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Lakshmipathy D, Allibone M, Rajasekaran K. Dysphagia in Head and Neck Cancer. Otolaryngol Clin North Am 2024; 57:635-647. [PMID: 38485539 DOI: 10.1016/j.otc.2024.02.013] [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] [Indexed: 07/01/2024]
Abstract
Dysphagia is a common symptom in patients with head and neck cancer that can significantly impact health outcomes and quality of life. The origin of dysphagia in these patients is often multifactorial, making diagnosis and management especially complex. The evaluating otolaryngologist should be well versed with the patient's neoplasm, comorbidities, and treatment history alongside dysphagia-specific imaging modalities. Management is often dynamic, requiring frequent monitoring, interprofessional collaboration, and a variety of supportive and invasive measures to achieve optimal outcomes.
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Affiliation(s)
- Deepak Lakshmipathy
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Melissa Allibone
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Department of Speech-Language Pathology, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA.
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Xia X, Zhang W, Guo J, Chang X, Zhao R, Wang J, Pang X, Zhang J. Diagnostic utility of different dysphagia screening tools to detect dysphagia in individuals with amyotrophic lateral sclerosis. Neurol Sci 2023; 44:3919-3927. [PMID: 37368071 DOI: 10.1007/s10072-023-06918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Dysphagia is a common and serious clinical symptom of amyotrophic lateral sclerosis (ALS). The study aimed to evaluate the diagnostic utility of four dysphagia screening tools in ALS, including the ALS Functional Rating Scale-Revised (ALSFRS-R) bulbar subscale, water-swallowing test (WST), Eating Assessment Tool-10 (EAT-10) and Sydney Swallow Questionnaire (SSQ). METHODS A total of 68 individuals from First Hospital, Shanxi medical university, were recruited in the study. The ALSFRS-R, WST, EAT-10, SSQ and the gold standard video fluoroscopic swallowing study (VFSS) were performed. The Penetration Aspiration Scale (PAS) during VFSS was assessed to identify unsafe swallowing (PAS ≥ 3) and aspiration (PAS ≥ 6). Receiver operator characteristic curve (ROC) analyses were performed to evaluate the accuracy of the 4 tools. Youden index was used to determine the ideal cut-off value for each tool. RESULTS Of the patients, 20.59% (14/68) presented unsafety swallowing and 16.18% (11/68) had aspiration. The four tools could effectively identify patients with unsafe swallowing and aspiration. The EAT-10 had the maximum AUC (0.873 and 0.963, respectively) among the tools in the diagnosis of unsafe swallowing and aspiration. To detect unsafe swallowing and aspiration, an EAT-10 score of 6 (sensitivity: 78.6%, specificity: 87.0%) and an EAT-10 score of 8 (sensitivity: 90.9%, specificity: 91.2%), were the most appropriate cut-off points, respectively. CONCLUSIONS The ALSFRS-R bulbar subscale, WST, EAT-10, and SSQ could effectively identify unsafe swallowing and aspiration in patients with ALS. Of the four tools, the EAT-10 was relatively accurate, safe, and convenient. Further studies including more patients should be conducted to verify the conclusions.
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Affiliation(s)
- Xiaoqian Xia
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Wei Zhang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China.
| | - Junhong Guo
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Xueli Chang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Rongjuan Zhao
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Juan Wang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Xiaomin Pang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
| | - Jing Zhang
- Department of Neurology, First Hospital, Shanxi Medical University, No.85, Jiefang South Street, Taiyuan, China
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Benedict PA, Kravietz A, Yang J, Achlatis E, Doyle C, Johnson AM, Dion GR, Amin MR. Longitudinal Effects of Base of Tongue Concurrent Chemoradiation Therapy in a Pre-Clinical Model. Laryngoscope 2023; 133:1455-1461. [PMID: 36134872 PMCID: PMC10030382 DOI: 10.1002/lary.30393] [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: 03/22/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES Base of tongue (BOT) dysfunction is common following oropharyngeal concurrent chemoradiation therapy (CCRT). We present a clinically relevant animal model quantifying the effects of CCRT on tongue strength and elasticity over time. METHODS Fifty-three male and 53 female Sprague-Dawley rats were randomized to control or experimental groups. Experimental animals received cisplatin, 5-fluorouracil, and 5 fractions of 7 Gy directed to the BOT. Controls received no intervention. At 2 weeks, 5 months, or 10 months after CCRT, animals underwent non-survival surgery to measure twitch and tetanic tongue strength, which were analyzed using multivariate linear mixed effects models. Tongue displacement, a surrogate for tongue elasticity, was also determined via stress-strain testing and analyzed via a multivariate linear mixed effects model. RESULTS Reporting the combined results of both sexes, the estimated experimental group mean peak twitch forces became more divergent over time compared to controls, being 8.3% lower than controls at 2 weeks post-CCRT, 15.7% lower at 5 months, and 31.6% lower at 10 months. Estimated experimental group mean peak tetanic forces followed a similar course and were 2.9% lower than controls at 2 weeks post CCRT, 20.7% lower at 5 months, and 27.0% lower at 10 months. Stress-strain testing did not find CCRT to have a significant effect on tongue displacement across experimental timepoints. CONCLUSIONS This study demonstrates an increasing difference in tongue strength over time between controls and animals exposed to CCRT. Tongue elasticity was not significantly affected by CCRT, suggesting that changes in strength may not be caused by fibrosis. LEVEL OF EVIDENCE NA Laryngoscope, 133:1455-1461, 2023.
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Affiliation(s)
- Peter A. Benedict
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Adam Kravietz
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jackie Yang
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Efstratios Achlatis
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Carina Doyle
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Aaron M. Johnson
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Gregory R. Dion
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
- Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | - Milan R. Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Mazerolle P, Fuchsmann C, Schultz P, Benmoussa N, Malard O, Bozec A, Deneuve S, Folia M, Perréard M, Lasne-Cardon A, Chabrillac E, Vergez S, Chaltiel L, Dupret-Bories A. Salvage total glossectomy and total glosso-laryngectomy: Are they worth it? A GETTEC French multicenter study. Oral Oncol 2022; 130:105896. [PMID: 35567979 DOI: 10.1016/j.oraloncology.2022.105896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Salvage total glossectomy (TG) or total glosso-laryngectomy (TGL) remain controversial, as highly morbid procedures. The objective was to describe oncological and functional outcomes after salvage TG or TGL. METHODS We performed a multicenter retrospective study, including patients with previous neck irradiation undergoing TG or TGL for squamous cell carcinoma involving the base of tongue. RESULTS We included 42 patients: 27 in the TG group and 15 in the TGL group. For the entire cohort, median OS and DFS were estimated at 19 months (95% IC [14-44]) and 10 months (95% IC [7-13]) respectively, with no difference between the two groups. After a median follow-up of 90 months, 10 patients (24%) were alive and free of disease. Att he end of follow-up, we noted a gastrostomy dependency of 89% and 87 %respectively in the TG and TGL group, and 48% of patients in the TG group had a tracheotomy. CONCLUSION Although local control is difficult to achieve after salvage TG or TGL, these procedures are associated with acceptable survival and chance of cure for a last-resort situation. TG and TGL can be proposed in selected motivated patients after careful shared decision-making.
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Affiliation(s)
- Paul Mazerolle
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France
| | - Carine Fuchsmann
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Schultz
- Department of Otorhinolaryngology, Centre Hospitalo-Universitaire de Hautepierre, Strasbourg, France
| | - Nadia Benmoussa
- Department of Head and Neck Surgical Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, 94805, France
| | - Olivier Malard
- Department of Head and Neck Surgery, University Hospital of Nantes, France
| | - Alexandre Bozec
- Department of Head and Neck Surgery, Institut Universitaire de la Face et du Cou, Nice, France
| | - Sophie Deneuve
- Department of Oncologic Surgery, Léon Bérard Center, Lyon, France
| | - Mireille Folia
- Department of Otolaryngology-Head and Neck Surgery, François-Mitterrand University Hospital Center, Dijon, France
| | - Marion Perréard
- Department of Head and Neck Surgery, University Hospital of Caen, France
| | - Audrey Lasne-Cardon
- Department of Head and Neck Surgery, François Baclesse Cancer Center, Caen, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France
| | - Sébastien Vergez
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France
| | - Léonor Chaltiel
- Biostatistics Unit, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole Toulouse, France
| | - Agnès Dupret-Bories
- Department of Surgery, University Cancer Institute Toulouse - Oncopole, University Hospital of Toulouse, Toulouse, France.
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Liou HH, Tsai SW, Hsieh MHC, Chen YJ, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Hung DSY. Evaluation of Objective and Subjective Swallowing Outcomes in Patients with Dysphagia Treated for Head and Neck Cancer. J Clin Med 2022; 11:jcm11030692. [PMID: 35160142 PMCID: PMC8836568 DOI: 10.3390/jcm11030692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
We evaluated objective and subjective swallowing function outcomes in patients with dysphagia treated for head and neck cancer (HNC) and identified risk factors for poor swallowing outcomes. Patients undergoing videofluoroscopic swallowing studies (VFSS) between January 2016 and March 2021 were divided into four groups according to primary tumor sites; post-treatment dysphagia was assessed. The penetration–aspiration scale (PAS) and bolus residue scale (BRS) were used to objectively assess swallowing function through VFSS. The Functional Oral Intake Scale (FOIS) was used for subjective analyses of swallowing statuses. To account for potential confounding, important covariates were adjusted for in logistic regression models. Oropharyngeal tumors were significantly more likely to have poor PAS and BRS scores than oral cavity tumors, and the patients with nasopharyngeal tumors were significantly less likely to have poor FOIS scores. Old age, having multiple HNCs, and a history of radiotherapy were associated with an increased odds of poor PAS scores (for all types of swallows), poor BRS scores (for semiliquid and solid swallows), and poor FOIS scores, respectively. This indicates using only subjective assessments may not allow for accurate evaluations of swallowing function in patients treated for HNC. Using both objective and subjective assessments may allow for comprehensive evaluations.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yi-Jen Chen
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
- Correspondence:
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Ku PKM, Vlantis AC, Hui TSC, Yeung DCM, Lee AKF, Law T, Chan SYP, Poon ESM, Lee SYY, Chan BYT, Cheung TYL, Lok LYW, Cheng DTH, Li JWS, Yam KCW, Ho CSM, Fung KPT, Chan CSY, Wang WHS, Wong JKT, Abdullah V, van Hasselt A, Tong MCF. Assessment of pharyngeal motor function using a novel velopharyngeal squeeze maneuver and a novel endoscopic pharyngeal contraction grade scale in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma. Head Neck 2021; 43:3586-3597. [PMID: 34523766 PMCID: PMC9293071 DOI: 10.1002/hed.26871] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background To investigate a novel velopharyngeal squeeze maneuver (VPSM) and novel endoscopic pharyngeal contraction grade (EPCG) scale for the evaluation of pharyngeal motor function. Methods During endoscopic examination of 77 post‐irradiated nasopharyngeal carcinoma patients and control subjects, VPSM was rated and lateral pharyngeal wall movement graded with EPCG scale during swallowing. Pharyngeal constriction ratio (PCR) measured by videofluoroscopy was used for correlation. Results VPSM and EPCG scale showed almost perfect intra‐rater and inter‐rater reliability (Kappa: >0.90). VPSM was present in 61% of patients suggesting good pharyngeal motor function. VPSM was predictive of EPCG scale (Wald statistic = 29.99, p < 0.001). EPCG scale also correlated strongly with PCR (r: 0.812) and was predictive for aspiration (odds ratio: 22.14 [95% CI 5.01–97.89, p < 0.001]). Conclusions VPSM and EPCG scale are two novel tools to assess pharyngeal motor function, and both correlate well with pharyngeal contractility and aspiration.
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Affiliation(s)
- Peter K M Ku
- Department of Otorhinolaryngology-Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong.,Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Alexander C Vlantis
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Thomas S C Hui
- Department of Otorhinolaryngology-Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong
| | - David C M Yeung
- Department of Otorhinolaryngology-Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong
| | - Alex K F Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong
| | - Thomas Law
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Simon Y P Chan
- Department of Speech Therapy, Prince of Wales Hospital, Hong Kong
| | - Esther S M Poon
- Department of Speech Therapy, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong
| | - Sophie Y Y Lee
- Department of Speech Therapy, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong
| | - Becky Y T Chan
- Department of Speech Therapy, Prince of Wales Hospital, Hong Kong
| | | | - Laurie Y W Lok
- Department of Speech Therapy, Prince of Wales Hospital, Hong Kong
| | - Dennis T H Cheng
- Department of Speech Therapy, Prince of Wales Hospital, Hong Kong
| | - Jade W S Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Ken C W Yam
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Christina S M Ho
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Kristy P T Fung
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Coco S Y Chan
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - William H S Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Jeffrey K T Wong
- Department of Interventional Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Victor Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong
| | - Andrew van Hasselt
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Michael C F Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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Chiu YH, Tseng WH, Ko JY, Wang TG. Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc 2021; 121:3-13. [PMID: 34246510 DOI: 10.1016/j.jfma.2021.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Swallowing dysfunction is a prevailing state following radiotherapy in patients with head and neck cancer. Following the advancement of cancer treatment in recent years, the survival rate of head and neck cancer has gradually increased. Simultaneously, patients with head and neck cancer suffer due to the long-duration and more prominent swallowing dysfunction states. Based on an extensive literature review, we aimed to explore the mechanisms, risk factors, and clinical evaluations of swallowing dysfunction and their related symptoms following radiotherapy. These include functional changes of the muscles, trismus, xerostomia, neuropathy, and lymphedema. When swallowing dysfunction occurs, patients usually seek medical help and are referred for rehabilitation therapy, such as muscle strengthening and tongue resistance exercise. Furthermore, clinicians should discuss with patients how and when to place the feeding tube. Only through detailed evaluation and management can swallowing dysfunction resolve and improve the quality of life of patients with head and neck cancer following radiotherapy.
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Affiliation(s)
- Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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