Remmerswaal, G. (Gawein) (2014) Relationship between hyoid displacement on video fluoroscopic studies and swallowing impairment in head and neck cancer patients. thesis, Medicine.
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Abstract
Background: Concomitant chemo radiation therapy (CCRT) is nowadays the treatment of choice for advanced squamous cell carcinoma (SCC) of the head and neck. Each treatment option has undesirable functional side effects as does dysphagia, as does CCRT. Organ preservation does not necessarily preservation of function. Dysphagia can be serious health issue. For instance aspiration pneumonia can be potentially life threatening consequence of CCRT. Radiation-induced xerostomia may diminish patients’ swallowing disability. Due to this swallowing impairment is largely underappreciated and underreported. Also from recent studies it is stated that a reduced anterior and superior movement of the hyoid bone, during swallowing, is contributing to this aspiration risk. The aim of this study is to determine to which degree reduced movement of the hyoid bone, as assessed with video fluoroscopy (VFS), is correlated with (both objective and subjective) swallowing impairment, and to assess to which degree reduced movement range can be a predictor of penetration-aspiration. Patient’s perceived swallowing impairment will be scored using a questionnaire (subjective outcome measure). And objective swallowing impairment will be scored in two ways: by scores on the penetration-aspiration scale (PAS) and measures of the hyoid bone displacement on VFS images. Methods: This is a retrospective, single-blind study. All the data used in this study were obtained from a recent RCT: prevention of trismus, swallowing and speech problems in patients treated with CCRT for advanced head and neck cancer (H&NC.) 17 patients with advanced (stage III and IV) SCC of the head and neck treated at the Netherlands Cancer Institute (AvL-NKI) with CCRT participated in this study. We analyzed hyoid bone displacement using video fluoroscopy. We used a coordinate system to measure the anterior and superior hyoid displacement during swallowing. Due to poor image quality of VFS images, we had to exclude eight patients before analyzing. Results: our findings on hyoid bone displacement measurements were at the level of normal subjects, which was not what we expected. We found a significant increase in mean superior hyoid bone displacement (SHD) at ten weeks post CCRT for twee consistencies. For 5cc thin liquid boluses (P value 0,024. And for cake ( P value 0,012.) At one year follow-up this increase in SHD had disappeared. For anterior hyoid displacement (AHD) no significant increase or decrease was measured. Furthermore 6 patients scored for penetration or aspiration on the PAS. At the same time three of them did not report any perceived swallowing problems. In general our subjects did not report much perceived problems at baseline. Ten weeks after CCRT an increase in scores on the questionnaires was witnessed. At one year follow-up most of those complaints diminished. A correlation was found between one question at baseline assessment (swallow more than once while eating) with SHD in all four consistencies (P value 0,005.) At ten weeks follow up a significant correlation was found between SHD and the question difficulty with eating (P value 0,019). Conclusion: Ten weeks post CCRT a significant increase in mean SHD was measured in our study. Only in a few subjective outcome measures (questions) we could find a correlation with hyoid bone displacement. Discrepancies exist between the perception of the swallowing problems by the patient and the problems as identified by the doctor. Therefore it stresses once again that a thorough examination is of importance in the follow-up in patients who were treated with CCRT for cancer in the head neck region. Because the risk of silent aspiration, and therefore a potentially health issue will always exist.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Reurings, Dr. J. |
| Supervisor name: | Kraaijenga, Drs. S.A.C. and Brekel, Prof. Dr. M.W.M. van den and Nederlands Kanker Instituut and Antoni van Leeuwenhoek, Amsterdam |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1722 |
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