A Functional Outcome Swallowing Scale for Staging Oropharyngeal Dysphagia

Abstract

Objective: To develop a simple and straightforward functional outcome swallowing scale (FOSS) for patients with oropharyngeal dysphagia to determine the severity of the disorder and the effectiveness of therapy or outcome. Design: Five years ago, the author developed a dysphagia staging scale based on personal experience and a review of the English literature. This scale was shared with colleagues from the specialties of otolaryngology, speech pathology, neurology, and gastroenterology, both within and outside the author’s institution. Minor modifications have been made. The scale has been used in clinical management and retrospective studies. Setting: Patients were seen in a multispecialty, tertiary care, academic center. Patients: The patient population included the full spectrum of oropharyngeal dysphagia in adults, but was weighted heavily toward aging patients and patients with head and neck cancer, neurologic disorders, gastroesophageal conditions, and psychiatric problems. Results: The stages are as follows: stage 0 = normal function and asymptomatic; stage I = normal function but with episodic or daily symptoms of dysphagia; stage II = compensated abnormal function manifested by significant dietary modifications or prolonged mealtime (without weight loss or aspiration); stage III = decompensated abnormal function with weight loss of 10% or less of body weight over 6 months due to dysphagia, or daily cough, gagging, or aspiration during meals; stage IV = severely decompensated abnormal function with weight loss of more than 10% of body weight over 6 months due to dysphagia, or severe aspiration with bronchopulmonary complications, nonoral feeding recommended for most of nutrition, and stage V = nonoral feeding for all nutrition. Conclusions: The FOSS was successful for staging various adult patients with dysphagia into clinically useful, overall performance categories. It has been applied successfully to retrospective outcome studies and to clinical management by clinicians from different specialties.

Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia

“…Data were collected during a 3-month period. All patients with grade-2 feeding difficulties on the functional outcome swallowing scale (FOSS) [22] and the NGTfed residents of these LTC wards were eligible for the study. FOSS was used since on the same scale it grades patients with no swallowing difficulties, those with various stages of dysphagia, and also those enteral fed by tube.…”

Transoral laser microsurgery as primary treatment for advanced‐stage oropharyngeal cancer: A united states multicenter study

“…Secondary endpoints were HPV status (p16, ISH, histopathology), patterns of failure (local, regional, distant), ECS from neck nodes, tracheostomy rates, days of hospitalization, and swallowing function as determined by gastrostomy tube (G-tube) placement (single-center study) and Functional Outcome Swallowing Scale (FOSS). 24 The FOSS ranks swallowing function from 0 to 5, with 0 being normal function and 4 to 5 being gastrostomy tube (G-tube) dependent (Table 1). OS was defined as the time from surgery to the date of death resulting from any cause.…”

Efficacy of large-diameter dilatation in cricopharyngeal dysfunction

“…Functional Outcomes Swallowing Scale (FOSS) scores were applied retrospectively to each outpatient visit based on the practitioner notes (Table I). 4 …”