An Investigation of the Post-laryngectomy Swallow Using Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Abstract

This study investigates the post-laryngectomy swallow. Presence and degree of residue on the post-laryngectomy swallow as observed on videofluoroscopy and FEES is described. In addition, videofluoroscopy and FEES are assessed for reliability and inter-instrument agreement. 30 laryngectomy subjects underwent dysphagia evaluation using simultaneous videofluoroscopy and FEES. These were reviewed post-examination by three expert raters using a rating scale designed for this purpose. Raters were blinded to subject details, type of laryngectomy surgery, pairing of FEES and videofluoroscopy examinations and the scores of other raters. There was a finding of residue in 78% of videofluoroscopy ratings, and 83% of FEES ratings. Comparison of the tools indicated poor inter-rater reliability and poor inter-instrument agreement. Dysphagia is an issue post laryngectomy as measured by patient self-report and by instrumental evaluation. However, alternative dysphagia rating tools and dysphagia evaluation tools are required to enable accurate identification and intervention for underlying swallow physiology post laryngectomy.Electronic supplementary materialThe online version of this article (10.1007/s00455-017-9862-7) contains supplementary material, which is available to authorized users.

Simultaneous Radiological and Fiberendoscopic Evaluation of Swallowing (“SIRFES”) in Patients After Surgery of Oropharyngeal/Laryngeal Cancer and Postoperative Dysphagia

“…We combined scale 0 and 1 (bolus head at posterior angel of ramus and bolus head at vallecular pit), since in older patients both timepoints can be considered to be within normal limits, as stated by Stephen et al [30]. Contrary to former studies [11, 31–33], our results showed good interrater variability for both modalities. This may be due to the fact that our readers were highly qualified, which is reported to increase consistency between raters´ results [32, 33].…”

“…Kelly compared videofluoroscopy and FEES simultaneously with regard to the assessment of penetration and aspiration and pharyngeal residue [8, 9]. Recently, a British group investigated simultaneous FEES and VFSS in patients after laryngectomy [11]. In most studies, patients were suffering from dysphagia of mixed etiology.…”

“…Through a simultaneous examination, both the examination conditions, as well as the general condition of the patient, can be ruled out as a variable. To date, only a few studies have analyzed the simultaneous application of both diagnostic methods [6, 8–11]. These studies have focused on the examination of unimpaired swallowing in healthy subjects [6], or the assessment of the risk of aspiration [8], and pharyngeal residue [9, 10] in a small number of dysphagic patients without assignment to a specific clinical group.…”

“…These studies have focused on the examination of unimpaired swallowing in healthy subjects [6], or the assessment of the risk of aspiration [8], and pharyngeal residue [9, 10] in a small number of dysphagic patients without assignment to a specific clinical group. Coffey et al evaluated simultaneously performed examinations in patients after laryngectomy [11]. Especially in patients after surgery in the area of the oropharynx and larynx and concomitant radiotherapy, the combination of structural and functional deficits represents a particular challenge for imaging modalities.…”

Reconstruction technique following total laryngectomy affects swallowing outcomes

“…Dysphagia following total laryngectomy is attributed to stricture, diverticula, reduced transit in the neopharynx, and reflux 8,13 . Frequent complaints reported by patients include globus, regurgitation, prolonged mealtime, and food sticking 8,14,15 …”