Quality Of Life Questionnaire

This questionnaire consists of 17 questions which have to be answered on a visual analogue scale of 0-100. The questions cover the consistency of food associated with dysphgia, the anatomic region involved and type of dysfunction.(41) This score has been validated in patients with head and neck cancer(41) and oropharyngeal cancer(42).

There are other scoring system used especially in patients with head and neck cancer like - The Swallowing Questionnaire Quality of Life Questionnaire (SWAL-QOL and SWAL-CARE) and The MD Anderson Dysphagia Inventory (MDADI).

Several screening tests were designed to identify patients with dysphagia following stroke who needed to be referred to speech therapists for detailed assessment. Some of the tests which were

This was shown to have a sensitivity of 92 percent compared to videoflouroscopic modified barium swallow.

The Gugging swallowing screen(44) is a scoring system consisting of preliminary part and direct swallowing test. In the direct swallow test, several considtencies are used like solid, semi-solid and liquids. The scores range from 0 to 20 and lower scores indicating dysphagia. The score was compared to Fibreoptic endoscopic evaluation of swallowing and the sensitivity was found to be 100 percent and a positive predictive value of 81 percent for

Topical anesthesia is given to decrease discomfort during the procedure. It also permits sensory testing. But, this technique evaluates mainly pharyngeal stage of swallowing with a brief period of ‘white-out’ during swallow.(55)

The advantages of this procedure are that it is less invasive, can be repeated, can be performed bedside and pharyngeal sensations can be tested. The disadvantages are - it needs skilled performer and needs costly equipment. Oral phase cannot be tested by this method.(38) The main complications associated with this procedure are discomfort, epistaxis, laryngospasm, vasovagal reflex. The incidence of these complications is very low. (56) The procedure requires the combined effort of otolaryngologist, who performs the endoscopy and speech-pathologist, who does the swallowing assessment.

The practice of using flexible endoscopes for assessment of dysphagia was started by Langmore et al in 1988. Later, several studies were done demonstrating the usefulness of endoscopy in the evaluation of dysphagia under multiple names like videoendoscopic evaluation of dysphagia and videoendoscopic evaluation of swallowing