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Predicting Swallowing Outcomes from Objective Videofluoroscopic Timing and Displacement Measures in Head and Neck Cancer Patients

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Abstract

Radiation therapy with or without chemotherapy compromises swallowing efficiency and safety in patients with head and neck cancer (HNC). The resulting dysphagia leads to overall morbidity, with altered diets, reduced nutritional intake, reduced quality of life, and potential interruption of curative cancer treatment. Despite well-documented radiation-related changes in swallowing physiology, scarce research exists on the potential clinical value for measurements of swallowing timing and displacement in this population. This study investigated the discriminatory value of quantitative timing and displacement parameters for the Functional Oral Intake Scale and Penetration Aspiration Scale scores using pre- and post-radiation videofluoroscopy data. Swallowtail Software Version 1 (Belldev Medical, Arlington Heights, IL) was used to obtain objective timing and displacement measurements from the pre- and post-radiation videofluoroscopy data for 31 patients who underwent radiation therapy, with or without chemotherapy, for head and neck cancer. The total pharyngeal transit time (BP2) (p < 0.000, r = 0.43) in pudding bolus trials and the maximal upper esophageal sphincter opening (PESMax/cm) (p = 0.001, r = 0.31) in thin bolus trials were discriminatory for Functional Oral Intake Scale (FOIS). Findings suggest that measurement of post-radiation changes using objective and quantitative parameters may offer some discriminatory value regarding future dysphagia risk and prognosis based on total pharyngeal transit time and degree of UES opening. In addition, the results suggest that different bolus types may offer different discriminatory values in HNC population, and that some timing and displacement variables may have discriminatory value for patients’ diet levels independent from any aspiration risk.

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Authors and Affiliations

  1. Department of Communication Science and Disorders, Louisiana State University, 68 Hatcher Hall, Field House Drive, Baton Rouge, LA, 70803, USA

    Mathew B. Vansant, Lindsey A. Parker, Andrew J. McWhorter & Melda Kunduk

  2. Department of Experimental Statics, Louisiana State University, 61 M. D. Woodin Hall, Baton Rouge, LA, 70803, USA

    David Bluoin

  3. Our Lady of the Lake Regional Medical Center -Voice Center, 4950 Essen Lane, Suite 401, Baton Rouge, LA, 70809, USA

    Mathew B. Vansant, Lindsey A. Parker, Andrew J. McWhorter & Melda Kunduk

  4. Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, 433 Bolivar Street, New Orleans, LA, 70112, USA

    Andrew J. McWhorter & Melda Kunduk

  5. Department of Communication Science and Disorders, University of Montevallo, Station 6720 Wallace Speech and Hearing Center, Montevallo, AL, 35115, USA

    Mathew B. Vansant

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  1. Mathew B. Vansant
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  2. Lindsey A. Parker
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Correspondence to Melda Kunduk.

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Vansant, M.B., Parker, L.A., McWhorter, A.J. et al. Predicting Swallowing Outcomes from Objective Videofluoroscopic Timing and Displacement Measures in Head and Neck Cancer Patients. Dysphagia 35, 853–863 (2020). https://doi.org/10.1007/s00455-020-10091-5

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  • DOI: https://doi.org/10.1007/s00455-020-10091-5

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