Oropharyngeal Swallow Efficiency as a Representative Measure of Swallowing Function

The purpose of this investigation was to correlate oropharyngeal swallow efficiency (OPSE), a summary measure of swallowing function, with its component variables. Videofluorographic assessment of oropharyngeal swallow resulted in the measurement of multiple measures of swallow function in five patient populations and a group of normal volunteers. In total, 759 swallows were studied in 149 persons. Specific dimensions of impairment were identified in the patient groups. Multiple regression analyses were used to relate multiple component variables to OPSE. In patient groups with distinct swallow impairments, OPSE was shown to be representative of the dimensions of impairment. In patient groups with limited impairment and in normal volunteers, the strongest correlates of OPSE were bolus transit times. In all groups, at least four variables were significantly related to OPSE and the squared multiple correlation coefficients ranged from 76% to 89%. We conclude that oropharyngeal swallow efficiency is a representative summary measure of swallowing function across populations characterized by a wide range of swallowing impairment

Failure of Cricopharyngeal Myotomy to Improve Dysphagia Following Head and Neck Cancer Surgery

OBJECTIVE To determine whether cricopharyngeal myotomy can improve dysphagia associated with head and neck cancer surgery. DESIGN Prospective, randomized, multicenter trial. SETTING Twelve clinical sites across the United States. PATIENTS Between 1989 and 1994, 125 patients undergoing combined modality therapy for head and neck cancer, including resection of the tongue base or supraglottic larynx, were prospectively entered into the trial. INTERVENTION Cricopharyngeal myotomy on a randomized basis. MAIN OUTCOME MEASURES Videofluoroscopic examination to determine oropharyngeal swallowing efficiency, which is defined as the ratio of percentage of the bolus swallowed to total swallowing time using 3 different bolus consistencies. RESULTS No significant difference in oropharyngeal swallowing efficiency between myotomy vs no myotomy was seen at 6 months of follow-up regardless of bolus consistency. CONCLUSIONS In this prospective test of cricopharyngeal myotomy, the procedure fails to significantly improve dysphagia associated with head and neck cancer surgery. The efficacy of this surgical procedure in other disease entities should also be rigorously explored.Arch Otolaryngol Head Neck Surg. 1999;125:942-946--

Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer

BACKGROUND: Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients. METHODS: Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects. All were randomized to receive sour, sweet, or salty bolus flavor. Patients were evaluated at 7–10 days, 1 month, and 3 months after completion of tumor treatment. Control subjects received 1 assessment. RESULTS: All bolus flavors affected oropharyngeal swallow; sour flavor significantly shortened pharyngeal transit time across all evaluations. CONCLUSIONS: Sour flavor influenced the swallow of patients treated for head and neck cancer, as well as that of control subjects in a manner similar to those with neurologic impairment observed in an earlier study. Sour flavor may improve the speed of pharyngeal transit regardless of whether a patient has suffered peripheral or central sensory damage

RELATION OF MUCOUS MEMBRANE ALTERATIONS TO ORAL INTAKE DURING THE FIRST YEAR AFTER TREATMENT FOR HEAD AND NECK CANCER

BACKGROUND: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing. METHODS: Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected. RESULTS: Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet. CONCLUSION: Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors