Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Dysphagia. 2019 Dec;34(6):852-861. doi: 10.1007/s00455-019-09979-8. Epub 2019 Feb 14.
To compare the results of a simultaneously performed videofluoroscopic swallowing study and fiberendoscopic evaluation of swallowing in patients with dysphagia after surgery and radiotherapy for oropharyngeal or laryngeal cancer. This prospective study included 31 patients who were examined simultaneously with a standardized protocol. The fiberendoscopic and videofluoroscopic swallowing loops were independently scored by two otorhinolaryngologists/phoniatricians and two radiologists. The presence of penetration/aspiration, the amount of pharyngeal residues and the position of the bolus head when triggering of pharyngeal swallow begins were evaluated. Generalized linear models were used to model the impact of rater, method, bolus and quantities as well as specified moderation effects on scorings. In addition, post hoc Wilcoxon tests were used. Rater agreement was assessed using weighted kappas and their 95% confidence intervals. A total of 202 swallow sequences in 29 patients was evaluated. Interrater agreement was substantial to excellent for both methods (weighted k = 0.979-0.613). Significant differences between both methods were found when assessing the penetration-aspiration scale (p = 0.001, tendency of higher scores by videofluoroscopic (median = 2.59) as opposed to fiberendoscopic (median = 2.14) and the residue severity scores in the valleculae (p = 0.029) and the sinus piriformes (p = 0.002) with larger residues scored by fiberendoscopic evaluation of swallowing. No significant differences were found regarding the time point of triggering (p = 0.273). Simultaneous evaluation of swallowing with FEES and VFSS showed significantly different results in symptomatic patients after tumor operation and radiotherapy.
比较同时进行的视频荧光吞咽研究和纤维内镜吞咽评估在接受口咽或喉癌手术后和放射治疗后的吞咽困难患者中的结果。这项前瞻性研究纳入了 31 名患者，他们使用标准化方案同时进行检查。纤维内镜和视频荧光吞咽循环由两名耳鼻喉科/语音治疗师和两名放射科医生独立评分。评估了穿透/吸入的存在、咽部残留物的量以及触发咽吞咽时食团头部的位置。使用广义线性模型来模拟评分受评估者、方法、食团和数量的影响以及指定的调节效应。此外，还使用了事后 Wilcoxon 检验。使用加权 kappa 及其 95%置信区间评估评估者间的一致性。总共评估了 29 名患者的 202 个吞咽序列。两种方法的评估者间一致性均为中等至极好（加权 kappa=0.979-0.613）。当评估穿透-吸入量表时，两种方法之间存在显著差异（p=0.001，倾向于视频荧光法（中位数=2.59）而不是纤维内镜法（中位数=2.14）评分较高）以及 vallecula（p=0.029）和 piriform sinuses（p=0.002）中的残留严重程度评分，纤维内镜吞咽评估的残留量较大。在触发时间点方面未发现显著差异（p=0.273）。在接受肿瘤手术和放射治疗后的有症状患者中，同时使用纤维内镜吞咽评估和 VFSS 进行吞咽评估显示出明显不同的结果。
