Abstract
To compare the results of a simultaneously performed videofluoroscopic swallowing study and fiberendoscopic evaluation of swallowing in patients with dysphagia after surgery and radiotherapy for oropharyngeal or laryngeal cancer. This prospective study included 31 patients who were examined simultaneously with a standardized protocol. The fiberendoscopic and videofluoroscopic swallowing loops were independently scored by two otorhinolaryngologists/phoniatricians and two radiologists. The presence of penetration/aspiration, the amount of pharyngeal residues and the position of the bolus head when triggering of pharyngeal swallow begins were evaluated. Generalized linear models were used to model the impact of rater, method, bolus and quantities as well as specified moderation effects on scorings. In addition, post hoc Wilcoxon tests were used. Rater agreement was assessed using weighted kappas and their 95% confidence intervals. A total of 202 swallow sequences in 29 patients was evaluated. Interrater agreement was substantial to excellent for both methods (weighted k = 0.979–0.613). Significant differences between both methods were found when assessing the penetration-aspiration scale (p = 0.001, tendency of higher scores by videofluoroscopic (median = 2.59) as opposed to fiberendoscopic (median = 2.14) and the residue severity scores in the valleculae (p = 0.029) and the sinus piriformes (p = 0.002) with larger residues scored by fiberendoscopic evaluation of swallowing. No significant differences were found regarding the time point of triggering (p = 0.273). Simultaneous evaluation of swallowing with FEES and VFSS showed significantly different results in symptomatic patients after tumor operation and radiotherapy.
Highlights
Swallowing disorders after surgery and concomitant radiotherapy for oropharyngeal and laryngeal cancer are found in up to 50–70% of patients, 20% of whom will need nutrition through a PEG tube [1, 2]
Consecutive patients scheduled for assessment of dysphagia by Fiberendoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing studies (VFSS) to assess further diet modifications or the necessity of a change to or a continuation of nonoral feeding were included in this study
We demonstrated that VFSS and FEES may show different results regarding the evaluation of oropharyngeal swallowing in patients after surgery and concomitant radiotherapy for pharyngeal or laryngeal cancer
Summary
Swallowing disorders after surgery and concomitant radiotherapy for oropharyngeal and laryngeal cancer are found in up to 50–70% of patients, 20% of whom will need nutrition through a PEG tube [1, 2]. Swallowing impairment is due to restrictions in mobility and loss of sensitivity which can be due to both the resection of anatomical structures necessary for swallowing and the aftereffects of radiotherapy. M. Scharitzer et al.: SIRFES in Patients with Pharyngolaryngeal Cancer. For a personalized dysphagia management and therapy it is essential to assess the structural and functional deficits of swallowing, e.g. post swallow residue or triggering of the swallow reflex in relation to bolus passage. Patients’ subjective symptoms vary significantly from quantitative assessments of swallowing function [4], emphasizing the necessity for objective diagnostic examination tools
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