Dysphagia after radiotherapy: Endoscopic examination of swallowing in patients with nasopharyngeal carcinoma

Dysphagia is a late sequela compromising the lives of more than one fourth of patients with nasopharyngeal carcinoma (NPC) who survive long after radi otherapy. By using fiberoptic endoscopic examination of swallowing as a mod ality for dysphagia evaluation, we were able to easily recognize the functi onal and anatomic changes in 31 dysphagic NPC patients. The majority of pat ients were found to aspirate after the act of swallowing (77.4%). Seventeen (54.8%) Rad tongue atrophy, and 9 (29%) had vocal cord palsy. Dysfunctions such as dry mouth (45.2%), velopharyngeal incompetence (58%), premature le akage (41.9%), delay or absence of swallow reflex (87.1%), poor pharyngeal constriction (80.6%), pharyngeal residue retention (83.9%), penetration or aspiration (93.5%), and silent aspiration (41.9%) were noted in these patie nts. Multiple dysfunctions were demonstrated in each patient. Abnormality o f pharyngeal constriction and/or aberrant upper esophageal sphincter functi on played the major role in the postswallow aspiration of these irradiated NPC patients, Clinically compromised patients (weight loss of greater than or equal to 5 kg in 1 year or pneumonia) had more of the above anatomic and functional impairments. The radiation dosage and volume bore no correlatio n to the time of symptom onset, or to the occurrence of functional changes.