Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

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.

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. Batıoğlu-Karaaltın A, Binbay Z, Yiğit Ö, Dönmez Z. Evaluation of life quality, self-confidence and sexual functions in patients with total and partial laryngectomy. Auris Nasus Larynx. 2017;44:188–94. https://doi.org/10.1016/j.anl.2016.03.007.

    Article  PubMed  Google Scholar 

  2. Succo G, Peretti G, Piazza C, Remacle M, Eckel HE, Chevalier D, Simo R, Hantzakos AG, Rizzotto G, Lucioni M, Crosetti E, Antonelli AR. Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society. Eur Arch Otorhinolaryngol. 2014;271:2489–96. https://doi.org/10.1007/s00405-014-3024-4.

    Article  PubMed  CAS  Google Scholar 

  3. Woisard V, Serrano E, Yardeni E, Puech M, Pessey JJ. Deglutition after supra-glottic laryngectomy. J Otolaryngol. 1993;22:278–83.

    PubMed  CAS  Google Scholar 

  4. Naudo P, Laccourreye O, Weinstein G, Jouffre V, Laccourreye H, Brasnu D. Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Otolaryngol Head Neck Surg. 1998;118:124–9.

    Article  CAS  Google Scholar 

  5. Benito J, Holsinger FC, Pérez Martín A, Garcia D, Weinstein GS, Laccoureye O. Aspiration after supracricoid partial laryngectomy: incidence, risk factors, management, and outcomes. Head Neck. 2011;33:679–85. https://doi.org/10.1002/hed.21521.

    Article  PubMed  Google Scholar 

  6. Pinar E, Imre A, Calli C, Oncel S, Katilmis H. Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes. Otolaryngol Head Neck Surg. 2012;147:1093–8. https://doi.org/10.1177/0194599812457334.

    Article  PubMed  Google Scholar 

  7. Rizzotto G, Crosetti E, Lucioni M, Succo G. Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures. Eur Arch Othorinolaryngol. 2012;269:1635–46. https://doi.org/10.1007/s00405-012-1928-4.

    Article  CAS  Google Scholar 

  8. Webster KT, Samlan RA, Jones B, Bunton K, Tufano RP. Supracricoid partial laryngectomy: swallowing, voice, and speech outcomes. Ann Otol Rhinol Laryngol. 2010;119:10–6. https://doi.org/10.1177/000348941011900102.

    Article  PubMed  Google Scholar 

  9. Bron L, Pasche P, Brossard E, Monnier P, Schweizer V. Functional analysis after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Laryngoscope. 2002;122:1289–93. https://doi.org/10.1097/00005537-200207000-00027.

    Article  Google Scholar 

  10. Goeleven A, Dejaeger E, Vander Poorten V, Delaere P. Swallowing and functional outcome after partial laryngectomy: a literature review. B-ENT. 2005;1:165–72.

    PubMed  CAS  Google Scholar 

  11. Schindler A, Favero E, Nudo S, Albera R, Schindler O, Cavalot AL. Long-term voice and swallowing modifications after supracricoid laryngectomy: objective, subjective and self-assessment data. Am J Otolaryngol. 2006;27:378–83. https://doi.org/10.1016/j.amjoto.2006.01.010.

    Article  PubMed  Google Scholar 

  12. Schindler A, Fantini M, Pizzorni N, Crosetti E, Mozzanica F, Bertolin A, Ottaviani F, Rizzotto G, Succo G. Swallowing, voice and quality of life after supratracheal laryngectomy: preliminary long-term results. Head Neck. 2015;37:557–66. https://doi.org/10.1002/hed.23636.

    Article  PubMed  Google Scholar 

  13. Zacharek MA, Pasha R, Meleca RJ, Dworkin JP, Stachler RJ, Jacobs JR, Marks SC, Garfield I. Functional outcomes after supracricoid laryngectomy. Laryngoscope. 2001;111:1558–64.

    Article  CAS  Google Scholar 

  14. Saito K, Araki K, Ogawa K, Shiotani A. Laryngeal function after supracricoid laryngectomy. Otolaryngol Head Neck Surg. 2009;140:487–92. https://doi.org/10.1016/j.otohns.2008.12.036.

    Article  PubMed  Google Scholar 

  15. Simonelli M, Ruoppolo G, de Vincentiis M, Di Mario M, Calcagno P, Vitiello C, Manciocco V, Pagliuca G, Gallo A. Swallowing ability and chronic aspiration after supracricoid partial laryngectomy. Otolaryngol Head Neck Surg. 2010;142:873–8. https://doi.org/10.1016/j.otohns.2010.01.035.

    Article  PubMed  Google Scholar 

  16. Xu B, Boero IJ, Hwang L, Le QT, Moiseenko V, Sanghvi PR, Cohen EE, Mell LK, Murphy JD. Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer. Cancer. 2015;121:1303–11. https://doi.org/10.1002/cncr.29207.

    Article  PubMed  Google Scholar 

  17. Gallo O, Deganello A, Gitti G, Santoro R, Senesi M, Scala J, Boddi V, De Campora E. Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies. Oral Oncol. 2009;45:30–8.

    Article  CAS  Google Scholar 

  18. Schindler A, Pizzorni N, Mozzanica F, Fantini M, Ginocchio D, Bertolin A, Crosetti E, Succo G. Functional outcomes after supracricoid laryngectomy: what do we not know and what do we need to know? Eur Arch Otorhinolaryngol. 2016;273:3459–75.

    Article  Google Scholar 

  19. Leipzig B. Neoglottic reconstruction following total laryngectomy: a reappraisal. Ann Otol Rhinol Laryngol. 1980;89:534–7.

    Article  CAS  Google Scholar 

  20. Pearson BW. Subtotal laryngectomy. Laryngoscope. 1981;91:1904–12. https://doi.org/10.1288/00005537-198111000-00016.

    Article  PubMed  CAS  Google Scholar 

  21. Yuceturk AV, Tarhan S, Günhan K, Pabuçu Y. Videofluoroscopic evaluation of the swallowing function after supracricoid laryngectomy. Eur Arch Otorhinolaryngol. 2005;262:198–203. https://doi.org/10.1007/s00405-004-0790-4.

    Article  PubMed  Google Scholar 

  22. Lewin JS, Hutcheson KA, Barringer DA, May AH, Roberts DB, Holsinger FC, Diaz EM. Functional analysis of swallowing outcomes after supracricoid partial laryngectomy. Head Neck. 2008;30:559–66. https://doi.org/10.1002/hed.20738.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration–aspiration scale. Dysphagia. 1996;11:93–8.

    Article  CAS  Google Scholar 

  24. Steele CM, Grace-Martin K. Reflections on clinical and statistical use of the Penetration–Aspiration scale. Dysphagia. 2017;32:601–16. https://doi.org/10.1007/s00455-017-9809-z.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rizzotto G, Crosetti E, Lucioni M, Succo G. Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures. Eur Arch Otorhinolaryngol. 2012;269:1635–46. https://doi.org/10.1007/s00405-012-1928-4.

    Article  PubMed  CAS  Google Scholar 

  26. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med. 2012;22:276–82.

    Article  Google Scholar 

  27. Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (fees) using the penetration-aspiration scale: a replication study. Dysphagia. 2002;17:308–15. https://doi.org/10.1007/s00455-002-0073-4.

    Article  PubMed  Google Scholar 

  28. Butler SG, Markley L, Sanders B, Stuart A. Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol. 2015;124:480–503. https://doi.org/10.1177/0003489414566267.

    Article  PubMed  Google Scholar 

  29. Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117:1723–7.

    Article  Google Scholar 

  30. Hey C, Pluschinski P, Pajunk R, Almahameed A, Girth L, Sader R, Stöver T, Zaretsky Y. Penetration–aspiration: is their detection in FEES® reliable without video recording? Dysphagia. 2015;30:418–22. https://doi.org/10.1007/s00455-015-9616-3.

    Article  PubMed  Google Scholar 

  31. Hind JA, Gensler G, Brandt DK, et al. Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial. Dysphagia. 2009;24:211–7. https://doi.org/10.1007/s00455-008-9196-6.

    Article  PubMed  Google Scholar 

  32. Baijens L, Barikroo A, Pilz W. Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. Eur J Radiol. 2013;82:1683–95. https://doi.org/10.1016/j.ejrad.2013.05.009.

    Article  PubMed  Google Scholar 

  33. de Virgilio A, Simonelli M, Greco A, Gallo A, Moretta A, Wang CC, Martellucci S, Calcagno P, de Vincentiis M. Tracheocutaneous fistula in patients undergoing supracricoid partial laryngectomy: the role of chronic aspiration. Acta Otorhinolaryngol Ital. 2015;35:9–14.

    Google Scholar 

  34. Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment–MBSImp: establishing a standard. Dysphagia. 2008;23:392–405. https://doi.org/10.1007/s00455-008-9185-9.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Molfenter SM, Steele CM. Kinematic and temporal factors associated with penetration–aspiration in swallowing liquids. Dysphagia. 2014;29:269–76. https://doi.org/10.1007/s00455-013-9506-5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Troche MS, Brandimore AE, Okun MS, Davenport PW, Hegland KW. Decreased cough sensitivity and aspiration in Parkinson disease. Chest. 2014;146:1294–9. https://doi.org/10.1378/chest.14-0066.

    Article  PubMed  PubMed Central  Google Scholar 

  37. McCullough GH, Rosenbek JC. Ordinality and intervality of a penetration–aspiration scale. J Med Speech Lang Pathol. 1998;6:65–72.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy

    Nicole Pizzorni, Elena Santambrogio, Giada de Cillis & Antonio Schindler

  2. Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Candiolo, Italy

    Erika Crosetti, Marco Fantini & Giovanni Succo

  3. Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, Belluno, Italy

    Andy Bertolin & Giuseppe Rizzotto

Authors
  1. Nicole Pizzorni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erika Crosetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elena Santambrogio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giada de Cillis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andy Bertolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giuseppe Rizzotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marco Fantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giovanni Succo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Schindler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicole Pizzorni.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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

Pizzorni, N., Crosetti, E., Santambrogio, E. et al. The Penetration–Aspiration Scale: Adaptation to Open Partial Laryngectomy and Reliability Analysis. Dysphagia 35, 261–271 (2020). https://doi.org/10.1007/s00455-019-10025-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-019-10025-w

Keywords

Search

Navigation