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Background: Acquired laryngotracheal stenosis (LTS) is a rare condition that causes breathlessness and dyspnoea. Patients have reconstructive airway surgery to improve their breathing difficulties, but both LTS and the surgery can cause voice difficulties. The existing evidence base for management of voice difficulties for adults with LTS focuses on symptoms. There is limited information to provide clinical guidance for speech and language therapists (SLTs) and a limited understanding of the impact of voice changes on adults with LTS. Aim: To investigate the lived experience of adults with laryngotracheal stenosis (LTS), who have had reconstructive surgery; here focussing on voice concerns with the aim of guiding clinical care for SLTs. Methods and Procedures: A phenomenological, qualitative study design was used. Focus groups and semi-structured interviews were completed with adults living with LTS who had had reconstructive surgery. Audio recordings were transcribed and inductive thematic analysis was used by the research team to identify themes and sub-themes. Outcomes and Results: A total of 24 participants (five focus groups and two interviews) took part in the study before thematic saturation was identified in analysis. Three main themes were identified specific to the experience of living with LTS: the Medical, Physical and Emotional journey. All participants referenced voice difficulties as they related to each of these overall themes. Sub-themes directly related to voice included experience of surgery, information provision, staff expertise/complacency, symptoms, symptom management, identity, support networks, impact on life and living with a chronic condition. Conclusions and Implications: In this qualitative study participants have described the integral part voice difficulties play in their lived experience of LTS and reconstructive surgery. This is considered in the context of their clinical care and the need for individualised management and information provision throughout the course of their condition. The broader research literature relating to voice difficulties is explored with links made to people with LTS and recommendations made for future research into people living with LTS and dysphonia.

Objectives: To investigate how the symptoms of mucus and cough impact adults living with laryngotracheal stenosis, and to use this information to guide future research and treatment plans. Methods: A survey was developed with the support of patient advisors and distributed to people suffering with laryngotracheal stenosis. The survey comprised 15 closed and open questions relating to mucus and cough and included the Leicester Cough Questionnaire (LCQ). Descriptive statistics, X2 and thematic analyses were completed. Results: In total, 641 participants completed the survey, with 83.62% (n = 536) reporting problems with mucus; 79% having daily issues of varying severity that led to difficulties with cough (46.18%) and breathing (20.90%). Mucus affected voice and swallowing to a lesser degree. Respondents described a range of triggers; they identified smoky air as the worst environmental trigger. Strategies to manage mucus varied widely with drinking water (72.26%), increasing liquid intake in general (49.35%) and avoiding or reducing dairy (45.32%) the most common approaches to control symptoms. The LCQ showed a median total score of 14 (interquartile range 11-17) indicative of cough negatively affecting quality of life. Thematic analysis of free text responses identified 4 key themes--the Mucus Cycle, Social impact, Psychological impact, and Physical impact. Conclusion: This study shows the relevance of research focusing on mucus and cough and its negative impact on quality of life, among adults with laryngotracheal stenosis. It demonstrates the inconsistent advice and management strategies provided by clinicians for this issue. Further research is required to identify clearer treatment options and pathways. [ABSTRACT FROM AUTHOR]

Objectives: Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.Study Design: Systematic review.Methods: Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria.Results: A total of 143 abstracts were reviewed, with 67 articles selected for full-text review. Twenty studies met the inclusion criteria. Data extraction was completed with the Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous, and there was limited information provided about rationale or reliability.Conclusions: The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there are no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement. Laryngoscope, 131:146-157, 2021. [ABSTRACT FROM AUTHOR]

Background: Dysphagia can occur in advanced lung cancer due to direct tumour invasion or nerve compression. Anti-cancer treatments and co-morbid conditions may also cause or compound dysphagic symptoms. Speech and language therapy (SLT), medical and surgical interventions are available to address dysphagic symptoms in patients with lung cancer, however, management options are not described in national guidelines. Given the potentially short prognoses for patients with lung cancer, the aim of care should be to reduce symptom burden and maximise quality of life (QOL). Central to that aim is the identification and treatment of swallowing difficulties.Purpose: This study sought to identify the prevalence and impact of dysphagia on QOL in patients with advanced lung cancer.Methods: A single-site, prospective, exploratory study was undertaken. Previously validated patient-reported outcome measures of swallowing were used to identify the presence and impact of dysphagia on QOL: EAT-10 assessment and the SWAL-QOL assessment.Results: Seventy-two participants were recruited with 18.1% identified as having dysphagia on completion of the EAT-10 assessment. On further evaluation using the SWAL-QOL, compromised quality of life was noted with increased fatigue and meal time duration, difficulties with food selection and reduced eating desire. Frequent throat clearing, coughing and perceived pharyngeal stasis were reported.Conclusions: Dysphagia is a potential symptom in advanced lung cancer which may impact QOL. Patients, carers and healthcare professionals should be aware of this so that early referral to SLT can be expedited. More robust prevalence and interventional studies are required to inform optimal management of this distressing condition. [ABSTRACT FROM AUTHOR]

Background: Persistent dysphagia following primary chemoradiation (CRT) for head and neck cancers can have a devastating impact on patients' quality of life. Single arm studies have shown that the dosimetric sparing of critical swallowing structures such as the pharyngeal constrictor muscle and supraglottic larynx can translate to better functional outcomes. However, there are no current randomised studies to confirm the benefits of such swallow sparing strategies. The aim of Dysphagia/Aspiration at risk structures (DARS) trial is to determine whether reducing the dose to the pharyngeal constrictors with dysphagia-optimised intensity- modulated radiotherapy (Do-IMRT) will lead to an improvement in long- term swallowing function without having any detrimental impact on diseasespecific survival outcomes. Methods/design: The DARS trial (CRUK/14/014) is a phase III multicentre randomised controlled trial (RCT) for patients undergoing primary (chemo) radiotherapy for T1-4, N0-3, M0 pharyngeal cancers. Patients will be randomised (1:1 ratio) to either standard IMRT (S-IMRT) or Do-IMRT. Radiotherapy doses will be the same in both groups; however in patients allocated to Do-IMRT, irradiation of the pharyngeal musculature will be reduced by delivering IMRT identifying the pharyngeal muscles as organs at risk. The primary endpoint of the trial is the difference in the mean MD Anderson Dysphagia Inventory (MDADI) composite score, a patient-reported outcome, measured at 12 months post radiotherapy. Secondary endpoints include prospective and longitudinal evaluation of swallow outcomes incorporating a range of subjective and objective assessments, quality of life measures, locoregional control and overall survival. Patients and speech and language therapists (SLTs) will both be blinded to treatment allocation arm to minimise outcome-reporting bias. Discussion: DARS is the first RCT investigating the effect of swallow sparing strategies on improving long-term swallowing outcomes in pharyngeal cancers. An integral part of the study is the multidimensional approach to swallowing assessment, providing robust data for the standardisation of future swallow outcome measures. A translational sub- study, which may lead to the development of future predictive and prognostic biomarkers, is also planned. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about approaches to functional outcome assessment after treatment of oral cavity.

We undertook a service evaluation to establish how oropharyngeal dysphagia is managed in head and neck cancer patients receiving radiotherapy in the United Kingdom. A web-based survey including 23 open and closed questions was distributed to Speech and Language Therapy (SLT) teams via a national network of Royal College of Speech and Language Therapists (RCSLT) special interest groups with members involved in head and neck cancer care. Forty-six teams responded to the survey and 89% completed the questionnaire fully. Fifty percent (n=21/42) of the SLT teams reported routinely seeing patients prior to commencing radiotherapy. Baseline oromotor assessment (85.7% (n=36/42)), clinical dysphagia assessment (90.5% (n=38/42)) and information provision on the potential treatment effects on swallowing (97.6% (n=41/42)) and communication ability (85.7% (n=36/42)) were the most common components of initial evaluation. In keeping with expert opinion and emerging evidence, prophylactic swallowing exercises were administered by 71.4% (n=30/42) of teams targeting specific aspects of swallowing, although the nature, intensity and duration of programmes varied. A range of measures are used to monitor progress during treatment. Our survey highlighted that resource limitations affect service provision with some teams managing the consequences of treatment rather than proactive multidisciplinary intervention prior to and during treatment. Cancer- and treatment-related dysphagia can impact significantly on a broad range of outcomes following radiotherapy. There is variability in dysphagia service provision to patients before, during and following treatment. Comprehensive evaluation of swallowing function prior to treatment and proactive management can yield benefits for patients, inform multidisciplinary case management and support those involved in clinical trials to accurately determine treatment effects. [ABSTRACT FROM AUTHOR]

Purpose: A systematic review to establish what evidence is available for swallowing outcomes following IMRT for head and neck cancer.Methods: Online electronic databases were searched to identify papers published in English from January 1998 to December 2009. Papers were independently appraised by two reviewers for methodological quality, method of swallowing evaluation and categorized according to the World Health Organisation's International Classification of Health Functions. The impact of radiation dose to dysphagia aspiration risk structures (DARS) was also evaluated.Results: Sixteen papers met the inclusion criteria. The literature suggests that limiting the radiation dose to certain structures may result in favourable swallowing outcomes. Methodological limitations included variable assessment methods and outcome measures and heterogeneity of patients. There are only limited prospective data, especially where pre-treatment measures have been taken and compared to serial post-treatment assessment.Conclusions: Few studies have investigated the impact of IMRT on swallow function and the impact on everyday life. Initial studies have reported potential benefits but are limited in terms of study design and outcome data. Further well designed, prospective, longitudinal swallowing studies including multidimensional evaluation methods are required to enable a more comprehensive understanding of dysphagia complications and inform pre-treatment counselling and rehabilitation planning. [ABSTRACT FROM AUTHOR]

Background: Over 200,000 patients are referred onto the suspected head and neck cancer (HNC) pathway annually in the UK, with around 3% receiving a cancer diagnosis. With new HNC advancements in identifying patients at low risk of a cancer diagnosis, one proposal is a speech and language therapy (SLT)-led first point of contact clinic for low-risk patients presenting with voice or swallowing symptoms., Aims: To explore ear, nose and throat (ENT) surgeons' views regarding this model., Materials & Methods: The study used a qualitative study design using semi-structured interviews. Transcribed responses were analysed using thematic analysis., Outcomes & Results: A total of 11 UK ENT surgeons participated. Themes included the positives and challenges of the proposed model; existing facilitators that increase the likelihood of success; and the requirements for successful implementation. Service variation impacted level of interest. Waiting times were problematic at some sites more than others; SLT workforce issues were of differing prevalence; SLT competence and interest differed; and support from organizational leaders varied. Participants' personal views also varied, for example, acceptability of the model to patients, or what governance structure is required. There was no single SLT-led clinic model suitable for all centres; however, some general principles were identified to inform further evaluation and implementation of this model., Conclusions & Implications: Principles included the deployment of SLTs experienced in laryngeal examination and flexible nasendoscopy; dedicated job plans and workforce; professional and regulatory body recognition and support; and clear training, supervision structure and job description for the role. Service outcomes, training protocol and competencies require robust evaluation., What This Paper Adds: What is already known on this subject During the SARS-CoV-2 pandemic, a risk calculator tool was developed to identify patients at highest risk of cancer who were referred to the 2-week-wait (2ww) ENT pathway. These patients require urgent face to face ENT assessment. Lower risk patients with voice and swallowing difficulties still require management of their symptoms and an SLT-led clinic model is one potential solution for this population. While SLTs' views of this model have been explored with a UK-wide survey and focus groups, ENT surgeons' perspectives are yet to be investigated. What this study adds to the existing knowledge This study explores ENT surgeons' views regarding SLT-led clinics for patients who are referred through the 2ww ENT pathway, stratified as being at low risk of cancer, and with voice and/or swallowing symptoms of likely benign aetiology. Participants shared many positive perceptions of the clinic along with factors that they felt would enhance its success (facilitators). Key requirements for the success of this clinic model were also highlighted, along with challenges that need to be addressed. What are the practical and clinical implications of this work? The need for this clinic model varied by centre. However, general principles included the importance of a dedicated workforce with pre-existing relevant expertise; and a clear role profile, training process and competencies framework. Professional, statutory and regulatory bodies' recognition of the role is required, and robust evaluation of the model is necessary., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Purpose of Review: Head and neck cancer (HNC) and its treatment impacts profoundly on patients' functional abilities, emotional well being and social interactions. Communication and swallowing are fundamental to everyday life, and the Speech and Language Therapist (SLT) has a critical role for both patients and their carers. In clinical practice, patient-reported outcome measures (PROMs) are a key part of the armamentarium of the SLT. The purpose of the review is to summarize how these measures can be beneficial in the context of time pressured SLT outpatient consultations., Recent Findings: Unmet needs in HNC are common and impact negatively on quality of life. There is an ever-increasing number of articles in this area, and it can be a challenge to identify, distil and summarize those specific to SLT., Summary: In this review, we discuss the scope of holistic evaluation, strengths and limitations of PROMs, the Patient Concerns Inventory-Head and Neck, barriers to the use of outcome measures, the carers perspective and surveillance. SLT are uniquely placed members of the multidisciplinary team and provide expert advice and intervention. The inclusion of PROMs in routine consultations provides a model of follow up, which helps address patients and carers complex and unmet needs, ultimately promoting better outcomes., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The purpose of this prospective study was to evaluate the swallowing performance of patients with head and neck cancer treated with parotid-sparing intensity-modulated radiotherapy (IMRT)., Methods: Sixty-two patients were recruited. Data were collected before and up to 12 months after treatment. Measures included the Performance Status Scale for head and neck cancer (PSS-HN Normalcy of Diet and Eating in Public subscales), tube feeding status, and 100 mL water swallow test (WST) volume and capacity scores., Results: There was a significant reduction in PSS-HN and WST scores from baseline to 3 months (p < .001). Significant improvements were observed up to 12 months on the PSS-HN. Swallowing volume and capacity scores recovered but did not reach statistical significance. Tube feeding was not required in 47% of the patients., Conclusion: IMRT significantly impacts on swallowing performance, although there is a trend for improvement up to 12 months after treatment. Our data support a case-by-case approach to tube feeding. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1436-E1444, 2016., (© 2015 Wiley Periodicals, Inc.)

Objectives: Swallowing can be significantly affected during and following radiotherapy for head and neck cancer (HNC). The purpose of this study was to understand: (1) the trajectory of swallowing recovery following parotid-sparing intensity-modulated radiotherapy (IMRT) and (2) overall physical and social-emotional wellbeing and how patients prioritise swallowing following treatment., Materials and Methods: Sixty-one HNC patients completed questionnaires as part of a prospective study exploring patient-reported swallowing outcomes following parotid-sparing IMRT. Participants were asked to complete the M.D. Anderson Dysphagia Inventory (MDADI) and University of Washington Quality of Life Questionnaire (UW-QoL) v.04 before treatment and 3, 6 and 12months after treatment. Given the rise in human papilloma virus (HPV) and associated oropharyngeal cancers, we completed a sub analysis of the data in those participants., Results: There was a significant reduction in the MDADI composite scores 3months after completion of treatment. Improvements were observed by 12months, however, scores did not recover to baseline. The recovery in physical function was limited in comparison to social-emotional recovery at 12months. When oropharyngeal cancer scores were analysed, there was not a substantial difference to the whole group results. There was a shift in priorities following treatment. Swallowing was highlighted as a concern by 44% of HNC patients up to 12months after treatment with swallowing-related factors (saliva, taste and chewing) rated highly., Conclusions: Patient reported swallowing outcomes were significantly affected from baseline to all follow-up time points and remained a priority concern at 12months following treatment. Overall social-emotional functioning does improve, suggesting that patients have the potential to adapt to their "new normal" following IMRT for HNC., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose of Review: Oncological treatment outcomes in head and neck cancer suggest both acute and longer-term oropharyngeal dysphagia. Studies have been published exploring the potential to improve swallowing outcomes using more targeted treatment modalities such as intensity-modulated radiotherapy (IMRT) and through the introduction of swallowing exercises prior to treatment. In this article, we will explore the literature relating to prophylactic swallowing exercises for patients undergoing (chemo-)radiotherapy., Recent Findings: Recent studies have attempted to evaluate the benefit of prophylactic, pretreatment swallowing exercises for patients undergoing (chemo-)radiotherapy. We identified three peer-reviewed published studies which present data on the potential benefit of exercise. Only one randomized control trial which includes multidimensional swallowing evaluation with instrumental measures has been published. Authors of all the reviewed studies agree that randomized control trials including baseline measures are required with longitudinal follow-up., Summary: More research is required to complement oncological clinical trials evaluating the impact of prophylactic exercise on swallowing outcome. Multidimensional swallowing evaluation including instrumental and patient-reported measures should be conducted pretreatment and longitudinally to develop the evidence base for intervention in patients undergoing organ-preserving treatment protocols.

Impairment of swallowing function is a common multidimensional symptom complex seen in 50-75% of head and neck cancer (HNC) survivors. Although there are a number of validated swallowing-specific questionnaires, much of their focus is on the evaluation of swallowing-related quality of life (QOL) rather than swallowing as a specific function. The aim of this study was to validate the Sydney Swallow Questionnaire (SSQ) as a swallowing-specific instrument in HNC patients. Fifty-four consecutive patients in follow-up for oral and oropharyngeal cancer completed the SSQ and MD Anderson Dysphagia Inventory (MDADI). Thirty-one patients completed both questionnaires again four weeks later to address test-retest reliability. Internal consistency and test-retest reliability was assessed using Cronbach's alpha and Spearman's correlation coefficient, respectively. Construct validity (including group validity) and criterion validity were determined using Spearman's correlation coefficient and Mann-Whitney U-test. Internal consistency, test-retest reliability, construct validity, group validity and criterion validity of the SSQ was found to be significant (P<0.01). We were able to demonstrate the reliability and validity of the SSQ in HNC patients. The SSQ is a precise, reliable and valid tool for assessing swallow in this patient group., (Copyright 2010 Elsevier Ltd. All rights reserved.)