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Dysphagia among patients after total laryngectomy: diagnostic and therapeutic procedures

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Jamróz B., Chmielewska-Walczak J., Milewska M.

Polski Przegląd Otorynolaryngologiczny

2020

vol. 9(4)

23-28

Dysphagia concerns 10–89% patients after total laryngectomy; to a greater extent it regards patients receiving complementary radiotherapy. The disease mechanism is associated with anatomical changes after surgery (typeof surgery) or complications of adjuvant therapy (xerostomia, neuropathy, swelling of tissue, etc.). The above changes lead to: decreased mobility of the lateral walls of the pharynx and tongue retraction, the occurrence of tounge pumping movements, decreased swallowing reflex, weakening of the upper esophageal sphincter opening, contraction of the cricopharyngeal muscle, tissue fibrosis, formation of pharyngeal pseudodiverticulum, etc. As a result: regurgitation of food through the nose and oral cavity, food sticking in middle and lower pharynx, prolongation of bolus transit time. Upon the formation of tracheoesophageal fistula, there may be aspiration of gastric contents. The above changes considerably reduce patients’ quality of life after surgery. The diagnostic protocol includes: medical interview (questionnaires such as EAT 10, SSQ, MDADI, DHI can be helpful), clinical swallowing assessment and instrumental examinations: primarily videofluoroscopy but also endoscopic evaluation of swallowing. Selected cases also require high frequency manometry. The treatment options include: surgical methods (e.g. balloon dilatation of the upper esophageal sphincter, cricopharyngeal myotomy, pharyngeal plexus neurectomy, removal of the pharyngeal pseudodiverticulum), pharmacological treatment or conservative methods (e.g. botulinum toxin injection of the upper esophageal sphincter, speech therapy, nutritional treatment) and supportive methods such as consultation with a psychologist, physiotherapist, clinical dietitian). The selection of a specific treatment method should be preceded by a diagnostic process in which the mechanism of functional disorders related to voice formation and swallowing will be established.

Videofluoroscopic examination – study procedure with an assessment questionnaire

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Chmielewska J., Jamróz B., Gibiński K., Sielska-Badurek E., Milewska M., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

2017

vol. 6(1)

12-20

In this article, we proposed a questionnaire for assessment of videofluorscopic examination in patients with swallowing disorders. It was developed during years 2015 - 2016 by the Department of Otolaryngology at the Medical University of Warsaw. The main body of the form consists of 3 parts assessing the oral phase, the pharyngeal phase and the esophageal phase. The main column contains a list of specific symptoms with yes/no answers. There is a four-point scale assessing the severity of the disorders from 0 to 3, where 0 corresponds to clinically insignificant findings, 1- mild impairment, 2 - moderate impairment, and 3 – severe impairment. Other elements of the form include: basic demographic and nutritional data, assessment of the consistency and texture of ingested food, food texture recommended based on the evaluation acc. to the recommendations of the International Dysphagia Diet Standardization Initiative (www.iddsi.org), and therapeutic assessment before implementation of speech therapy. The questionnaire was prepared on the basis of Trinity College survey, own experience and literature data.

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2 Polski Przegląd Otorynolaryngologiczny

1 2020

1 2017

2 Jamróz B.

2 Milewska M.

1 Chmielewska J.

1 Chmielewska-Walczak J.

1 Gibiński K.

1 Niemczyk K.

1 Sielska-Badurek E.

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Dysphagia among patients after total laryngectomy: diagnostic and therapeutic procedures

Videofluoroscopic examination – study procedure with an assessment questionnaire