Improving the Quality of Life of Patients With Severe Dysphagia by Surgically Closing the Larynx

Abstract

Objectives:

The aim of this study was to elucidate the utility of the Kano method with surgical closure of the larynx by cricoid cartilage removal in improving quality of life in patients with severe dysphagia and their caregivers.

Methods:

Nine patients with severe dysphagia who underwent the Kano method were evaluated for oral intake and activities of daily living using the functional oral intake scale and the Barthel index, respectively, as indices of quality of life. Additionally, nutritional status, inflammation, and postoperative complications were assessed. Furthermore, 7 family caregivers were queried regarding frequency of sputum suction, mood of family caregivers, and postoperative satisfaction.

Results:

Functional oral intake scale and Barthel index scores as well as inflammation improved significantly after surgery (P < .05). There were no severe complications or other complications requiring surgical intervention. The frequency of sputum suction was reduced postoperatively (P < .05). The mood of family caregivers was significantly improved and satisfaction level was high postoperatively.

Conclusions:

Surgical closure of the larynx is an appropriate choice for patients with irreversible severe dysphagia and impaired articulation or vocal function because quality of life is improved for both patients and family caregivers and the satisfaction of family caregivers is sufficient.

Keywords

dysphagia deglutition disorders aspiration pneumonia surgical closure of the larynx cricoid cartilage quality of life

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References

Teramoto

Fukuchi

Sasaki

Sato

Sekizawa

Matsuse

High incidence of aspiration pneumonia in community and hospital acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008;56:577-579.

Lindemann

RC.

Diverting the paralyzed larynx: a reversible procedure for intracta. Laryngoscope. 1975;85:157-180.

Montgomery

WW.

Surgery to prevent aspiration. Arch Otolaryngol. 1975;101:679-682.

Kitahara

Ikeda

Ohmae

Nakanoboh

Inouye

Healy

GB.

Laryngeal closure at the level of the false cord for the treatment of aspiration. J Laryngol Otol. 1993;107:826-828.

Ninomiya

Yasuoka

Inoue

et al . Simple and new surgical procedure for laryngotracheal separation in pediatrics. Laryngoscope. 2008;118:958-961.

Kawamoto

Katori

Honkura

et al . Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration. Eur Arch Otorhinolaryngol. 2014;271:1149-1155.

Kano

Kuwahata

Takatori

Kida

Surgical closure of the larynx with removing cricoid cartilage for intractable aspiration pneumonia in bedridden patients. Koutou. 2008;20:5-12.

Crary

Mann

GDC

Groher

ME.

Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86:1516-1520.

Mahoney

Barthel

Functional evaluation: the Barthel Index. Md State Med J. 1965;14:56-61.

10.

Arai

Kudo

Hosokawa

Washio

Miura

Hisamichi

Reliability and validity of the Japanese version of the Zarit Caregiver Burden interview. Psychiatry Clin Neurosci. 1997;51:281-287.

11.

Takano

Suga

Sakamoto

Sato

Samejima

Ando

Satisfaction of patients treated surgically for intractable aspiration. Chest. 1999;116:1251-1256.

12.

Fuke

Ito

Kato

Yamada

Surgical therapy for intractable aspiration pneumonia and the quality of life of care persons in patients with progressive neural disease. Jpn Bronchoesophagol Soc. 2007;58:371-376.

13.

Iida

Yasuoka

Ninomiya

Watanabe

Furuya

Analysis of questionnaire on family-related QOL of pediatric patients following tracheal separation. Pediatr Otorhinolaryngol Jpn. 2011;32:113-118.

14.

Oto-Rhino-Laryngological Society of Japan. Surgical treatment: the guideline for the examination of dysphagia. Tokyo: Oto-Rhino-Laryngological Society of Japan; 2012.