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Letters to the Editor
Apr 2012

The Need for Further Evaluation of Objective Parameters of Swallowing Function After Transoral Robotic Surgery—Reply

Author Affiliations

Author Affiliations: Department of Surgery, Division of Otolaryngology–Head and Neck Surgery (Drs Sinclair, Carroll, Rosenthal, and Magnuson and Ms McColloch), and Department of Medicine, Medical Statistics Section, Biostatistics and Bioinformatics Unit (Dr Desmond), University of Alabama at Birmingham.

Arch Otolaryngol Head Neck Surg. 2012;138(4):432-433. doi:10.1001/archoto.2012.116

In reply

We thank Sanders and Babbar for their letter. Our article focused on patient perceptions of swallowing after TORS for T1 and T2 oropharyngeal carcinomas using the M. D. Anderson Dysphagia Inventory (MDADI), a subjective measurement of swallowing function. However, we also reported on feeding tube retention rates, an objective measure of swallowing function. We agree that the PAS and modified barium swallow (MBS) represent other objective techniques for assessing risk of aspiration and that the objective findings from these studies may not always correlate well with subjective MDADI scores. However, patients who are at high risk of aspiration on PAS or MBS would generally have feeding tubes and, therefore, for the purposes of predicting aspiration, percutaneous endoscopic gastrostomy tube retention, as discussed in our article, is a useful clinical indicator of swallowing function. Also, in the absence of frank aspiration, MBS (and PAS) results do not necessarily correlate with real-life swallowing function, and subjective scales such as the MDADI are thereby indispensable. As noted in our study, few patients undergoing TORS-assisted resection of T1 and T2 oropharyngeal carcinomas require PEG tubes, and very few for longer than 3 months. In contrast, patient perception of swallowing as measured by MDADI scores continues to improve, even after 12 months after surgery.

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