Dysphagia-related Quality Of Life Research Articles

Reliability and Validity of the Turkish Version of the Deglutition Handicap Index.

The Deglutition Handicap Index (DHI) is a self-reported questionnaire focus on dysphagia related quality of life of patients. The present study was aimed to translate the DHI into Turkish, and investigate the reliability and validity of the Turkish version of the DHI (T-DHI). A total of 100 patients with different diagnoses participated. The study was carried out in 3 phases including translation, reliability and validation phases. The translation phase was performed by the forward-backward-forward translation methodology. The internal consistency and test-retest reliability were used for reliability phase. The criterion validity of the T-DHI was investigated for validation phase. The Cronbach's alpha value of the T-DHI was 0.93 of which indicates excellent internal consistency. The Intraclass Correlation Coefficient ranged from 0.96 to 0.99 for test-retest reliability. There was negative and weak correlation between functional subscale score from the T-DHI and the Functional Oral Intake Scale (r=-0.29, p = 0.004), and positive and moderate to strong correlations between total and subscale scores from the T-DHI and the Turkish version of the Eating Assessment Tool (r = 0.67-0.78, p < 0.001) indicating sufficient criterion validity. The T-DHI is a reliable and valid questionnaire to define dysphagia related quality of life of patients. Clinicians could be used the T-DHI during swallowing evaluation part during the management process of deglutition disorders to plan patient centered rehabilitation, improve care and follow up.

Development of Symptom Specific Dysphagia Quality of Life Questionnairein Tamil.

Swallowing intricately involves sensorimotor systems, pivotal for integrating upper digestive and respiratory functions. Dysphagia, challenging swallowing, often precipitates anxiety and depression, deeply affecting the quality of life (QOL). Understanding patient-centric symptoms is vital for assessing dysphagia's QOL impact. This study aimed at developing and validating the Symptom Specific Dysphagia Quality of Life Questionnaire in Tamil (SSDQOL-T). SSDQOL-T was developed in Tamil and underwent rigorous content validation. This questionnaire was administered to 120 normal individuals and 32 dysphagia patients, assessing various swallowing difficulties and their QOL impact. Results indicate SSDQOL-T's good internal consistency (Cronbach's α = 0.78). Significant differences in swallowing ability and QOL were noted across age groups, with older adults experiencing heightened symptoms. A high significance in mean score was obtained between healthy adults and dysphagia across all sub-domains with a 'p-value' of 0.0005. Symptoms that were found to have high significance were cough/gag reflex, regurgitation, odynophagia, globus sensation, heartburn and tiredness when compared between mechanical and degenerative dysphagia group. Strong correlations were found between SSDQOL-T scores and the Dysphagia Handicap Index in Tamil (r = 0.89). The SSDQOL-T questionnaire provides a robust tool for evaluating dysphagia-related QOL in the Tamil-speaking population. Its validation underscores its clinical relevance and utility for understanding the multidimensional impact of dysphagia. This study emphasizes the importance of culturally sensitive assessment tools in comprehensively evaluating dysphagia's QOL implications.

Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer

Efforts are underway to deintensified treatment protocols for patients with human papillomavirus virus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes. To assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS. This was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses. QOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes. Among the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, -4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, -1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret. The findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.

Dysphagia is closely related to frailty in mild-to-moderate Alzheimer’s disease

IntroductionPhysical phenotype and the cumulative deficit model are two well-known concepts of frailty. One of the main components of frailty is loss of muscle mass and function, which may also include swallowing muscles, therefore is a risk factor for dysphagia. Since dysphagia is seen starting from the early stages of Alzheimer’s Disease (AD), in this study we aimed to reveal the relationship between frailty and dysphagia and dysphagia-related quality of life through Swallow Quality of Life (SwalQoL) tool in patients with AD and compare them with cognitively intact older adults.MethodsComprehensive geriatric assessment, dysphagia evaluation by Eating-Assessment Tool (EAT-10) and SwalQoL questionnaire, and frailty assessment via FRAIL and Clinical Frailty Scale (CFS) were performed on all 101 participants of the study. Thirty-five patients were cognitively intact, 36 patients were diagnosed with mild AD, and 30 patients were diagnosed with moderate AD.ResultsSex distribution was similar between the groups, however, there was a statistically significant age difference. The prevalence of frailty increased according to both frailty indexes as the cognitive status deteriorated. All parameters of SwalQoL except fear and sleep parameters deteriorated as cognitive status impaired. In quantile regression of the total score of the SwalQoL questionnaire and multivariable logistic regression of EAT-10, frailty, as defined by CFS and FRAIL, was associated with dysphagia and poor quality of life regardless of age, presence of dementia, as well as nutritional status.ConclusionSwallowing difficulties in AD negatively affects the quality of life, and it is closely related to frailty in mild-to-moderate AD.

Understanding the Independent Predictors of Dysphagia-Related Quality of Life in Stroke Survivors.

It is important to pinpoint modifiable factors contributing to reduced dysphagia-related quality of life (QoL) in order to improve treatment outcomes and patient health given that a large proportion of stroke survivors experience dysphagia. The purpose of this exploratory study was to identify the independent predictors of dysphagia-related QoL in community-dwelling stroke survivors. A sample of 31 adult stroke survivors with dysphagia (M age = 62 years; 23 males) and their partners (M age = 57 years; seven males) participated in the study. Survivors were > 3 months poststroke and living with their partner. Backward regression analysis methods were employed to determine independent predictors of dysphagia-related QoL using scores from the Swallowing-Related Quality of Life questionnaire. Independent variables tested included age, employment status, receiving dysphagia treatment, number of medical conditions, level of diet modification, Stroke Impact Scale (SIS) scores, relationship with partner, partner age, partner employment status, partner burden, and partner depression. Results indicated that number of survivor medical conditions, degree of diet modification, SIS emotional subscale score, and partner employment status significantly predicted dysphagia-related QoL (p < .001). More specifically, stroke survivors with more medical conditions or a partner who worked outside of the home had worse dysphagia-related QoL, and those with better mental health or a less modified diet had better dysphagia-related QoL. Factors related to dysphagia-related QoL are multifactorial and include both survivor and spousal variables. The results of this exploratory study highlight the need for clinicians and researchers to consider patient function and needs more wholistically to maximize perceived QoL.

Long-term voice outcomes and quality of life after open partial horizontal laryngectomy type II vs. total laryngectomy: A cross-sectional study.

We aim to analyse long-term voice outcomes and quality of life (QoL) in patients undergoing open partial horizontal laryngectomy type II (OPHL type II) and to compare them to those obtained by patients undergoing total laryngectomy (TL) with voice prosthesis (VP). Cross-sectional cohort study. Patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). Forty-five patients were enrolled and divided into two groups: OPHL group and TL group. Acoustic analysis, maximum phonation time, INFV0 scale, I-SECEL, UW-QoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. Voices of patients undergoing OPHL Type II were worse than those of laryngectomised patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the social domain of QoL were higher in OPHL group. Open partial horizontal laryngectomy Type II allows an acceptable voice recovery and a satisfactory QoL.

Pharyngeal electrical stimulation in amyotrophic lateral sclerosis: a pilot study.

Background:Patients with amyotrophic lateral sclerosis (ALS) suffer from dysphagia that increases the risk for aspiration, pneumonia and weight loss. Pharyngeal electrical stimulation (PES) is a therapeutic technique that applies electric stimuli to the patient’s pharynx in order to improve swallowing based on the principle of cortical plasticity and reorganization. Previous studies have demonstrated positive effects in patients with various neurological diseases.Objective:This study was initiated to investigate the effect of PES on swallowing function in patients with ALS.Methods:In all, 20 ALS patients with severe dysphagia [characterized by a Penetration Aspiration Scale (PAS) of at least 4 in thin liquid] were randomized to receive either PES for 10 min at 3 consecutive days in addition to Standard Logopaedic Therapy (SLT) or SLT alone. Swallowing function was evaluated by Fiberoptic Endoscopic Evaluation of Swallowing (FEES) at five timepoints: at baseline, 1 day, 4 days, 3 weeks and 3 months after treatment. Primary endpoint was the severity of penetrations or aspirations as classified by PAS. Secondary endpoints were adverse events, dysphagia-related quality of life, Swallowing Quality of Life (SWAL-QOL), Dysphagia Severity Rating Scale (DSRS), residues, leaking, ALS Functional Rating Scale Revised (ALSFRS-R), and the performance in Clinical Evaluation of Swallowing (CES). The trial is registered under the name of ‘Pharyngeal Electrical Stimulation in Amyotrophic Lateral Sclerosis’ with ClinialTrials.gov, number NCT03481348 (https://clinicaltrials.gov/ct2/show/NCT03481348).Results:Both groups combined showed a significant improvement (p = 0.003) of median Total-PAS from 3.6 [interquartile range (IQR) = 2.9–5.0] at baseline to 2.3 (IQR = 1.8–4.0) 1 day after treatment. During subsequent study visits, PAS increased again but remained below baseline. PES and control group did not differ significantly 1 day after intervention (p = 0.32). Similar effects were found in the majority of secondary endpoints.Interpretation:The findings suggest that PES may not provide an additional positive effect on swallowing function in ALS. SLT seems to yield at least short-term positive effects on swallowing function and swallowing-specific life quality in ALS.Registration: ClinialTrials.gov: NCT03481348

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Dysphagia represents the impairment of swallowing liquids and/or solid food and may occur due to an impairment of any part of the swallowing mechanism. Swallowing disorder has significant morbidity and mortality due to the possibility of malnutrition, loss of muscle mass, dehydration, aspiration, and aspirational pneumonia. Furthermore, it may significantly affect the quality of life and treatment of comorbidities. The purpose of this scoping review was to provide an overview of current guidelines and published literature (PubMed) to identify patients at risk for dysphagia eligible for further examinations, and treatment. Swallowing is a partly voluntary, and partly involuntary action. It can be divided into the oral, pharyngeal, and esophageal phases. Although swallowing disorders can occur in all age groups, they occur most often in the elderly, neurological patients, and patients with head and neck cancer. The diagnostic protocol for dysphagia includes a detailed history, physical examination of all structures involved in the act of swallowing, radiologic examinations (barium swallow test, videofluoroscopic swallow study, CT/MRI), endoscopic procedures (rigid or fiberoptic) and specific questionnaires to evaluate dietary intake, nutritional status and dysphagia-related quality of life. Therapeutic modalities include medications, correction of metabolic and nutritional deficits, bolus consistency modification, postural adjustments and swallow manoeuvers, specific exercise treatment, and surgery. Recently, an increasing number of studies have been published on sensory stimulation, which involves applying techniques like thermal and chemical stimulation, as well as neurostimulation in patients with dysphagia. Identifying persons at risk and treatment of dysphagia may prevent potentially fatal complications, reduce hospital length of stay and improve tolerance to the treatment of comorbidities.

Chronic Obstructive Pulmonary Disease and Dysphagia: What Have We Learned So Far and What Do We Still Need to Investigate?

PurposeDysphagia is an underrecognized concern in people with chronic obstructive pulmonary disease (COPD) and may contribute to disease exacerbations. In this review article, we share information regarding dysphagia in people with COPD, synthesizing knowledge both from the literature and from studies performed in the context of a multidisciplinary clinical pulmonary rehabilitation program at the Federal University of Santa Maria in Brazil.ResultsThis narrative review presents evidence showing that awareness of dysphagia and patient-reported symptoms of dysphagia are rare in individuals with stable COPD. However, evidence from the routine collection of patient-reported symptom data using the Eating Assessment Tool 10 and about dysphagia-related quality of life using the Swallowing Quality of Life questionnaire do suggest that dysphagia is experienced by some individuals with COPD. Several studies suggest that patients with stable COPD present with altered swallowing physiology on videofluoroscopic exams, including silent aspiration in a small number of these individuals. However, both patient self-report and clinical screening using the Volume–Viscosity Swallowing Test have been found to be poor predictors of these videofluoroscopic findings. We discuss the possibility that altered laryngeal sensation and respiratory–swallow discoordination play a role in dysphagia in people with COPD, and highlight assessment tasks that appear to have the highest sensitivity for detecting penetration–aspiration in this population. Finally, we review preliminary evidence suggesting that physical therapy techniques targeting altered respiratory muscle biomechanics may benefit swallowing in people with COPD. Knowledge gaps requiring further research are identified, and implications for clinical practice are discussed.

Understanding the Predictors of Swallowing-Related Quality of Life

<h3>Research Objectives</h3> To identify the independent predictors of swallowing-related quality of life (QOL) in stroke survivors. Give that a large proportion of stroke survivors suffer from swallowing difficulties (dysphagia), which negatively impact survival and QOL, it is important pinpoint modifiable factors contributing to reduced quality of life in order to improve treatment outcomes and the overall health of the patient. <h3>Design</h3> Cross-sectional online survey. <h3>Setting</h3> General community. <h3>Participants</h3> A volunteer sample of 31 adult stroke survivors with dysphagia (mean age 62 years; 23 males) and their spouses (mean age 57 years; 7 male). Survivors were >3 months post-stroke and living with their spouse who was providing some degree of caregiving. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Backward regression analysis methods were employed.Dependent variable: dysphagia-related quality of life (SWAL-QOL)Independent variables: age; employment status; receiving dysphagia treatment; number of medical conditions; diet restrictiveness (based on consumption of texture modified food and drink); stroke impact (Stroke Impact Scale; SIS); relationship with spouse; spousal age; spousal employment status; spousal burden; spousal depression. <h3>Results</h3> Number of survivor medical conditions, degree of diet restrictiveness, SIS emotional subscale score, and spousal employment status significantly predicted dysphagia-related QOL, F(3, 21) = 16.423, p < .001, accounting for 75.4% of the variation in SWAL-QOL scores with an adjusted R2 of 70.1%. The model suggested that stroke survivors with more medical conditions and/or a caregiver who worked outside of the home had worse dysphagia-related QOL, and those with fewer feelings of sadness, burden, nervousness, etc. and/or a less restrictive diet had better dysphagia-related QOL. <h3>Conclusions</h3> Factors related to dysphagia-related QOL are multifactorial and include both survivor and spousal variables. Results support the interrelatedness of overall patient health, patient mental health, and family support, particularly for individuals coping with dysphagia-related dietary restrictions. These data highlight the need for speech-language pathologists and other members of the rehabilitation team to consider patient disability and needs more holistically in order to maximize perceived treatment outcomes. <h3>Author(s) Disclosures</h3> Nothing to disclose.

Videofluoroscopic and manometric outcomes of cricopharyngeus balloon dilation for treatment of pharyngo-esophageal dysphagia associated with nasopharyngeal cancer: A case series.

BackgroundProblems with pharyngo‐esophageal bolus flow have been reported following nasopharyngeal cancer (NPC) treatment. While studies using videofluoroscopic assessment have shown balloon dilation can help address this impairment, the impact of dilation on pressure and bolus flow characteristics incorporating high‐resolution pharyngeal manometry (HRPM) has not been reported.MethodsFive cases with pharyngo‐esophageal dysphagia post NPC underwent balloon dilation. Videofluoroscopic swallowing study (VFSS) and HRPM were completed before and 1 month post dilation. Oral intake and dysphagia related quality of life were reported to 3 months.ResultsVFSS, manometry and functional outcomes revealed positive benefits from dilation in two cases. In the other three cases, two showed improvements on VFSS only. These three failed to make functional swallowing gains.ConclusionsWhere there was functional gain, both fluoroscopy and HRPM recorded improvement to UES function. Across the cases, response to dilation was variable and further work is needed to determine which patients would receive most benefit.Level of Evidence4.

Swallowing Outcomes Post Volumetric Modulated Arc Therapy for Head and Neck Cancer Patients Using MD Anderson Dysphagia Inventory: An Institutional Experience

Background: MD Anderson dysphagia inventory (MDADI) is a dysphagia-specific quality of life (QOL) questionnaire for patients with head and neck (H&N) cancer. Objectives: This study aimed at ascertaining the impact of dysphagia on the QOL of patients undergoing radiation therapy for H&N cancer with curative intent. Methods: This prospective observational study was conducted at a tertiary care hospital in India. Patients with H&N cancer meeting the selection criteria were enrolled in this study. The patients completed the MDADI questionnaire administered to them at the treatment completion and 3 to 6 months after the treatment. The chi-square test, Independent-samples t-test, and Spearman correlation coefficients were used for analysis. Results: After the treatment, the total MDADI score was significantly related to the constrictor mean dose (P = 0.035) and larynx mean dose (P = 0.050). This association was maintained 3 months after the treatment by the constrictors and larynx mean dose (P < 0.05). Keeping the dose constraints for constrictors < 50 Grays (Gy) and larynx < 45 Gy resulted in a better QOL. The mean doses to the cervical esophagus did not statistically correlate with the questionnaire scores. At 6 months after the treatment, a correlation was seen only with the larynx mean doses. Spearman’s rank analysis was significantly correlated to the total as well as individual MDADI scores. Conclusions: MDADI scores provided significant insights into the dysphagia-related QOL for patients with H&N cancer. Modern techniques like volumetric modulated arc therapy (VMAT) are translated into an improved QOL for patients and justify their use. Furthermore, parameters like V30/V40 would have been even more valuable and should be undertaken in future studies.

Dysphagia Prevalence, Attitudes, and Related Quality of Life in Patients with Multiple Sclerosis.

Dysphagia in patients with multiple sclerosis (MS) is associated with significant morbidity and has profound impact on the quality of life (QoL). This study aimed to analyze the dysphagia prevalence, attitudes, and dysphagia-related QoL in patients with MS, not at relapse. A prospective study of 108 consecutively recruited patients. The patients were asked to report dysphagia and completed a general dysphagia questionnaire (the Eating Assessment Tool-10, EAT-10), a disease-specific dysphagia questionnaire (the Dysphagia in Multiple Sclerosis, DYMUS), and a dysphagia-related QoL questionnaire (the Swallowing-Quality of Life). Twenty-six percent of the patients reported dysphagia. Many more were classified as dysphagic by the questionnaires (34.3% by EAT-10 and 44.4% by DYMUS). Overall, one out of four patients reported difficulties or choking while drinking fluids and eating food, cough related to eating, food sticking in the throat, need for food and drink segmentation, and repetitive swallows. The pleasure of eating was found to be moderately affected. The patients seem to cope well with the psychological and social impact of dysphagia. Serious consideration must be given to patients' perceptions and attitudes towards dysphagia. Our patients reported very little fear associated with their swallowing difficulties and choking. Apparently, they do not perceive the severity of their symptoms as an actual danger, as they have developed coping strategies. Dysphagia is common in MS patients not at relapse, even with mild disease-related impairment. Swallowing should be systematically assessed with validated questionnaires in all patients with MS at the course of the disease.

Effects of prophylactic swallowing exercises on dysphagia and quality of life in patients with head and neck cancer receiving (chemo) radiotherapy: the Redyor study, a protocol for a randomized clinical trial

BackgroundRadiation-induced dysphagia is common in patients with head and neck cancer (HNC). Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve deglutition and quality of life; however, a randomized clinical trial is needed to confirm this observation.Methods/designThe Redyor study is a single-blind randomized clinical trial designed to compare the effect of prophylactic oropharyngeal exercises on quality of life and dysphagia of 52 patients with HNC referred to the Radiotherapy Department. The intervention will consist of respiratory muscle training (3 times/day, 5 days/week, 21 weeks) added to the standard swallow therapy. All patients will perform the same exercise intervention, but at different times: before chemoradiotherapy (CRT; early intervention group) or immediately after completing CRT (late intervention group). The main outcome will be change in dysphagia severity assessed with the Penetration-Aspiration Scale in videofluoroscopy study; quality of life will be assessed with the EORTC-QLQ-C30 and its Head and Neck Cancer Module (QLQ-H&N35) at 3, 6, and 12 months after completing CRT.DiscussionThis ongoing clinical trial, registered in 2016, is based on the hypothesis that undergoing a pre-radiotherapy rehabilitation (pre-habilitation) program will have greater benefits (less decrease in quality of life, less delay in swallowing parameters, and less severe dysphagia) compared to post-CRT rehabilitation. The main objective is to assess dysphagia severity in HNC patients; and secondly, to evaluate changes in dysphagia-related quality of life, and to determine the correlation between a clinical variable and instrumental parameters during this period.Trial registrationNCT0209009911.

Association between trismus and dysphagia-related quality of life in survivors of head and neck cancer in Brazil

The aim of this study was to evaluate the association between trismus and other radiation-associated conditions with dysphagia-related quality of life in patients who have undergone radiotherapy of the head and neck. This cross-sectional study included 88 patients who had squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx and had been treated with 3-dimensional (3-D) conformal radiotherapy, which had been completed at least 3 months earlier. Clinical data were obtained from medical records. Trismus, hyposalivation, and radiation caries were evaluated clinically. Dysphagia-related quality of life (DRQoL) was investigated by using the M. D. Anderson Dysphagia Inventory (MDADI). Binary logistic regression was performed to determine associations between DRQoL and both demographic and clinical variables. The mean total MDADI score was 67.33 ± 15.47, and the physical domain was the most affected (60.28 ± 19.00). Patients with cancer of the mouth and oropharynx had worse scores (P = .001). Trismus was associated with poorer DRQoL in all domains of the MDADI (P = .001) and with a greater chance of moderate to profound swallowing limitation (P = .024). Trismus and tumors located in the mouth and oropharynx were associated with poor swallowing function, exerting a negative impact on DRQoL.

Comparison of Functional Organ Preservation by Concomitant Boost Radiotherapy Versus Concurrent Chemoradiation in Locally Advanced Carcinoma of Larynx or Hypopharynx: A Prospective Randomized Study

Functional organ preservation is a major challenge in management of advanced laryngeal and hypopharyngeal carcinoma. Although ideal approach is a subject of much debate, radiotherapy with or without chemotherapy is most commonly used modality. This randomized study was conducted to compare functional organ preservation by chemoradiation (CRT) versus concomitant boost radiotherapy (CBRT). A total of 40 patients with advanced (stage III/stage IVa) laryngeal and hypopharyngeal cancer were randomized to receive either CRT (n = 20) to a dose of 66Gy in 33 fractions over 6.5weeks with concurrent cisplatin (100mg/m2 on days 1, 22 and 43) or CBRT (n = 20) to a dose of 67.5Gy in 40 fractions over 5weeks. Patients were assessed for organ preservation rate, toxicities, voice and swallowing functions utilizing Voice Related Quality of Life (VRQOL) and MD Anderson Dysphagia Inventory (MDADI) scores, respectively, for minimum follow up of 6months. Organ preservation rate (intact disease free larynx) at 6months post treatment was observed in 100% in CRT arm and 95% in CBRT arm. There was no significant difference in mucositis and dermatitis in two arms (p = 0.82 and 0.78, respectively). Dysphagia was observed more in CRT arm (n = 12 vs n = 6). Late toxicities grade 3 xerostomia, grade 2 dysguesia, were seen significantly more in CRT arm. There was no statistical difference between the two arms in terms of VRQOL (p = 0.55) and MDADI scores (p = 0.13). In CRT arm 13 patients complete response and in CBRT arm 12 patients had complete response. Accelerated fractionation with concomitant boost schedule is as effective as CRT in anatomical and functional preservation of larynx. The toxicities, voice and dysphagia related quality of life is comparable.

Dysphagia-Related Quality of Life in Adults with Cerebral Palsy on Full Oral Diet Without Enteral Nutrition.

There have been no quantitative studies on dysphagia and its impact on quality of life (QOL) of adults with cerebral palsy (CP). In this cross-sectional study, we aimed to investigate the characteristics of dysphagia symptoms and their impact on QOL in adults with CP on a full oral diet compared with healthy adults. Additionally, we aimed to determine the factors affecting dysphagia-related QOL in this population. We enrolled adults with CP on full oral diet (N=117) and healthy individuals (N=117) and interviewed them using the swallowing-quality of life (SWAL-QOL) questionnaire which includes 14 items regarding dysphagia symptoms and 30 items regarding swallowing-related QOL. The functional status of each participant with CP was evaluated using the gross motor function classification system, the manual ability classification system (MACS), and the Functional Oral Intake Scale (FOIS). Among pharyngeal symptoms, choking on food was reported most frequently (sometimes or more 76.9%), followed by coughing and choking on liquid. Among oral symptoms, chewing problems were reported most frequently (sometimes or more 59.8%), followed by food dribbling from the mouth (sometimes or more 53.8%). Compared to healthy adults, those with CP reported worse QOL across all SWAL-QOL items, with the lowest scores obtained for meal duration, followed by communication, burden, fatigue, sleep, and eating desire. On multiple linear regression analysis, higher MACS level, lower FOIS level, and older age were predictors of worse SWAL-QOL score. Among adults with CP, it is necessary to evaluate swallowing function and establish an active intervention plan even if a full oral diet is established.

The effect of "xanthan gum-based fluid thickener" on hydration, swallowing functions and nutritional status in total maxillectomy patients.

Swallowing functions are affected after total maxillectomy operations and adjuvant chemoradiotherapy. The purpose of our study is to assess the role of xanthan gum based thickening agents on swallowing and hydration of maxillectomy patients on a randomized controlled fashion. 12 of the 22 patients diagnosed with maxillary carcinoma and planned to undergo total maxillectomy was identified as study group and 10 of them were identified as control group. The study group used "xantham based liquid thickener" for liquid foods up to 3 months postoperatively and the control group did not use. Dysphagia-related quality of life, bioimpedance analysis, EAT-10 scores, swallowing functions were evaluated both preoperative and postoperative period. The mean age of the study group was 56 ± 9.87, and 41.6% were women. The mean age of control group was 60 ± 15.63, and 50% were women. Postoperative EAT-10 scores were statistically significant higher than preoperative scores in both groups (p < 0.05). In both of the study and control groups, a statistically significant reduction in dysphagia related quality of life was detected postoperatively (p < 0.05). Intracellular water, extracellular water and total body water detected statistically significant higher in study group at postoperative month three. Swallowing functions are affected due to total maxillectomy and radiotherapy. With this study, it has been shown that, total maxillectomy and radiotherapy reduce dysphagia-related quality of life. Swallowing dysfunction and dehydration has been shown to affect total maxillectomy patients. Using of 'xanthan gum-based fluid thickener' helps to maintain intracellular water, extracellular water, and total body water.

Dysphagia related quality of life (QoL) following total laryngectomy (TL)

Abstract Purpose: This cross-sectional study evaluated the relationship between dysphagia post-total laryngectomy (TL) and quality of life (QoL) of people who reside in Greece. This is the first such report to be undertaken on the topic. Methods: Speech and language therapists typically use patient judgement to identify difficulties with swallowing. The Greek adaptations of the M.D. Anderson Dysphagia Inventory (MDADI) and the Eating Assessment Tool (EAT-10) were completed by members of the Hellenic Association of Laryngectomees (HAL). More than 400 questionnaires were sent, but only 23 were returned (18 males and 5 females). Results: The results revealed that dysphagia has a negative impact on the QoL of people who have undergone TL for treatment of laryngeal cancer. Conclusion: It appears that not only treatment (i.e. TL) of the primary disease, but also secondary problems as a result of the treatment, such as dysphagia, have a significant impact on the QoL of patients and must be taken into consideration when therapeutic decisions for laryngeal cancer are made. The qualitative measures used here provide a starting point to objectively describe QoL as perceived by TL patients. This is particularly pertinent in Greece where access to delivery and quality of health services has been challenging because of recent fiscal constraints.

Acupuncture for Chemoradiation Therapy-Related Dysphagia in Head and Neck Cancer: A Pilot Randomized Sham-Controlled Trial

Dysphagia is common in head and neck cancer patients after concurrent chemoradiation therapy (CRT). This study evaluated the feasibility of conducting a randomized sham-controlled trial and collected preliminary data on safety and efficacy of acupuncture. Head and neck cancer (HNC) patients with stage III-IV squamous cell carcinoma were randomized to 12 sessions of either active acupuncture (AA) or sham acupuncture (SA) during and following CRT. Patients were blinded to treatment assignment. Swallowing-related quality of life (QOL) was assessed using the MD Anderson Dysphagia Inventory (MDADI) total and subscale scores. Multiple aspects of trial feasibility were confirmed. Forty-two of 196 patients screened (21%) were enrolled and randomized to receive AA (n = 21) or SA (n = 21); 79% completed at least 10 of 12 planned acupuncture sessions; 81% completed the study follow-ups. The majority of patients reported uncertainty regarding their treatment assignment, with no difference between the AA and SA groups. Audits confirmed both AA and SA treatments were delivered with high fidelity. No serious acupuncture-related side effects were observed. MDADI total scores significantly improved from baseline to 12 months post-CRT in both groups (AA: +7.9; SA +13.9; p = .044, p < .001). Similar patterns were observed for the MDADI global subscale (AA: +25.0; SA +22.7; p = .001, p = .002). Intent-to-treat analyses suggested no difference between the treatment groups (p = .17, p = .76 for MDADI total and global scores, respectively). A sham-controlled randomized trial evaluating acupuncture in dysphagia-related QOL in HNC found the procedure to be feasible and safe. Further investigation is required to evaluate efficacy. Dysphagia or swallowing difficulty is an important and common condition after concurrent chemoradiation therapy in head and neck cancer patients. In addition to current available supportive care, acupuncture may offer potential for treating dysphagia. This study demonstrated that both active acupuncture and sham acupuncture are safe and were associated with improved dysphagia-related quality of life from baseline to 12 months after concurrent chemoradiation therapy. This study was not designed to inform underlying specific versus nonspecific effects. Future larger-scale pragmatic clinical trials evaluating the effectiveness of acupuncture versus standard of care are warranted, and further mechanistic research is needed to understand how active versus purportedly sham acupuncture procedures affect dysphagia-related symptoms.