Pizzorni Nicole, Schindler Antonio, Fantini Marco, Bertolin Andy, Rizzotto Giuseppe, Ambrogi Federico, Succo Giovanni, Crosetti Erika
Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.
UOS Foniatria, Azienda Ospedaliera-Polo Universitario "L. Sacco", Via GB Grassi 74, 20154, Milan, Italy.
Eur Arch Otorhinolaryngol. 2018 Apr;275(4):973-985. doi: 10.1007/s00405-018-4888-5. Epub 2018 Feb 8.
Several studies have previously analyzed the relationship between QOL and signs of dysphagia in patients treated for head and neck cancer and have reported heterogeneous findings. To the best of our knowledge, no study has previously investigated this relationship among patients who underwent open partial horizontal laryngectomy (OPHL). The aim of the study is to determine if patient-reported swallowing-related QOL can discriminate between safe and unsafe swallowing in OPHL patients.
92 type I, type II, and type III OPHL patients at least 6 months postoperatively were recruited. Fiberoptic endoscopic evaluation of swallowing (FEES) was conducted using liquids, semisolids, and solids. FEES recordings were assessed through the penetration-aspiration scale, the pooling score and the dysphagia outcome and severity scale. All patients completed the MD Anderson dysphagia inventory (MDADI). Kruskal-Wallis test and post-hoc Mann Whitney U test were performed to compare MDADI scores among different level of airway invasion, post-swallow pharyngeal residue's degree and overall dysphagia severity. ROC curves were generated to determine diagnostic accuracy of the MDADI.
Statistically significant differences in MDADI scores were found between level of airway invasion with semisolids and solids, degree of pharyngeal residue with solids, and severity of dysphagia. MDADI showed significant diagnostic accuracy only in the detection of moderate/severe pharyngeal residue and severe dysphagia; however, sensitivity and specificity were low.
Investigating patients' perception of swallowing impairment and swallowing-related QOL is not sufficient to discriminate safe and unsafe swallowing in OPHL patients.
此前已有多项研究分析了接受头颈癌治疗的患者的生活质量（QOL）与吞咽困难体征之间的关系，报告结果不一。据我们所知，此前尚无研究调查接受开放性部分水平喉切除术（OPHL）的患者之间的这种关系。本研究的目的是确定患者报告的吞咽相关生活质量是否能够区分OPHL患者的安全吞咽和不安全吞咽。
招募了92例术后至少6个月的I型、II型和III型OPHL患者。使用液体、半固体和固体进行纤维内镜吞咽功能评估（FEES）。通过渗透-误吸量表、潴留评分和吞咽困难结果与严重程度量表对FEES记录进行评估。所有患者均完成了MD安德森吞咽困难量表（MDADI）。进行Kruskal-Wallis检验和事后Mann-Whitney U检验，以比较不同气道侵犯水平、吞咽后咽部残留物程度和总体吞咽困难严重程度之间的MDADI评分。绘制ROC曲线以确定MDADI的诊断准确性。
在使用半固体和固体时气道侵犯水平之间、使用固体时咽部残留物程度之间以及吞咽困难严重程度之间，MDADI评分存在统计学显著差异。MDADI仅在检测中度/重度咽部残留物和严重吞咽困难方面显示出显著的诊断准确性；然而，敏感性和特异性较低。
调查患者对吞咽障碍和吞咽相关生活质量的感知不足以区分OPHL患者的安全吞咽和不安全吞咽。
