Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma

Dysphagia is a late sequela compromising the lives of more than one fourth of patients with nasopharyngeal carcinoma (NPC) who survive long after radiotherapy. By using fiberoptic endoscopic examination of swallowing as a modality for dysphagia evaluation, we were able to easily recognize the functional and anatomic changes in 31 dysphagic NPC patients. The majority of patients were found to aspirate after the act of swallowing (77.4%). Seventeen (54.8%) had tongue atrophy, and 9 (29%) had vocal cord palsy. Dysfunctions such as dry mouth (45.2%), velopharyngeal incompetence (58%), premature leakage (41.9%), delay or absence of swallow reflex (87.1%), poor pharyngeal constriction (80.6%), pharyngeal residue retention (83.9%), penetration or aspiration (93.5%), and silent aspiration (41.9%) were noted in these patients. Multiple dysfunctions were demonstrated in each patient. Abnormality of pharyngeal constriction and/or aberrant upper esophageal sphincter function played the major role in the postswallow aspiration of these irradiated NPC patients. Clinically compromised patients (weight loss of > or =5 kg in 1 year or pneumonia) had more of the above anatomic and functional impairments. The radiation dosage and volume bore no correlation to the time of symptom onset, or to the occurrence of functional changes.