EAT-10 Scores and Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients

Abstract

Objective: The purpose of this study was to determine the relationship between patient-reported symptoms of oropharyngeal dysphagia (OD) using the Eating Assessment Tool (EAT)-10 and the swallowing function using a standardized fiberoptic endoscopic evaluation of swallowing (FEES) protocol in head and neck cancer (HNC) patients with confirmed OD.

Methods: Fifty-seven dysphagic HNC patients completed the EAT-10 and a FEES. Two blinded clinicians scored the randomized FEES examinations. Exclusion criteria consisted of presenting with a concurrent neurological disease, scoring below 23 on a Mini-Mental State Examination, being older than 85 years, having undergone a total laryngectomy, and being illiterate or blind. Descriptive statistics, linear regression, sensitivity, specificity, and predictive values were calculated.

Results: The majority of the dysphagic patients (N = 38; 66.7%) aspirated after swallowing thin liquid consistency. A large number of patients showed postswallow pharyngeal residue while swallowing thick liquid consistency. More specifically, 42 (73.0%) patients presented postswallow vallecular residue, and 39 (67.9%) patients presented postswallow pyriform sinus residue. All dysphagic patients had an EAT-10 score ≥ 3. Linear regression analyses showed significant differences in mean EAT-10 scores between the dichotomized categories (abnormal vs. normal) of postswallow vallecular (P = .037) and pyriform sinus residue (P = .013). No statistically significant difference in mean EAT-10 scores between the dichotomized categories of penetration or aspiration was found (P = .966).

Conclusion: The EAT-10 questionnaire seems to have an indicative value for the presence of postswallow pharyngeal residue in dysphagic HNC patients, and a value of 19 points turned out to be useful as a cutoff point for the presence of pharyngeal residue in this study population.

Level of evidence: 2B.

Keywords: Dysphagia, deglutition, deglutition disorders, EAT-10, head and neck cancer.

Fig 1

Association between FEES outcome variables and EAT‐10 scores in means and 95% CI and maximum spread of EAT‐10 scores for the FEES variable postswallow vallecular residue (n = 48). CI = confidence interval; EAT = Eating Assessment Tool; FEES = fiberoptic endoscopic evaluation of swallowing.

Fig 2

Association between FEES outcome variables and EAT‐10 scores in means and 95% CI and maximum spread of EAT‐10 scores for the FEES variable postswallow pyriform sinus residue (n = 47). CI = confidence interval; EAT = Eating Assessment Tool; FEES = fiberoptic endoscopic evaluation of swallowing.

Fig 3

Association between FEES outcome variables and EAT‐10 scores in means and 95% CI and maximum spread of EAT‐10 scores for the FEES variable penetration/aspiration (n = 47). CI = confidence interval; EAT = Eating Assessment Tool; FEES = fiberoptic endoscopic evaluation of swallowing.

Fig 4

ROC curve of the EAT‐10 outcome score. AUC (AUC 0.719, 95% CI 0.641, 0.797) of the mathematically composed FEES variable postswallow pharyngeal residue at any location (= postswallow vallecular and/or pyriform sinus residue). AUC = area under the curve; CI = confidence interval; EAT = Eating Assessment Tool; FEES = fiberoptic endoscopic evaluation of swallowing; ROC = receiver operating characteristic.