Ch. Wu et al., Dysphagia after radiotherapy: Endoscopic examination of swallowing in patients with nasopharyngeal carcinoma, ANN OTOL RH, 109(3), 2000, pp. 320-325
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.