Cathy L. Lazarus

Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy

The nature of swallowing problems was examined in nine patients treated primarily with external‐beam radiation and adjuvant chemotherapy for newly diagnosed tumors of the head and neck. All subjects underwent videofluorographic examination of their swallowing. Three analyses were completed, including the following: observations of motility disorders, residue, and aspiration; temporal analyses; and biomechanical analyses. Oropharyngeal swallow efficiency was calculated for the first swallow of each bolus.

Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients

This study examined the effects of bolus volume and viscosity and the variability of repeated swallows in ten stroke patients and ten age-matched nonstroke subjects. The ten stroke patients demonstrated single unilateral cortical (three subjects), subcortical (six subjects), or brainstem (one subject) infarcts on computed tomography or magnetic resonance imaging scans at three weeks post-ictus. All subjects underwent videofluoroscopic swallow studies in which seven temporal pharyngeal swallow measures were examined. Despite the dissimilarity in lesion locations, the swallow physiology in the stroke patients was relatively homogeneous, ie, no swallowing disorders severe enough to prevent oral intake. As bolus volume increased, pharyngeal delay time diminished in stroke patients, but not in nonstroke subjects. Increasing bolus volume affected three other pharyngeal swallow measures similarly in nonstroke and stroke subjects: laryngeal closure durations and cricopharyngeal (CP) opening durations increased and duration of tongue base contact to posterior pharyngeal wall decreased. On viscosity comparisons (liquid vs paste), both subject groups displayed longer duration of base of tongue contact to posterior pharyngeal wall. On paste swallows, nonstroke subjects had longer CP opening and lower swallow efficiency, whereas stroke patients did not. This study found no statistically significant learning/repetition effect for repeated swallows in either subject group, or both groups combined.

Impact of thermal stimulation on the triggering of the swallowing reflex

This study was designed to quantify the effects of thermal sensitization on the oral and pharyngeal transit times of the swallow following sensitization in a group of 25 neurologically impaired patients exhibiting delayed triggering of the swallowing reflex. Thermal sensitization consists of applying cold (thermal) contact to the base of the anterior faucial arches in order to sensitize the area of the oral cavity where the reflex is triggered. Thermal sensitization improved triggering of the swallowing reflex in 23 of the 25 neurologically impaired patients on swallows of at least one food consistency. Results are discussed in relation to neurologic recovery and carryover of these effects.

Swallowing disorders in the first year after radiation and chemoradiation

Radiation alone or concurrent chemoradiation can result in severe swallowing disorders. This manuscript defines the swallowing disorders occurring at pretreatment and 3 and 12 months after completion of radiation or chemoradiation.

Xerostomia: 12‐Month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation

Previous investigators have found permanent changes in saliva production after chemoradiation but have not examined these in relation to swallowing measures, diet changes, and patient comfort over time.

Swallow function and perception of dysphagia in patients with head and neck cancer

The relationship between subjective complaints of dysphagia and objective measures of swallow function in patients with cancers of the oral cavity, pharynx, or larynx, treated with radiotherapy ± chemotherapy has not been well documented in the literature.

Effects of Voluntary Maneuvers on Tongue Base Function for Swallowing

Concurrent manometry and videofluoroscopy were utilized to examine tongue base function during swallowing in 3 patients with head and neck cancer. Subjects were instructed in four voluntary swallow maneuvers, including the supersupraglottic swallow, effortful swallow, Mendelsohn maneuver, and tongue-hold maneuver. Peak catheter pressures (mm Hg) at the tongue base-pharyngeal wall level were recorded and duration of tongue base to pharyngeal wall contact was measured for each swallow. This pilot study revealed that tongue base-pharyngeal wall pressures and contact duration increased with use of maneuvers. Preliminary data are provided to support the use of swallow maneuvers to improve tongue base posterior motion and pressures generated at the tongue base-pharyngeal wall level during swallowing in patients who exhibit this disorder.

Effects of Two Types of Tongue Strengthening Exercises in Young Normals

This pilot study examines the effects of two types of tongue strengthening exercises on tongue function measures of strength and endurance in a group of 31 healthy young subjects. Subjects underwent baseline and 1 month post-baseline assessments of tongue function and were randomized to one of three groups, including: (1) no exercise; (2) exercise group receiving standard tongue strength exercises using a tongue depressor, and (3) exercise group receiving tongue strengthening exercises using the Iowa Oral Performance Instrument. Results revealed a significantly greater change in maximum tongue strength in the group that received any treatment compared with the group receiving no treatment (p = 0.04). Results provide support for the theory that tongue strengthening exercises improve tongue strength in healthy young subjects.

SITE OF DISEASE AND TREATMENT PROTOCOL AS CORRELATES OF SWALLOWING FUNCTION IN PATIENTS WITH HEAD AND NECK CANCER TREATED WITH CHEMORADIATION

The relationship between type of chemoradiation treatment, site of disease, and swallowing function has not been sufficiently examined in patients with head and neck cancer treated primarily with chemoradiation.

SURGICAL VARIABLES AFFECTING SWALLOWING IN PATIENTS TREATED FOR ORAL/OROPHARYNGEAL CANCER

Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function.