Satisfaction of patients treated surgically for intractable aspiration

Study objective: Impaired laryngeal protective function can result in intra ctable aspiration requiring surgical treatment. There are, however, few rep orts evaluating the satisfaction of patients and the efficacy of surgical t herapy. The purpose of this study is to determine whether surgery for intra ctable aspiration is beneficial for alleviating depression and improving th e mood of patients who have undergone surgical treatment and whether patien ts and their families are satisfied with the therapy. Patients and study design: Seven patients with recurrent aspiration pneumon ia that could not be controlled by appropriate medical therapies participat ed in the study. These patients had no hope of recovering laryngeal functio n. Six underwent laryngectomy and one underwent laryngotracheal separation. After surgery, we evaluated the efficacy of the therapy and the patients' satisfaction with the therapy. Methods: The following clinical variables concerning surgical procedure wer e examined: operation time, time until oral intake, videofluorographic stud y, and surgical complications. The treatment methods including feeding stat us were also examined before and after surgery. In addition, the following markers were examined to evaluate the efficacy of the surgery: score of asp iration pneumonia, body mass index, total protein, albumin, hematocrit, WBC count, C-reactive protein, erythrocyte sedimentation rate, and the Barthel Index, an indicator of daily activity. Furthermore, the grade of depressio n and mood, and satisfaction of patients and their caretakers among family members were scored by the Zung self-rating depression scale, a 20-picture face scale, and the visual analog scale. Results: After surgical therapy, we confirmed by videofluorography that asp iration was completely prevented. No surgical complications occurred. By 18 +/- 6 days, all seven patients were able to ingest a meal orally. The need for extensive medical care and repeated hospitalizations became unnecessar y after surgery. The control of pneumonia and albumin improved significantl y, The grade of depression and mood of patients and their families also imp roved significantly. Satisfaction scores of patients receiving therapy were very high. Conclusions: Our study shows that surgical therapy to prevent aspiration im proves the depression and mood of patients and their families as well as fe eding status and clinical outlook. Surgical therapy for patients with intra ctable aspiration is effective and beneficial.