Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors.

OBJECTIVES/HYPOTHESIS: Dysphagia is one of the most significant side effects of the treatment of head and neck cancer. Residue and aspiration are two indicators of dysphagia, but aspiration is historically the only indicator of interest, because it may impact health outcomes. Clinicians have anecdotally used residue as another marker of swallowing dysfunction, but it is understudied. This project investigated the impact of aspiration versus residue on function and quality of life (QoL) in these patients. STUDY DESIGN: Observational study. METHODS: A total of 168 head and neck cancer survivors with moderate to severe dysphagia were enrolled in a randomized clinical trial comparing two swallow therapy interventions. Data at time of entry were used for the current study. A modified barium swallow study was done to compute Penetration-Aspiration Scale (PAS) scores, percentage oral residue, and percentage pharyngeal residue with three bolus consistencies (5 mL thin, nectar, and pudding). The Performance Status Scale (PSS) and the Head Neck Cancer Inventory (HNCI) questionnaires were administered. Data were analyzed to determine associations between aspiration and residue estimates with function and QoL scores. RESULTS: Worsening aspiration and residue estimates were all correlated with decreased scores on the PSS functional scales (r = -0.190 to -0.324, P ≤ .031). However, only increasing residue estimates were significantly related to decreased patient-perceived QoL on the HNCI (r = -.178 to -.194, P < .046). This effect was more pronounced with oral versus pharyngeal residue. CONCLUSIONS: In this group of head and neck cancer survivors, penetration/aspiration and residue show independent effects. PAS affects functional status only, but residue affects both functional status and QoL. This study supports that residue should be considered a primary measurement of swallowing function and be a target for identification, treatment, and evaluation of swallowing. LEVEL OF EVIDENCE: 2c. Laryngoscope, 127:1615-1621, 2017.

Quality of life and functional evaluation in patients with tongue base tumors treated exclusively with transoral robotic surgery: A 1-year follow-up study.

BACKGROUND: To evaluate quality-of-life (QoL), swallowing and voice in patients with base of tongue (BOT) tumors treated with transoral robotic surgery (TORS) alone without any adjuvant treatment. METHODS: The study was a prospective, single-center cohort trial. Swallowing, QoL and voice were evaluated in 13 patients with T1 or T2 oropharyngeal carcinomas of the BOT. Patients underwent evaluation using the following: a dysphagia score (DS); fiberoptic endoscopic evaluation-of-swallowing with the penetration aspiration scale (PAS); the MD Anderson Dysphagia Inventory (MDADI); and the Voice Handicap Index-10 (VHI-10). RESULTS: Subjective (DS) and objective (PAS) evaluation of swallowing produced mean scores of 1.08, 2.23 and 1.46 before surgery and at 6 and 12 months after surgery, respectively, for both tests. A significant difference was found when comparing DS and PAS data at baseline and 6 months after surgery; while no difference was observed between the baseline and 12 months after surgery. The mean values of the MDADI and VHI scores recorded before surgery, and at 6 and 12 months after surgery did not show any statistical difference. CONCLUSIONS: Objective swallowing deterioration in the first 6 months after TORS alone for BOT tumors was possible, but complete recovery of deglutition was observed within 12 months. No changes were reported in the patients' self-perceived status of swallowing and voice dysfunction, and related QoL after 1 year.

"Fishing in the trachea": a unique case of foreign body aspiration.

A 36-year-old white man presented with hemoptysis and hematemesis. The medical history was significant for a bipolar disorder and schizophrenia. He had swallowed 3 fishhooks and aspirated 1 into his lungs. A chest x-ray showed the fishhook in the right main stem bronchus. He underwent a flexible bronchoscopy for removal of the foreign object. The technique of the removal of the fishhook is described. Foreign object aspiration usually occurs in the pediatric or the geriatric population. Aspiration of foreign objects in adults is commonly associated with psychiatric illnesses in patients. After appropriate imaging, bronchoscopy or even cardiothoracic surgery is usually required for removal of the foreign object. Fishhooks may be more difficult to remove.

Aspiration of foreign bodies in adults with personality disorders: impact on diagnosis and recurrence.

Most cases of foreign-body aspiration are accidental events in children, whereas the majority of adults will have neurological dysfunction, trauma, alcohol abuse, or psychological disorders. Much has been written about psychiatric patients engaging in self-mutilation such as cutting and burning, but little is recorded about deliberate aspiration of objects in these patients, who clinically can be separated into 4 groups: (1) malingering, (2) psychosis, (3) pica, and (4) personality disorders. The immediate psychological gain for these patients is unclear, as the act is insidious with no evidence of intentional harm or immediate danger. Thus, they are considered as being parasuicidal events designed to diminish other psychological processes. Aspirated objects that are not immediately dislodged by coughing, choking, or gagging require surgical intervention. Most of these patients usually come to the attention of a psychiatrist, but such intervention does not prevent recurrences. We discuss a schizophrenic patient who aspirated multiple coins while under psychiatric treatment for prior episodes of aspiration of coins, ingestion of objects, and insertion of others in his urethra and rectum, while also reviewing some of the diagnostic and therapeutic challenges inherent in the management of these patients.