Prediction of aspiration in patients with newly diagnosed untreated advanced head and neck cancer.
OBJECTIVE
To determine the prevalence of aspiration in patients with newly diagnosed nontreated advanced head and neck cancer and to determine the ability of the clinical examination to predict aspiration in this patient population.


METHODS
A descriptive prevalence study of the presence of aspiration in patients with advanced (stages III and IV) head and neck cancer and a prospective correlation study between variables of the clinical evaluation with the criterion standard videofluoroscopy.


METHODS
Regional veterans affairs medical center.


METHODS
A consecutive sample of 27 patients without previous treatment or tracheostomy.


METHODS
All patients underwent evaluation by an otolaryngologist and speech pathologist prior to videofluoroscopy.


METHODS
Variables in the dysphagia evaluation (consisting of a directed medical history, physical examination, and food challenge), the self-rated 45-item questionnaire, and the clinicians "educated prediction" of aspiration were analyzed with reference to aspiration on videofluoroscopy using univariant analysis.


RESULTS
The prevalence of aspiration determined by videofluoroscopy was 41% (11 of 27 patients). Two (6%) of 32 items in the medical history, 1 (4%) of 25 items in the physical examination, and 8 (50%) of 16 items in the food challenge were found to be statistically significantly correlated (P<.05) with aspiration on videofluoroscopy by univariate analysis. Nine (25%) of 45 items in the self-rated questionnaire were correlated with aspiration on videofluoroscopy. The clinicians' educated prediction of aspiration was not correlated with aspiration determined by videofluoroscopy.


CONCLUSIONS
Clinical evaluation alone is inadequate in predicting patients who aspirated, determined objectively by videofluoroscopic swallowing study. Further study is needed to develop an efficient dysphagia evaluation to identify patients at risk for aspiration.
Rosen
A
A
Division of Otolaryngology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103, USA. ROSENAR@UMDNJ.EDU
Rhee
T H
TH
Kaufman
R
R
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000175:diagnosis; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D005471:Fluoroscopy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications*; D010610:Pharyngeal Neoplasms / Q000150:complications*; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies