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- Dotevall, Hans, 1958, et al.
(author)
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Treatment with head-lift exercise in head and neck cancer patients with dysphagia: results from a randomized, controlled trial with flexible endoscopic evaluation of swallowing (FEES)
- 2023
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 31:1
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Journal article (peer-reviewed)abstract
- Background: This randomized study aimed to evaluate the effects of the Shaker head-lift exercise (HLE) to improve dysphagia following oncologic treatment for head and neck cancer (HNC). Methods: Patients with dysphagia following oncologic treatment for HNC were randomly assigned to intervention (n = 23) or control (standard dysphagia management, n = 24) groups. Swallowing was evaluated at baseline and at 8-week follow-up using flexible endoscopic evaluation of swallowing (FEES) and self-perceived swallowing with the Eating Assessment Tool (EAT-10). Analysis was performed regarding secretion, initiation of swallow, residue after swallowing, and penetration/aspiration. Results: Few statistically significant differences were found in the FEES analysis. Some improvement of self-perceived swallowing function was found in both groups. Adherence to training was high. Conclusions: This randomized study regarding the effect of the HLE demonstrated that swallowing outcome measures used in assessment of FEES did not improve in patients treated with radiotherapy for patients with dysphagia following HNC.
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- Finizia, Caterina, 1961, et al.
(author)
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Intelligibility and perceptual ratings after treatment for laryngeal cancer: laryngectomy versus radiotherapy.
- 1998
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In: The Laryngoscope. - 0023-852X. ; 108:1 Pt 1, s. 138-43
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Journal article (peer-reviewed)abstract
- In Sweden the most common treatment for T3-T4 laryngeal carcinoma is radical radiotherapy (with surgery for salvage), because the voice is thus preserved. A Swedish study showed that surgery yielded a significantly better 5-year survival and locoregional control at 3 years in T4 laryngeal carcinoma than radical radiotherapy. With these results in mind, we wanted to compare the different modes of treatment (surgery with a tracheoesophageal [TE] fistula and radical radiotherapy) with respect to the patients' speech proficiency. Twenty-eight subjects (with 14 patients in each treatment group) were judged by inexperienced and experienced listeners according to intelligibility by transcription and three perceptual ratings. From the perceptual ratings of speech intelligibility, voice quality, and speech acceptability we conclude that there is a significant difference, the irradiated speakers being rated higher than the tracheoesophageal speakers. It is also clear that most of the TE and irradiated laryngeal speaking patients are comparable to normal laryngeal speakers in intelligibility by transcription. Experienced and inexperienced listeners are able to rate TE and irradiated laryngeal speech reliably and similarly according to intelligibility by transcription. The inexperienced listeners rated the TE speakers significantly higher than did the experienced listeners.
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- Osbeck Sandblom, H., et al.
(author)
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Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU-An observational clinical study
- 2021
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:6
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Journal article (peer-reviewed)abstract
- Background Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive care unit (ICU) is still limited. Objectives The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19. Method A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings. Results Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%. Conclusion Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.
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