Reliability of the Dysphagia Test Following Resection for Head-neck Cancer

Objectives: We conducted a dysphagia screening test (Dysphagia test) in these patients to assess their risk for aspiration. The aim of this study was to evaluate the association between the results of Dysphagia test and video fluoroscopic examination (VF) of swallowing tests conducted in patients who underwent resection for head and neck cancer (HNC).
Methods: The study included 39 patients who underwent surgical resection, and were indicated as requiring the VF. The VF was conducted in the sitting position with the following liquids, which have been listed in order of difficulty of swallowing: honey, thick soup, water (3 ml), and water (30 ml). The penetration-aspiration (PA) scale was used for scoring. The Dysphagia test comprised the repetitive saliva swallowing test (RSST), the water swallowing test (WST), the modified water swallowing test (MWST), the food test (FT), and tongue pressure measurement. From the VF results, we used the PA scale and assessed 1 as normal and 2 or more as abnormal (2-5: penetration, 6-8: aspiration). For the Dysphagia test, we used the Japanese Society of Dysphagia Rehabilitation method for assessment. For statistical analyses, we used the Spearman's correlation coefficient and ROC curve to analysis.
Results: A significant correlation was shown between the PA scale assessment and Dysphagia test/tongue pressure, excluding RSST. The MWST had a ROC-AUC of 0.81 (0.65-0.97; 95% CI, P = 0.002) with a sensitivity/specificity of 0.85/0.77. FT had a ROC-AUC of 0.79 (0.63-0.95, P = 0.004) with a sensitivity/specificity of 0.81/0.77. In contrast, the prediction accuracy for aspiration was low with WST and RSST. The results for tongue pressure showed an ROC-AUC of 0.73 (0.55-0.91, P = 0.02). At a tongue pressure of 12.4 kPa, the sensitivity/specificity was 0.77/0.68.
Conclusions: The high reliability of the MWST and FT results from the Dysphagia test suggests that they can be recommended as screening tests.