Assessment of pharyngeal motor function using a novel velopharyngeal squeeze maneuver and a novel endoscopic pharyngeal contraction grade scale in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma

Abstract

Background To investigate a novel velopharyngeal squeeze maneuver (VPSM) and novel endoscopic pharyngeal contraction grade (EPCG) scale for the evaluation of pharyngeal motor function. Methods During endoscopic examination of 77 post‐irradiated nasopharyngeal carcinoma patients and control subjects, VPSM was rated and lateral pharyngeal wall movement graded with EPCG scale during swallowing. Pharyngeal constriction ratio (PCR) measured by videofluoroscopy was used for correlation. Results VPSM and EPCG scale showed almost perfect intra‐rater and inter‐rater reliability (Kappa: >0.90). VPSM was present in 61% of patients suggesting good pharyngeal motor function. VPSM was predictive of EPCG scale (Wald statistic = 29.99, p < 0.001). EPCG scale also correlated strongly with PCR (r: 0.812) and was predictive for aspiration (odds ratio: 22.14 [95% CI 5.01–97.89, p < 0.001]). Conclusions VPSM and EPCG scale are two novel tools to assess pharyngeal motor function, and both correlate well with pharyngeal contractility and aspiration.

Longitudinal Analysis of Swallowing Displacement Kinematics After Oropharyngeal Cancer Treatment

“…Prior studies that demonstrated worsening PCR tend to have a median follow-up of 6 to 14 years from treatment, suggesting that PCR changes are more evident in late radiation associated dysphagia. 38,39 Similarly, PESmax did not change significantly in this study, which is consistent with previous research in OPSCC suggesting no differences when compared to controls 6 and 12 months following radiation. 6,36 Results from this study in conjunction with prior literature suggest PCR and PESmax may not significantly change in the first 2 years after treatment, however, long-term surveillance is critical.…”

“…Although mean PCR worsened in the study cohort, significance was lost after sex and age matching. Prior studies that demonstrated worsening PCR tend to have a median follow‐up of 6 to 14 years from treatment, suggesting that PCR changes are more evident in late radiation associated dysphagia 38,39 . Similarly, PESmax did not change significantly in this study, which is consistent with previous research in OPSCC suggesting no differences when compared to controls 6 and 12 months following radiation 6,36 .…”

“…21,25 Although longitudinal change in swallowing physiology after radiation treatment has been studied using qualitative measures, 19,[26][27][28][29][30][31][32] analysis of dysphagia in oropharyngeal cancer patients using quantitative swallowing kinematics is lacking. 6,26,[33][34][35][36][37][38][39][40][41] The purpose of this study is two-fold: (1) to perform a longitudinal analysis of swallowing function in patients with OPSCC after definitive and adjuvant radiation treatment using both quantitative DSS displacement kinematic measures and swallowing function outcome measures; and (2) to report how changes in swallowing kinematic measures correlate with swallowing functional outcome measures. We postulate that swallowing displacement kinematic measures can reliably detect fluctuant changes in pharyngeal mobility and capture the decline in swallowing function seen following cancer treatment.…”

“…In addition, the use of quantitative measures allows for age‐ and sex‐matched normative comparison 20,23,24 and prediction of an individual's risk for future aspiration 21,25 . Although longitudinal change in swallowing physiology after radiation treatment has been studied using qualitative measures, 19,26–32 analysis of dysphagia in oropharyngeal cancer patients using quantitative swallowing kinematics is lacking 6,26,33–41 …”

Effects of Swallowing Rehabilitation Training with a Balloon Dilation Therapy on the Deglutition Function and Quality of Life of Patients with Dysphagia after Radiotherapy for Nasopharyngeal Carcinoma

“…Dysphagia refers to swallowing problems caused by the impaired structure and function of swallowing organs, which often happens to patients with head and neck malignant tumors after treatment, such as NPC, laryngeal cancer, and tongue cancer [ 15 , 16 ]. As the most prevalent head and neck cancer in China [ 17 ], high-dose radiotherapy is preferred for NPC.…”