Literature Review: A Roundup of Important Recent Studies

Reference: Weinstein GS, Quon H, Newman HJ, et al. Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch Otolaryngol Head Neck Surg. 2012;138(7):628-634.

—Reviewed by Christine G. Gourin, MD

Swallowing Exercises During Cancer Treatment Help Muscle Maintenance

Does preventive swallowing intervention reduce the incidence of dysphagia in patients undergoing chemoradiation for head and neck cancer?

Background: Pharyngoesophageal dysfunction is common after chemoradiation for head and neck cancer and results in dysphagia due to radiation-induced tissue fibrosis, muscle disuse and muscle atrophy. Aggressive treatment using weight-loading exercises has been shown to improve strength and work capacity in previously weakened muscles. It is unclear if strength-training exercises aimed at the swallowing musculature can mitigate the effects of chemoradiation in the occurrence of dysphagia-related complications.

Study design: Randomized controlled clinical trial.

Setting: University of Florida, Gainsville.

Synopsis: Fifty-eight patients undergoing chemoradiation for head and neck cancer were randomized to one of three groups: usual care, sham swallowing intervention or active high-intensity swallowing exercise therapy treatment—termed “pharyngocise.” The intervention groups were treated daily during chemoradiation. The primary outcome measures were six-month post-treatment muscle size and composition as determined by T2-weighted MRI imaging, functional swallowing ability, dietary intake, chemosensory function, salivation, nutritional status and the occurrence of dysphagia-related complications. Patients randomized to the active swallowing program group demonstrated significantly less structural muscle deterioration in the genioglossus, hyoglossus and mylohoid muscles by MRI and greater preservation of functional swallowing, mouth opening, chemosensory acuity and salivation compared with the usual care and sham swallowing intervention groups. A composite measure was designed to designate a favorable swallowing-related outcome and included weight loss of less than 10 percent, maintenance of oral diet and a change of fewer than 10 points on the Mann Assessment of Swallowing Ability. The active treatment group was associated with six-fold greater odds of a favorable outcome after chemoradiation compared with patients who did not receive preventive exercises (p=0.009).

Bottom line: A prophylactic program of swallowing exercises during chemoradiation results in superior muscle maintenance and functional swallowing ability. Preventive swallowing therapy by a speech language pathologist should begin at the point of diagnosis and continue throughout non-operative treatment.

Reference: Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(1):210-219.

—Reviewed by Christine G. Gourin, MD

Better Analytic Tools Needed for Pediatric OSA

What is the accuracy of current diagnostic clinical symptoms and signs in predicting pediatric obstructive sleep apnea (OSA)?

Background: Pediatric OSA is a severe condition that differs from its adult counterpart in physiology, clinical presentation, polysomnographic characteristics and outcomes. Although polysomnography is the gold standard for diagnosis and quantification, it requires an overnight stay in the laboratory for both parents and child. However, access to a sleep laboratory is limited in some areas. Therefore, pediatric OSA is often still diagnosed on a clinical basis.