Early application value of flexible laryngoscope swallowing function assessment in patients after partial laryngectomy

Abstract

To investigate the influence of early dysphagia on quality of life in patients with partial laryngectomy, and to investigate the application value of Flexible Endoscopic Evaluation of Swallowing (FEES). This study included 30 inpatients who underwent partial laryngectomy due to laryngeal cancer. In the early postoperative period, a comprehensive assessment was conducted on each patient, encompassing Videofluoroscopic Swallowing Study (VFSS), Flexible Endoscopic Evaluation of Swallowing (FEES), and MD Anderson Dysphagia Inventory (MDADI). Each patient underwent two evaluations at different time points following the surgical procedure, all conducted on the same day. The patients’ first MDADI assement score after surgery was 45.4 ± 3.6 points, and the second score was 54.7 ± 13.4 points. VFSS as the gold standard, FEES showed good sensitivity (84%) and specificity (94%) for detecting aspiration, as well as good sensitivity (78%) and moderate specificity (86%) for detecting penetration. The Kappa consistency test results showed high consistency between FEES and VFSS swallowing function evaluations (Kappa value = 0.669); evaluations of thin liquid, thick liquid, and solid bolus had high consistency (Kappa value = 0.631, 0.675, and 0.678, respectively), while evaluations of semi-liquid bolus had poor consistency (Kappa value = 0.598); evaluations of four bolus sizes all had high consistency (Kappa value = 0.658, 0.647, 0.705, 0.670). The Kappa values for evaluating patients undergoing horizontal partial laryngectomy, vertical partial laryngectomy, and supraglottic laryngectomy were 0.572, 0.604, and 0.680, respectively. This study shows that dysphagia is an important problem affecting the early quality of life of patients after partial laryngectomy, and early instrumental evaluation is also extremely important. This study also emphasizes the reliability problems in the identification of false invasion and aspiration. FEES can be used to evaluate the early swallowing function of patients after partial laryngectomy, thus guiding the timing and type of eating, and evaluating the rehabilitation effect. In addition, compared with VFSS, FEES have more advantages for the identification of penetration.