Changes in postoperative laryngeal function and their influencing factors in elderly patients with laryngeal malignancy

To analyze the changes in laryngeal function and health status in elderly patients with laryngeal malignant tumors before and after surgery, and to explore the influencing factors for postoperative dysphagia.

A total of 124 elderly patients with laryngeal malignancy undergoing partial laryngectomy at the First Affiliated Hospital of Air Force Medical University from January 2022 to June 2024 were enrolled in this study. The changes in voice disorder [voice handicap index (VHI)], swallowing function [gugging swallowing screen (GUSS)] and health status [university of Michigan head and neck quality of Life (HNQOL)] scale were compared between before and 6 months after operation. Based on swallowing function at 6 months postoperatively, the patients were divided into a dysphagia group (GUSS <15, n=35) and a non-dysphagia group (GUSS ≥15, n=89). SPSS statistics 25.0 was used for statistical analysis. Depending on data type, independent samples t-test or Chi-square test was employed for comparisons between groups. Multivariate logistic regression analysis was performed to identify influencing factors for postoperative dysphagia in the patients.

At 6 months after surgery, the VHI score and GUSS score of elderly patients with laryngeal malignant tumors were significantly reduced than the baseline levels (both P<0.05), whereas no significant changes were observed in the HNQOL scores of speech, psychological and physical functions before and after surgery (all P>0.05). There were statistical differences in age, frailty, laryngeal cancer type, surgical approach, and early postoperative active cycle of breathing technique (ACBT) training between the dysphagia group and the non-dysphagia group (all P<0.05). Multivariate logistic regression analysis showed that age ≥75 years (OR=2.707, 95%CI 1.259–5.820; P<0.05), frailty (OR=4.255, 95%CI 2.228–8.123; P<0.05), supraglottic laryngeal cancer (OR=5.607, 95%CI 3.283–9.576; P<0.05) and horizontal partial laryngectomy (OR=5.468, 95%CI 3.107–9.624; P<0.05) were risk factors for dysphagia, and early postoperative combined ACBT training (OR=0.294, 95%CI 0.009–0.689; P<0.05) was a protective factor in elderly patients with laryngeal malignant tumors at 6 months after surgery.

Elderly patients with laryngeal malignancy demonstrate stable health status and improved voice quality at 6 months postoperatively, but the swallowing function declines. Advanced age, frailty, supraglottic laryngeal cancer, and horizontal partial laryngectomy increase the risk of postoperative dysphagia, whereas early postoperative combined ACBT training reduces this risk.