Smaoui Sana, Lee Sean M, Ganesan Sandhya, Ankeney Emily, Ferraro Tatiana, Dorward Rebecca, Cardman Erin-Anne, Joshi Arjun
Department of Hearing and Speech Sciences, Faculty of Allied Health Sciences, Kuwait University.
Office of Clinical Research, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Head Neck. 2025 Jul 11. doi: 10.1002/hed.28240.
Swallowing dysfunction is a common postoperative challenge for patients following total laryngectomy. Videofluoroscopic swallow study (VFSS) can be used to assess the mechanism of swallowing dysfunction in patients; however, many standardized protocols do not account for the anatomical changes in patients who have undergone total laryngectomy. In this study, we aim to utilize the ASPEKT (Analysis of Swallowing Physiology: Events, Kinematics & Timing) Method to quantify swallowing mechanics in a cohort of post-laryngectomy patients.
A retrospective study of swallowing post total laryngectomy was performed. All participants received a VFSS as part of standard care up to 10 months following their surgery between 2011-2021. Blinded raters trained in the ASPEKT method scored the VFSS for: number of swallows, UES opening duration, pharyngeal area at maximum pharyngeal constriction (PhAMPC), and total pharyngeal residue. A mixed-effects beta regression model was fitted to the data, with total pharyngeal residue as the dependent variable and number of swallows, UES duration, and pharyngeal area at maximum constriction as independent variables.
The average number of swallows per bolus was greater than 2. For patients who required more than 1 swallow to clear the bolus, the average UES opening duration increased with each swallow, from 567 ms during the first swallow to 633 ms during the third swallow. Additionally, the average PhAMPC for patients who required more than one swallow was 40.4% C2-C4 compared with 22.2% C2-C4 in patients who cleared the bolus with one swallow. Results from the mixed-effects beta regression model showed that PhAMPC (OR = 22.58; p < 0.001; [95% CI 7.39, 64.28]) was a significant predictor of residue. UES opening duration and number of swallows were not significantly predictive of total pharyngeal residue.
This study represents the application of the ASPEKT Method to more precisely analyze VFSS in patients following total laryngectomy. Changes in swallowing function and efficiency post-laryngectomy may largely be attributed to ineffective maximal pharyngeal constriction. Future work further characterizing this change in swallowing dynamics is crucial in developing treatment options to address swallowing dysfunction following total laryngectomy.
吞咽功能障碍是全喉切除术后患者常见的术后挑战。电视荧光吞咽造影检查（VFSS）可用于评估患者吞咽功能障碍的机制；然而，许多标准化方案并未考虑全喉切除患者的解剖结构变化。在本研究中，我们旨在利用ASPEKT（吞咽生理分析：事件、运动学和时间）方法量化一组喉切除术后患者的吞咽力学。
对全喉切除术后的吞咽情况进行回顾性研究。所有参与者在2011年至2021年期间术后10个月内接受了VFSS检查，作为标准护理的一部分。接受ASPEKT方法培训的盲法评分者对VFSS进行评分，包括：吞咽次数、UES开放持续时间、最大咽部收缩时的咽部面积（PhAMPC）和咽部残留总量。对数据拟合混合效应β回归模型，以咽部残留总量为因变量，吞咽次数、UES持续时间和最大收缩时的咽部面积为自变量。
每团食物的平均吞咽次数大于2次。对于需要多次吞咽才能清除食物团的患者，平均UES开放持续时间随着每次吞咽而增加，从第一次吞咽时的567毫秒增加到第三次吞咽时的633毫秒。此外，需要多次吞咽的患者的平均PhAMPC为C2-C4水平的40.4%，而一次吞咽清除食物团的患者为C2-C4水平的22.2%。混合效应β回归模型的结果显示PhiMPC（OR = 22.58；p < 0.001；[95% CI 7.39, 64.28]）是残留量的显著预测因子。UES开放持续时间和吞咽次数对咽部残留总量无显著预测作用。
本研究展示了ASPEKT方法在更精确分析全喉切除术后患者VFSS中的应用。喉切除术后吞咽功能和效率的变化可能主要归因于无效的最大咽部收缩。未来进一步表征这种吞咽动力学变化的工作对于开发解决全喉切除术后吞咽功能障碍治疗方案至关重要。
