Predictive Power of Pharyngolaryngeal Secretion Accumulations for Penetration and Aspiration in Head and Neck Cancer Patients

Pharyngolaryngeal secretions, penetration, and aspiration belong to the cardinal symptoms of swallowing disorders in head and neck cancer patients. In order to provide safe swallowing diagnostics, it is of interest whether pharyngolaryngeal secretion accumulations can be used as a predictor for penetration and aspiration of food and liquids. This study analyzed the predictive power of pharyngolaryngeal secretion accumulations for the penetration and aspiration in head and neck cancer patients. Between 2016 - 2024, 403 head and neck cancer patients underwent swallowing diagnostics via Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Pharyngolaryngeal secretions were graded with the secretion severity rating scale (SSRS) by Murray et al., penetration and aspiration with the penetration-aspiration scale (PAS) by Rosenbek et al. Both scales were cross-tabulated and correlated with each other. Possible influencing factors on PAS were analyzed by Spearman's correlations and Kruskal-Wallis-H-tests: patients' age, tumor stage and site, type of the oncological therapy, and time of examination. A linear regression and a Categorical Principal Components Analysis were utilized for the same purpose. Higher SSRS and PAS values tended to co-occur. In univariate calculations, the tumor stage and time of examination showed significant correlations with PAS. In multivariate analyses, the tumor stage, patients' age, but above all the SSRS were shown to be significant influencing factors on PAS. Pharyngolaryngeal secretion accumulations can be used for the prediction of aspiration of food and liquids and thus for the improvement of safety of the swallowing diagnostics via FEES.