Clinical Swallow Examination Following Laryngectomy: An International e-Delphi Consensus Process

Clinical swallow examination (CSE) following laryngectomy (± pharyngeal resection) remains a critical step in dysphagia evaluation. Whilst the core components of a standard CSE service a broad spectrum of patient populations, no evidence exists examining the essential assessment items specific to CSE in the laryngectomy population. The aim of this study was to identify the tasks, measures and observations considered necessary to include in a CSE post laryngectomy. Using an e-Delphi approach, a 4-round online survey series was undertaken with 34 speech pathologists experienced in laryngectomy swallowing management from 6 countries. In the first round (item generation) participants were provided with the questions from the swallowing outcomes after laryngectomy (SOAL) as stimulus, to generate a list of tasks, measures and observations as well as clarifying questions they would ask the patient during a CSE. In the subsequent e-Delphi rounds the participants rated the importance of the compiled assessment items. A total of 34 items were rated of critical importance for inclusion in a laryngectomy CSE by ≥ 75% of participants. Two thirds of the consensus items (23 items) were patient history and interview questions incorporating medical and swallowing history (4 items) and patient interview (19 items). The remaining 11 items related to swallow tasks and observations (9 items) and onward referral (2 items). These 34 consensus items can be considered as a draft framework for laryngectomy CSE to guide clinical practice and research.