Effects of chemoradiotherapy on voice and swallowing

Lazarus, Cathy L.

doi:10.1097/moo.0b013e32832af12f

Cited by 111 publications

(76 citation statements)

References 77 publications

(99 reference statements)

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“…water swallow challenge. Silent aspiration occurs more frequently due to laryngeal desensitization from chronic aspiration of secretions [46,47], the effects of chemoradiation therapy [48], and, although a tracheotomy is not causal for aspiration [49,50], if aspiration occurs it is often silent, leading to higher falsenegative rates. Therefore, objective testing with VFSS or FEES is recommended for this patient population.…”

Section: Discussionmentioning

confidence: 99%

Silent Aspiration Risk is Volume-dependent

Leder

Suiter²,

Green

2010

Dysphagia

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Clinical swallow protocols cannot detect silent aspiration due to absence of overt behavioral signs, but screening with a much larger bolus volume, i.e., 90 cc vs. 1-10 cc, may elicit a reflexive cough in individuals who might otherwise exhibit silent aspiration. A swallow screen that maintains high sensitivity to identify aspiration risk while simultaneously reducing the false-negative rate for silent aspiration would be beneficial. The purpose of this study was to investigate whether silent aspiration risk was volume-dependent by using a 3-oz. (90-cc) water swallow challenge to elicit a reflexive cough when silent aspiration occurred on smaller bolus volumes. A prospective, consecutive, referral-based sample of 4102 inpatients from the acute-care setting of a large urban tertiary-care teaching hospital participated. Silent aspiration was determined first by fiberoptic endoscopy and then each participant was instructed to drink 3 oz. of water completely and without interruption. Criteria for challenge failure were inability to drink the entire amount, stopping and starting, or coughing and choking during or immediately after completion. Improved identification of aspiration risk status occurred for 58% of participants who exhibited silent aspiration on smaller volumes, i.e., an additional 48% of liquid silent aspirators and 65.6% of puree silent aspirators coughed when attempting the 3-oz. water swallow challenge. A low false-negative rate was observed for the entire population sample, i.e., ≤2.0%. A combined false-negative rate for participants who silently aspirated was 6.9%, i.e., 7.8% if silently aspirated liquid and 6.1% if silently aspirated puree consistency. Determination of silent aspiration risk was shown to be volume-dependent, with a larger volume eliciting a reflexive cough in individuals who previously silently aspirated on smaller volumes. A 3-oz. water swallow challenge's previously reported high sensitivity for identification of aspiration risk combined with the newly reported low false-negative rate mitigates the issue of silent aspiration risk during clinical swallow screening.

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Section: Discussionmentioning

confidence: 99%

Silent Aspiration Risk is Volume-dependent

Leder

Suiter²,

Green

2010

Dysphagia

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“…In the present cohort, due to positive lymph nodes, the vast majority of patients (20/22) received a radiation dose of 43.5 Gy and higher to the larynx, which has been described in the literature as cutoff value for developing voice problems or chronic edema [4,5]. Voice problems can also occur due to changes in saliva production and lubrication, mainly as a result of radiation dose to the parotid gland and the laryngeal mucosa, which can lead to insufficient lubrication/dryness of the vocal folds [37,55]. Hence, the fact that generally all patients with a tumor located at the larynx or hypopharynx (still) demonstrated less voicedness and increased fundamental frequency at voice recordings at 6 years post-treatment is understandable.…”

Section: Voice Qualitymentioning

confidence: 97%

“…Adequately controlled and randomized data on voice outcomes are scarce anyway, and the available studies often used different diagnostic tests to assess voice quality. Voice problems after (CC)RT treatment may be attributed to impaired vocal fold vibration with incomplete closure, as a result of dryness of the laryngeal mucosa, muscle atrophy, fibrosis, hyperemia, and erythema [8,37]. As a result, abnormal acoustic and aerodynamic measures (harmonicsto-noise ratio, fundamental frequency, measures of jitter, shimmer, and spectral tilt) have been demonstrated in irradiated HNC patients.…”

Section: Introductionmentioning

confidence: 97%

Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises

Kraaijenga

Molen

Jacobi

et al. 2014

Eur Arch Otorhinolaryngol

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Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

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“…60 Some 10-15% of patients are treated with surgery, half of whom subsequently have dysphagia. 60,61 Organ preservation after radio-chemotherapy does not always translate into function preservation owing to inflammation in the acute phase and fibrosis in the late stage. The highest rates of nonfunctional pharynx and larynx, oropharyngeal dysphagia and aspiration are found among patients treated with both surgery and radio-chemotherapy.…”

Section: Patients With Head And/or Neck Diseasesmentioning

confidence: 99%

Dysphagia: current reality and scope of the problem

Clavé

Shaker

2015

Nat Rev Gastroenterol Hepatol

412

248

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Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.

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Effects of chemoradiotherapy on voice and swallowing

Cited by 111 publications

References 77 publications

Silent Aspiration Risk is Volume-dependent

Silent Aspiration Risk is Volume-dependent

Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises

Dysphagia: current reality and scope of the problem

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