DIGEST Scale Predictis More Quality of Life Than PAS: The Residue Influence on Supracricoid Laryngectomy

Freitas, Andressa Silva de; Zica, Guilherme Maia; Salles, Mariana; Silva, Ana Catarina Alves e; Silva, Thiago Huaytalla; Dias, Fernando Luiz; Santos, Izabella Costa

doi:10.1055/s-0041-1730306

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International Archives of Otorhinolaryngology

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Original Research • iao 26 (3) • Jul-Sep 2022 • https://doi.org/10.1055/s-0041-1730306 copy

DIGEST Scale Predictis More Quality of Life Than PAS: The Residue Influence on Supracricoid Laryngectomy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Supracricoid laryngectomy (SCL CHEP) removes ~ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature.

Objective

To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP.

Methods

A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST).

Results

In a group of 86 patients, there was a significant relationship between oncological staging and the global (p<0.001) and total (p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (p = 0.045). The swallowing function proved to be relevant for QoL.

Conclusion

The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.

Keywords
rehabilitation; radiology; deglutition disorders; laryngectomy; quality of life

Variables		N	%
Age (years old)^a a = Mean / standard deviation ,^b b = Median / minimum and maximum.		61.4 (9.55)	62 (28–82)
Sex	Female	2	2.32
Sex	Male	84	97.67
Marital status	Single	25	29.07
Marital status	Married	61	70.93
Educational level	Elementary School	52	60.47
Educational level	High school and higher education	34	39.53
Smoker	Yes	72	83.72
Smoker	No	14	16.28
Alcohol consumption	Yes	71	82.56
Alcohol consumption	No	15	17.44
Arytenoid	1	29	33.72
Arytenoid	2	57	66.28
Oncological staging	II	53	61.63
	III	29	33.72
	IV	4	4.65
Adjuvant radiotherapy	Yes	61	70.93
Adjuvant radiotherapy	No	25	29.07
% Emotional ^b b = Median / minimum and maximum.		100	(46.65–100)
% Functional ^b b = Median / minimum and maximum.		100	(32–100)
% Physical ^b b = Median / minimum and maximum.		83.75	(47.5–100)
% Global ^b b = Median / minimum and maximum.		100	(20–100)
% Total ^b b = Median / minimum and maximum.		94.60	(45.12–100)
DIGEST ^b b = Median / minimum and maximum.		2	(1–4)
PAS ^b b = Median / minimum and maximum.		5	(2–8)

Domains MDADI	DIGEST		PAS
	r	p-value^* * Pearson correlation.	r	p-value^* * Pearson correlation.
Emotional	− 0.216	0.045	0.057	0.605
Functional	− 0.083	0.446	0.142	0.191
Physical	− 0.171	0.116	− 0.061	0.578
Global	− 0.141	0.196	− 0.021	0.846
Total	− 0.180	0.097	0.031	0.774

Variables	DIGEST		PAS		Global		Total
	Average (SD)	p-value^* Student t-test for dichotomous variables and ANOVA for nondichotomous variables.	Average (SD)	p-value^* Student t-test for dichotomous variables and ANOVA for nondichotomous variables.	Average (SD)	p-value^* Student t-test for dichotomous variables and ANOVA for nondichotomous variables.	Average (SD)	p-value^* Student t-test for dichotomous variables and ANOVA for nondichotomous variables.
Age (years old)
< 60	1.76 (0.60)	0.696	5.73 (1.52)	0.773	91.76 (17.83)	0.730	90.53 (11.45)	0.742
>60	1.82 (0.78)		5.63 (1.61)		93.02 (16.75)		89.72 (10.78)
Sex
Male	1.80 (0.71)	0.102	5.67 (1.55)	0.768	92.38 (17.26)	0.536	89.88 (11.07)	0.399
Female	2.00 (1.41)		6.00 (2.83)		100 (0.00)		96.56 (1.33)
Marital status
Single	2.00 (0.82)	0.102	6.12 (1.59)	0.092	89.60 (20.10)	0.307	87.59 (13.37)	0.188
Married	1.72 (0.66)		5.49 (1.53)		93.77 (15.72)		91.04 (9.80)
Educational level
Elementary School	1.79 (0.61)	0.825	5.63 (1.53)	0.773	90.77 (19.59)	0.232	89.32 (12.42)	0.455
High school and higher education	1.82 (0.87)		5.73 (1.64)		95.29 (12.12)		91.14 (8.38)
Smoker
Yes	1.76 (0.66)	0.262	5.60 (1.52)	0.303	91.11 (18.35)	0.075	89.15 (11.68)	0.088
No	2.00 (0.96)		6.07 (1.77)		100 (0.00)		94.62 (4.13)
Alcohol consumption
Yes	1.85 (0.72)	0.110	5.77 (1.57)	0.199	92.39 (17.36)	0.848	89.99 (11.14)	0.924
No	1.53 (0.64)		5.20 (1.52)		93.33 (16.33)		90.29 (10.58)
Arytenoid
1	1.97 (0.78)	0.133	6.10 (1.52)	0.070	94.48 (15.94)	0.460	91.32 (9.09)	0.442
2	1.71 (0.67)		5.46 (5.04)		91.58 (17.71)		89.39 (11.85)
Adjuvant radiotherapy
Yes	1.92 (0.81)	0.332	5.59 (1.53)	0.439	96.80 (12.49)	0.142	92.69 (9.47)	0.153
No	1.75 (0.67)		5.88 (1.67)		90.82 (18.47)		88.95 (11.45)
Oncological staging
II	1.71 (0.69)	0.777	5.57 (1.63)	0.121	95.09 (11.02)	<0.001	91.12 (8.27)	0.002
III	2.00 (0.75)		6.00 (1.49)		89.65 (23.07)		90.07 (12.19)
IV	1.50 (0.58)		4.75 (5.00)		80 (28.28)		75.47 (23.32)

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[1] Address for correspondence Andressa Silva de Freitas, PhD, Seção de Cirurgia de Cabeça e Pescoço, Instituto Nacional do Câncer (INCA), Praça da Cruz Vermelha, 23, Centro — Rio de Janeiro (RJ), CEP 20230-130, Brasil (e-mail: andressa.freitas@inca.gov.br).