved. All participants presented tuning, and almost all showed a more significant presence of legato4. Continuing in time, specific choirs for laryngectomees has been set up. For instance, we are aware of the total laryngectomized choral that Professor Louis Traissac from the Bordeaux University set up in France before he retired. In 2016, Dr. Thomas Moors started the charity (and choir) Shout at Cancer. This charity implements singing and acting techniques in voice rehabilitation after a
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