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Background and study aims Oropharyngeal dysphagia (OPD) is prevalent in patients with Parkinson’s disease (PD). Upper esophageal sphincter (UES) dysfunction is an important pathophysiological factor for OPD in PD. The cricopharyngeus (CP) is the main component of UES. We assessed the preliminary efficacy of cricopharyngeal peroral endoscopic myotomy (C-POEM) as a treatment for dysphagia due to UES dysfunction in PD. Patients and methods Consecutive dysphagic PD patients with UES dysfunction underwent C-POEM. Swallow metrics derived using high-resolution pharyngeal impedance manometry (HRPIM) including raised UES integrated relaxation pressure (IRP), raised hypopharyngeal intrabolus pressure (IBP), reduced UES opening caliber and relaxation time defined UES dysfunction. Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Questionnaire (SWAL-QOL) at before and 1 month after C-POEM measured symptomatic improvement in swallow function. HRPIM was repeated at 1-month follow-up. Results C-POEM was performed without complications in all (n = 8) patients. At 1 month, there was an improvement in both the mean SSQ (from 621.5 to 341.8, mean difference –277.3, 95 %CI [–497.8, –56.7], P = 0.02) and SWAL-QOL (from 54.9 to 68.3, mean difference 9.1, 95 %CI [0.7, 17.5], P = 0.037) scores. Repeat HRPIM confirmed a decrease in both the mean UES IRP (13.7 mm Hg to 3.6 mm Hg, mean difference –10.1 mm Hg, 95 %CI [–16.3, –3.9], P = 0.007) and the mean hypopharyngeal IBP (23.5 mm Hg to 10.4 mm Hg, mean difference –11.3 mm Hg, 95 %CI [–17.2, –5.4], P = 0.003). Conclusions In dysphagic PD patients with UES dysfunction, C-POEM is feasible and enhances UES relaxation and reduces sphincteric resistance to flow during the swallow, thereby improving dysphagia symptoms.

Purpose Patient-reported outcomes (PROs) are an important feature in clinical evaluation of swallowing. The Eating Assessment Tool (EAT-10) and the Sydney Swallow Questionnaire (SSQ) are two validated dysphagia PROs commonly used in healthy older adult populations as screening tools for swallowing problems. The purpose of this study is to compare the consistency of the EAT-10 and SSQ scores for self-reported swallowing difficulties in a group of community-dwelling older adults (CDOA) completing both questionnaires. Method A total of 316 individuals over the age of 60 years completed the EAT-10, SSQ, and provided demographic data, including a self-report of any medical diagnoses. Participants were excluded if they had any diagnoses known to cause dysphagia. Questionnaire responses were analyzed for frequencies of responses across all participants. Results Seventy-five participants were identified as having dysphagia by the EAT-10 (23.7%), while 30 participants were identified by the SSQ (9.49%). When comparing the results of the two assessments, the scales agreed on 289 out of 316 participants (91%). There was a disagreement on the results in 27 of the 316 participants, with 26 of these self-reporting dysphagia symptoms on the EAT-10 but not on the SSQ. Conclusions Two commonly used dysphagia PROs resulted in different prevalence rates of self-reported dysphagia in a group of CDOA. CDOAs may need questionnaires specifically validated for them with special consideration for specific age-related risk factors, to ensure accurate early identification.

Introduction/aims Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharyngeal dysphagia in various NMD groups and diseases. Finally, we compared results of this screening with those from their corresponding medical records for eventual "clinical history" of dysphagia. Methods We asked patients to fill in the SSQ during follow-up outpatient visits at our neuromuscular reference center. A total score above the cutoff score of 118.5 out of 1700 was indicative of oropharyngeal dysphagia. Results Of the 304 adult patients assessed for eligibility, 201 NMD patients (96 women and 105 men, aged 49.0 ± 16.2 years) were included and tested in this study. Oropharyngeal dysphagia was detected in 45% of all the NMD patients when using the SSQ, whereas only 12% had a positive medical record for dysphagia. The median SSQ scores for patients with myotonic syndromes (including myotonic dystrophy type 1), with amyotrophic lateral sclerosis, and with facioscapulohumeral dystrophy were above the cutoff score. The SSQ scores obtained revealed distinct oropharyngeal dysphagia characteristics in the different NMD groups and diseases. Discussion The SSQ tests positively for oropharyngeal dysphagia in a higher proportion of NMD patients compared with their medical records. The distinct oropharyngeal dysphagia characteristics we revealed in different NMD groups and diseases may help to elaborate adapted clinical approaches in the management of oropharyngeal dysphagia.

The Functional Assessment of Cancer Therapy (FACT) instrument is comprised of a group of related and overlapping quality of life (QoL) questionnaires including a core general form, head and neck cancer (HNC)-specific items, and an expert-selected index (FACT-HNSI). Understanding how these relate to more HNC-specific instruments such as the MD Anderson Dysphagia Inventory (MDADI) and Sydney Swallow Questionnaire (SSQ) is vital for guiding their use in clinical trials.HNC patients concurrently completed MDADI, SSQ, and FACT questionnaires at radiation oncology clinic visits (2015-2016). Spearman correlation coefficients were calculated between each FACT instrument and MDADI or SSQ. Unsupervised k-means cluster analyses were performed to identify clusters of similar QoL responses. Principal component analysis (PCA) identified the degree of variability explained by each instrument.We identified 631 instances (363 patients) where the questionnaires were completed concurrently. Correlations between the various FACT measures and SSQ or MDADI were all significant (p 0.001), but FACT HNC-specific subscale and FACT-HNSI showed the strongest correlation with MDADI and SSQ. Clustering identified 3 distinct groups of responses when combining instruments either pairwise or three-way. PCA revealed that MDADI and FACT HNC-specific subscale provide similar and likely redundant information.FACT HNC-subscale and FACT-HNSI may be preferable over other FACT measures for use in clinical trials where patient-reported swallow function is evaluated. MDADI and FACT provide similar insights into HNC patient QoL while SSQ provides additional, complementary information which could serve to better stratify patients into groups with high, medium, and low QoL outcomes.

En Abstract Background Laryngeal cancer is the most common malignant tumor of the upper aerodigestive tract. Surgical treatment of advanced laryngeal cancer often requires a total laryngectomy (TL), resulting in a permanent tracheostomy and potential difficulties with a patient’s speech and communication. Objectives The aim of this study was to assess post-treatment voice changes, swallowing, and quality of life (QoL) of patients with carcinoma of the larynx treated with different treatment modalities. Patients and methods A total of 100 patients with laryngeal cancer treated with different treatment modalities were included in the present study. The primary treatment modality included TL (n = 46), partial laryngectomy (PL) (n = 7), transoral cordectomy (n = 9), radiotherapy (Rx) (n = 29), or combined treatment during the last 10 years with radiation after TL (TL and Rx, n = 9). Patients were subjected to full history taking, complete ENT examination, and assessment of: global QoL, voice, and acoustic parameters using the computerized speech lab at the outpatient clinic of Tanta University Hospitals (TUH). Evaluation of swallowing was carried out using a modified Arabic version of the QoL questionnaire called the Sydney Swallow Questionnaire. Patients having problems with swallowing were further evaluated using fiberoptic endoscopic evaluation of swallowing, at the outpatient clinic of TUH. Respiratory function of the larynx was evaluated by applying a modification of St George’s Respiratory Questionnaire. Results Results of voice analysis showed that the best voice was evident in patients who had undergone cordectomy, followed by those who had received radiotherapy. There was no significant difference in voice characteristics between patients using voice prosthesis, esophageal voice, or electrolarynx after TL and those using these aids after PL. Worst voice as well as swallowing was seen in patients who had undergone combined TL and postoperative radiotherapy. The best results of swallowing were seen in patients who had undergone cordectomy. Patients who had undergone TL or radiotherapy alone showed similar swallowing results, but better than those who had undergone PL, especially those who had undergone supracricoid laryngectomy. Assessment of respiratory function showed best results in patients who had undergone cordectomy, followed by those who had undergone TL and radiotherapy. Poorest results were seen in patients with combined surgery and Rx, and those who had been treated with PL. Conclusion Our study revealed that the best significant performance results were seen in patients who had undergone transoral cordectomy, followed by patients who had received radiotherapy only. This was followed by patients who had undergone TL and PL, with no significant difference between the two groups. The worst results were seen in patients who had undergone combined surgery and radiotherapy as the primary treatment modality.

Oropharyngeal dysphagia is frequently under-reported and early detection may lead to adapt strategies of rehabilitation and management decisions. The Sydney Swallow Questionnaire (SSQ), a self-reported questionnaire for the detection and quantification of oropharyngeal dysphagia, was previously adapted and validated in other languages but not in French. The purposes of this study were to develop and validate a French version of SSQ (SSQ-f) and to assess its psychometric properties. This SSQ-f, obtained by back-translation and cross-cultural adaptation, was validated in 27 patients with impaired swallowing and 27 healthy controls. After inclusion, patients filled in the SSQ-f and performed a videofluoroscopic swallow study. The penetration aspiration scale (PAS) and Dysphagia outcome and severity scale (DOSS) were assigned to assess construct validity. Sensitivity and specificity of cut-off scores for the SSQ-f were assessed by the receiver operating characteristic (ROC) curves. Moreover, the SSQ-f was repeated after 2 weeks to evaluate its test-retest reliability. The results supported that SSQ-f was considered understandable. Its total score was strongly correlated to the DOSS (r = - 0.873) and to the PAS (r = 0.738). It demonstrated acceptable internal consistency, with Cronbach's alpha values ranging from 0.744 to 0.956. The test-retest reliability was excellent. According to the ROC curve, cut-off scores of 118.5 or 218.5 were proposed for determining oropharyngeal dysphagia using DOSS as a reference and 755.0, using PAS as reference. No ceiling or floor effects were observed. In conclusion, the SSQ-f is a valid and reliable instrument to measure and detect oropharyngeal dysphagia in French-speaking subjects and can be used in a clinical setting.

Background: Voice and swallowing problems are often seen in patients with advanced larynx cancer, after total laryngectomy (TL) and chemo/radiotherapy. The aim of this study was to determine the occurrence of voice and swallowing problems in patients who have been laryngectomised and investigate if these symptoms were related to age, time after TL, radiotherapy and TNM-classification. In addition, we studied how often the patients changed their voice prostheses and the need of therapeutic interventions after TL. Methods: Forty-five patients were included in the study and completed the Swedish version of the Sydney Swallow Questionnaire and the Voice Handicap Index-T. Results: Swallowing problems were reported by 89% of the patients and moderate-to-severe voice handicap was reported by 66%. Most of the subjects who had dysphagia also presented voice problems (rs = 0.67 p ≤ .01). Additional therapeutic interventions to manage problems with voice and/or swallowing after TL were required in 62% of the patients. Conclusions: Swallowing and voice problems after TL are common. Thus, the preoperative information and assessment of these functions, as well as the treatment and the post-operative rehabilitation should be evaluated and optimised to provide better functional results after treatment of advanced larynx cancer.

Purpose To test the hypothesis that quantifying swallow function with multiple patient-reported outcome (PRO) instruments is an important strategy to yield insights in the development of personalized deintensified therapies seeking to reduce the risk of head and neck cancer (HNC) treatment–related dysphagia (HNCTD). Methods and Materials Irradiated HNC subjects seen in follow-up care (April 2015 to December 2015) who prospectively completed the Sydney Swallow Questionnaire (SSQ) and the MD Anderson Dysphagia Inventory (MDADI) concurrently on the web interface to our Oncospace database were evaluated. A correlation matrix quantified the relationship between the SSQ and MDADI. Machine-learning unsupervised cluster analysis using the elbow criterion and CLUSPLOT analysis to establish its validity was performed. Results We identified 89 subjects. The MDADI and SSQ scores were moderately but significantly correlated (correlation coefficient −0.69). K-means cluster analysis demonstrated that 3 unique statistical cohorts (elbow criterion) could be identified with CLUSPLOT analysis, confirming that 100% of variances were accounted for. Correlation coefficients between the individual items in the SSQ and the MDADI demonstrated weak to moderate negative correlation, except for SSQ17 (quality of life question). Conclusions Pilot analysis demonstrates that the MDADI and SSQ are complementary. Three unique clusters of patients can be defined, suggesting that a unique dysphagia signature for HNCTD may be definable. Longitudinal studies relying on only a single PRO, such as MDADI, may be inadequate for classifying HNCTD.

Dysphagia has been estimated to affect around 8-16 % of healthy elderly individuals living in the community. The present study investigated the stability of perceived dysphagia symptoms over a 3-year period and whether such symptoms predicted death outcomes. A population of 800 and 550 elderly community-dwelling individuals were sent the Sydney Swallow Questionnaire (SSQ) in 2009 and 2012, respectively, where an arbitrary score of 180 or more was chosen to indicate symptomatic dysphagia. The telephone interview cognitive screen measured cognitive performance and the Geriatric Depression Scale measured depression. Regression models were used to investigate associations with dysphagia symptom scores, cognition, depression, age, gender and a history of stroke; a paired t test was used to examine if individual mean scores had changed. A total of 528 participants were included in the analysis. In 2009, dysphagia was associated with age (P = 0.028, OR 1.07, CI 1.01, 1.13) and stroke (P = 0.046, OR 2.04, CI 1.01, 4.11) but these associations were no longer present in 2012. Those who had symptomatic dysphagia in 2009 (n = 75) showed a shift towards improvement in swallowing (P < 0.001, mean = -174.4, CI -243.6, -105.3), and for those who died from pneumonia, there was no association between the SSQ derived swallowing score and death (P = 0.509, OR 0.10, CI -0.41, -0.20). We conclude that swallowing symptoms are a temporally dynamic process, which increases our knowledge on swallowing in the elderly.

Background The aim of this study was to translate and adapt the Sydney Swallow Questionnaire to Swedish conditions and to evaluate the validity and test-retest reliability of the Swedish translation in patients with oropharyngeal dysphagia and in healthy controls. Methods The validation included 20 patients with swallowing problems and 20 controls matched in age and sex. Patients were assigned a Dysphagia Outcome and Severity Scale. Content, construct, discriminant and predictive validity and test-retest reliability were evaluated. Results The Swedish version of the Sydney Swallow Questionnaire was close to the original version, easy to fill in, and well accepted. The form fulfilled the criteria for content, construct, discriminant and predictive validity and test-retest reliability. Conclusions The Swedish translation of the Sydney Swallow Questionnaire proved to be a valid instrument to assess dysphagia symptoms and could be used in clinical settings. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-742) contains supplementary material, which is available to authorized users.

Introduction. Questionnaires on Functional Health Status (FHS) are part of the assessment of oropharyngeal dysphagia.Objective. To conduct a systematic review of the literature on the psychometric properties of English-language FHS questionnaires in adults with oropharyngeal dysphagia.Methods. A systematic search was performed using the electronic databases Pubmed and Embase. The psychometric properties of the questionnaires were determined based on the COSMIN taxonomy of measurement properties and definitions for health-related patient-reported outcomes and the COSMIN checklist using preset psychometric criteria.Results. Three questionnaires were included: the Eating Assessment Tool (EAT-10), the Swallowing Outcome after Laryngectomy (SOAL), and the Self-report Symptom Inventory. The Sydney Swallow Questionnaire (SSQ) proved to be identical to the Modified Self-report Symptom Inventory. All FHS questionnaires obtained poor overall methodological quality scores for most measurement properties.Conclusions. The retrieved FHS questionnaires need psychometric reevaluation; if the overall methodological quality shows satisfactory improvement on most measurement properties, the use of the questionnaires in daily clinic and research can be justified. However, in case of insufficient validity and/or reliability scores, new FHS questionnaires need to be developed using and reporting on preestablished psychometric criteria as recommended in literature.

Objective: Oculopharyngeal muscular dystrophy (OPMD) is a rare, autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. Cricopharyngeal myotomy improves symptoms, yet dysphagia frequently recurs, failing to prevent aspiration and enteral feeding. The objective is to evaluate safety and efficacy of repeated endoscopic dilatation for OPMD over a 15-year period.Method: All patients at our unit with genetically confirmed OPMD were included. Cricopharyngeal dilatation was performed with a wire-guided 18 mm Savary-Gilliard bougie. Repeat dilatation was offered when symptoms recurred. Symptom severity prior to initial dilatation and at follow-up was evaluated using the Sydney Swallow Questionnaire (SSQ).Results: Nine patients (7 female, 2 male) were included. Median total treatment period was 13 years (range, 3-15 years), median number of dilatations per patient was 7.2 (1-16), and median interval between treatments was 15 months (range, 4.5-45 months). ...