Gintas P. Krisciunas

Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial

Neuromuscular electrical stimulation (NMES) is a highly sought after but poorly studied treatment for dysphagia among patients with head and neck cancer with dysphagia. This study investigated the efficacy of NMES in this patient population.

The Boston Residue and Clearance Scale: Preliminary Reliability and Validity Testing

Background: There is no appropriately validated scale with which to rate the problem of residue after swallowing. The Boston Residue and Clearance Scale (BRACS) was developed to meet this need. Initial reliability and validity were assessed. Methods: BRACS is an 11-point ordinal residue rating scale scoring three aspects of residue during a fiberoptic endoscopic evaluation of swallowing (FEES): (1) the amount and location of residue, (2) the presence of spontaneous clearing swallows, and (3) the effectiveness of clearing swallows. To determine inter-rater and test-retest reliability, 63 swallows from previously recorded FEES procedures were scored twice by 4 raters using (1) clinical judgment (none, mild, mild-moderate, moderate, moderate-severe, severe) and (2) BRACS. Concurrent validity was tested by correlating clinical judgment scores with BRACS scores. Internal consistency of the items in BRACS was examined. A factor analysis was performed to identify important factors that suggest grouping within the 12 location items in BRACS. Results: BRACS showed excellent inter-rater reliability (intraclass correlation coefficient, ICC = 0.81), test-retest reliability (ICC: 0.82-0.92), high concurrent validity (Pearsons r = 0.76), and high internal consistency (Cronbachs α = 0.86). Factor analysis revealed 3 main latent factors for the 12 location items. Conclusion: BRACS is a valid and reliable tool that can rate the severity of residue.

Effect of Lidocaine on Swallowing During FEES in Patients With Dysphagia

Purpose: The aims of this study were to assess the effects of 0.2 mL of 4% atomized lidocaine on swallowing and tolerability during Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Methods: A single blinded study was conducted with 17 dysphagic patients, who received 4 standardized boluses in 2 sequential FEES exams under 2 conditions: non-anesthetized (decongestant only) and anesthetized (lidocaine 4% + decongestant). After each procedure, patients rated their pain on the Wong Baker FACES Pain Rating Scale. Clinicians scored each swallow with the Penetration Aspiration Scale (PAS) and an author-developed Residue Rating Scale. Because the assessments were ordinal, a series of Wilcoxon signed-rank tests were conducted to detect differences between the 2 conditions. Results: No significant differences were detected between groups on PAS or residue in the 4 boluses. Pain scores, however, were significantly lower in the anesthetized condition than the decongested-only condition (P = .035). Conclusion: The findings of this study indicated that 0.2 mL of 4% lidocaine enhanced exam tolerability and did not impair the swallow in dysphagic patients.

A Comparison of 2 Methods of Endoscopic Laryngeal Sensory Testing A Preliminary Study

Objective: This study examined the association between laryngeal sensory deficits and penetration or aspiration. Two methods of testing laryngeal sensation were carried out to determine which was more highly correlated with Penetration-Aspiration Scale (PAS) scores. Methods: Healthy participants and patients with dysphagia received an endoscopic swallowing evaluation including 2 sequential laryngeal sensory tests—air pulse followed by touch method. Normal/impaired responses were correlated with PAS scores. Results: Fourteen participants completed the endoscopic swallowing evaluation and both sensory tests. The air pulse method identified sensory impairment with greater frequency than the touch method (P < .0001). However, the impairment identified by the air pulse method was not associated with abnormal PAS scores (P = .46). The sensory deficits identified by the touch method were associated with abnormal PAS scores (P = .05). Conclusion: Sensory impairment detected by the air pulse method does not appear to be associated with risk of penetration/aspiration. Significant laryngeal sensory loss revealed by the touch method is associated with compromised airway protection.

Comparing dysphagia therapy in head and neck cancer patients in Australia with international healthcare systems

Abstract Purpose: The Australian healthcare system has invested heavily in multidisciplinary cancer care teams. Despite such investments, guidelines that clearly delineate standard of care dysphagia treatment are lacking and services provided to Head and Neck Cancer (HNC) patients are not always consistent. There is little consensus regarding the frequency and intensity of dysphagia therapy. This is largely due to a lack of well-designed clinical trials that establish the efficacy of any dysphagia therapy in this patient population. The aim of this study was to evaluate HNC dysphagia therapy patterns among Australian speech-language pathologists (SLPs). Method: A 22 question internet-based survey was administered to a web-based professional interest group. Results were analysed by institution type and individual clinical experience. Result: A response rate of 46% was achieved (67 out of 144 surveyed). This survey identified several aspects of dysphagia management that were provided uniformly in addition to many aspects of care that showed a lack of consensus. Conclusion: By comparing the results of this survey with existing international best-evidence treatment guidelines, the development of uniform Australian guidelines may be facilitated. However, more authoritative data on dysphagia treatment efficacy is needed to provide uniform evidence-based HNC dysphagia treatment guidelines.

Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors

Dysphagia is one of the most significant side effects of the treatment of head and neck cancer. Residue and aspiration are two indicators of dysphagia, but aspiration is historically the only indicator of interest, because it may impact health outcomes. Clinicians have anecdotally used residue as another marker of swallowing dysfunction, but it is understudied. This project investigated the impact of aspiration versus residue on function and quality of life (QoL) in these patients.

A novel manual therapy programme during radiation therapy for head and neck cancer – our clinical experience with five patients

and neck cancer – our clinical experience with five patients Krisciunas, G.P.,* Golan, H.,* Marinko, L.N., Pearson, W., Jalisi, S.* & Langmore, S.E. *Department of Otolaryngology –Head&Neck Surgery, BostonUniversityMedical Center, Department of Physical Therapy and Athletic Training, Sargent College of Health & Rehabilitation Sciences, Boston University, Department of Cellular Biology and Anatomy, Medical College of Georgia, Georgia Regents University, Department of Speech, Language, and Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA

Comprehensive Emergency Airway Response Team (EART) Training and Education Impact on Team Effectiveness, Personnel Confidence, and Protocol Knowledge

Objective: To evaluate the efficacy and utility of simulation of the Emergency Airway Response Team (EART) at a tertiary care hospital to improve team dynamics and confidence and knowledge in managing an emergency airway. Methods: This was a descriptive, quantitative performance improvement study. From September 1, 2013, to December 1, 2013, 177 members of the EART from anesthesia, otolaryngology, trauma surgery, emergency medicine, ICU nursing, and respiratory therapy participated in emergency airway simulations. Team dynamics and confidence levels and knowledge of EART were assessed using pre-and post-simulation questionnaires. Results: All participants regardless of their role, experience in the medical field, or any prior exposure to a difficult airway showed significant improvement in self-rated team participation and confidence and objective knowledge regarding EART after undergoing simulation. Conclusion: Our study highlights the efficacy and utility of simulation in assessing personnel team dynamics and confidence levels and knowledge of emergency airway scenarios. Practitioners in all fields and level of experience benefit in EART training and simulation. We hope that with this information, we will be able to conduct future studies on reduction of patient morbidity and mortality.

The color of cancer: Margin guidance for oral cancer resection using elastic scattering spectroscopy

To evaluate the usefulness of elastic scattering spectroscopy (ESS) as a diagnostic adjunct to frozen section analysis in patients with diagnosed squamous cell carcinoma of the oral cavity.

Variability of the Pressure Measurements Exerted by the Tip of Laryngoscope During Laryngeal Sensory Testing: A Clinical Demonstration.

Purpose Clinicians often test laryngeal sensation by touching the laryngeal mucosa with the tip of a flexible laryngoscope. However, the pressure applied to the larynx by using this touch method is unknown, and the expected responses elicited by this method are uncertain. The variability in pressure delivered by clinicians using the touch method was investigated, and the subject responses to the touches were also reported. Methods A fiberoptic pressure sensor passed through the working channel of a laryngoscope, with its tip positioned at the distal port of the channel. Two examiners each tested 8 healthy adults. Each examiner touched the mucosa covering the left arytenoid 3 times. The sensor recorded the pressure exerted by each touch. An investigator noted subject responses to the touches. From the recorded videos, the absence or presence of the laryngeal adductor reflex in response to touch was judged. Results Pressure values obtained for 46 of the 48 possible samples ranged from 17.9 mmHg to the measurement ceiling of 350.0 mmHg. The most frequently observed response was positive subject report followed by the laryngeal adductor reflex. Conclusion Pressure applied to the larynx by using the touch method was highly variable, indicating potential diagnostic inaccuracy in determining laryngeal sensory function.