Bolus effects on patient awareness of swallowing difficulty and swallow physiology after chemoradiation for head and neck cancer.
BACKGROUND
Patients treated for head and neck cancer frequently develop dysphagia. Bolus characteristics are altered during fluoroscopic swallowing studies to observe the impact on swallowing function. The purpose of this study was to determine bolus volume and consistency effects on oropharyngeal swallowing physiology and patient awareness of swallowing difficulty.


METHODS
Twenty-one patients with head and neck cancer were assessed pre-chemoradiation and post-chemoradiation. The Modified Barium Swallow Study (MBSS) was utilized to examine swallow physiology. Each patient provided perceptual ratings of swallowing difficulty after each swallow of varying bolus types.


RESULTS
Oral transit times were significantly longer with pudding boluses. There were trends for higher residue percentages as well as perceptual ratings for pudding and cookie boluses. One correlation between perceptual ratings and physiology was significant.


CONCLUSIONS
Patient awareness of swallowing difficulty and aspects of swallowing physiology vary with bolus consistency. Patient awareness does not correlate with observed changes in swallowing physiology.
William S. Middleton Memorial Veterans Hospital, University of Wisconsin-Madison, Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, Madison, Wisconsin.
Nicole M
NM
Rogus-Pulia
Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois.
Margaret
M
Pierce
Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Bharat B
BB
Mittal
Northwestern University, Department of Communication Sciences and Disorders, Evanston, Illinois.
Steven G
SG
Zecker
Northwestern University, Department of Communication Sciences and Disorders, Evanston, Illinois.
Jeri
J
Logemann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003287:Contrast Media; D003679:Deglutition / Q000187:drug effects* / Q000528:radiation effects*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000503:physiopathology*; D011182:Postoperative Care; D011300:Preoperative Care; D013997:Time Factors
D003287:Contrast Media; D001466:Barium Sulfate
bolus; chemoradiation; consistency; dysphagia; head and neck cancer; perception; volume