Swallowing Patterns in the HNC Population: Timing of Penetration-Aspiration Events and Residue. Otolaryngol Head Neck Surg 2020 Dec;163(6):1232-1239
Date
07/08/2020Pubmed ID
32633196DOI
10.1177/0194599820933883Scopus ID
2-s2.0-85087626955 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
OBJECTIVE: This study described swallowing patterns in a large head/neck cancer (HNC) cohort.
STUDY DESIGN: In a retrospective review of data from a randomized controlled trial, we studied timing of penetration events as they related to aspiration and oral/pharyngeal residue.
SETTING: Retrospective review of a multicenter randomized controlled trial.
SUBJECTS AND METHODS: In total, 168 patients who were >3 months postradiation received baseline modified barium swallow evaluations. Retrospective analyses of data from these exams were studied, including Penetration-Aspiration Scale (PAS) scores and timing of these events (before, during, or after the swallow), as well as percentage of oral and pharyngeal residue.
RESULTS: Aspiration occurred more frequently after than before or during the swallow (P < .05). There were significantly more events of penetration that led to aspiration after the swallow (n = 260) when compared to events before (n = 6) or after (n = 81) the swallow. There was more pharyngeal (16%-25%) than oral residue (5%-20%). Weak correlations were found between thin liquid, nectar-thick liquid, pudding residue, and PAS scores, with varying significance (pharyngeal residue/PAS rs: .26*, .35*, .07*; oral residue/PAS rs: .21*, .16, .3; *P < .05).
CONCLUSION: The predominant pattern for this sample of postradiation patients with HNC with dysphagia was aspiration that occurred after the swallow, rather than before or during the swallow. The aspiration was directly caused by penetration events that occurred during the swallow, resulting in aspiration as the airway reopened. Patients demonstrated more pharyngeal residue than oral residue, but a weak relationship was found between residue and penetration/aspiration events. These results guide clinicians in targeting appropriate swallowing interventions.
Author List
Pisegna JM, Langmore SE, Meyer TK, Pauloski BAuthor
Barbara R. Pauloski PhD, CCC-SLP Associate Professor in the Communication Sciences & Disorders department at University of Wisconsin - MilwaukeeMESH terms used to index this publication - Major topics in bold
Barium SulfateContrast Media
Deglutition Disorders
Female
Head and Neck Neoplasms
Humans
Male
Middle Aged
Neoplasm Staging
Respiratory Aspiration
Retrospective Studies
