The Penetration–Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis

Abstract

A standard for assessing swallowing function after open partial horizontal laryngectomy (OPHL) is still not established. The variability in the measures used to investigate swallowing functional outcomes after OPHL limits the communication among clinicians and the possibility to compare and combine results from different studies. The study aims to adapt the PAS to the altered anatomy after OPHLs using fiberoptic endoscopic evaluation of swallowing (FEES) and to test its reliability. To adapt the PAS, two landmarks were identified: the entry of the laryngeal vestibule and the neoglottis. Ninety patients who underwent an OPHL were recruited (27 type I, 31 type II and 32 type III). FEES was performed and video-recorded. Two speech and language therapists (SLTs) independently rated each FEES using the PAS adapted for OPHL (OPHL-PAS). FEES recordings were rated for a second time by both SLTs at least 15 days from the first video analysis. Inter-and intra-rater agreement was assessed using unweighted Cohen's kappa. Overall, inter-rater agreement of the OPHL-PAS was k = 0.863, while intra-rater agreement was k = 0.854. Concerning different OPHL types, inter-and intra-rater agreement were k = 0.924 and k = 0.914 for type I, k = 0.865 and k = 0.790 for type II, and k = 0.808 and k = 0.858 for type III, respectively. The OPHL-PAS is a reliable scale to assess the invasion of lower airway during swallowing in patients with OPHL using FEES. The study represents the first attempt to define standard tools to assess swallowing functional outcome in this population.

Supracricoid laryngectomy: the impact of senescence on swallowing safety

“…Supracricoid laryngectomy CHEP is a traditionally prescribed surgical procedure for the treatment of intermediate and advanced stage tumors, which justifies the prevalence of individuals with clinical staging two and three (71.5%). (9,11,(16)(17)(18) The procedure has proven to be a viable alternative to total laryngectomy, with partial preservation of laryngeal functions in all individuals.…”

“…Tracheal aspiration is a known chronic clinical outcome of SCL, with approximately 40% incidence in the postoperative period, even in individuals without complaints. (17)(18)(19) Deficits in glottic closure and airway protection, due to the removal of approximately 70% of organ, and changes in sensitivity in the neolarynx may partially justify such findings. (19) Patients aged over 60 years had a higher prevalence of penetration and aspiration during the objective analysis of swallowing.…”

Surgical rehabilitation of swallowing with polydimethylsiloxane injections after open partial horizontal laryngectomy: Long‐term functional results and quality of life

“…We used a modified version of the penetration‐aspiration scale 13 (Table 1) because all the patients had undergone a partial laryngectomy. The penetration‐aspiration scale considers the vocal folds in the evaluation of penetration of the bolus, being not suitable for patients with previous OPHL II or III.…”

“…In particular, after blind reviewing of the registered videos of FEES, scores were assigned by investigators using a modified penetration‐aspiration scale 13 (Table 1). These scores were used to evaluate the swallowing function before the Vox implant injection and at last follow‐up.…”

European white paper: oropharyngeal dysphagia in head and neck cancer

“…FEES rating scales, such as the PAS [132,156] and the Yale Pharyngeal Residue Rating Scale [157], were not specifically developed for HNC patients. An exception is the adaptation of the PAS for patients who underwent partial laryngectomy [158] and the scale developed to evaluate swallowing residue post-TLE [159]. Although the level of intra-and interobserver agreement of the FEES rating scales was reported to be similar in neurology and oncology patients [160] there is insufficient evidence that FEES scales developed and validated for neurogenic OD are also suitable to evaluate swallowing in HNC patients.…”