Objectives To determine the prevalence of aspiration in patients with newly diagnosed
nontreated advanced head and neck cancer and to determine the ability of the
clinical examination to predict aspiration in this patient population.
Design A descriptive prevalence study of the presence of aspiration in patients
with advanced (stages III and IV) head and neck cancer and a prospective correlation
study between variables of the clinical evaluation with the criterion standard
videofluoroscopy.
Setting Regional veterans affairs medical center.
Patients A consecutive sample of 27 patients without previous treatment or tracheostomy.
Interventions All patients underwent evaluation by an otolaryngologist and speech
pathologist prior to videofluoroscopy.
Main Outcome Measures Variables in the dysphagia evaluation (consisting of a directed medical
history, physical examination, and food challenge), the self-rated 45-item
questionnaire, and the clinicians "educated prediction" of aspiration were
analyzed with reference to aspiration on videofluoroscopy using univariant
analysis.
Results The prevalence of aspiration determined by videofluoroscopy was 41%
(11 of 27 patients). Two (6%) of 32 items in the medical history, 1 (4%) of
25 items in the physical examination, and 8 (50%) of 16 items in the food
challenge were found to be statistically significantly correlated (P<.05) with aspiration on videofluoroscopy by univariate analysis.
Nine (25%) of 45 items in the self-rated questionnaire were correlated with
aspiration on videofluoroscopy. The clinicians' educated prediction of aspiration
was not correlated with aspiration determined by videofluoroscopy.
Conclusions Clinical evaluation alone is inadequate in predicting patients who aspirated,
determined objectively by videofluoroscopic swallowing study. Further study
is needed to develop an efficient dysphagia evaluation to identify patients
at risk for aspiration.
