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Does Laryngectomy Improve Swallowing After Chemoradiotherapy?
A Case Study
Cathy Lazarus, PhD;
Jeri A. Logemann, PhD;
Guoxiang Shi, MD, PhD;
Peter Kahrilas, MD;
Harold Pelzer, MD;
Kara Kleinjan, MA
Arch Otolaryngol Head Neck Surg. 2002;128:54-57.
Organ preservation protocols of high-dose chemoradiotherapy have become
fairly common to treat head and neck cancers. However, significant swallowing
problems can occur. This study examines swallowing, oral tongue pressures,
and tongue base–to–pharyngeal wall pressures in a patient who
underwent total laryngectomy for improvement of swallowing after chemoradiotherapy
for treatment of a hypopharyngeal tumor. The patient underwent concurrent
videofluorographic and manometric examination of swallowing and examination
of oral tongue pressures after the laryngectomy. One healthy subject was used
as a control. After the laryngectomy, the patient no longer aspirated; however,
he could swallow only liquids and pureed foods. He demonstrated difficulty
with bolus clearance through the oral cavity and pharyngocervical esophagus.
Pharyngeal pressures were reduced compared with those of the control subject.
While total laryngectomy will stop unremitting aspiration, swallowing after
chemoradiation may be severely compromised. This may not be overcome by total
laryngectomy.
From the Voice, Speech and Language Service and Swallowing Center (Dr
Lazarus) and the Departments of Gastroenterology (Drs Shi and Kahrilas) and
Otolaryngology–Head and Neck Surgery (Dr Pelzer), Northwestern University
Medical School, Chicago, Ill; and the Department of Communication Sciences
and Disorders, Northwestern University, Evanston, Ill (Dr Logemann and Ms
Kleinjan).
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Arch Otolaryngol Head Neck Surg. 2002;128(1):95-96.
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