A comparison of Fiberoptic Endoscopic Evaluation and Videofluoroscopy in post laryngectomy swallowing, and swallow and voice evaluation with different voice prostheses.

Abstract

Dysphagia can be problematic for many patients after laryngectomy surgery. While laryngectomy patients have a low risk of aspiration, they often experience other symptoms of dysphagia. There is no standard protocol for swallow assessment and no consensus on the best evaluation tool to use post laryngectomy. The purpose of the first part of this study was to establish Fiberoptic Endoscopic Evaluation of Swallowing (FEES) as an alternative tool to Videofluroscopy for the evaluation of dysphagia after laryngectomy and to develop a rating scale suitable for use with both evaluation tools. The purpose of the second part of the study was to examine whether voice prostheses have an effect on swallowing and whether an optimum voice prosthesis exists for swallowing and voice.

A prospective observational study was carried out on 30 laryngectomy subjects who had simultaneous videofluroscopy and FEES swallow exams. These were rated by 3 expert examiners to determine whether endoscopy could be established as swallow evaluation tool suitable for laryngectomy patients. This was followed by a second prospective observational study on 41 subjects which involved each subject undergoing both swallowing and voice evaluations on 4-6 different voice prostheses.

Results of the first part of this study establish FEES as an alternative tool to videofluroscopy. A rating scale was successfully developed for use with both videofluroscopy and FEES post laryngectomy swallow evaluations. Results of the second part of this study indicate that both swallow and voicing performance can change for some laryngectomy patients with the use of different voice prostheses. The hypothesis that quality of life is altered by swallowing impairment post laryngectomy is confirmed.

This work improves the options available to patients and clinicians for the evaluation of swallowing post laryngectomy. In addition, it has highlighted that choice of voice prosthesis may influence swallowing ability in some laryngectomy patients.