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Head and Neck Surgery

(475) Telemedicine Enabled Biofeedback Electropalatography Rehabilitation (TEBER): A pilot study

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • JP

    Justine Philteos, MD

    Resident Physician
    University of Toronto
    Toronto, Ontario, Canada

    • Co-Author(s)

  • CB

    Carly Barbon, PhD

    Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States

  • AE

    Alex Esemezie, BSc

    University of Toronto, Department of Otolaryngology - Head and Neck Surgery, United States

  • JD

    John R. De Almeida, MD, MSc

    Surgeon
    Princess Maragaret Cancer Center, University Health Network, University of Toronto
    Toronto, ON, Ontario, Canada

  • David P. Goldstein, MD, FRCSC, MSc

    Staff Physician
    Department of Otolaryngology-Head and Neck Surgery, University of Toronto
    Toronto, Ontario, United States

  • Jonathan Irish, MD, MSc, FRCSC

    Professor
    University of Toronto/University Health Network/Cancer Care Ontario
    Toronto, Ontario, Canada

    • Senior Author(s)

  • DC

    Douglas B. Chepeha, MD, MScPH

    Adjunct Professor
    Department of Otolaryngology – Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI
    Ann Arbor, Michigan, United States

Introduction: Oral cavity cancer survivors may develop significant social and functional barriers after treatment that adversely impacts quality of life related to speaking and swallowing. To address the barriers to speech and swallowing rehabilitation, we conducted a pilot trial using an electropalatography device paired with telemedicine.

Methods: A prospective 8-week telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) program following 8 weeks of “standard of care” (SOC) rehabilitation conducted through a tertiary care center. Twenty-seven patients who underwent primary surgery with or without adjuvant radiation for oral cavity carcinoma were consented. Outcome measures (tongue mobility, speech intelligibility, and diet outcomes) were collected at baseline, midterm (after SOC rehabilitation, prior to TEBER, and final (post-rehabilitation).

Results: Eleven patients adhered to the rehabilitation protocol to completion. All outcome measures except “speaking in public” improved across the 16-week program. When examining the benefit of TEBER independent of standard of care, “range of liquids” improved by +0.36 [95% CI, 0.025 - 0.70, p<.05] and “range of solids” improved by +0.73 [95% CI, 0.12 - 1.34, p<.05]. There was a positive trend toward improved oral cavity obliteration, as residual volume decreased by 1.2 [95% CI, -2.45 - 0.53, p=.06]. Qualitative comments from patients who completed the protocol indicated that 7/10 patients were satisfied with using the electropalatography device.

Conclusions: This pilot suggests that telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) has potential to improve oral rehabilitation beyond 8 week SOC rehabilitation. TEBER is a complex intervention requiring further refinements in patient selection, device design and program design to improve compliance. However, TEBER provides a potential framework for decreasing barriers to care and implementing personalized rehabilitation programs for patients following surgery for oral cavity cancer.