There is currently no assessment tool in widespread use that permits a valid and reliable perceptual assessment of voice quality following laryngectomy. Such a scale is needed to investigate the functional outcomes of surgical voice restoration and rehabilitation regimes. Existing scales are limited by the fact that they assess degree of deviation from normal and are consequently of minimal value in laryngectomy patients. This paper describes the development of a new scale – the Sunderland Tracheoesophageal Perceptual Scale (SToPS) – that assesses post-laryngectomy voice according to 10 parameters: overall grade, tonicity, strain, wetness, volume, social acceptability, whisper, intelligibility, stoma noise and fluency. Intra- and inter-rater reliability of the scale was investigated using a cohort of speech and language therapists (SLTs) and ENT surgeons to assess the voice produced by 55 voice prosthesis speakers on two separate occasions. Good intra-rater reliability was noted for this scale, especially among SLTs. Inter-rater reliability scores were lower than for intra-rater reliability, but sub-group analysis showed that good agreement was recorded for nine parameters assessed by ‘expert’ SLTs (those who had worked with both alaryngeal and laryngeal voice rehabilitation at specialist level with a mean experience of 12 years). Reliability among ENT surgeon assessors was lower than among SLTs, regardless of surgeon experience. This finding arguably highlights the benefits of formal training in voice assessment and the need for multidisciplinary input for laryngectomy patients. There is clearly a need for a valid, reliable scale for the assessment of surgical voice restoration outcomes in laryngectomy patients to help determine the factors that contribute to the quality of their voice. The SToP scale certainly appears to be very promising in this respect.
A novel scale for the assessment of tracheoesophageal voice quality – the SToPS
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