Voice and swallowing outcomes following radiotherapy for primary nasopharyngeal carcinoma in a randomized controlled trial of neuromuscular electrical stimulation
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AbstractObjectives: Dysphagia and dysphonia following the treatment of nasopharyngeal carcinoma (NPC) are common. Treatment with traditional swallowing excercises (TR) like the Masako manoeuvre, Mendelsohn manoeuvre have been shown to be effective in head and neck cancer patients. Recently, transcutaneous electrical stimulation (ES) has been suggested to be useful in rehabilitation. Neither therapy has been thoroughly investigated in nasopharyngeal carcinoma and here we sought to evaluate differences in voice and swallowing outcomes at one year post treatment after radiotherapy in NPC. Materials and Methods: A randomized control trial of TR or ES after radiotherapy +/- chemotherapy for primary nasopharyngeal carcinoma was evaluated with FEES penetration aspiration score (PAS) and the quality of life instruments FACT-NP and VHI-30. Statistical analyses and graphical representations were performed with SPSS 20.0 software (SPSS, Chicago, IL). Results: Seventy six patients completed the swallowing therapy. Fifty-eight patients completed a 1 year follow-up. The mean age of those that completed the 1 year follow-up was 52.1 years old (Range 20 -81), thirty-eight (65.5%) were male. Twenty-nine patients were randomized to the TR group and twenty-nine patients were randomized to the ES group. There was no significant differences in gender, age, smoking, alcohol and education level between the two groups. At one year, comparison between the two treatment groups using the Mann Whitney U test showed no significant difference between VHI-30, FACT-NP and PAS scores. Furthermore, penetration or aspiration at one year was not significantly associated with VHI-30, FACT-NP or average doses of radiotherapy to the anterior tongue, posterior tongue, superior constrictor muscle, middle constrictor muscle, inferior constrictor muscle, cricopharygneus muscle or esophageal inlet on the Mann Whitney U test. Overall, the VHI-30 subscales and total score showed no significant improvement after any swallowing therapy on the Wilcoxon Signed Rank Test. The FACT-NP subscales nasopharynx (P<0.001), funtional well being (p = 0.02), physical well being (P<0.001) and total sccore (p<0.001) showed significant improvement at one year on the Wilcoxon Signed Rank Test. PAS score showed no significant improvement at one year (p = 0.06) on the Wilcoxon Signed Rank Test. Conclusion: There are no differences between TR and ES on both swallowing and voice outcomes at one year following primary treatment of nasopharyngeal carcinoma. Both swallowing therapies may play a role in voice and swallowing rehabilitation within the first year of patients treated for primary nasopharyngeal carcinoma.
All Author(s) ListJason Chan, Rita W Wong, Kathy Y Lee, Louisa Ng, Eddy Wong, Alexander Vlantis, Thomas Law, Peter Ku, CA van Hasselt, Michael C Tong
Name of ConferenceAmerican Head & Neck Society Annual Meeting
Start Date of Conference26/04/2017
End Date of Conference27/04/2017
Place of ConferenceSan Diego, CA
Country/Region of ConferenceUnited States of America
Journal nameJAMA Otolaryngology - Head & Neck Surgery
Year2017
Month4
LanguagesEnglish-United Kingdom

Last updated on 2018-22-01 at 12:48