Skip to main content
SpringerLink
Log in

The results of sequential swallowing assessments after total laryngectomy for laryngeal and hypopharyngeal malignancies

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Swallowing after total laryngectomy (TL) is altered and the swallowing related issues are largely underreported. It is important to identify factors that may negatively influence swallowing after TL in order to rehabilitate these patients appropriately.

Methods

The study included patients who underwent TL from June 2015 to November 2017 for laryngeal and hypopharyngeal malignancy. Sequential swallowing assessment was done in these patients over time. The assessments were done using the FOIS scale and the PSS-HN normalcy of diet scores and analysed to assess the presence of swallowing related issues, factors influencing swallowing and its recovery over time.

Results

Sixty-seven who underwent total laryngectomy (TL) were included in the study. Swallowing assessments were done once in 3 months. Overall there was an improvement in swallowing over time. Both the FOIS (Median score of 3.82 in first to 5.77 in the fifth visit) and the PSS-HN scores (median score of 33.63 at first visit to 63.66 at fifth visit) improved over time. Patients undergoing TL after treatment failure with chemoradiotherapy (p value < 0.001) and those with advanced stage disease (p-value < 0.001) did poorly in terms of swallowing. At the last follow up only 8 patients were dependent on feeding tube; the rest of the patients were able to take food orally.

Conclusion

Following total laryngectomy swallowing gradually improves in the first 18 months after surgery. It is essential to identify factors influencing swallowing negatively so that these patients can get appropriate attention to improve swallowing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Matsuo K, Palmer J (2008) Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am 19(4):691–707

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pauloski B, Rademaker A, Logemann J, Stein D, Beery Q, Newman L et al (2000) Pretreatment swallowing function in patients with head and neck cancer. Head Neck 22(5):474–482

    Article  CAS  PubMed  Google Scholar 

  3. Logemann J, Rademaker A, Pauloski B, Lazarus C, Mittal B, Brockstein B et al (2006) Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck 28(1):64–73

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schindler A, Denaro N, Russi EG, Pizzorni N, Bossi P, Merlotti A et al (2015) Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus. Crit Rev Oncol/Hematol 96(2):372–384

    Article  Google Scholar 

  5. Maclean J, Cotton S, Perry A (2008) Post-laryngectomy: it’s hard to swallow. Dysphagia 24(2):172–179

    Article  PubMed  Google Scholar 

  6. Maclean J, Cotton S, Perry A (2009) Post-laryngectomy: it’s hard to swallow Australian study of prevalence and self-reports of swallowing function after a total laryngectomy. Dysphagia 24:172–179

    Article  PubMed  Google Scholar 

  7. Sullivan P, Hartig G (2001) Dysphagia after total laryngectomy. Curr Opin Otolaryngol Head Neck Surg 9(3):139–146

    Article  Google Scholar 

  8. Denaro N, Merlano M, Russi E (2013) Dysphagia in head and neck cancer patients: pretreatment evaluation, predictive factors, and assessment during radio-chemotherapy, recommendations. Clin Exp Otorhinolaryngol 6(3):117

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hutcheson K, Barringer D, Rosenthal D, May A, Roberts D, Lewin J (2008) Swallowing outcomes after radiotherapy for laryngeal carcinoma. Arch Otolaryngol Head Neck Surg 134(2):178

    Article  PubMed  Google Scholar 

  10. Ward EC, Kerle SM, Hancock KL, Perkins KA (2014) Swallowing rehabilitation following total laryngectomy. In: Ward EC, van As-Brooks CJ (eds) Head and neck cancer: treatment, rehabilitation and outcomes. Plural Publishing, San Diego, pp 343–373

    Google Scholar 

  11. Clarke P, Radford K, Coffey M, Stewart M (2016) Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130(Suppl 2):S176–S180

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Shultz JR, Harrison J (1992) Defining and predicting tracheoesophageal puncture success. Arch Otolaryngol Head Neck Surg 118(8):811–816

    Article  CAS  PubMed  Google Scholar 

  13. Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098

    Article  CAS  PubMed  Google Scholar 

  14. Lippert D, Hoffman M, Britt C, Jones C, Hernandez J, Ciucci M et al (2016) Preliminary evaluation of functional swallow after total laryngectomy using high-resolution manometry. Ann Otol Rhinol Laryngol 125(7):541–549

    Article  PubMed  PubMed Central  Google Scholar 

  15. Coffey M, Tolley N, Howard D, Drinnan M, Hickson M (2018) An Investigation of the post-laryngectomy swallow using videofluoroscopy and fiberoptic endoscopic evaluation of swallowing (FEES). Dysphagia 33(3):369–379

    Article  PubMed  PubMed Central  Google Scholar 

  16. List M, D’Antonio L, Cella D, Siston A, Mumby P, Haraf D et al (1996) The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy-head and neck scale: a study of utility and validity. Cancer 77(11):2294–2301

    Article  CAS  PubMed  Google Scholar 

  17. Crary M, Mann G, Groher M (2005) Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 86(8):1516–1520

    Article  PubMed  Google Scholar 

  18. Maclean J, Cotton S, Perry A (2008) Variation in surgical methods used for total laryngectomy in Australia. J Laryngol Otol 122:728–732

    Article  CAS  PubMed  Google Scholar 

  19. Hui Y, Wei WI, Yuen PW et al (1996) Primary closure of pharyngeal remnant after total laryngectomy and partial pharyngectomy: how much residual mucosa is sufficient. Laryngoscope 106:490–494

    Article  CAS  PubMed  Google Scholar 

  20. Tan NC, Lin PY, Kuo PJ, Tsai YT, Chen YC, Nguyen KT et al (2015) An objective comparison regarding rate of fistula and stricture among anterolateral thigh, radial forearm, and jejunal free tissue transfers in circumferential pharyngo-esophageal reconstruction. Microsurgery 35:345–349

    Article  PubMed  Google Scholar 

  21. Van der Kamp MF, Rinkel RNPM, Eerenstein SEJ (2017) The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia. Eur Arch Otorhinolaryngol 274:1967–1973

    Article  PubMed  Google Scholar 

  22. Hanasono MM, Lin D, Wax MK, Rosenthal EL (2012) Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck 34:580–588

    Article  PubMed  Google Scholar 

  23. Pou A (2004) Tracheoesophageal voice restoration with total laryngectomy. Otolaryngol Clin North Am 37(3):531–545

    Article  PubMed  Google Scholar 

  24. Coffey M, Tolley N, Howard D, Hickson M (2018) Double-blind study investigating the effect of different voice prostheses on ease of swallowing and residue post laryngectomy. Dysphagia 33(5):616–626

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rosenthal DI, Mohamed AS, Weber RS, Garden AS, Sevak PR, Kies MS et al (2015) Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4squamous cell carcinoma of the larynx: a 3-decade survey. Cancer 121:1608–1619

    Article  PubMed  Google Scholar 

  26. Weber RS, Berkey BA, Forastiere A, Cooper J, Maor M, Goepfert H et al (2003) Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg 129(1):44–49

    Article  PubMed  Google Scholar 

  27. Eisbruch A, Schwartz M, Rasch C, Vineberg K, Van Damen E, As CJ et al (2004) Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 60(5):1425–1439

    Article  PubMed  Google Scholar 

  28. Hutchison A, Cartmill B, Wall L, Ward E (2019) Dysphagia optimized radiotherapy to reduce swallowing dysfunction severity in patients undergoing treatment for head and neck cancer: a systematized scoping review. Head Neck 41(6):2024–2033

    Article  PubMed  Google Scholar 

  29. Ohba S, Yokoyama J, Kojima M, Fujimaki M, Anzai T, Komatsu H et al (2016) Significant preservation of swallowing function in chemoradiotherapy for advanced head and neck cancer by prophylactic swallowing exercise. Head Neck 38(4):517–521

    Article  PubMed  Google Scholar 

  30. Carroll W, Locher J, Canon C, Bohannon I, McColloch N, Magnuson J (2008) Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope 118(1):39–43

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Speech and Swallowing, Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

    Arun Balaji

  2. Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

    Shivakumar Thiagarajan, Adhara Chakraborthy, Snehal Shah & Devendra Chaukar

  3. Narayana Superspeciaility Hospital, Howrah, Kolkata, West Bengal, India

    Harsh Dhar

  4. Crossing Chair Hospital, London, UK

    Akshat Malik

  5. Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhaba National Institute (HBNI), Navi Mumbai, India

    Atanu Bhattacharjee

  6. Department of ENT, Base Hospital, New Delhi, India

    Supreet Nayyar

  7. Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, 400012, India

    Shivakumar Thiagarajan

Authors
  1. Arun Balaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shivakumar Thiagarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harsh Dhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akshat Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atanu Bhattacharjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Adhara Chakraborthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Snehal Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Supreet Nayyar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Devendra Chaukar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concepts: ST, DC, HD. Study design: ST, HD. Data acquisition: AC, HD, SSN, SS. Quality control of data and algorithms: ST, DC. Statistical analysis: AB, ST, HD. Manuscript preparation: all authors. Manuscript editing: ST, HD, DC. Manuscript reviewing: all authors.

Corresponding author

Correspondence to Shivakumar Thiagarajan.

Ethics declarations

Conflict of interest

None.

Ethical approval

Institute ethical committee clearance taken for this study (Approval Number: IEC/1219/3308/001, Project Number-3308). All received the standard of care for their condition and was as per the ethical standards.

Informed consent

No identifying information about participants is available in the article. However, all patients have given consent for the treatment they have received.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balaji, A., Thiagarajan, S., Dhar, H. et al. The results of sequential swallowing assessments after total laryngectomy for laryngeal and hypopharyngeal malignancies. Eur Arch Otorhinolaryngol 277, 3469–3477 (2020). https://doi.org/10.1007/s00405-020-06105-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-06105-5

Keywords

Search

Navigation