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      Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review

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          Abstract

          Background

          This systematic review qualitatively summarizes the current literature on diagnosis and treatment of oropharyngeal dysphagia (OD) after total laryngectomy (TLE).

          Methods

          Electronic databases PubMed, Embase, and the Cochrane Library were used. Two independent reviewers carried out the literature search and assessed the methodological quality of the included studies using a critical appraisal tool.

          Results

          Forty‐four articles met the inclusion criteria. Of these, 35 studies were on diagnosis, four on therapy, and five on both diagnosis and treatment of OD following TLE. Study aims, swallowing‐assessment methods, and main findings of the included studies were summarized and presented.

          Conclusions

          The reviewers found heterogeneous outcomes and serious methodological limitations, which prevented us from pooling data to identify trends that would assist in designing best clinical practice protocols for OD following TLE. Further research should focus on several remaining gaps in our knowledge on diagnosis and treatment interventions for OD following TLE.

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          Most cited references53

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          Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae, and rehabilitation.

          Barbara Murphy, Jill Gilbert (2009)
          Dysphagia is commonly seen in patients undergoing radiation-based therapy for locally advanced squamous carcinoma of the head and neck. Within 4 to 5 weeks of starting therapy, patients develop mucositis, radiation dermatitis, and edema of the soft tissues. Resulting pain, copious mucous production, xerostomia, and tissue swelling contribute to acute dysphagia. As the acute effects resolve, late effects including fibrosis, lymphedema, and damage to neural structures become manifest. Both acute and late effects result in adverse sequelae including aspiration, feeding tube dependence, and nutritional deficiencies. Early referral for evaluation by speech-language pathologists is critical to (1) ensure adequate assessment of swallow function, (2) determine whether further testing is needed to diagnose or treat the swallowing disorder, (3) generate a treatment plan that includes patient education and swallow therapy, (4) work with dieticians to ensure adequate and safe nutrition, and (5) identify patients with clinically significant aspiration.
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            Dysphagia following a total laryngectomy: the effect on quality of life, functioning, and psychological well-being.

            Julia Maclean, Susan Cotton, Alison Perry (2009)
            The aim of this study was to investigate the effect that dysphagia has on quality of life (QoL), functioning, and psychological well-being of people who have undergone a total laryngectomy. A questionnaire battery was sent to all members (N = 197) of the Laryngectomee Association of NSW, Australia. QoL and functioning were assessed using the World Health Organisation Quality of Life-Bref (WHOQoL-Bref) and the University of Washington QoL (UW-QoL) measures. Psychological well-being was measured using the Depression Anxiety and Stress Scale (DASS). One hundred ten questionnaires (56%) were completed and returned. There were no significant differences in QoL, as measured by the WHOQoL-Bref, between those laryngectomees with and without dysphagia. Laryngectomees with dysphagia, however, had significantly impaired functioning and markedly reduced social participation as measured by the UW-QoL. Significantly higher levels of depression and anxiety were also documented in those laryngectomees who had dysphagia. Dysphagia may not necessarily determine QoL following a total laryngectomy. However, it may have a negative impact on functioning and on psychological well-being.
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              Swallowing outcomes following laryngectomy and pharyngolaryngectomy.

              E. Ward, J Frisby, Donald Bishop … (2002)
              To determine the incidence of dysphagia (defined as the inability to manage a diet of normal consistencies) at hospital discharge and beyond 1 year postsurgery and examine the impact of persistent dysphagia on levels of disability, handicap, and well-being in patients. Retrospective review and patient contact. Adult acute care tertiary hospital. The study group, consecutively sampled from January 1993 to December 1997, comprised 55 patients who underwent total laryngectomy and 37 patients who underwent pharyngolaryngectomy with free jejunal reconstruction. Follow-up with 36 of 55 laryngectomy and 14 of 37 pharyngolaryngectomy patients was conducted 1 to 6 years postsurgery. Number of days until the resumption of oral intake; swallowing complications prior to and following discharge; types of diets managed at discharge and follow-up; and ratings of disability, handicap, and distress levels related to swallowing. Fifty four (98%) of the laryngectomy and 37 (100%) of the pharyngolaryngectomy patients experienced dysphagia at discharge. By approximately 3 years postsurgery, 21 (58%) of the laryngectomy and 7 (50%) of the pharyngolaryngectomy patients managed a normal diet. Pharyngolaryngectomy patients experienced increased duration of nasogastric feeding, time to resume oral intake, and incidence of early complications affecting swallowing. Patients experiencing long-term dysphagia identified significantly increased levels of disability, handicap, and distress. Patients without dysphagia also experienced slight levels of handicap and distress resulting from taste changes and increased durations required to complete meals of normal consistency. The true incidence of patients experiencing a compromise in swallowing following surgery has been underestimated. The significant impact of impaired swallowing on a patient's level of perceived disability, handicap, and distress highlights the importance of providing optimal management of this negative consequence of surgery to maximize the patient's quality of life.
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                Author and article information

                Contributors
                Lisanne T. Terlingen:
                ORCID: https://orcid.org/0000-0003-3250-8207
                l.terlingen@student.maastrichtuniversity.nl
                Laura W. Baijens: laura.baijens@mumc.nl
                Journal
                Journal ID (nlm-ta): Head Neck
                Journal ID (iso-abbrev): Head Neck
                Journal ID (doi): 10.1002/(ISSN)1097-0347
                Journal ID (publisher-id): HED
                Title: Head & Neck
                Publisher: John Wiley & Sons, Inc. (Hoboken, USA )
                ISSN (Print): 1043-3074
                ISSN (Electronic): 1097-0347
                Publication date (Electronic): 26 November 2018
                Publication date (Print): December 2018
                Volume: 40
                Issue: 12 ( doiID: 10.1002/hed.v40.12 )
                Pages: 2733-2748
                Affiliations
                [ 1 ] Department of Otorhinolaryngology, Head and Neck Surgery Maastricht University Medical Center Maastricht The Netherlands
                [ 2 ] School for Mental Health and Neuroscience – MheNs Maastricht University Medical Center Maastricht The Netherlands
                [ 3 ] School for Oncology and Developmental Biology – GROW Maastricht University Medical Center Maastricht The Netherlands
                Author notes
                [*] [* ] Correspondence

                Laura W. Baijens, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.

                Email: laura.baijens@ 123456mumc.nl

                Author information
                https://orcid.org/0000-0003-3250-8207
                https://orcid.org/0000-0002-3914-5587
                Article
                Publisher ID: HED25508
                DOI: 10.1002/hed.25508
                PMC ID: 6587738
                PubMed ID: 30478930
                SO-VID: 0da05e8f-1600-4f5b-8edc-efa79bf0772c
                Copyright © © 2018 The Authors. Head & Neck published by Wiley Periodicals, Inc.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date received : 24 January 2018
                Date revision received : 09 May 2018
                Date accepted : 17 August 2018
                Page count
                Figures: 1, Tables: 6, Pages: 16, Words: 9504
                Categories
                Subject: Clinical Review
                Subject: Clinical Reviews
                Custom metadata
                source-schema-version-number 2.0
                component-id hed25508
                cover-date December 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:21.06.2019

                ScienceOpen disciplines: Otolaryngology
                Keywords: deglutition disorders,dysphagia,pharyngolaryngectomy,swallowing disorder,total laryngectomy
                Data availability:
                ScienceOpen disciplines: Otolaryngology
                Keywords: deglutition disorders, dysphagia, pharyngolaryngectomy, swallowing disorder, total laryngectomy

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