Water swallow screening test for patients after surgery for head and neck cancer: early identification of dysphagia, aspiration and limitations of oral intake.

Patients with head and neck cancer (HNC) are at high risk for oropharyngeal dysphagia (OD) following surgical therapy. Early identification of OD can improve outcomes and reduce economic burden. This study aimed to evaluate the validity of a water screening test using increasing volumes postsurgically for patients with HNC (N=80) regarding the early identification of OD in general, and whether there is a need for further instrumental diagnostics to investigate the presence of aspiration as well as to determine the limitations of oral intake as defined by fiberoptic endoscopic evaluation of swallowing. OD in general was identified in 65%, with aspiration in 49%, silent aspiration in 21% and limitations of oral intake in 56%. Despite a good sensitivity, for aspiration of 100% and for limitations of oral intake of 97.8%, the presented water screening test did not satisfactorily predict either of these reference criteria due to its low positive likelihood ratio (aspiration=2.6; limitations of oral intake=3.1). However, it is an accurate tool for the early identification of OD in general, with a sensitivity of 96.2% and a positive likelihood ratio of 5.4 in patients after surgery for HNC.

[1]  S. Daniels,et al.  Valid Items for Screening Dysphagia Risk in Patients With Stroke: A Systematic Review , 2012, Stroke.

[2]  P. Vos,et al.  Dysphagia severity and aspiration following postoperative radiation for locally advanced oropharyngeal cancer. , 2008, Anticancer Research.

[3]  J. Rosenbek,et al.  Utility of clinical swallowing examination measures for detecting aspiration post-stroke. , 2005, Journal of speech, language, and hearing research : JSLHR.

[4]  A. Wrench,et al.  Chewing and swallowing after surgical treatment for oral cancer: functional evaluation in 196 selected cases. , 2004, Plastic and Reconstructive Surgery.

[5]  P. Carding,et al.  Swallowing performance in patients with head and neck cancer: a simple clinical test. , 2009, Oral oncology.

[6]  B. Pauloski,et al.  Rehabilitation of dysphagia following head and neck cancer. , 2008, Physical medicine and rehabilitation clinics of North America.

[7]  D. Altman,et al.  Diagnostic tests 4: likelihood ratios , 2004, BMJ : British Medical Journal.

[8]  Ellen B. Roecker,et al.  A penetration-aspiration scale , 2004, Dysphagia.

[9]  O. Ekberg,et al.  Identifying vulnerable patients: role of the EAT-10 and the multidisciplinary team for early intervention and comprehensive dysphagia care. , 2012, Nestle Nutrition Institute workshop series.

[10]  S. Konsulov.  Surgical treatment of anterolateral tongue carcinoma. , 2005, Folia medica.

[11]  M Brandon Westover,et al.  Send Orders of Reprints at Bspsaif@emirates.net.ae Information Theoretic Quantification of Diagnostic Uncertainty , 2022 .

[12]  G. Guyatt,et al.  Users' Guides to the Medical Literature: III. How to Use an Article About a Diagnostic Test: B. What Are the Results and Will They Help Me In Caring for My Patients? , 1994 .

[13]  M. Crary,et al.  Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. , 2005, Archives of physical medicine and rehabilitation.

[14]  P. Pasche,et al.  [Reconstruction of the anterior mouth floor by surgical flap microanastomosis: oncologic and functional results]. , 2000, Schweizerische medizinische Wochenschrift. Supplementum.

[15]  K. Kitikidou,et al.  Cutaneous squamous cell carcinoma (SCC) of the head and neck: risk factors of overall and recurrence-free survival. , 2010, European journal of cancer.

[16]  S. Langmore.  Endoscopic Evaluation and Treatment of Swallowing Disorders , 2000 .

[17]  P. Carding,et al.  The clinical application of the 100mL water swallow test in head and neck cancer. , 2011, Oral oncology.

[18]  R. Martino,et al.  Screening for Oropharyngeal Dysphagia in Stroke: Insufficient Evidence for Guidelines , 2000, Dysphagia.

[19]  Heather M. Starmer,et al.  The effect of pneumonia on short‐term outcomes and cost of care after head and neck cancer surgery , 2012, The Laryngoscope.

[20]  S. Rogers,et al.  Swallowing rehabilitation after oro-pharyngeal resection for squamous cell carcinoma. , 2000, The British journal of oral & maxillofacial surgery.

[21]  Yeun-Chung Chang,et al.  Evaluating Swallowing Dysfunction Using a 100-ml Water Swallowing Test , 2003, Dysphagia.

[22]  C. Arens,et al.  Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology – Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children , 2015, GMS current topics in otorhinolaryngology, head and neck surgery.

[23]  Susan E. Langmore,et al.  Fiberoptic endoscopic examination of swallowing safety: A new procedure , 2006, Dysphagia.

[24]  G. Guyatt,et al.  Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. , 1994, JAMA.

[25]  H. Danker,et al.  [Swallowing disorders after partial laryngectomy. Prevalence and predictors]. , 2012, HNO.

[26]  J. Macmahon,et al.  Aspiration in acute stroke: a clinical study with videofluoroscopy. , 1993, The Quarterly journal of medicine.

[27]  Robert Teasell,et al.  The Toronto Bedside Swallowing Screening Test (TOR-BSST): Development and Validation of a Dysphagia Screening Tool for Patients With Stroke , 2009, Stroke.

[28]  R. Martino.  Screening and clinical assessment of oropharyngeal dysphagia. , 2012, Nestle Nutrition Institute workshop series.

[29]  N. Gellrich,et al.  Speech and swallowing impairment after treatment for oral and oropharyngeal cancer. , 2008, Archives of otolaryngology--head & neck surgery.