Purpose. Oropharyngeal dysphagia represents one of the most frequent postsurgical complications in head-and-neck cancer (HNC) patients, either as aspiration or as limitations of oral intake. At the moment, no dysphagia screening is available for this target population. This study aimed at the development of a water swallow test FraMaDySc that should reliably identify aspiration, limitations of oral intake and, first and foremost, relevant oropharyngeal dysphagia (ROD).

Methods. A total of 184 postsurgical HNC patients were tested after surgeon"s approval of and before the first postsurgical oral intake (mean age 62 years, 71% male). First, a water swallow test was conducted that was followed by the endoscopic evaluation of swallowing (FEES®). FEES results were graduated by the Penetration-aspiration scale (PAS) and Functional Oral Intake Scale (FOIS). ROD was derived from results of these two scales. For the analysis of the FraMaDySc quality criteria, its dichotomized results were cross-tabulated with the dichotomized FEES results ("pass/fail"). ROD was defined as the most important reference standard, aspiration and limitations of oral intake as secondary reference standards.

Results. ROD was found in 65% of patients, aspiration in 44%, limitations of oral intake in 56%. FraMaDySc showed sensitivity of 91%, specificity of 88%, positive likelihood ratio of 7.3 for ROD. Respective values for aspiration were 94%, 60%, 2.3, those for limitations of oral intake 91%, 72%, 3.2.

Conclusion. FraMaDySc was confirmed as a valid screening tool for the detection of the oropharyngeal dysphagia in postsurgical HNC patients, with very good quality criteria.

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