Cheryl Frank

Effectiveness of the Cough Reflex in Patients with Aspiration Following Radiation for Head and Neck Cancer

The effectiveness of the cough reflex in patients who aspirated following radiation for head and neck cancer was evaluated in 89 patients (49 chemoradiation, 33 postoperative radiation, and 7 radiation alone). All patients had modified barium swallow because of dysphagia. The cough reflex was graded as present and effective, ineffective, intermittently effective, or absent. All patients were cancer-free at the time of the swallowing study. The cough reflex was present and effective in 46 patients (52%), ineffective in 17 patients (19%), and absent in 26 patients (29%) on initial investigation. Among the 43 patients who had ineffective or absent cough reflex, their treatment was chemoradiation (26), postoperative radiation (13), and radiation alone (4). In 30 patients who had sequential modified barium swallow, the cough reflex was constantly effective, ineffective, or intermittently effective in 12 (40%), 13 (43%), and 5 (17%) patients, respectively. The cough reflex was frequently ineffective or absent in patients who aspirated following radiation for head and neck cancer. Cough may also be intermittently ineffective to protect the airways following radiation.

Dysphagia severity and aspiration risk following oral cavity cancer surgery

ObjectivesWe assessed the severity of dysphagia before and after oral cavity cancer surgery.MethodsWe retrospectively reviewed modified barium swallow (MBS) studies of 12 patients who underwent surgery for oral cavity cancer. A MBS was performed before and after treatment to assess the severity of dysphagia and aspiration risk. All patients were cancer-free at the time of the posttreatment MBS. Dysphagia severity was graded from 1 to 7 on a scale of increasing severity.ResultsBefore surgery, seven cases were grade 1 and five were grade 2 dysphagia. At a median of 2 months (1–15 months) following surgery, grade 1–6 dysphagia was present in one, two, four, three, one, and one patient, respectively. In all, 17% (2/12) of the patients developed aspiration (grades 5–7). Seven patients (58%) experienced mild to moderate dysphagia. Only three patients (25%) had normal swallowing postoperatively. The two patients who developed aspiration had T3 tumors and underwent hemiglossectomies.ConclusionsDysphagia is common following surgery for oral cavity cancer. Diagnostic studies such as MBS should be included in future prospective oral cavity cancer studies to assess the dysphagia severity and for patient rehabilitation.