Effects of Change in Tongue Pressure and Salivary Flow Rate on Swallow Efficiency Following Chemoradiation Treatment for Head and Neck Cancer.
Nicole M Rogus-Pulia, Charles Larson, Bharat B Mittal and 5 others
PMID 27492408WHAT IT FOUND
After chemoradiation for head and neck cancer, saliva flow fell and its change predicted swallowing efficiency change on 1mL thin, 3mL nectar, and 3mL pudding boluses.
Tongue pressure and endurance showed no clear change. Check saliva before assuming tongue strength is the main problem.
Key findings
01From before to after chemoradiation, salivary flow rate decreased, while maximum tongue pressure and endurance did not show significant change.
02Change in saliva weight predicted change in OPSE for 1mL thin liquid, 3mL nectar-thick liquid, and 3mL standard barium pudding boluses.
03After treatment, patients had lower tongue endurance and salivary flow than controls; lower maximum tongue pressure approached but did not reach significance.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study included only 21 patients. Patients differed in tumor site, exact chemoradiation protocol, and smoking or alcohol history. Post-treatment assessment timing varied from 78 to 809 days, and three patients were assessed beyond one year. Some analyses excluded participants with missing data, so the number used in each analysis may differ from 21. Tongue strength and endurance were measured in an isolated task, not during swallowing. The swallowing perception questionnaire has not been validated and reliability has not been established. The study examined chemoradiation as a combined treatment, so it cannot separate the effects of radiation and chemotherapy. No treatment was tested, so it cannot show that saliva substitutes, water swallows, or food modifications improve swallowing.
Declared interests
No relevant conflicts of interest are reported for the named authors.
The easy way to misread this
Do not conclude that tongue strength and endurance are unimportant because they did not change significantly. They were measured outside swallowing, the sample was small, and lower maximum tongue pressure was associated with more oral residue on 10mL thin and nectar-thick boluses.