Clinical Swallow Evaluation in Head and Neck Cancer

  • Brenda Capobres VillegasEmail author


Evaluating the swallowing function of the patient with head and neck cancer (HNC) is an important part of the management process and should be completed on all patients. The ability to swallow is an integral part of our existence and impacts the quality of life as well as nutrition and hydration. Proper nutrition is critical for wound healing and to provide the body with energy as the patient goes through the treatment process.


  1. 1.
    Stenson KM, MacCracken E, List M, et al. Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg. 2000;126:371–7.CrossRefGoogle Scholar
  2. 2.
    Pauloski BR, Rademaker AW, Logemann JA, et al. Pretreatment swallowing function in patients with head and neck cancer. Head Neck. 2000;22:474–82.CrossRefGoogle Scholar
  3. 3.
    Van der Molen L, van Rossum MA, Ackerstaff AH, Smeele L, Rasch CR, Hilgers FJ. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients’ views. BMC Ear Nose Throat Disord. 2009;15:10.CrossRefGoogle Scholar
  4. 4.
    Starmer H, Gourin C, Lua LL, Burkhead L. Pretreatment swallowing assessment in head and neck cancer patients. Laryngoscope. 2011;121:1208–11.CrossRefGoogle Scholar
  5. 5.
    Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. “Pharyngocize”: randomized controlled trial of preventive exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:210–9.CrossRefGoogle Scholar
  6. 6.
    Hutcheson KA, Bhayani M, Beadle BM, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139:1127–34.CrossRefGoogle Scholar
  7. 7.
    Kotz T, Federman AD, Kao J, et al. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg. 2012;138:376–82.CrossRefGoogle Scholar
  8. 8.
    Kulbersch BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006;116:883–6.CrossRefGoogle Scholar
  9. 9.
    Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118:39–43.CrossRefGoogle Scholar
  10. 10.
    Van der Molen L, van Rossum MA, Rasch CR, Smeele LE, Hilgers FJ. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otolaryngol. 2014;271:1257–70.CrossRefGoogle Scholar
  11. 11.
    Van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia. 2011;26:155–70.CrossRefGoogle Scholar
  12. 12.
    Gillespie MB, Brodsky MB, Day TA, Lee FS, Martin-Harris B. Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope. 2004;114:1362–7.CrossRefGoogle Scholar
  13. 13.
    Shinn EH, Basen-Engquist K, Baum G, et al. Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck. 2013;35:1707–12.CrossRefGoogle Scholar
  14. 14.
    Hirano M, Kuroiwa Y, Tanaka S, Yoshida T. Dysphagia following various degrees of surgical resection for oral cancer. Ann Otol Rhinol Laryngol. 1992;101:138–41.CrossRefGoogle Scholar
  15. 15.
    Tei K, Maekawa K, Kitada H, Ohiro Y, Yamazaki Y, Totsuka Y. Recovery from postsurgical swallowing dysfunction in patients with oral cancer. J Oral Maxillofac Surg. 2007;65:1077–83.CrossRefGoogle Scholar
  16. 16.
    Tei K, Sakakibara N, Yamazaki Y, Ohiro Y, Ono M, Totsuka Y. Does swallowing function recover in the long-term in patients with surgically treated tongue carcinomas? J Oral Maxillofac Surg. 2012;70:2680–6.CrossRefGoogle Scholar
  17. 17.
    Friedlander P, Caruana S, Sing B, et al. Functional status after primary surgical therapy for squamous cell carcinoma of the base of tongue. Head Neck. 2002;24:111–4.CrossRefGoogle Scholar
  18. 18.
    Liang Y, Cui Y, Liao G. Comparison of quality of life in tongue cancer patients undergoing tongue reconstruction with lateral upper arm free flap and radial forearm free flap. Int J Clin Exp Med. 2015;8:4533–8.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Owen S, Puvanendran M, Meikle D, et al. Baseline swallowing measures predict recovery at 6 weeks after transoral robotic surgery for head and neck cancer. Clin Otolaryngol. 2017;42:366–72.CrossRefGoogle Scholar
  20. 20.
    Eisbruch A, Schwartz M, Rasch C, et al. Dysphagia and aspiration after chemoradiotherapy for head and neck cancer: which anatomic structures are affected and can they be spared by IMRT. Int J Radiat Oncol Biol Phys. 2004;60:1425–39.CrossRefGoogle Scholar
  21. 21.
    Feng FY, Kim HM, Lyden TH, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007;68:1289–98.CrossRefGoogle Scholar
  22. 22.
    Levendag PC, Teguh DN, Voet P, et al. Dysphagia disorders in patients with head and neck cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose effect relationship. Radiother Oncol. 2007;50:65–70.Google Scholar
  23. 23.
    Denaro N, Merlano MC, Russi EG. Dysphagia in head and neck cancer patients: pretreatment evaluation, predictive factors, and assessment during radio-chemotherapy, recommendations. Clin Exp Otorhinol. 2013;6:117–26.CrossRefGoogle Scholar
  24. 24.
    Starmer HM, Quon H, Kumar R, et al. The effect of radiation dose on swallowing evaluation of aspiration and kinematics. Dysphagia. 2015;30:430–7.CrossRefGoogle Scholar
  25. 25.
    Rogus-Pulia NM, Larson C, Mittal BB, et al. Effects of change in tongue pressure and salivary flow rate on swallow efficiency following chemoradiation treatment for head and neck cancer. Dysphagia. 2016;31:687–96.CrossRefGoogle Scholar
  26. 26.
    Kumar R, Madanikia S, Starmer H, et al. Radiation dose to the floor of mouth muscles predicts swallowing complications following chemoradiation in oropharyngeal squamous cell carcinoma. Oral Oncol. 2014;50:65–70.CrossRefGoogle Scholar
  27. 27.
    Agarwal J, Dutta D, Palwe V, et al. Prospective subjective evaluation of swallowing function and dietary pattern in head and neck cancers treated with concomitant chemoradiation. J Cancer Res Ther. 2011;6:15–21.CrossRefGoogle Scholar
  28. 28.
    Patterson JM, McColl E, Carding PN, Hildreth AJ, Kelly C, Wilson JA. Swallowing in the first year after chemoradiotherapy for head and neck cancer: clinician-and patient-reported outcomes. Head Neck. 2014;36:352–8.CrossRefGoogle Scholar
  29. 29.
    Mercadante S. Options for treating pain in cancer patients with dysphagia. Drugs. 2017;77:629–35.CrossRefGoogle Scholar
  30. 30.
    Pauli N, Johnson J, Finizia C, Andrell P. The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer. Acta Oncol. 2013:1137–45.CrossRefGoogle Scholar
  31. 31.
    Mercadante S, Aielli F, Adile C, et al. Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients. Support Care Cancer. 2015;23:3249–55.CrossRefGoogle Scholar
  32. 32.
    Wang X, Eisbruch A. IMRT for head and neck cancer: reducing xerostomia and dysphagia. J Radiat Res. 2016;57:i69–75.CrossRefGoogle Scholar
  33. 33.
    Kent ML, Brennan MT, Noll JL, et al. Radiation-induced trismus in head and neck cancer patients. Support Care Cancer. 2008;16:305–9.CrossRefGoogle Scholar
  34. 34.
    Johnson J, van As-Brooks CJ, Fagerberg-Mohlin B, Finizia C. Trismus in head and neck cancer patients in Sweden: incidence and risk factors. Med Sci Monit. 2010;16:CR278–82.PubMedGoogle Scholar
  35. 35.
    Scott B, D’Souza J, Perinparajah N, Lowe D, Rogers SN. Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg. 2011;49:106–11.CrossRefGoogle Scholar
  36. 36.
    Bensadoun RJ, Riesenbeck D, Lockhart PB, Elting LS, Spijkervet FK, Brennan MT. A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer. 2010;18:1033–8.CrossRefGoogle Scholar
  37. 37.
    Ridner SH, Dietrich MS, Niermann K, Cmelak A, Mannion K, Murphy B. A prospective study of the lymphedema and fibrosis continuum in patients with head and neck cancer. Lymphat Res Biol. 2016;14:198–205.CrossRefGoogle Scholar
  38. 38.
    Deng J, Murphy BA, Dietrich MS, et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck. 2013;35:1026–35.CrossRefGoogle Scholar
  39. 39.
    Smith BG, Lewin JS. Lymphedema management in head and neck cancer. Curr Opin Otolarynol Head Neck Surg. 2010;18:153–8.CrossRefGoogle Scholar
  40. 40.
    Nourissat A, Bairati I, Samson E, et al. Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer. Cancer. 2010;116:2275–83.PubMedGoogle Scholar
  41. 41.
    Nourissat A, Bairati I, Fortin A, et al. Factors associated with weight loss during radiotherapy in patients with stage I or II head and neck cancer. Support Care Cancer. 2012;20:591–9.CrossRefGoogle Scholar
  42. 42.
    Langius JA, Tuisk J, Kampman M, et al. Prediction model to predict critical weight loss in patients with head and neck cancer during (chemo) radiotherapy. Oral Oncol. 2016;52:91–6.CrossRefGoogle Scholar
  43. 43.
    Kubrak C, Olson K, Baracos VE. The head and neck symptom checklist: an instrument to evaluate nutrition impact symptoms effect on energy intake and weight loss. Support Care Center. 2013;21:3127–36.CrossRefGoogle Scholar
  44. 44.
    Kubrak C, Olson K, Jha N, et al. Clinical determinants of weight loss in patients receiving radiation and chemo-irradiation for head and neck cancer: a prospective longitudinal view. Head Neck. 2013;35:695–703.CrossRefGoogle Scholar
  45. 45.
    Yamashita H, Nakagawa K, Tago M, et al. Taste dysfunction in patients receiving radiotherapy. Head Neck. 2006;28:508–16.CrossRefGoogle Scholar
  46. 46.
    McLaughlin L. Taste dysfunction in head and neck cancer survivors. Oncol Nurs Forum. 2013;40:E4–E13.CrossRefGoogle Scholar
  47. 47.
    Tsutsumi R, Goda M, Fujimoto C, et al. Effects of chemotherapy on gene expression of lingual taste receptors in patients with head and neck cancer. Laryngoscope. 2016;126:E103–9.CrossRefGoogle Scholar
  48. 48.
    Ogama N, Suzuki S, Umeshita K, et al. Appetite and adverse effects associated with radiation therapy to patients with head and neck cancer. Eur J Oncol Nurs. 2010;14:3–10.CrossRefGoogle Scholar
  49. 49.
    Jiang N, Zhang L, Zhao Y. Risk factors for late dysphagia after (chemo) radiotherapy for head and neck cancer: a systematic methodological review. Head Neck. 2016;38:792–800.CrossRefGoogle Scholar
  50. 50.
    Popovtzer A, Cao Y, Feng FY, Eisbruch A. Anatomical changes in the pharyngeal constrictors after chemo-irradiation of head and neck cancer and their dose-effect relationship: MRI-based study. Radiother Oncol. 2009;93:510–5.CrossRefGoogle Scholar
  51. 51.
    Hutcheson KA, Lewin JS, Barringer DA, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012;118:5793–9.CrossRefGoogle Scholar
  52. 52.
    Kraaijenga SA, Oskam IM, van der Molen L, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Evaluation of long term (10 years+) dysphagia and trismus in patients treated with concurrent chemoradiotherapy for advanced head and neck cancer. Oral Oncol. 2015;51:787–94.CrossRefGoogle Scholar
  53. 53.
    Kraaijenga SA, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol. 2015;272:3521–31.CrossRefGoogle Scholar
  54. 54.
    Morton RP. Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional cross-cultural survey. Laryngoscope. 2003;113:1091–103.CrossRefGoogle Scholar
  55. 55.
    Rogus-Pulia NM, Pierce M, Mittal BB, Zecker SG, Logemann J. Bolus effects on patient awareness of swallowing difficulty and swallowing physiology after chemoradiation for head and neck cancer. Head Neck. 2015;37:1122–9.CrossRefGoogle Scholar
  56. 56.
    Patterson JM, McColl E, Wilson J, Carding P, Rapley T. Head and neck cancer patients’ perceptions of swallowing following chemoradiotherapy. Support Care Cancer. 2015;23:3531–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Keck Medical CenterUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.USC Voice CenterUSC Caruso Department of Otolaryngology-Head and Neck SurgeryLos AngelesUSA

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