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Jabbour N, Agarwal P, Pisegna JM, Mathur N, Zuckerman M, Caten H, Tracy LF. Socioeconomic Impact on Swallow Therapy Attendance. Dysphagia 2024; 39:757-764. [PMID: 38238573 DOI: 10.1007/s00455-023-10656-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 12/15/2023] [Indexed: 07/12/2024]
Abstract
Dysphagia negatively impacts quality of life and increases health care costs. Swallow therapy is the primary and effective treatment for dysphagia of various etiologies, and attendance is critical to success. This study seeks to identify barriers to swallow therapy attendance at a tertiary care, safety-net hospital. A total of 309 patients were referred for swallow therapy from January 1, 2018, to April 30, 2019. Patients were divided into those who "Attended" at least one swallow therapy appointment and those who "Did not Attend" any swallow therapy appointment. Demographics, socioeconomic factors, and diagnosis prompting therapy referral were compared between the two groups. Socioeconomic status (SES) was based on insurance status and income. 177 patients (57%) attended at least one swallow therapy appointment and 132 (43%) did not attend any appointments. Overall, 240 (78%) patients had public insurance and 69 (22%) had private insurance. Analysis of SES status identified 106 (34%) patients as double-low SES, 157 (51%) as low SES, and 43 (14%) as high SES. Referral diagnoses were "Dysphagia-unspecified type" (n = 119, 38%), "Cancer" (n = 66, 21%), "Neurologic" (n = 46, 15%), "Globus" (n = 29, 9%), "Aspiration" (n = 17, 6%), "Reflux" (n = 17, 6%), and "Throat Pain" (n = 15, 5%). No patient demographic factors, SES factors, or referral diagnosis correlated significantly with swallow therapy attendance. Overall, swallow therapy attendance was poor. In this group, socioeconomic and demographic factors did not significantly impact swallow therapy attendance. Future research should focus on identifying barriers to swallow care and strategies to improve attendance.
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Affiliation(s)
- Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA.
| | - Pratima Agarwal
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| | - Jessica M Pisegna
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
- Boston University Chobanian and Avedesian School of Medicine, Boston, MA, USA
| | - Nisha Mathur
- Boston University Chobanian and Avedesian School of Medicine, Boston, MA, USA
| | - Melani Zuckerman
- Boston University Chobanian and Avedesian School of Medicine, Boston, MA, USA
| | - Holly Caten
- Department of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock, Concord, NH, USA
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
- Boston University Chobanian and Avedesian School of Medicine, Boston, MA, USA
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2
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Awad L, Langridge BJ, Noy D, Govender R, Sinha D, Butler PE, Kalavrezos N. Correlation between oral and oropharyngeal resection subsites and impact of reconstruction on speech and swallowing function in head and neck cancer patients: A systematic review. J Craniomaxillofac Surg 2024; 52:809-820. [PMID: 38627188 DOI: 10.1016/j.jcms.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/03/2023] [Accepted: 01/16/2024] [Indexed: 07/23/2024] Open
Abstract
This review aims to provide a correlation between oral and oropharyngeal subsites and type of reconstruction used in the management of head and neck cancer patients. A literature search of PubMed, Embase and Web of Science was conducted. All study types describing long-term speech and swallow outcomes of adults following head and neck oncological reconstruction, which used a subsite classification, were included. Risk of bias was assessed using the Robbins-1 tool. A total of 2270 patients were found in 26 studies. The number of subsites/studies ranged from 2 to 18. Subsites were predominantly divided on an anatomical basis. Other classifications included functionally grouped subsites. Seven articles considered combinations, unilateral and bilateral defects. Base of tongue, FOM, and defects crossing the midline are negatively correlated with post-operative speech and swallow. Lateral distributions were associated with superior outcomes. The University of Washington Quality of Life Questionnaire (UW-QOL) was the most prevalent tool for speech and swallow assessment. Other factors that significantly affect speech and swallow outcomes include adjuvant therapy, size, type of reconstruction (free flap compared to pedicled or local). The role of neoadjuvant therapy remains unknown. A consistent and formalised approach including risk stratification for multiple contributing factors would be useful in clinical pre- and post-operative management.
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Affiliation(s)
- Laura Awad
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
| | - Benjamin J Langridge
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
| | - Dani Noy
- Department of Head and Neck Surgery, University College of London Hospital, London, United Kingdom.
| | - Roganie Govender
- Department of Head and Neck Surgery, University College of London Hospital, London, United Kingdom.
| | - Deepti Sinha
- Department of Head and Neck Surgery, University College of London Hospital, London, United Kingdom.
| | - Peter Em Butler
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
| | - Nicholas Kalavrezos
- Department of Head and Neck Surgery, University College of London Hospital, London, United Kingdom.
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3
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Manduchi B, Fitch MI, Ringash JG, Howell D, Martino R. A core outcome set for patient-reported dysphagia for use in head and neck cancer clinical trials: An international multistakeholder Delphi study. Head Neck 2024; 46:831-848. [PMID: 38204219 DOI: 10.1002/hed.27626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Measuring dysphagia-related patient-reported outcomes (PROs) in Head and Neck Cancer (HNC) patients is challenging due to dysphagia's multidimensional impact, causing inconsistency in outcome reporting. To address this issue, this study derived a consensus-based core outcome set (COS) for patient-reported dysphagia in HNC clinical trials where swallowing is a primary or secondary endpoint. METHODS A sample of HNC clinicians, researchers, patients, and caregivers participated in a 2-Round Delphi technique. A Delphi survey, containing a comprehensive list of dysphagia-related PROs, was developed. In Round 1, participants rated item importance on a 5-point scale. Items rated ≥4 by >70% advanced to Round 2, where a consensus meeting addressed items with varied opinions, and the Delphi survey with remaining items was completed. Items rated ≥4 by >70% formed the final COS. RESULTS Forty-five participants from nine countries were recruited. After Round 1, 40 items were excluded and 64 advanced to Round 2. After Round 2, a 7-outcome COS was established, comprising the domains of dysphagia symptoms, health status and quality of life. CONCLUSION This study achieved consensus among HNC stakeholders on essential dysphagia PROs for HNC clinical trials. It is advisable to include these 7-core concepts in clinical trials involving people with HNC to facilitate treatment comparisons and data synthesis.
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Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
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Costa DR, Guedes RLV, Mituuti CT, Rubira CMF, da Silva Santos PS, Berretin-Felix G. Symptoms of oropharyngeal dysphagia, efficiency, and safety of swallowing in patients after treatment for head and neck cancer. Support Care Cancer 2023; 32:21. [PMID: 38093087 DOI: 10.1007/s00520-023-08215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE The aim of this study is to investigate the relation between symptoms and signs of oropharyngeal dysphagia after treatment for head and neck cancer. METHODS An observational analytical study with retrospective and prospective components was carried out including 25 adult and elderly patients with head and neck cancer who had completed the treatment at least 3 months before data collection. Data from the Eating Assessment Tool (EAT-10) protocol were analyzed, as well as from the videofluoroscopic swallowing exams. Based on videofluoroscopy, the degree of oropharyngeal dysphagia was classified, as well as the safety and efficiency grade using the DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scale. Pearson's correlation test was applied, adopting a significance level of 5%. RESULTS There was a significant correlation between question 4 of the EAT-10 (swallowing solids takes extra effort) and the efficiency profile (p = 0.004), as well as between question 4 and the DIGEST score (p = 0.002). No significant relation was found between the DIGEST score and EAT-10 total score (p = 0.180) and not even between EAT-10 total score and efficiency (p = 0.129) or safety grade (p = 0.878). CONCLUSION In conclusion, no relation was found between most of the dysphagia signs and symptoms investigated, demonstrating that the individual's perception of the swallowing function may not be consistent with the findings of the instrumental evaluation after long-term treatment for head and neck cancer.
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Affiliation(s)
- Danila Rodrigues Costa
- Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | | | - Cassia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology and Radiology of Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology of Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Giédre Berretin-Felix
- Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Borders JC, Sevitz JS, Curtis JA, Vanegas-Arroyave N, Troche MS. Quantifying Impairments in Swallowing Safety and Efficiency in Progressive Supranuclear Palsy and Parkinson's Disease. Dysphagia 2023; 38:1342-1352. [PMID: 36763187 DOI: 10.1007/s00455-023-10560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Dysphagia is a largely inevitable symptom in both progressive supranuclear palsy (PSP) and Parkinson's disease (PD). To date, comparative studies in these diseases have failed to detect differences in the severity of impairments in swallowing safety or efficiency, potentially due to small sample sizes and outcome measures with low sensitivity. Therefore, this study sought to address these limitations by using novel measurement methodology to comprehensively compare swallowing safety and efficiency impairments between these populations in order to better understand whether differences may exist and guide clinical management. Twenty-four participants with PSP and 24 with PD were matched for disease duration and completed flexible endoscopic evaluations of swallowing. A visual analog scale and penetration-aspiration scale quantified swallowing safety and efficiency. Bayesian multilevel models compared the frequency, severity, and variability of swallowing impairments. Individuals with PSP demonstrated greater impairments in swallowing safety, including deeper and more variable airway invasion and more frequent vocal fold and subglottic residue. Swallowing efficiency was also more impaired among individuals with PSP, including more frequent hypopharyngeal residue (with solids) and more severe residue in the oropharynx (with thin liquids and solids) and hypopharynx (with thin liquids). When airway or pharyngeal residue was present, similar within-subject variability of the amount of residue was appreciated across anatomic landmarks. This is the first study comparing the frequency, severity, and variability of swallowing impairments between PSP and PD populations. Our findings demonstrate more pronounced impairments in swallowing safety and efficiency for PSP compared to PD. These findings provide a clinically relevant characterization of swallowing measures using novel methodological and statistical approaches attempting to resolve some limitations of prior studies.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | | | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
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7
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Liou HH, Hsieh MHC, Tsai SH, Hung DSY, Chen YJ, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. Relationship Between Pharyngeal Residues Assessed by Bolus Residue Scale or Normalized Residue Ratio SCALE and Risk of Aspiration in Head and Neck Cancer Who Underwent Videofluoroscopy. Dysphagia 2023; 38:700-710. [PMID: 35953736 DOI: 10.1007/s00455-022-10501-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
Abstract
Dysphagia affects 60-75% of patients treated for head and neck cancer (HNC). We aimed to evaluate the association between residue severity and airway invasion severity using a videofluoroscopic swallowing study and identify risk factors for poor penetration-aspiration outcomes in patients with dysphagia treated for HNC. Penetration-Aspiration Scale (PAS) was used to assess airway invasion severity, while residue severity was assessed using both the Bolus Residue Scale (BRS) for residue location and the Normalized Residue Ratio Scale (NRRS) for residue amount. Relevant covariates were adjusted in the logistic regression models to account for potential confounding. Significantly higher abnormal PAS was reported for increased piriform sinus NRRS (NRRSp) [odds ratio (OR), 4.81; p = 0.042] with liquid swallowing and increased BRS value (OR, 1.52; p = 0.014) for semi-liquid swallowing in multivariate analysis. Tumor location, older age, and poorer Functional Oral Intake Scale (FOIS) were significant factors for abnormal PAS in both texture swallowings. After adjusting for confounding factors (sex, age, and FOIS score), NRRS model in liquid swallowing (area under the curve [AUC], 0.83; standard error = 0.04, 95% confidence interval [CI]: 0.75, 0.91) and BRS in semi-liquid swallowing (AUC, 0.83; SE = 0.04; 95% CI: 0.76, 0.91) predicted abnormal PAS. The results indicate that while assessing residue and swallowing aspiration in patients with HNC, it is important to consider age, tumor location, and functional swallowing status. The good predictability of abnormal PAS with BRS and NRRS indicated that residue location and amount were both related to the aspiration event in patients with HNC.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Han Tsai
- Division of General Medicine, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Yi-Jen Chen
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan.
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8
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Weng W, Imaizumi M, Murono S, Zhu X. Expert-level aspiration and penetration detection during flexible endoscopic evaluation of swallowing with artificial intelligence-assisted diagnosis. Sci Rep 2022; 12:21689. [PMID: 36522385 PMCID: PMC9753025 DOI: 10.1038/s41598-022-25618-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Flexible endoscopic evaluation of swallowing (FEES) is considered the gold standard in diagnosing oropharyngeal dysphagia. Recent advances in deep learning have led to a resurgence of artificial intelligence-assisted computer-aided diagnosis (AI-assisted CAD) for a variety of applications. AI-assisted CAD would be a remarkable benefit in providing medical services to populations with inadequate access to dysphagia experts, especially in aging societies. This paper presents an AI-assisted CAD named FEES-CAD for aspiration and penetration detection on video recording during FEES. FEES-CAD segments the input FEES video and classifies penetration, aspiration, residue in the vallecula, and residue in the hypopharynx based on the segmented FEES video. We collected and annotated FEES videos from 199 patients to train the network and tested the performance of FEES-CAD using FEES videos from other 40 patients. These patients consecutively underwent FEES between December 2016 and August 2019 at Fukushima Medical University Hospital. FEES videos were deidentified, randomized, and rated by FEES-CAD and laryngologists with over 15 years of experience in performing FEES. FEES-CAD achieved an average Dice similarity coefficient of 98.6[Formula: see text]. FEES-CAD achieved expert-level accuracy performance on penetration (92.5[Formula: see text]), aspiration (92.5[Formula: see text]), residue in the vallecula (100[Formula: see text]), and residue in the hypopharynx (87.5[Formula: see text]) classification tasks. To the best of our knowledge, FEES-CAD is the first CNN-based system that achieves expert-level performance in detecting aspiration and penetration.
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Affiliation(s)
- Weihao Weng
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan.
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Xin Zhu
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan.
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9
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Verdonck-de Leeuw I, Dawson C, Licitra L, Eriksen JG, Hosal S, Singer S, Laverty DP, Golusinski W, Machczynski P, Varges Gomes A, Girvalaki C, Simon C, Leemans CR. European Head and Neck Society recommendations for head and neck cancer survivorship care. Oral Oncol 2022; 133:106047. [PMID: 35932637 DOI: 10.1016/j.oraloncology.2022.106047] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Survivors of head and neck cancer can experience long-term consequences of the cancer and subsequent treatments even after the cancer has resolved. Increasingly clinicians are aware of the social, psychological, financial, and emotional impacts of these cancers, in addition to the support required for the physical symptoms. This review provides recommendations on the long-term management and support required for survivors of head and neck cancer in the European healthcare setting.
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Affiliation(s)
- Irma Verdonck-de Leeuw
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department Otolaryngology-Head and Neck Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department Clinical, Neuro and Developmental Psychology, Van der Boechorststraat 7-9, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands.
| | - Camilla Dawson
- Speech and Language Therapist-Dysphagia and Altered Airways University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Unit and Head & Neck Research Program at the Istituto Nazionale Tumori in Milan, Italy.
| | - Jesper Grau Eriksen
- Experimental Clinical Oncology, Aarhus University Hospital, Entrance C, Level 1, C108, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark.
| | - Sefik Hosal
- Department of Otolaryngology-Head & Neck Surgery, Atılım University Faculty of Medicine, Ankara, Turkey.
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Hospital of Johannes Gutenberg University Mainz, Germany.
| | - Dominic P Laverty
- Restorative Dentistry, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham B5 7EG, UK.
| | - Wojciech Golusinski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Piotr Machczynski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Ana Varges Gomes
- Centro Hospitalar e Universitario do Algarve, Chair of Administration Council, MD Medical Oncologist, Portugal.
| | - Charis Girvalaki
- European Cancer Patient Coalition, Avenue des Arts 6, 1210 Brussels, Belgium.
| | - Christian Simon
- Chef-de-service, Service d'Oto-rhino-laryngologie et chirurgie cervico-faciale CHUV, UNIL, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC - Vumc, P.O. Box 7057, 1007MB Amsterdam, the Netherlands.
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10
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Freitas ASD, Zica GM, Freitas EQ, Silva ACAE, Dias FL, Santos IC. Residue localization and risk for aspiration in partial laryngectomy: the relevance of assertive therapeutic strategies and resources. EINSTEIN-SAO PAULO 2022; 20:eAO6262. [PMID: 35293434 PMCID: PMC8909125 DOI: 10.31744/einstein_journal/2022ao6262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.
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11
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Freitas ASD, Zica GM, Salles M, Silva ACAE, Silva TH, Dias FL, Santos IC. DIGEST Scale Predictis More Quality of Life Than PAS: the Residue Influence on Supracricoid Laryngectomy. Int Arch Otorhinolaryngol 2021; 26:e357-e364. [PMID: 36109048 PMCID: PMC9282976 DOI: 10.1055/s-0041-1730306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction
Supracricoid laryngectomy (SCL CHEP) removes ∼ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature.
Objective
To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP.
Methods
A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST).
Results
In a group of 86 patients, there was a significant relationship between oncological staging and the global (
p
< 0.001) and total (
p
= 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (
p
= 0.045). The swallowing function proved to be relevant for QoL.
Conclusion
The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.
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Affiliation(s)
- Andressa Silva de Freitas
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Guilherme Maia Zica
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Mariana Salles
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Ana Catarina Alves e Silva
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Thiago Huaytalla Silva
- Departamento de Nutrição e Dietética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando Luiz Dias
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
| | - Izabella Costa Santos
- Departamento de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, RJ, Brazil
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12
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Kuniyuki I, Hisaoka T, Ikeda R, Suzuki J, Sato N, Tagaino R, Kambayashi T, Hirano-Kawamoto A, Ohta J, Ohkoshi A, Ishii R, Shitraishi N, Kato K, Koyama S, Sasaki K, Katori Y. Changes in tongue pressure and dysphagia at oral cancer patients by palatal augmentation prosthesis. Cancer Rep (Hoboken) 2021; 5:e1516. [PMID: 34472726 PMCID: PMC9327658 DOI: 10.1002/cnr2.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/31/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background The palatal augmentation prosthesis (PAP) is an intraoral prosthesis used in the treatment of dysphagia. Aim The objective of the study is to examine the effect of PAP using tongue pressure and the Videofluoroscopic Dysphagia Scale (VDS) to understand the precise mechanism for improvement in swallowing function with PAP for oral cancer at retrospective survey. Methods and results Fifteen patients were provided PAPs. Tongue pressure and VDS were evaluated with and without PAP. After intervention with PAP, tongue pressure significantly increased as compared to when without PAP (p < .05). The total mean VDS score with PAP was found to have significantly improved (p < .05). The mean VDS score of the oral phase also significantly improved with the PAP compared to without the PAP group (p < .05). Significant differences (p < .01) were found in each category, such as tongue to palate contact and pyriform sinus residue. Conclusion PAP can improve tongue pressure, tongue to palate contact, and pyriform sinus residue.
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Affiliation(s)
- Izumita Kuniyuki
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Takuma Hisaoka
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Sato
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Ryo Tagaino
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Tomonori Kambayashi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ai Hirano-Kawamoto
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Ohta
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ishii
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naru Shitraishi
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Kengo Kato
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeto Koyama
- Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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13
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Freitas ASD, Zica GM, Silva ACAE, Dias FL, Freitas EQ, Santos IC. Supracricoid laryngectomy: the impact of senescence on swallowing safety. EINSTEIN-SAO PAULO 2021; 19:eAO5715. [PMID: 33978098 PMCID: PMC8081437 DOI: 10.31744/einstein_journal/2021ao5715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: To investigate the association between aging and the functional aspects of swallowing (laryngeal penetration and laryngotracheal aspiration) in individuals who underwent supracricoid laryngectomy in the late period and without complaints. Methods: A total of 70 patients, 56 (80%) aged >60 years and 14 (20%) <60 years, under outpatient follow-up, after cancer treatment and with no complaints of swallowing, performed functional evaluation using the swallowing videofluoroscopy. Image classification was performed using the penetration-aspiration scale developed by Rosenbek. The χ2 test and logistic regression were applied to associate the age categories to the outcomes (penetration and aspiration). Results: Patients aged over 60 years had a higher prevalence of penetration (24.29%) and aspiration (48.57%) than patients aged under 60 years. In this sample, aspiration was associated with age. Patients aged over 60 years were more likely to present penetration (27% more) during swallowing than patients under 60 years. Patients aged over 60 years had an approximately four-fold greater probability of laryngotracheal aspiration than patients aged under 60 years. Conclusion: In patients without complaints of swallowing in the late postoperative period of supracricoid laryngectomy, there is a greater probability of laryngotracheal aspiration in elderly aged over 60 years than in individuals under 60 years.
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Affiliation(s)
| | - Guilherme Maia Zica
- Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil
| | | | - Fernando Luiz Dias
- Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil
| | | | - Izabella Costa Santos
- Instituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil
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14
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Barbon CEA, Chepeha DB, Hope AJ, Peladeau-Pigeon M, Waito AA, Steele CM. Determining the Impact of Thickened Liquids on Swallowing in Patients Undergoing Irradiation for Oropharynx Cancer. Otolaryngol Head Neck Surg 2021; 166:511-514. [PMID: 33940982 PMCID: PMC8892064 DOI: 10.1177/01945998211010435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current standard for the treatment of oropharynx cancers is radiation therapy. However, patients are frequently left with dysphagia characterized by penetration-aspiration (impaired safety) and residue (impaired efficiency). Although thickened liquids are commonly used to manage dysphagia, we lack evidence to guide the modification of liquids for clinical benefit in the head and neck cancer population. The objective of this study was to assess the impact of slightly and mildly thick liquids on penetration-aspiration and residue in 12 patients with oropharyngeal cancer who displayed penetration-aspiration on thin liquid within 3 to 6 months after completion of radiotherapy. Significantly fewer instances of penetration-aspiration were seen with slightly and mildly thick liquids as compared with thin (P < .05). No differences were found across stimuli in the frequency of residue. Patients with oropharyngeal cancers who present with post-radiation therapy dysphagia involving penetration-aspiration on thin liquids may benefit from slightly and mildly thick liquids without risk of worse residue.
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Affiliation(s)
- Carly E A Barbon
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute-University Health Network, Swallowing Rehabilitation Research Laboratory, Toronto, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Andrew J Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Melanie Peladeau-Pigeon
- Toronto Rehabilitation Institute-University Health Network, Swallowing Rehabilitation Research Laboratory, Toronto, Canada
| | - Ashley A Waito
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute-University Health Network, Swallowing Rehabilitation Research Laboratory, Toronto, Canada
| | - Catriona M Steele
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute-University Health Network, Swallowing Rehabilitation Research Laboratory, Toronto, Canada
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15
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Thickened liquids: do they still have a place in the dysphagia toolkit? Curr Opin Otolaryngol Head Neck Surg 2021; 28:145-154. [PMID: 32332203 DOI: 10.1097/moo.0000000000000622] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The use of commercially or naturally thickened liquids is a well-established treatment for patients with dysphagia to fluids, the aim of which is to improve swallow safety by minimizing risk of aspiration. Although the most recent systematic reviews conclude that this treatment lacks evidential support and leads to patient-reported worsening health and quality of life, thickened liquids continue to be used with patients with dysphagia across clinical settings. This review briefly summarizes the evidence and considers potential reasons for the apparent mismatch between the evidence and clinical practice. RECENT FINDINGS Continuing practice with thickened liquids is influenced by a range of factors, including gaps in clinical knowledge, inadequate patient involvement, a culture of common practice and a reliance on invalid surrogate studies or research lacking a credible association between thickened liquids and clinically meaningful endpoints. SUMMARY While awaiting further research, clinical decision-making about thickened liquids can be improved by considering the evidence of clinically meaningful endpoints, promoting shared decision-making with patients and underpinning practice with knowledge about the complex relationship between dysphagia, aspiration and pneumonia.
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16
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Evangelista LM, Bayoumi A, Dyer BA, Shukla RP, Rao SD, Belafsky PC. The relationship between posterior pharyngeal wall thickness and swallowing function after radiation therapy. Acta Otolaryngol 2020; 140:693-696. [PMID: 32340517 DOI: 10.1080/00016489.2020.1752933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Dysphagia is a complication following radiation therapy (RT) for head and neck cancers (HNC). Radiologic findings of posterior pharyngeal wall thickening (PPWT) after RT has not been quantified and correlated to swallowing outcomes.Aims/objective: To evaluate PPWT and its impact on swallowing function following RT.Material and methods: Retrospective analysis of pre- and three-month post-RT PPWT, demographics, oncologic history, and swallowing parameters of patients undergoing RT for HNC. Multivariate analysis of variance was performed to evaluate the effect of PPWT on swallowing outcomes.Results: The mean age of the cohort (n = 207) was 61.8 (± 11.29) years. The mean PPWT increased by 0.28 (± 0.19) cm (p = .00) three-months after RT. A significant difference in PPWT score between tumor subsites, χ2(2) = 45.883, p = .00, with the highest mean rank score of 135.97 for nasopharynx and 103.46 for oropharynx. PPWT was significantly associated with increased pyriform sinus retention, higher Penetration-Aspiration Scale (PAS) scores and post-deglutitive aspiration (p < .05).Conclusions and significance: PPWT increase significantly after RT for HNC. Increased PPWT was associated with mean radiation dose to the nasopharynx and oropharynx and was an independent risk factor for increased pharyngeal residue, higher PAS scores, and timing of aspiration (p < .05).
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Affiliation(s)
- Lisa M. Evangelista
- Department of Otolaryngology-Head & Neck Surgery, Center for Voice and Swallowing, University of California, Davis, CA, USA
| | - Ahmed Bayoumi
- Department of Otolaryngology-Head & Neck Surgery, Center for Voice and Swallowing, University of California, Davis, CA, USA
| | - Brandon A. Dyer
- Department of Radiation Oncology, Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Rakendu P. Shukla
- Department of Radiation Oncology, Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Shyam D. Rao
- Department of Radiation Oncology, Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Peter C. Belafsky
- Department of Otolaryngology-Head & Neck Surgery, Center for Voice and Swallowing, University of California, Davis, CA, USA
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17
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Pisegna JM, Langmore SE, Meyer TK, Pauloski B. Swallowing Patterns in the HNC Population: Timing of Penetration-Aspiration Events and Residue. Otolaryngol Head Neck Surg 2020; 163:1232-1239. [DOI: 10.1177/0194599820933883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective This study described swallowing patterns in a large head/neck cancer (HNC) cohort. Study Design In a retrospective review of data from a randomized controlled trial, we studied timing of penetration events as they related to aspiration and oral/pharyngeal residue. Setting Retrospective review of a multicenter randomized controlled trial. Subjects and Methods In total, 168 patients who were >3 months postradiation received baseline modified barium swallow evaluations. Retrospective analyses of data from these exams were studied, including Penetration-Aspiration Scale (PAS) scores and timing of these events (before, during, or after the swallow), as well as percentage of oral and pharyngeal residue. Results Aspiration occurred more frequently after than before or during the swallow ( P < .05). There were significantly more events of penetration that led to aspiration after the swallow (n = 260) when compared to events before (n = 6) or after (n = 81) the swallow. There was more pharyngeal (16%-25%) than oral residue (5%-20%). Weak correlations were found between thin liquid, nectar-thick liquid, pudding residue, and PAS scores, with varying significance (pharyngeal residue/PAS rs: .26*, .35*, .07*; oral residue/PAS rs: .21*, .16, .3; * P < .05). Conclusion The predominant pattern for this sample of postradiation patients with HNC with dysphagia was aspiration that occurred after the swallow, rather than before or during the swallow. The aspiration was directly caused by penetration events that occurred during the swallow, resulting in aspiration as the airway reopened. Patients demonstrated more pharyngeal residue than oral residue, but a weak relationship was found between residue and penetration/aspiration events. These results guide clinicians in targeting appropriate swallowing interventions.
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Affiliation(s)
- Jessica M. Pisegna
- Boston University School of Medicine, Department of Otolaryngology, Boston, Massachusetts, USA
- Boston Medical Center, Voice and Swallowing Center, Moakley Building, Boston, Massachusetts, USA
| | - Susan E. Langmore
- Boston University School of Medicine, Department of Otolaryngology, Boston, Massachusetts, USA
| | - Tanya K. Meyer
- Department of Otolaryngology Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Barbara Pauloski
- University of Wisconsin–Milwaukee, College of Health Sciences, Comm-unication Sciences and Disorders, Milwaukee, Wisconsin, USA
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18
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Pisegna JM, Kaneoka A, Coster WJ, Leonard R, Langmore SE. Residue Ratings on FEES: Trends for Clinical Application of Residue Measurement. Dysphagia 2020; 35:834-842. [DOI: 10.1007/s00455-019-10089-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
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19
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Borders JC, Brates D. Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review. Dysphagia 2019; 35:583-597. [PMID: 31538220 DOI: 10.1007/s00455-019-10064-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022]
Abstract
The penetration-aspiration scale (PAS) is an 8-point scale used to characterize the depth and response to airway invasion during videofluoroscopy. Though widely used in the field of deglutition, there is a lack of consensus regarding the statistical properties of the scale. In order to better understand the state of the literature and the statistical use of the PAS, a systematic review was undertaken to descriptively examine trends in statistical and reporting practices of the PAS since its inception. Online databases were searched for studies citing the original PAS article, which yielded 754 unique articles. Of these, 183 studies were included in the review. Results showed inconsistencies in the statistical use of the scale; 79 studies treated the PAS as ordinal, 71 as categorical, and 49 as interval. Ten types of categorizations were identified. Reporting of power analyses (9%), as well as inter- (26%) and intra-rater (17%) reliability, was uncommon. Among studies that administered multiple bolus volumes or consistencies, 55% reported PAS analyses at the participant/group level only. This review confirms the existence of discrepancies in the statistical treatment of the PAS. A lack of consensus among researchers limits comparisons between studies. The approach to handling this scale dictates the statistical tests used, potentially affecting results and interpretations. Consistent application of statistically sound approaches to PAS analyses is vital for the future of deglutition research.
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Affiliation(s)
- James C Borders
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA.
| | - Danielle Brates
- Department of Communication Sciences and Disorders, New York University, New York, NY, USA
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20
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Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment. Dysphagia 2019; 35:479-491. [DOI: 10.1007/s00455-019-10053-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
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21
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Patterson J, Toft K, McAuley F, King E, McLachlan K, Roe JWG, Wells M. Feasibility and outcomes of fibreoptic endoscopic evaluation of swallowing following prophylactic swallowing rehabilitation in head and neck cancer. Clin Otolaryngol 2019; 44:549-556. [PMID: 30892816 DOI: 10.1111/coa.13331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 01/26/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Investigate the feasibility and outcomes of fibreoptic endoscopic evaluation of swallowing (FEES) following a programme of prophylactic swallowing exercises in head and neck cancer (HNC) patients treated with radiotherapy. DESIGN Prospective, single cohort, feasibility study. SETTING Three head and neck cancer centres in Scotland. PARTICIPANTS Pre-radiotherapy HNC patients who consented to participate in a prophylactic swallowing intervention. OUTCOME MEASURES Fibreoptic endoscopic evaluation of swallowing recruitment and retention rates, assessment acceptability and compliance, qualitative process evaluation. RESULTS Higher rates of recruitment and retention were achieved in centres where FEES equipment was available on-site. Travel and anticipated discomfort were barriers to recruitment. Data completion was high for all rating scales, with good reliability. Following radiotherapy, swallowing safety significantly deteriorated for liquid boluses (P = 0.005-0.03); pharyngeal residue increased for liquid and semi-solid boluses. Pharyngo-laryngeal oedema was present pre-treatment and significantly increased post-radiotherapy (P = 0.001). Patients generally reported positive experience of FEES for their own learning and establishing a baseline. CONCLUSIONS Fibreoptic endoscopic evaluation of swallowing is an acceptable method of assessing patients for a prophylactic swallowing intervention and offers some additional information missing from VF. Barriers have been identified and should be taken into account in order to maximise recruitment for future trials.
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Affiliation(s)
- Joanne Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Speech and Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK
| | - Kate Toft
- Speech and Language Therapy Department, NHS Lothian Western General Hospital, Edinburgh, UK
| | - Fiona McAuley
- Speech and Language Therapy Department, Ninewells Hospital, Dundee, UK
| | - Emma King
- Nursing, Midwifery, Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Kirsty McLachlan
- Speech and Language Therapy Department, NHS Lothian Western General Hospital, Edinburgh, UK
| | - Justin W G Roe
- Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.,Department of Speech and Language Therapy, Royal Marsden NHS Foundation Trust, London, UK
| | - Mary Wells
- Department of Nursing, Imperial College Healthcare NHS Trust, London, UK
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22
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Shapira-Galitz Y, Shoffel-Havakuk H, Halperin D, Lahav Y. Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing. Dysphagia 2019; 34:548-555. [DOI: 10.1007/s00455-019-10001-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022]
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23
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Kirsh E, Naunheim M, Holman A, Kammer R, Varvares M, Goldsmith T. Patient‐reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation. Laryngoscope 2018; 129:2059-2064. [DOI: 10.1002/lary.27610] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Elliana Kirsh
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Matthew Naunheim
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - Allison Holman
- Department of Speech, Language, and Swallowing DisordersMassachusetts General Hospital Boston Massachusetts U.S.A
| | - Rachel Kammer
- Department of Speech, Language, and Swallowing DisordersMassachusetts General Hospital Boston Massachusetts U.S.A
| | - Mark Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts U.S.A
| | - Tessa Goldsmith
- Department of Speech, Language, and Swallowing DisordersMassachusetts General Hospital Boston Massachusetts U.S.A
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24
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Gerschke M, Schöttker-Königer T, Förster A, Netzebandt JF, Beushausen UM. Validation of the German Version of the Yale Pharyngeal Residue Severity Rating Scale. Dysphagia 2018; 34:308-314. [DOI: 10.1007/s00455-018-9935-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
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25
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Martínez MP, Troncoso E, Robert P, Quezada C, Zúñiga RN. Time-Dependent Rheological Behavior of Starch-Based Thickeners and Herb Infusion Dispersions for Dysphagia Management. STARCH-STARKE 2018. [DOI: 10.1002/star.201700276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Macarena P. Martínez
- Department of Speech, Language and Hearing Sciences; Faculty of Medicine; Universidad de Chile; Independencia 1027 Independencia Santiago Chile
| | - Elizabeth Troncoso
- Department of Chemistry; Universidad Tecnológica Metropolitana; Las Palmeras 3360 Ñuñoa Santiago Chile
| | - Paz Robert
- Departament of Food Science and Chemical Technology; Universidad de Chile; Santos Dumont Nº 964 Independencia Santiago Chile
| | - Camilo Quezada
- Department of Speech, Language and Hearing Sciences; Faculty of Medicine; Universidad de Chile; Independencia 1027 Independencia Santiago Chile
| | - Rommy N. Zúñiga
- Programa Institucional de Fomento a la Investigación; Desarrollo e Innovación; Universidad Tecnológica Metropolitana; Ignacio Valdivieso 2409 San Joaquín Santiago Chile
- Department of Biotechnology; Universidad Tecnológica Metropolitana; Las Palmeras 3360 Ñuñoa Santiago Chile
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26
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Shapira-Galitz Y, Drendel M, Yousovich-Ulriech R, Shtreiffler-Moskovich L, Wolf M, Lahav Y. Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients. Dysphagia 2018; 34:63-72. [PMID: 29882103 DOI: 10.1007/s00455-018-9914-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
The Dysphagia Handicap Index (DHI) is a 25-item questionnaire assessing the physical, functional, and emotional aspects of dysphagia patients' quality of life (QoL). The study goal was to translate and validate the Hebrew-DHI. 148 patients undergoing fiberoptic endoscopic examination of swallowing (FEES) in two specialized dysphagia clinics between February and August 2017 filled the Hebrew-DHI and self-reported their dysphagia severity on a scale of 1-7. 21 patients refilled the DHI during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency), penetration and aspiration (1 point for penetration, 2 points for aspiration, per consistency). 51 healthy volunteers also filled the DHI. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was established by comparing DHI scores of dysphagia patients and healthy controls. Concurrent validity was established by correlating the DHI score with the FEES score. Internal consistency of the Hebrew-DHI was high (Cronbach's alpha = 0.96), as was the test-retest reproducibility (Spearman's correlation coefficient = 0.82, p < 0.001). The Hebrew-DHI's total score, and its three subscales (physical/functional/emotional) were significantly higher in dysphagia patients compared to those in healthy controls (median 38 pts, IQR 18-56 for dysphagia patients compared to 0, IQR 0-2 for healthy controls, p < 0.0001). A strong correlation was observed between the DHI score and the self-reported dysphagia severity measure (Spearman's correlation coefficient = 0.88, p < 0.0001). A moderate correlation was found between the DHI score and the FEES score (Pearson's correlation coefficient = 0.245, p = 0.003). The Hebrew-DHI is a reliable and valid questionnaire assessing dysphagia patients' QoL.
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Affiliation(s)
- Yael Shapira-Galitz
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel.
| | - Michael Drendel
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Ruth Yousovich-Ulriech
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Liat Shtreiffler-Moskovich
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel
| | - Michael Wolf
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Yonatan Lahav
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel
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Managing the late effects of chemoradiation on swallowing: bolstering the beginning, minding the middle, and cocreating the end. Curr Opin Otolaryngol Head Neck Surg 2018; 26:180-187. [DOI: 10.1097/moo.0000000000000455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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