Carina Strehlau (Marburg), Almut Goeze (Marburg), Eugen Zaretsky (Marburg), Jenny Hötzel (Marburg), Christiane Hey (Marburg)
Purpose. An examination of clinical predictors (or parameters) is often used for the first evaluation of the swallowing function of head-and-neck (HNC) patients after surgery. This study aimed to scrutinize such clinical predictors regarding their predictive power for the aspiration, limitations of oral intake, and, as their derivate, a relevant oropharyngeal dysphagia (ROD). Following predictors were chosen: dysglossia, wet voice, volitional cough, mouth opening, tongue motility, tongue strength, gag reflex.
Methods. In 2010 – 2022, 184 postsurgical HNC patients were tested (29% female, UICC II – IV, mean age 62 years). Apart from the evaluation of clinical predictors, all patients underwent FEES®. Its results were graded by the Penetration-aspiration scale (PAS) and Functional Oral Intake Scale (FOIS). ROD was derived from these two scales. Clinical predictors and their combination were correlated and cross-tabulated with the dichotomized FEES results for the calculation of quality criteria.
Results. Only wet voice yielded significant phi-correlations with all three reference standards (PAS, FOIS, ROD). Four clinical predictors and their combination correlated significantly with FOIS and ROD. Almost all correlations were low. The sensitivity of clinical predictors and their combination for ROD was, on average, 40%, the specificity 77%, positive likelihood ratio 2.3. Respective values for PAS were 39%, 70%, 1.4, those for FOIS 42%, 76%, 2.3. The best quality criteria were achieved by wet voice but even in this case the sensitivity values under 40% cannot be considered sufficient.
Conclusion. Neither separate clinical predictors nor their combination can reliably predict postsurgical oropharyngeal dysphagia, aspiration, or limitations of oral intake in HNC patients.
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