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Colback AA, Arkfeld DV, Evangelista LM, Paydar A, Raslan O, Abouyared M, Cates DJ. Effect of Sarcopenia on Swallowing in Patients With Head and Neck Cancer. Otolaryngol Head Neck Surg 2024; 170:1331-1337. [PMID: 38314934 DOI: 10.1002/ohn.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Sarcopenia, characterized by decreased skeletal muscle mass, is associated with poorer oncologic outcomes in head and neck cancer (HNC) patients. The effect of sarcopenia on swallowing following HNC treatment is unknown. This study aims to investigate the association of sarcopenia and swallowing dysfunction in patients treated for HNC. STUDY DESIGN Retrospective cohort study. SETTING Academic medical center. METHODS Pretreatment sarcopenia was assessed using the skeletal muscle index calculated from cross-sectional imaging at the third cervical vertebra. Feeding tube dependence, patient-reported dysphagia, and swallowing safety were assessed before and after treatment with the Functional Oral Intake Scale, Eating Assessment Tool-10, and Penetration Aspiration Scale, respectively. The association between sarcopenia and swallowing dysfunction was evaluated. RESULTS A total of 112 patients were included, 84 males (75%) and 28 females (25%). A total of 69 (61.6%) had sarcopenia prior to initiating HNC therapy. Sarcopenia was significantly associated with an elevated risk of patient-reported dysphagia (odds ratio [OR] = 2.71 [95% confidence interval, CI, 1.12-6.79]; P < .05). Multivariate logistic regression demonstrated that sarcopenia (OR = 15.18 [95% CI, 1.50-453.53]; P < .05) is an independent predictor for aspiration following treatment for HNC. CONCLUSION Patients with pretreatment sarcopenia had higher rates of dysphagia before treatment and were more likely to develop aspiration after completion of HNC therapy. Sarcopenia is readily measured using cross-sectional imaging and may be useful for identifying patients at risk of swallowing dysfunction and those most likely to benefit from prehabilitation efforts.
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Affiliation(s)
- Angela A Colback
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Daniel V Arkfeld
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Lisa M Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Alireza Paydar
- Department of Radiology, Division of Neuroradiology, University of California, Davis, Sacramento, California, USA
| | - Osama Raslan
- Department of Radiology, Division of Neuroradiology, University of California, Davis, Sacramento, California, USA
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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Evangelista L, Nativ-Zeltzer N, Bewley A, Birkeland AC, Abouyared M, Kuhn M, Cates DJ, Farwell DG, Belafsky P. Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer With Intractable Aspiration. JAMA Otolaryngol Head Neck Surg 2024; 150:335-341. [PMID: 38451502 PMCID: PMC10921343 DOI: 10.1001/jamaoto.2024.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024]
Abstract
Importance Late effects of head and neck cancer (HNC) treatment include profound dysphagia, chronic aspiration, and death. Functional laryngectomy (FL) can improve patient survival and quality of life (QoL); however, removing a failing larynx for a noncancer reason is a difficult decision. Data regarding the ability of FL to improve self-perceptions of voice, swallowing, and QOL in survivors of HNC with intractable aspiration are inconclusive. Objective To investigate the association of FL with changes in self-reported perceptions of voice, swallowing, oral intake, QoL, and mood in survivors of HNC experiencing profound dysphagia and intractable aspiration. Design, Settings, and Participants This cohort study was conducted at a single academic institution and included survivors of HNC with profound swallowing dysfunction and intractable aspiration who underwent FL from July 2016 through March 2022. Of the initial 22 patients enrolled, 2 patients (15%) died of aspiration pneumonia before receiving FL. Data analyses were performed from July 2016 through March 2023. Main Outcomes and Measures Self-reported measures of voice using the VHI (30-item Voice Handicap Index), swallowing using the EAT-10 (10-item Eating Assessment Tool), functional oral intake scale using the FOIS (Functional Oral Intake Scale), and quality of life using the FACT-H&N (Functional Assessment of Cancer Therapy-Head & Neck) were assessed before FL and at 1, 3, and 6 months after FL. Mood states were evaluated using the POMS (Profile of Mood States, second edition), before FL and at 6 months after FL. Results The study analyses included 20 patients (mean [SD] age, 72.4 (7.0) years; 19 [95%] males and 1 [5%] female) who underwent FL and had complete data across all time points. Among these, 12 patients (60%) had received chemoradiation for oropharyngeal, 7 (35%) for laryngeal, or 1 (5%) for nasopharyngeal cancer. The mean (SD) time from completion of oncologic treatment to FL was 15.5 (5.5) years. Mean (SD) score on the EAT-10 improved from 33.2 (7.4) to 23.1 (10.8) at 1 month; 12.1 (9.1) at 3 months; and 8.3 (7.4) at 6 months, with a large effect size (η2 = 0.72; 95% CI, 0.54-0.80). Mean (SD) score on the FOIS improved from 2.0 (1.5) to 2.9 (1.7) at 1 month; 4.8 (2.5) at 3 months; and 5.2 (1.7) at 6 months, with a large effect size (η2 = 0.6; 95% CI, 0.38-0.71). Improvement in oral intake was achieved in 19 patients (95%), and feeding tubes were removed in 10 of 16 patients (63%) who were feeding tube-dependent; 6 patients (27%) continued to require supplemental tube feedings. Mean (SD) score on the VHI improved from 63.6 (34.0) to 86.9 (33.7) at 1 month; 71.3 (36.1) at 3 months; and 39.7 (26.9) at 6 months, with a large effect size (η2 = 0.42; 95% CI, 0.19-0.56). Seventeen patients (85%) were able to use a tracheoesophageal voice prosthesis for alaryngeal communication. Mean (SD) score on the FACT-H&N improved from 86.2 (17.8) to 93.6 (18.4) at 1 month; 109.0 (18.4) at 3 months; and 121.0 (16.8) at 6 months, with a large effect size (η2 = 0.64; 95% CI, 0.42-0.74). Mean (SD) score on the POMS improved from 58.9 (13.2) at baseline to 44.5 (9.9) at 6 months, with a large effect size (Cohen d = 1.04; 95% CI, 0.48-1.57). None of the patients experienced major complications of FL; 1 patient (5%) had a postoperative pharyngocutaneous fistula. Conclusions and Relevance The findings of this cohort study indicate that FL was associated with marked improvements in self-perception of voice and swallowing, functional oral intake, QoL, and mood state among survivors of HNC. These findings can serve as a framework for FL counseling among HNC survivors experiencing profound dysphagia and intractable aspiration.
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Affiliation(s)
- Lisa Evangelista
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Nogah Nativ-Zeltzer
- Department of Communication Disorders, Tel Aviv University, Tel Aviv, Israel
| | - Arnaud Bewley
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Andrew C. Birkeland
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Marianne Abouyared
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Maggie Kuhn
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - Daniel J. Cates
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
| | - D. Gregory Farwell
- Department of Otolaryngology–Head & Neck Surgery, Hospital of the University of Pennsylvania
| | - Peter Belafsky
- Department of Otolaryngology–Head & Neck Surgery, University of California, Davis Health System, Sacramento
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Zhao NW, Stasyuk A, Hernandez BO, Cates DJ, Kuhn MA, Belafsky PC. Objective Fluoroscopic Outcomes After Endoscopic Staple Versus Laser Zenker's Diverticulotomy. Laryngoscope 2023; 133:3057-3060. [PMID: 37129356 DOI: 10.1002/lary.30726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Endoscopic Zenker's diverticulotomy (EZD) is typically performed via stapling (endoscopic staple diverticulotomy; ESD) or CO2 laser (endoscopic laser diverticulotomy; ELD). Conflicting reports exist on which approach provides optimal outcomes. This investigation compared objective fluoroscopic data between ESD and ELD. METHODS A retrospective review of all patients undergoing primary EZD at a tertiary center between January 1, 2014 and January 10, 2022 was performed. Patients undergoing ESD and ELD were matched by preoperative diverticulum size. Primary outcome measures were postoperative diverticulum size and change in diverticulum size from pre- to postoperative swallowing fluoroscopy. Secondary outcome measures were the Eating Assessment Tool (EAT-10) score, penetration aspiration scale (PAS), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo). RESULTS Thirteen matched pairs with complete fluoroscopic data were identified. The mean (±SD) age of the cohort was 74.0 (±8.5) years. There were no age or gender differences between groups (p > 0.05). The mean pre-operative ZD size was 1.98 (±0.69) cm for ESD and 1.97 (±0.72) cm for ELD; the mean postoperative size was 0.84 (±0.62) cm for ESD and 0.34 (±0.27) cm for ELD (p < 0.05). Mean diverticulum size improved by 1.14 (±0.59) cm after ESD and 1.62 (±0.59) cm after ELD (p < 0.05). There were no significant differences in postoperative EAT-10, PAS, PCR, or PESo between groups. CONCLUSION The data suggest that endoscopic laser Zenker's diverticulotomy results in a greater improvement in diverticulum size than endoscopic staple diverticulotomy. The data did not suggest a difference in postoperative dysphagia symptom scores or other objective fluoroscopic parameters between staple and laser diverticulotomy. LEVEL OF EVIDENCES Level 3 Laryngoscope, 133:3057-3060, 2023.
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Affiliation(s)
- Nina W Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Anastasiya Stasyuk
- School of Medicine, University of California, Davis, Sacramento, California, U.S.A
| | - Brian O Hernandez
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
| | - Peter C Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A
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Cates DJ, Nachalon YN, Johnson AL, Lee CC, Belafsky PC. Use of a Novel Hypercrosslinked Carbohydrate Scaffold for Vocal Fold Medialization in an Ovine Model. OTO Open 2023; 7:e69. [PMID: 37823004 PMCID: PMC10562651 DOI: 10.1002/oto2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/22/2023] [Accepted: 07/14/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives Vocal fold medialization is commonly performed for glottic insufficiency and vocal fold immobility. Currently available materials are temporary injectables or synthetic implants. Acellular scaffolds may allow vocal fold augmentation with autologous tissue via host cell migration. The purpose of this investigation was to evaluate the use of a novel carbohydrate scaffold as a medialization implant. Study Design Animal model. Setting Academic medical center. Methods Unilateral type I medialization thyroplasty was performed in 3 Dorper cross ewes using a hypercrosslinked carbohydrate polymer (HCCP) scaffold. Animals were monitored for 4 weeks for general well-being, dyspnea, and weight loss. The animals were euthanized at 4 weeks and the larynges harvested. Histologic evaluation was performed to assess for adverse tissue reaction, migration, degradation, and biocompatibility. Results No adverse events were reported. No animals lost weight or displayed evidence of dyspnea. Histology demonstrated ingrowth of host cells and neovascularization with minimal peri-implant inflammatory reaction. Cellular ingrowth into the scaffold was predominately made up of fibroblasts and early inflammatory cells. Scaffold shape was grossly maintained as it underwent degradation and replacement with host tissue. Migration of the implant material was not observed. Conclusion Vocal fold medialization in an ovine model with an HCCP scaffold resulted in the ingrowth of host cells with minimal peri-implant inflammation. Scaffold shape was maintained without evidence of migration as it underwent replacement with host tissue. Further research is required to assess long-term efficacy in comparison to currently available implants.
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Affiliation(s)
- Daniel J. Cates
- Department of OtolaryngologyUniversity of California, DavisSacramentoCaliforniaUSA
| | - Yuval N. Nachalon
- Department of OtolaryngologyUniversity of California, DavisSacramentoCaliforniaUSA
| | - Amanda L. Johnson
- Comparative Pathology LaboratoryUniversity of California, DavisDavisCaliforniaUSA
| | - Charles C. Lee
- Department of Cell Biology and Human AnatomyUniversity of California, DavisDavisCaliforniaUSA
| | - Peter C. Belafsky
- Department of OtolaryngologyUniversity of California, DavisSacramentoCaliforniaUSA
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Nachalon Y, Nativ-Zeltzer N, Dhar SI, Cates DJ, Leon IW, Evangelista LM, Belafsky PC. Partners of persons with severe swallowing dysfunction have significantly reduced mental health. Support Care Cancer 2023; 31:519. [PMID: 37578591 DOI: 10.1007/s00520-023-07991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Dysphagia can result in malnutrition, dehydration, social isolation, depression, pneumonia, pulmonary abscess, and death. The effect of dysphagia on the health and quality of life (QOL) of the life partners of persons with dysphagia is uncertain. We hypothesize that the partners of individuals with significant dysphagia will experience a significant reduction in quality of life. PURPOSE To evaluate the QOL of the significant others of persons with swallowing dysfunction. METHODOLOGY Persons with significant swallowing dysfunction (defined as EAT10® > 10) and their significant others were prospectively administered the 10-item Eating Assessment Tool (EAT10®) patient-reported outcome measure and the 12-item SF quality of life instrument (SF12). Summary data from the 8 mean health domains were compared between patients and their significant others. Mean scores for each domain are calibrated at 50, and a score below 47 implies significantly diminished QOL for a particular domain. RESULTS Twenty-three couples were evaluated. The mean ± SD EAT10 score for persons with significant dysphagia was 21 ± 7; mean EAT10 for their significant others or for couples in the control group was 0.3 ± 0.8. The mean physical health composite score (PCS) was significantly lower for patients with dysphagia compared to their significant others (39.1 ± 10 and 46.2 ± 11, respectively) (p < 0.05). Both patients and their significant others had comparable mean mental health composite scores (MCS) of 46.6 ± 10 and 46.4 ± 10, respectively (p > 0.05). CONCLUSION Although significant others of persons with swallowing dysfunction have higher physical well-being than their partners, they exhibit the same reduction in mental well-being, which is significantly lower than the general population. The data suggest that clinicians should address the mental well-being of the partners of persons with severe swallowing dysfunction.
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Affiliation(s)
- Yuval Nachalon
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nogah Nativ-Zeltzer
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shumon I Dhar
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Daniel J Cates
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Isabella W Leon
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Lisa M Evangelista
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Peter C Belafsky
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
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Rao SJ, Gochman GE, Stasyuk A, Del Rosario KL, Cates DJ, Madden LL, Young VN. Interventions and Outcomes in Glottic Versus Multi-level Airway Stenosis: A Multi-institutional Review. Laryngoscope 2023; 133:528-534. [PMID: 35809043 DOI: 10.1002/lary.30269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Airway stenosis-particularly multi-level-presents complex management challenges. This study assessed rates of tracheostomy, decannulation, and the number of surgeries required in patients with posterior glottic stenosis (PGS), multi-level airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP). METHODS Airway stenosis patients treated between 2016 and 2021 at three tertiary medical centers were identified. Demographics, etiology of stenosis, medical comorbidities, and patient-reported outcome measures (PROMs) were collected. RESULTS 158 patients (84 women, mean age 56.98 ± 15.5 years) were identified (54 PGS, 38 MLAS, and 66 BVFP). 72.3% required tracheostomy, including 72.2%, 86.8%, and 63.6% in these groups, respectively. Decannulation rates were 43.6%, 21.2%, and 32.5% in these groups, respectively. Patients with MLAS had higher rates of tracheostomy than BVFP (p < 0.05). However, decannulation rates were not different between groups (p > 0.05). MLAS required more surgeries (mean 4.0 ± 3.9) than PGS (2.4 ± 2.2, p = 0.02) or BVFP (1.0 ± 1.8, p < 0.0001). Mean PROMs scores at the latest follow-up were abnormal: 15.4 ± 12.2 (Dyspnea Index), 19.9 ± 12.2 (Voice Handicap Index-10), and 9.67 ± 11.1 (Eating Assessment Tool-10). Co-morbidities present included body mass index >30 (41.4%), diabetes (31.8%), pulmonary disease (50.7%), gastroesophageal reflux disease (39.4%), autoimmune disease (22.9%), and tobacco use history (55.2%). CONCLUSIONS Airway stenosis is a challenging clinical problem that negatively impacts patients' quality of life and often requires numerous surgeries. PGS more frequently requires tracheostomy compared to BVFP, but patients can often decannulate successfully. Patients with multi-level stenosis have lower decannulation rates and require more surgeries than glottic stenosis alone; these patients may benefit from earlier and/or more aggressive intervention. LEVEL OF EVIDENCE 4 Laryngoscope, 133:528-534, 2023.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Grant E Gochman
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, U.S.A
| | - Anastasiya Stasyuk
- University of California-Davis School of Medicine, Sacramento, California, U.S.A
| | | | - Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis School of Medicine, Sacramento, California, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, U.S.A
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Cates DJ, Evangelista LM, Belafsky PC. Effect of Pretreatment Dysphagia on Postchemoradiation Swallowing Function in Head and Neck Cancer. Otolaryngol Head Neck Surg 2021; 166:506-510. [PMID: 33940987 DOI: 10.1177/01945998211009853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chemoradiation therapy (CRT) for head and neck cancer can have profound effects on swallowing function. Identification of risk factors for development of swallowing dysfunction after CRT may improve allocation of preventive strategies. The purpose of this study is to determine the association between pre-CRT dysphagia and post-CRT swallowing dysfunction. STUDY DESIGN Retrospective cohort study. SETTING Academic medical center. METHODS Patients with head and neck cancer were evaluated before and 3 months after CRT. Dysphagia was assessed with the Eating Assessment Tool (EAT-10). Swallowing dysfunction was evaluated by a videofluoroscopic swallow study and the Penetration-Aspiration Scale and swallowing safety was evaluated by the Functional Oral Intake Scale. The association between pre-CRT EAT-10 scores and post-CRT swallowing dysfunction was evaluated. RESULTS The mean ± SD post-CRT Functional Oral Intake Scale score was 6.5 ± 1.2 for individuals with a pre-CRT EAT-10 score <3 and 5.3 ± 1.9 for those with a pre-CRT EAT-10 score ≥3 (P < .001). The mean post-CRT Penetration-Aspiration Scale score was 2.2 ± 1.5 for individuals with a pre-CRT EAT-10 score <3 and 3.8 ± 2.6 for those with a pre-CRT EAT-10 score ≥3 (P < .001). After multivariate analysis adjusting for age, tumor subsite, T classification, and primary surgery, pre-CRT dysphagia (EAT-10 ≥3) was an independent predictor of post-CRT aspiration (odds ratio, 4.19 [95% CI, 1.08-16.20]; P = .04) and feeding tube dependence (odds ratio, 3.54 [95% CI, 1.01-12.33]; P = .04). CONCLUSION The presence of dysphagia before chemoradiation for head and neck cancer is an independent predictor of swallowing dysfunction after completion of therapy. These results may help target intervention toward preventing swallowing dysfunction in high-risk individuals.
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Affiliation(s)
- Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Lisa M Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Peter C Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
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Hoshal SG, Wickwire PC, Gandour-Edwards RF, Rajappa P, Cates DJ. Metastatic Renal Cell Carcinoma Presenting as a Rapidly Enlarging Endotracheal Mass Due to Hyperprogression on Anti-PD1 Immunotherapy. Ear Nose Throat J 2020; 100:905S-907S. [PMID: 32466731 DOI: 10.1177/0145561320931215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Steven G Hoshal
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| | - Peter C Wickwire
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| | - Regina F Gandour-Edwards
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, USA
| | - Prabhu Rajappa
- Department of Veterans Affairs, Northern California Healthcare System, Mather, CA, USA
| | - Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA.,Department of Veterans Affairs, Northern California Healthcare System, Mather, CA, USA
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Randall DR, Cates DJ, Strong EB, Belafsky PC. Three-dimensional analysis of the human pharyngoesophageal sphincter. Laryngoscope 2019; 130:2773-2778. [PMID: 31837160 DOI: 10.1002/lary.28450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Dysfunction of the pharyngoesophageal segment (PES) is a common cause of oropharyngeal dysphagia. Surgical dilation of the PES uses cylindrical dilators that expand radially in a circular shape. Animal studies, however, suggest that the PES is kidney-shaped. The purpose of this investigation was to evaluate the 3D shape of the human PES with a novel casting method. METHODS A platinum-cured liquid silicone polymer was infused under pressure into the upper aerodigestive tract of nine fresh human cadavers to construct 3D casts of the maximally distended PES. Cross-sectional and volumetric analysis were performed using computed tomography and serial sectioning of the models. Canonical variate analysis was used to identify the shape features that best distinguishes the PES from the cervical esophagus. RESULTS The mean age of the cadavers was 77.9 (SD ± 10.6) years, with 67% women. Analysis of the casts confirms that the human PES possesses a kidney-shaped structure at maximal distention, which is discretely different from the adjacent esophagus (P < 0.001). The posterior body of the cricoid cartilage formed the anterior wall of the PES, which provided a rigid structure responsible for preservation of the kidney shape during distention. The diameter of the maximally distended PES at the cricopharyngeus was highly variable (range = 0.86-4.68 cm2 ; SD = 1.33 cm2 ). CONCLUSION The data suggest that the human PES is not round and that targeted expansion at the level of the cricopharyngeus with an eccentrically shaped dilator may provide improved distention. LEVEL OF EVIDENCE 4 Laryngoscope, 2019.
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Affiliation(s)
- Derrick R Randall
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, University of California-Davis, Sacramento, California, U.S.A.,Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Cates
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, University of California-Davis, Sacramento, California, U.S.A
| | - E Brandon Strong
- California Polytechnic State University, San Luis Obispo, California, U.S.A
| | - Peter C Belafsky
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, University of California-Davis, Sacramento, California, U.S.A
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Cates DJ, Rosen CA, Yassin MH, Smith LJ. Primary Laryngeal Blastomycosis: Diagnostic Challenges and Advances in a Rare Cause of Laryngitis. Laryngoscope 2019; 129:2531-2533. [DOI: 10.1002/lary.27593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Daniel J. Cates
- From the Department of OtolaryngologyUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
| | - Clark A. Rosen
- From the Department of OtolaryngologyUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
| | - Mohamed H. Yassin
- Infectious Diseases DivisionUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
| | - Libby J. Smith
- From the Department of OtolaryngologyUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
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Cates DJ, Magnetta MJ, Smith LJ, Rosen CA. Novel, anatomically appropriate balloon dilation technique of the glottis to treat posterior glottic stenosis in a 3D‐printed model. Laryngoscope 2019; 129:2239-2243. [DOI: 10.1002/lary.27524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Daniel J. Cates
- Department of OtolaryngologyUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
| | - Michael J. Magnetta
- Department of RadiologyUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
| | - Libby J. Smith
- Department of OtolaryngologyUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
| | - Clark A. Rosen
- Department of OtolaryngologyUniversity of Pittsburgh Pittsburgh Pennsylvania U.S.A
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Rosen CA, Wang H, Cates DJ, Smith LJ. The glottis is not round: Teardrop‐shaped glottic dilation for early posterior glottic stenosis. Laryngoscope 2018; 129:1428-1432. [DOI: 10.1002/lary.27594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Clark A. Rosen
- Department of OtolaryngologyUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | - Hailun Wang
- Department of OtolaryngologyUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | - Daniel J. Cates
- Department of OtolaryngologyUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | - Libby J. Smith
- Department of OtolaryngologyUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
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Randall DR, Nativ-Zeltzer N, Cates DJ, Tinling SP, Belafsky PC. Decreased intramuscular calcium hydroxyapatite implant resorption in a murine model of osteoporosis. Laryngoscope 2018; 128:2576-2580. [PMID: 30194683 DOI: 10.1002/lary.27348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/21/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Calcium hydroxyapatite (CaHA) is a common material for vocal fold injection augmentation. Durability is variable, and factors involved in implant longevity are not understood. Animal models of osteoporosis show decreased bone density and increased mineral liberation, suggesting CaHA retention may be altered in these conditions. STUDY DESIGN Prospective murine investigation. METHODS Fourteen skeletally mature, 10-month-old female Sprague-Dewley rats were treated by one of three interventions: oophorectomy, laparotomy without oophorectomy (sham), or monthly risedronate injection (90 μg/kg, subcutaneous). CaHA was implanted into the right lateral thigh muscle in all animals at the time of procedure or first risedronate injection. After 17 weeks, all rats were sacrificed, and the residual CaHA isolated from excised lateral thigh muscle through incubation in a 900 °C calcinator for 9 hours. RESULTS Mean CaHA mass remaining in the oophorectomy group was 65.9 (standard deviation ± 16.1) mg, compared to 44.4 ± 10.0 mg CaHA in the risedronate group and 48.6 ± 7.5 mg in the sham group. One-way analysis of variance found a statistically significant difference between the oophorectomy and risedronate groups but not between the sham and other groups, F(2,11) = 4.404, P = 0.039. CONCLUSION Persistent estrogen deficiency in a murine model of osteoporosis demonstrated decreased rate of CaHA resorption. This suggests that hormone alterations associated with osteoporosis may alter the longevity of CaHA implant resorption through an uncertain mechanism. LEVEL OF EVIDENCE NA. Laryngoscope, 2576-2580, 2018.
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Affiliation(s)
- Derrick R Randall
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, U.S.A
- the Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, U.S.A
| | - Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, U.S.A
| | - Steve P Tinling
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, U.S.A
| | - Peter C Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, U.S.A
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Strong EB, Randall DR, Cates DJ, Belafsky PC. Analysis of Reported Balloon Malfunctions and Proposed Rescue Strategy for Malfunction during Airway Dilation. Otolaryngol Head Neck Surg 2017; 158:331-336. [PMID: 29232174 DOI: 10.1177/0194599817742356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective The rate of balloon dilator failure is unknown, and a rescue strategy for device malfunction has not been established. The purposes of this investigation were to determine the approximate number of balloon failures in the gastrointestinal tract and airway, evaluate the parameters required to rupture balloon dilators, and develop a rescue strategy to efficiently reestablish airway patency. Study Design Retrospective cohort and basic medical research. Setting Academic tertiary care medical center. Subjects and Methods The Manufacturer and User Facility Device Experience database was queried for adverse events associated with tracheal and esophageal dilators between January 1, 2014, and January 1, 2017. A bench-top model of airway stenosis was developed, and optimal conditions for the safe removal of a malfunctioning dilator were assessed (2, 4, 6 atm). Results There were 420 reported balloon malfunctions, including 104 cases with deflation/removal issues. The bench-top model determined that device rupture allowing for immediate removal occurs with needle puncture at balloon pressures ≥8 atm. Balloons inflated to 6 atm required a median of 17.5 seconds (range, 0-55.3) for removal, in comparison with 30.2 seconds (range, 7.1-87.5) at 2 atm ( P > .05). Conclusion Balloon dilator malfunction is a significant problem that practitioners must be prepared for. Pressure ≥8 atm (~33% overinflation) is required to consistently cause complete balloon dilator rupture via needle puncture. While counterintuitive, increasing the inflation pressure of a malfunctioning balloon (8-10 atm) may expedite rupture and safe removal. A rescue strategy for balloon malfunction is proposed.
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Affiliation(s)
- E Brandon Strong
- 1 Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA.,2 Department of Biological Sciences, California Polytechnic State University, San Luis Obispo, California, USA
| | - Derrick R Randall
- 1 Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA.,3 Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Daniel J Cates
- 1 Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Peter C Belafsky
- 1 Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
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Johnson CM, Venkatesan NN, Siddiqui MT, Cates DJ, Kuhn MA, Postma GM, Belafsky PC. Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia. Laryngoscope 2017; 127:E422-E427. [PMID: 28699193 DOI: 10.1002/lary.26754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/30/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the efficacy of various techniques of laryngohyoid suspension in the elimination of aspiration utilizing a cadaveric ovine model of profound oropharyngeal dysphagia. STUDY DESIGN Animal study. METHODS The head and neck of a Dorper cross ewe was placed in the lateral fluoroscopic view. Five conditions were tested: baseline, thyroid cartilage to hyoid approximation (THA), thyroid cartilage to hyoid to mandible (laryngohyoid) suspension (LHS), LHS with cricopharyngeus muscle myotomy (LHS-CPM), and cricopharyngeus muscle myotomy (CPM) alone. Five 20-mL trials of barium sulfate were delivered into the oropharynx under fluoroscopy for each condition. Outcome measures included the penetration aspiration scale (PAS) and the National Institutes of Health (NIH) Swallow Safety Scale (NIH-SSS). RESULTS Median baseline PAS and NIH-SSS scores were 8 and 6, respectively, indicating severe impairment. THA scores were not improved from baseline. LHS alone reduced the PAS to 1 (P = .025) and NIH-SSS to 2 (P = .025) from baseline. LHS-CPM reduced the PAS to 1 (P = .025) and NIH-SSS to 0 (P = .025) from baseline. CPM alone did not improve scores. LHS-CPM displayed improved NIH-SSS over LHS alone (P = .003). CONCLUSIONS This cadaveric model represents end-stage profound oropharyngeal dysphagia such as what could result from severe neurological insult. CPM alone failed to improve fluoroscopic outcomes in this model. Thyrohyoid approximation also failed to improve outcomes. LHS significantly improved both PAS and NIH-SSS. The addition of CPM to LHS resulted in improvement over suspension alone. LEVEL OF EVIDENCE NA. Laryngoscope, 127:E422-E427, 2017.
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Affiliation(s)
- Christopher M Johnson
- Department of Otolaryngology, Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A.,Department of Otolaryngology, Naval Medical Center, San Diego, California, U.S.A
| | - Naren N Venkatesan
- Department of Otolaryngology, University of California, Davis, Sacramento, California, U.S.A
| | - M Tausif Siddiqui
- Department of Otolaryngology, University of California, Davis, Sacramento, California, U.S.A
| | - Daniel J Cates
- Department of Otolaryngology, University of California, Davis, Sacramento, California, U.S.A
| | - Maggie A Kuhn
- Department of Otolaryngology, University of California, Davis, Sacramento, California, U.S.A
| | - Gregory M Postma
- Department of Otolaryngology, Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
| | - Peter C Belafsky
- Department of Otolaryngology, University of California, Davis, Sacramento, California, U.S.A
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Cates DJ, Venkatesan NN, Strong B, Kuhn MA, Belafsky PC. Effect of Vocal Fold Medialization on Dysphagia in Patients with Unilateral Vocal Fold Immobility. Otolaryngol Head Neck Surg 2016; 155:454-7. [PMID: 27165683 DOI: 10.1177/0194599816645765] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The effect of vocal fold medialization (VFM) on vocal improvement in persons with unilateral vocal fold immobility (UVFI) is well established. The effect of VFM on the symptom of dysphagia is uncertain. The purpose of this study is to evaluate dysphagia symptoms in patients with UVFI pre- and post-VFM. STUDY DESIGN Case series with chart review. SETTING Academic tertiary care medical center. SUBJECTS AND METHODS The charts of 44 persons with UVFI who underwent VFM between June 1, 2013, and December 31, 2014, were abstracted from a prospectively maintained database at the University of California, Davis, Voice and Swallowing Center. Patient demographics, indications, and type of surgical procedure were recorded. Self-reported swallowing impairment was assessed with the validated 10-item Eating Assessment Tool (EAT-10) before and after surgery. A paired samples t test was used to compare pre- and postmedialization EAT-10 scores. RESULTS Forty-four patients met criteria and underwent either vocal fold injection (73%) or thyroplasty (27%). Etiologies of vocal fold paralysis were iatrogenic (55%), idiopathic (29%), benign or malignant neoplastic (9%), traumatic (5%), or related to the late effects of radiation (2%). EAT-10 (mean ± SD) scores improved from 12.2 ± 11.1 to 7.7 ± 7.2 after medialization (P < .01) with a follow-up of 119 ± 65 days. CONCLUSION Patients with UVFI suffer from dysphagia and report significant improvement in swallowing symptoms following VFM. The symptomatic improvement appears to be durable over time.
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Affiliation(s)
- Daniel J Cates
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Naren N Venkatesan
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Brandon Strong
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Maggie A Kuhn
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Peter C Belafsky
- Department of Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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