Post-laryngectomy simplified dysphagia score (SDS) tool: Potential for screening and comparison with the swallowing outcomes after laryngectomy (SOAL) tool

Our understanding of swallowing disorders after laryngectomy remains limited. A literature search found that documentation of swallowing function in the laryngectomee population is lacking. Furthermore, no consensus exists regarding a suitable evaluation tool to assess swallowing function. While conventional questionnaires are time consuming, cost and time constraints make regular objective swallowing investigations impractical.

To develop a 2-question simplified dysphagia score (SDS) screening tool for routine documentation of swallowing function at post-laryngectomy follow-up visits, and to test this new tool against an established dysphagia measuring tool for laryngectomees. We also sought to identify risk factors for poor swallowing outcomes.

Cross-sectional surveys were used to compare results obtained from the validated swallowing outcomes after laryngectomy (SOAL) questionnaire and our novel SDS tool. The components of the SDS were guided by the experience and expertise of surgeons and speech therapists, as well as insights from patients and their families. Sixty laryngectomy patients (females, n=7; males, n=53) were enrolled in the study. All patients were >18 years of age. Each participant was asked to complete the SDS and the SOAL questionnaires. The results of each tool were compared using non-parametric tests, with multiple pairwise comparisons using Bonferroni tests.

Both sets of results showed a linear relationship using the Kruskal-Wallis non-parametric analysis of variance (ANOVA) test. The SDS had a specificity of 96% (95% confidence interval (CI) 76 - 100%), a sensitivity of 81% (CI 64 - 91%), a positive predictive value of 97% (CI 81 - 100%) and a negative predictive value of 76% (CI 56 - 89%) against the SOAL scores. The SDS results yielded 7 false-negative and 1 false-positive result for dysphagia compared with the SOAL questionnaire. Outcomes of the secondary objectives did not reach statistical significance.

The SDS is a 2-question, practical grading system that shows a statistically significant correlation with the recognised SOAL questionnaire, making it a useful alternative for everyday use, which provides outcome scores of direct practical value to patient and clinician. Prospective use of the SDS and higher patient numbers may allow a better understanding of dysphagia, its causes and risk factors.