Multidisciplinary evaluation and management of dysphagia: the role for otolaryngologists.

INTRODUCTION: The Dysphagia Clinic of the McGill University Health Centre (MUHC) is composed of a multidisciplinary team including an otolaryngologist, a speech therapist, an occupational therapist, and a nutritionist. The clinic was created to provide a comprehensive assessment of patients with dysphagia. All patients are evaluated with flexible endoscopic evaluation of swallowing (FEES) and other necessary investigations. Following this evaluation, appropriate treatment, dietary modifications, and swallowing techniques are taught to the patient. OBJECTIVE: To study the characteristics of the population evaluated at the McGill University Health Centre Dysphagia Clinic to better understand the role and impact of a multidisciplinary team. METHOD: A retrospective chart review of 183 patients presenting to the Dysphagia Clinic since its creation in December 2004 was conducted. Information regarding demographics, etiology, comorbidities, additional referrals or investigations, treatment, and outcome was collected. RESULTS: The majority of patients (61%) were referred by otolaryngologists. The FEES was normal for all consistencies in 28% of patients, and pooling was the most frequently encountered abnormality. The most common etiologies were neurologic (27%), laryngopharyngeal reflux (22%), and malignancy (21%). The four treatment modalities consisted of dietary modifications (37%), teaching of therapeutic swallowing manoeuvres (33%), medical treatment (26%), and surgical treatment (11%). CONCLUSION: A multidisciplinary dysphagia clinic is an invaluable resource for patients suffering from cervical dysphagia. As the etiologies and initial presentation of patients vary greatly, otolaryngologists' expertise in endoscopy gives them a critical role in the evaluation of this condition.

Radiotherapy versus surgery for early T1-T2 glottic carcinoma.

OBJECTIVES: To compare surgery and radiotherapy as treatments for early T1-T2 glottic cancer in terms of local and regional control, complications, cost, and voice outcome. METHODS: Retrospective comparative review of 36 patients with T1 or T2 glottic carcinoma diagnosed between 1992 and 2003 at the McGill University Health Centre. Twelve patients postsurgery (group 1) and 26 patients postradiotherapy (group 2) were compared in terms of local and regional control and complications related to treatment. The costs of surgery and radiotherapy, including all personnel and equipment, were estimated. A cross-sectional study was undertaken of 11 patients with a history of T1 or T2 glottic carcinoma: 5 patients postsurgery, 4 patients postradiotherapy, and 2 patients postradiotherapy and surgery. Vocal fold function and voice quality were assessed by an otolaryngologist using videostroboscopy and a standardized questionnaire (Voice Handicap Index) and by an experienced speech-language pathologist using the Visipitch II computer program (Kay Elemetrics Corp., Lincoln Park, NJ). RESULTS: Retrospective study: The recurrence rate following primary treatment was 37.5% for group 1 and 22% for group 2. Group 1 patients presented with 25% of local complications (vocal fold scars) and no systemic complications. Patients in group 2 presented with local and systemic complications: 35% for local and 27% for systemic. One patient had mild carotid stenosis, and one patient had mild esophageal stenosis. The cost of treatment with radiotherapy was five times higher than the cost of surgery. Cross-sectional study: Vocal fold function assessed by videostroboscopy was superior in group 2. However, patients in group 1 scored higher on the subjective (Voice Handicap Index questionnaire) and objective (Visipitch parameters) voice assessments. CONCLUSION: Surgery and radiotherapy are both very effective in terms of local and regional control for early glottic carcinoma. However, surgery tends to be more cost-effective, with less complications and possibly a better voice outcome.