Publications
63 results found
Clunie G, Roe J, Al-Yaghchi C, et al., 2024, The voice and swallowing profile of adults with laryngotracheal stenosis before and after reconstructive surgery: a prospective, descriptive observational study, Clinical Otolaryngology, ISSN: 0307-7772
Objectives:Airway reconstruction for laryngo tracheal stenosis (LTS) improves dyspnoea. There is little evidence relating to impact upon voice and swallowing. We explored voice and swallowing outcomes in adults with LTS before and after reconstructive surgery.Design:Outcome measures were collected pre-reconstructive surgery, two-weeks post-surgery and up to 4-6 months post-surgery.Setting:Tertiary referral centre.Participants:With ethical approval, twenty consecutive adult (≥18 years) LTS patients undergoing airway reconstruction were prospectively recruited.Main outcome measures:These included physiological values (maximum phonation time (MPT) and fundamental frequency; penetration aspiration score, residue score), clinician-reported (GRBAS, functional oral intake score, 100ml Water Swallow Test) and patient-reported outcomes (Voice Handicap Index-10, Reflux Symptoms Index, Eating Assessment Tool, Dysphagia Handicap Index).Results:The observational study identified patient-reported and clinician-reported voice and swallow difficulties pre- and post-surgery; median and interquartile range are reported at each time point: Voice Handicap Index-10 23 (8-31); 20.5 (9-33.5), 24.5 (12.5-29); Dysphagia Handicap Index 9 (0-37); 13 (7-44); 15 (4-34); GRBAS grade 1(1-2); 2 (1-2.5); 2(1-2); 100ml Water Swallow Test volume score 16.7 (11.1-20); 14.3 (12.5-16.7); 16.7 (14.3-20.0); 100ml Water Swallow Test capacity score 16.3 ± 9.0; 11.0 ± 4.1; 12.5 ± 2.6.Conclusions:We present the first prospective data on voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. The variability of the outcomes was higher than expected but importantly, for many the voice and swallow outcomes were not within normal limits before surgery. The clinical value of the study demonstrates the need for individual assessment and management of LTS patients’ voice and swallowing.
Brady G, Roe J, Paleri V, et al., 2023, Patient experience, functional and quality of life outcomes in patients receiving surgical and non-surgical treatment for residual, recurrent, or new oropharyngeal cancer in a previously irradiated field: A systematic review, Advances in Communication and Swallowing, Vol: 26, Pages: 109-123, ISSN: 2772-5383
<jats:p>BACKGROUND: National guidance recommends counselling on functional (swallowing/ speech/ voice) and quality of life outcomes (QoL) for patients with recurrent, residual or new primary head and neck cancer (HNC) in a previously irradiated field (ReRuNeR). AIM: To investigate the measurement and reporting of function and QoL outcomes and patient/carer experience for ReRuNeR, focussing exclusively on oropharyngeal cancer (OPC). METHODS: Systematic narrative review of quantitative/qualitative studies. RESULTS: Seventeen articles reporting functional/ QoL outcomes following surgery were included. Gastrostomy dependence was the primary method of reporting function. Previously validated outcome measures (OMs) were used for reporting swallowing in four, speech in one and QoL in two trials. Qualitative data or non-surgical studies reporting function/QoL outcomes specific to ReRuNeR OPC were not identified. Methodological issues and heterogeneity noted across studies including absent baseline data, varying/ undefined timepoints for outcome measurement and the use of unvalidated tools. Patient-reported swallowing outcomes were mixed. Whereas instrumental assessment of swallowing showed a deterioration in safety/ efficiency. A post-surgical decline in speech was noted. Stable overall HR-QoL was reported but an increase in specific symptoms including speech, saliva and swallowing were noted. Pooled long term gastrostomy feeding rate was 23.42% (95% CI 10.2 to 36.6) (n = 108). CONCLUSION: A core dataset of patient and clinician-rated OMs is required to provide a comprehensive understanding of functional and QoL complications with ReRuNeR OPC. In combination with patient/carer experience data, these data can be used to inform pre-treatment counselling, rehabilitation and future clinical trial design.</jats:p>
Nutting C, Finneran L, Roe J, et al., 2023, Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): a phase 3, multicentre, randomised, controlled trial, LANCET ONCOLOGY, Vol: 24, Pages: 868-880, ISSN: 1470-2045
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Zuydam AC, Rogers SN, Roe JWG, 2023, Addressing patients' concerns in speech and language therapy consultations following the diagnosis and treatment of head and neck cancer, CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY, Vol: 31, Pages: 159-164, ISSN: 1068-9508
Clunie G, Belsi A, Roe J, et al., 2023, “Is there something wrong with your voice?” A qualitative study of the voice concerns of people with laryngotracheal stenosis, International Journal of Language and Communication Disorders, Vol: 58, Pages: 376-389, ISSN: 1368-2822
BackgroundAcquired laryngotracheal stenosis (LTS) is a rare condition that causes breathlessness and dyspnoea. Patients have reconstructive airway surgery to improve their breathing difficulties, but both LTS and the surgery can cause voice difficulties. The existing evidence base for management of the voice difficulties for adults with LTS focuses on symptoms. There is limited information to provide clinical guidance for speech and language therapists (SLTs), and limited understanding of the impact of voice changes on adults with LTS. AimTo investigate the lived experience of adults with laryngotracheal stenosis (LTS), who have had reconstructive surgery; here focussing on voice concerns with the aim of guiding clinical care for SLTs.Methods & ProceduresA phenomenological, qualitative study design was used. Focus groups and semi-structured interviews were completed with adults living with LTS who had had reconstructive surgery. Audio-recordings were transcribed and inductive thematic analysis was used by the research team to identify themes and sub-themes. Outcomes & ResultsA total of 24 participants (5 focus groups and 2 interviews) took part in the study before thematic saturation was identified in analysis. Three main themes were identified specific to the experience of living with LTS: the Medical, Physical and Emotional journey. All participants referenced voice difficulties as they related to each of these overall themes. Sub-themes directly related to voice included: experience of surgery, information provision, staff expertise/complacency, symptoms, symptom management, identity, support networks, impact on life and living with a chronic condition. Conclusions & ImplicationsIn this qualitative study participants have described the integral part voice difficulties play in their lived experience of LTS and reconstructive surgery. This is considered in the context of their clinical care and the need for individualised management and information prov
Thomson DJ, Cruickshank C, Baines H, et al., 2023, TORPEdO: A phase III trial of intensity-modulated proton beam therapy versus intensity-modulated radiotherapy for multi-toxicity reduction in oropharyngeal cancer, CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY, Vol: 38, Pages: 147-154
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Loizidou A, Tatla TS, Harvey I, et al., 2022, COVID-VU – ENT-UK national survey of flexible nasendoscopy in the upper aerodigestive tract amidst the COVID-19 pandemic, BMC Health Services Research, Vol: 22, Pages: 1-11, ISSN: 1472-6963
BackgroundFlexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. In the UK, and other European countries, national guidelines were issued restricting FNE to essential cases. We surveyed ENT-UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic (first peak) on FNE practice in the UK.MethodsAn observational internet-based survey constructed in accordance to the CHERRIES checklist and setup in SurveyMonkey of FNE practice amongst UK-based ENT surgeons and speech and language therapists in community clinics, the outpatient department, inpatient wards, ICU, emergency department and operating theatres (through the NHS and private sector) prior to, during and following the first COVID-19 wave in the UK.Results314 responses collected (24% response rate), 82% from ENT clinicians, 17% from SLTs and 1% from other allied healthcare professionals. Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August 2020. Cancer and airway assessments were impacted less. A wide range of FNE protocols influenced by local factors are reported, varying in endoscope preference, Personal Protective Equipment (PPE) and sterilization methods. Where dedicated Aerosol Generating Procedure (AGP) rooms were unavailable, clinicians resorted to window opening and variable room “down-time” between patients. Endoscope preference reflected availability and user familiarity, ENT trainees favoring the use of single-use video endoscopes.ConclusionDespite national guidance, local practice of FNE remains interrupted and highly variable in the UK. A collaborative inter-disciplinary approa
Roe J, Brady G, Emery L, et al., 2022, Co-design of new post-covid oncology rehabilitation services offers a model for the future, BMJ-BRITISH MEDICAL JOURNAL, Vol: 379, ISSN: 0959-535X
Rothrie S, Fitzgerald E, Brady GC, et al., 2022, The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer, BRITISH DENTAL JOURNAL, Vol: 233, Pages: 801-805, ISSN: 0007-0610
Brady G, Leigh-Doyle L, Riva FMG, et al., 2022, Speech and Swallowing Outcomes Following Surgical Resection with Immediate Free Tissue Transfer Reconstruction for Advanced Osteoradionecrosis of the Mandible Following Radiation Treatment for Head and Neck Cancer, Dysphagia, Vol: 37, Pages: 1137-1141, ISSN: 0179-051X
<jats:title>Abstract</jats:title><jats:p>Despite recent advances in the radiation techniques used for the treatment of head and neck cancer (HNC) including intensity-modulated radiotherapy (IMRT), mandibular osteoradionecrosis (ORN) remains a significant complication. Advanced stage ORN is managed surgically with resection and immediate free tissue transfer reconstruction. An evaluation of the functional speech and swallowing outcomes was undertaken for patients undergoing surgical management of advanced ORN. We retrospectively reviewed consecutive patients, at a single, tertiary cancer centre, who underwent surgical resection for advanced Notani grade III ORN. Outcomes investigated included use and duration of tracheostomy and swallowing and speech status using Performance Status Scale for Head and Neck Cancer Normalcy of Diet (PSS-NOD) and Understandability of Speech (PSS-Speech) at baseline and 3 months following surgery. Ten patients underwent surgical resection with free tissue transfer reconstruction between January 2014 and December 2019. Two patients required supplemental nutrition via a gastrostomy at three months post surgery. As per the PSS-NOD data half of the patients’ (<jats:italic>n</jats:italic> = 5) diet remained stable (<jats:italic>n</jats:italic> = 2) or improved (<jats:italic>n</jats:italic> = 3) and half of the participants experienced a decline in diet (<jats:italic>n</jats:italic> = 5). The majority of patients had no speech difficulties at baseline (<jats:italic>n</jats:italic> = 8). The majority of patients’ speech remained stable (<jats:italic>n</jats:italic> = 8) with two patients experiencing a deterioration in speech clarity following surgery. Well-designed studies with robust, sensitive multidimensional dysphagia and communication as
Clunie G, Anderson C, Hughes C, et al., 2022, “A major quality of life issue”: A survey-based analysis of the experiences of adults with laryngotracheal stenosis with mucus and cough, Annals of Otology, Rhinology and Laryngology, Vol: 131, Pages: 962-970, ISSN: 0003-4894
Objectives:To investigate how the symptoms of mucus and cough impact adults living with laryngotracheal stenosis, and to use this information to guide future research and treatment plans.Methods:A survey was developed with the support of patient advisors and distributed to people suffering with laryngotracheal stenosis. The survey comprised 15 closed and open questions relating to mucus and cough and included the Leicester Cough Questionnaire (LCQ). Descriptive statistics, X2 and thematic analyses were completed.Results:In total, 641 participants completed the survey, with 83.62% (n = 536) reporting problems with mucus; 79% having daily issues of varying severity that led to difficulties with cough (46.18%) and breathing (20.90%). Mucus affected voice and swallowing to a lesser degree. Respondents described a range of triggers; they identified smoky air as the worst environmental trigger. Strategies to manage mucus varied widely with drinking water (72.26%), increasing liquid intake in general (49.35%) and avoiding or reducing dairy (45.32%) the most common approaches to control symptoms. The LCQ showed a median total score of 14 (interquartile range 11-17) indicative of cough negatively affecting quality of life. Thematic analysis of free text responses identified 4 key themes—the Mucus Cycle, Social impact, Psychological impact, and Physical impact.Conclusion:This study shows the relevance of research focusing on mucus and cough and its negative impact on quality of life, among adults with laryngotracheal stenosis. It demonstrates the inconsistent advice and management strategies provided by clinicians for this issue. Further research is required to identify clearer treatment options and pathways.
Hardman JC, Holsinger FC, Brady GC, et al., 2022, Transoral Robotic Surgery for Recurrent Tumors of the Upper Aerodigestive Tract (RECUT): An International Cohort Study, JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, ISSN: 0027-8874
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- Citations: 4
Brady G, Leigh-Doyle L, Riva F, et al., 2022, Early Post-operative Feeding: An Investigation of Early Functional Outcomes for Oral Cancer Patients Treated with Surgical Resection and Free Flap Reconstruction, Dysphagia, Vol: 37, Pages: 1008-1013, ISSN: 0179-051X
<jats:title>Abstract</jats:title><jats:p>Traditionally patients can remain nil by mouth (NBM) for up to 12 days after oral tumour resection with free flap reconstruction to reduce the risk of flap dehiscence, poor healing and fistulae. The literature reports that patients could on average remain an inpatient for up to 20 days post-surgery. An evaluation of the impact of a defined early oral feeding protocol was undertaken investigating functional outcomes and complications rates. We prospectively reviewed tracheostomy use, length of hospital stay, non-oral feeding status and swallowing function using the Performance Status Scale for Head and Neck Cancer (PSS-HN) within a defined early feeding protocol. Twenty-nine patients underwent surgical resection with free flap reconstruction for advanced primary oral cancer between January 2018 and December 2019. Average age was 59.5 (range 24–88). Tumour sites included oral tongue (<jats:italic>n</jats:italic> = 10), maxilla (<jats:italic>n</jats:italic> = 6), mandible (<jats:italic>n</jats:italic> = 6), floor of mouth (<jats:italic>n</jats:italic> = 5) and buccal mucosa (<jats:italic>n</jats:italic> = 2). Median time to decannulation was 7 days (range 3–20 days, <jats:italic>n</jats:italic> = 11). The majority of patients were able to tolerate at least oral fluids on day 1 post-operatively (86%, <jats:italic>n</jats:italic> = 25). In addition to oral intake, non-oral feeding was required in 90% (<jats:italic>n</jats:italic> = 26), the majority of which included a nasogastric tube (NGT) placed intraoperatively 54% (<jats:italic>n</jats:italic> = 14), others required gastrostomy 46% (<jats:italic>n</jats:italic> = 12).
Rouhani MJ, Morley I, Lovell L, et al., 2022, Assessment of swallow function pre- and post-endoscopic CO2 laser medial arytenoidectomy: a case series, CLINICAL OTOLARYNGOLOGY, Vol: 47, Pages: 347-350, ISSN: 1749-4478
Clunie G, Bolton L, Lovell L, et al., 2022, Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series, International Journal of Therapy and Rehabilitation, Vol: 29, ISSN: 1354-8581
Background/AimsPatients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic.MethodsA retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic.ResultsA total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake.ConclusionsThis study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
Brady G, Ashforth K, Cowan-Dickie S, et al., 2022, An evaluation of the provision of oncology rehabilitation services via telemedicine using a participatory design approach, SUPPORTIVE CARE IN CANCER, Vol: 30, Pages: 1655-1662, ISSN: 0941-4355
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Haywood M, Lovell L, Roe J, et al., 2021, Perioperative instrumental swallowing evaluation in adult airway reconstruction: a retrospective observational cohort study, Clinical Otolaryngology, Vol: 46, Pages: 1229-1236, ISSN: 1749-4478
ObjectivesAirway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well-recognised sequela of LTS and airway surgery, however studies have employed mostly non-validated assessments post-operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post-operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold-standard management framework for its management.Design, setting, participants and main outcome measuresWe performed a retrospective cohort study of adult airway reconstruction procedures from 2016-2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post-operative day one and post-stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores.ResultsForty-four patients underwent forty-six reconstructions. Baseline incidence of penetration-aspiration was considerably higher than the general population and worsened in the immediate post-operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post-operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent.ConclusionsWe present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may
Brady GC, Ashforth K, Cowan-Dickie S, et al., 2021, An Evaluation of the Provision of Oncology Rehabilitation Services via Telemedicine Using a Participatory Design Approach
<jats:title>Abstract</jats:title> <jats:p>Background The COVID-19 pandemic has fundamentally impacted the delivery of healthcare services globally. In line with UK government guidelines on social distancing, the use of telemedicine was implemented to facilitate the ongoing provision of cancer rehabilitation.Purpose We sought to evaluate and co-design telemedicine services to meet the complex needs of our patients and carers at a tertiary cancer centre.Methods Experience based co-design (EBCD) methodology was adapted to include virtual methods. Staff members (n = 12) and patients (n = 11) who had delivered or received or delivered therapies services at our UK cancer centre since March 2020 were recruited to take part in one-to-one virtual interviews. Patient interviews were video recorded, analysed and edited to a 30-minute summary video. Patient and staff virtual events were undertaken thereafter. A joint virtual patient and staff event occurred, where staff could see the video and with patients as partners, agree areas for change and develop groups for service co-design.Results Positive aspects regarding telemedicine provision were highlighted including reduced financial and time burden on patients, and increased flexibility for both staff and patients. The key concerns included digital exclusion, safety, communication and patient choice. Four co-design groups have been established to enact changes in these priority areas.Conclusion Using a participatory design approach, we have worked in partnership with patients and staff to ensure the safe, acceptable and effective delivery of rehabilitation services with integrated telemedicine.</jats:p>
Loizidou A, Tatla TS, Harvey I, et al., 2021, COVID-VU an ENT UK National Survey of Flexible Nasendoscopy in the Upper Aerodigestive Tract Amidst the COVID-19 Pandemic
<jats:title>Abstract</jats:title> <jats:p><jats:underline>Background</jats:underline>Flexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. In the UK, and other European countries, national guidelines were issued restricting FNE to essential cases. We surveyed ENT UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic (first peak) on FNE practice in the UK.<jats:underline>Methods</jats:underline>An observational internet-based survey constructed in accordance to the CHERRIES checklist and setup in SurveyMonkeyof FNE practice amongst UK-based ENT surgeons and speech and language therapists in community clinics, the outpatient department, inpatient wards, ICU, emergency department and operating theatres (through the NHS and private sector) prior to, during and following the first COVID-19 wave in the UK. <jats:underline>Results </jats:underline>314 responses collected (24% response rate), 82% from ENT clinicians, 17% from SLTs and 1% from other allied healthcare professionals. Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August 2020. Cancer and airway assessments were impacted less. A wide range of FNE protocols influenced by local factors are reported, varying in endoscope preference, Personal Protective Equipment (PPE) and sterilization methods. Where dedicated Aerosol Generating Procedure (AGP) rooms were unavailable, clinicians resorted to window opening and variable room “down-time” between patients. Endoscope preference reflected availability and user familiarity, ENT train
Rouhani MJ, Clunie G, Thong G, et al., 2021, A prospective study of voice, swallow, and airway outcomes following tracheostomy for COVID‐19, The Laryngoscope, Vol: 131, Pages: E1918-E1925, ISSN: 0023-852X
ObjectiveThe COVID‐19 pandemic has led to unprecedented demands on healthcare with many requiring intubation. Tracheostomy insertion has often been delayed and the enduring effects of this on voice, swallow, and airway outcomes in COVID‐19 tracheostomy patients are unknown. The aim of this study was to prospectively assess these outcomes in this patient cohort following hospital discharge.MethodsAll COVID‐19 patients who had undergone tracheostomy insertion, and were subsequently decannulated, were identified at our institution and followed up 2 months post‐discharge. Patient‐reported (PROMS) and clinician‐reported outcome measures, endoscopic examination, and spirometry were used to assess voice, swallow, and airway outcomes.ResultsForty‐one patients were included in the study with a mean age of 56 years and male:female ratio of 28:13. Average duration of endotracheal intubation was 24 days and 63.4% of tracheostomies were performed at day 21 to 35 of intubation. 53.7% had an abnormal GRBAS score and 30% reported abnormal swallow on EAT‐10 questionnaire. 81.1% had normal endoscopic examination of the larynx, however, positive endoscopic findings correlated with the patient self‐reported VHI‐10 (P = .036) and EAT‐10 scores (P = .027). 22.5% had spirometric evidence of fixed upper airway obstruction using the Expiratory‐Disproportion Index (EDI) and Spearman correlation analysis showed a positive trend between abnormal endoscopic findings and EDI scores over 50 (P < .0001).ConclusionThe preliminary results of this study reveal a high incidence of laryngeal injury among patients who underwent intubation and tracheostomy insertion during the COVID‐19 pandemic. As these patients continue to be followed up, the evolution of these complications will be studied.Level of EvidenceLevel 3. Laryngoscope, 2020
Starmer HM, Arrese L, Langmore S, et al., 2021, Adaptation and Validation of the Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing: DIGEST-FEES, JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH, Vol: 64, Pages: 1802-1810, ISSN: 1092-4388
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- Citations: 13
Lovell L, Clunie GM, Al-Yaghchi C, et al., 2021, Laryngeal sarcoidosis and swallowing: what do we know about dysphagia assessment and management in this population?, Dysphagia, Vol: 37, Pages: 548-557, ISSN: 0179-051X
IntroductionSarcoidosis is a chronic granulomatous disease of unknown aetiology and laryngeal involvement is seen in a small percentage of cases. Dysphagia is a common but under-reported symptom. Little is known about how dysphagia typically presents or is managed in the context of this fluctuating disease. We present our case series using an SLT-led model of assessment and management.MethodsA literature search was conducted for any articles that reported both laryngeal sarcoidosis and dysphagia. We then analysed a case series of laryngeal sarcoidosis patients treated at Charing Cross Hospital. We report on multidimensional swallowing evaluation and rehabilitative interventions.ResultsSeventeen papers report both laryngeal sarcoidosis and dysphagia, with only one paper giving details on the nature of the dysphagia and the treatment provided.In our case series (n = 7), patients presented with FOIS Scores ranging from 5 to 7 pre-operatively (median = 6). Aspiration (median PAS Score = 6 and Range = 3–8) and pharyngeal residue were common. Sensory issues were also prevalent with most unaware of the extent of their difficulties. Management interventions included safe swallowing advice, compensatory strategies, exercises and close surveillance given their potential for repeated surgical interventions.ConclusionLaryngeal sarcoidosis is a rare condition. Dysphagia is under-reported and our experience highlights the need for specialist dysphagia intervention. Further research is required to understand dysphagia management requirements in the context of this fluctuating disease process.
Murphy JL, Munir F, Davey F, et al., 2021, The provision of nutritional advice and care for cancer patients: a UK national survey of healthcare professionals, SUPPORTIVE CARE IN CANCER, Vol: 29, Pages: 2435-2442, ISSN: 0941-4355
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Clunie GM, Belsi A, Roe JWG, et al., 2021, Not just dyspnoea: swallowing as a concern for adults with laryngotracheal stenosis undergoing airway reconstruction, Dysphagia, Vol: 37, Pages: 365-374, ISSN: 0179-051X
Acquired laryngotracheal stenosis (LTS) is a rare condition causing dyspnea and stridor. Patients often require multiple surgical procedures with no guarantee of a definitive outcome. Difficulty swallowing is a recognised problem associated with LTS and the reconstructive surgeries required to manage the condition. The breathlessness patient’s experience impacts on swallowing, and the vulnerable structures of the larynx are implicated during complex surgeries. This leads to dysphagia post-surgery, with some patients experiencing more chronic symptoms depending on the biomechanical impact of the surgery, or a pre-existing dysphagia. Despite this there is limited observational research about the dysphagia associated with LTS, with no exploration of the patient experience. Our aim was to investigate patient experience of living with LTS focussing on dysphagia in order to guide clinical practice. A qualitative study was completed using focus groups and semi-structured interviews with 24 patients who have had reconstructive surgery for LTS. Thematic analysis was used to identify three over-arching themes: The Physical Journey, The Emotional Journey and The Medical Journey. Key sub-themes included the importance of self-management and control, presence of symptoms, benefits of therapy, living with a life-long condition, fear and anxiety, autonomy, medicalisation of normal processes and the dichotomy between staff expertise and complacency. Swallowing was connected to all themes. The results are reviewed with consideration of the wider literature of lived experience particularly in relation to other chronic conditions and those that carry a high symptom burden such as head and neck cancer. Future clinical and research recommendations have been made. Akin to other clinical groups, adults with LTS are keen that management of their swallowing is person-centred and holistic.
Schache A, Kerawala C, Ahmed O, et al., 2021, British Association of Head and Neck Oncologists (BAHNO) standards 2020, JOURNAL OF ORAL PATHOLOGY & MEDICINE, Vol: 50, Pages: 262-273, ISSN: 0904-2512
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Clunie G, Roe J, Alexander C, et al., 2021, Voice and swallowing outcomes following airway reconstruction in adults: a systematic review, The Laryngoscope, Vol: 131, Pages: 146-157, ISSN: 0023-852X
Objectives: Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact on voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.Study Design: Systematic review.Methods: Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. Results: A total of 143 abstracts were reviewed, with 67 articles selected for full text review. 20 studies met the inclusion criteria. Data extraction was completed with The Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous and there was limited information provided about rationale or reliability.Conclusion: The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there is no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement.
Patterson JM, Govender R, Roe J, et al., 2020, COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper, International Journal of Language and Communication Disorders, Vol: 55, Pages: 806-817, ISSN: 1368-2822
BACKGROUND: The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. AIMS: To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. METHODS & PROCEDURES: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. MAIN CONTRIBUTION: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding call
Brady GC, Roe JWG, 2020, Whose Service Is It Anyway? Patients as Co-Designers to Improve Dysphagia Care Pathways, Perspectives of the ASHA Special Interest Groups, Vol: 5, Pages: 1011-1014, ISSN: 2381-4764
<jats:sec> <jats:title>Purpose</jats:title> <jats:p>The field of speech-language pathology has made remarkable strides to improve the evidence-based management of oropharyngeal dysphagia. Dysphagia services have evolved in response to the ever-increasing evidence base for the role of the speech-language pathology in the assessment, diagnosis, and management of oropharyngeal dysphagia. However, dysphagia service pathway design and provision are driven by service capacity or national guidance. Rarely are patients and clinicians truly working together to develop or redesign dysphagia care pathways. This article will describe Experience Based Co-Design and how the methodology has contributed to a better understanding of pretreatment service provision at our center.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>We make recommendations for clinicians on the application of this methodology in future projects for the design and redesign of speech-language pathology dysphagia services.</jats:p> </jats:sec>
Dawson C, Roe J, Starmer H, et al., 2020, Patient advocacy in head and neck cancer: Realities, challenges and the role of the multi-disciplinary team, Clinical Otolaryngology, Vol: 45, Pages: 437-444, ISSN: 0307-7772
This paper explores the concept of advocacy in head and neck cancer. We define inherent challenges in the development and success of advocacy within this context and offer ways to embed it within clinical practice. We outline what advocacy is, ways in which it may benefit people with head and neck cancer and the engagement required from healthcare professionals to facilitate advocacy to improve outcomes.
Brady GC, Hardman JC, Paleri V, et al., 2020, Changing paradigms in the treatment of residual/recurrent head and neck cancer: implications for dysphagia management, CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY, Vol: 28, Pages: 165-171, ISSN: 1068-9508
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