Background: The pathophysiology of dysphagia associated with acute radiotherapy side effects differs from more traditional presentations, but sequelea such as pneumonia and sepsis remain a concern. Fibreoptic Endoscopic Evaluation Swallow (FEES) describes pharyngeal and laryngeal structure and function, allows visualisation of secretions, diagnosis of dysphagia and subsequent management. FEES allows for repeat assessment of patients, without radiation exposure, and gives additional information regarding oedema and secretions – specific characteristics of HNC-dysphagia.
Methods: A retrospective review was completed of FEES studies administered over a 12 month period for patients receiving HNC radiotherapy. A similar review was conduction on fewer medical oncology referrals. Details included patient demographics, referral source, site of lesion, secretions, impact on oral intake and factors negatively affecting study completion.
Findings: 70 studies completed over 12 months, on 41 patients, with mixed demographics of gender, age and inpatient:outpatient. 9 of 41 were Medical Oncology patients. No studies were abandoned during this timeframe, and no adverse events were reported. Changes in oral diet recommendations, use of therapeutic oral trials and deterioration in swallow function were recorded.
Conclusions: FEES during oncology treatment allows for timely and frequent assessment of patients, and determines management of secretions and dysphagia, within a multidisciplinary team context. This often allows for an earlier return to safe oral intake, allowing for specific side-effects such as odynophagia, secretion production and oedema which would otherwise complicate a traditional clinical assessment.
Karen Malherbe1, Sandra Brandon1, Hannah Loughnane1
1 Department of Speech & Language Therapy, Galway University Hospital, Galway