Investigation of the Impact of Preoperative Swallowing Therapy on Swallowing Function in Partial Laryngectomy

Partial laryngectomy can substantially compromise swallowing safety and efficiency, leading to reduced swallowing-related quality of life in patients with head and neck cancer (HNC). Although postoperative swallowing therapy is effective in managing dysphagia, postoperative pain, fatigue, and anatomical alterations may limit early rehabilitation adherence. This study aimed to investigate whether structured preoperative swallowing therapy enhances postoperative swallowing recovery in patients undergoing partial laryngectomy. Thirty patients with HNC were included. The study group (n = 16) received both preoperative and postoperative swallowing therapy, while the control group (n = 14) received postoperative therapy alone. Preoperative therapy was delivered using an individualized, Fiberoptic Endoscopic Evaluation of Swallowing (FEES)-guided protocol specified according to the Rehabilitation Treatment Specification System (RTSS), targeting airway protection, swallowing efficiency, and preparation for postoperative rehabilitation. Postoperative swallowing therapy content, timing, and dosage were fully standardized between groups. Swallowing function was assessed preoperatively and at postoperative days 5-7, and at 1, 3, and 6 months using FEES. Penetration-aspiration severity was evaluated via the Penetration-Aspiration Scale (PAS) across all International Dysphagia Diet Standardisation Initiative (IDDSI) consistencies, and pharyngeal residue was assessed using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Functional oral intake and swallowing-related quality of life were assessed using the Functional Oral Intake Scale (FOIS), Eating Assessment Tool-10 (EAT-10), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35). Both groups demonstrated significant postoperative improvements over time. However, patients receiving preoperative swallowing therapy achieved significantly higher FOIS levels at earlier postoperative time points (p = 0.018 to < 0.001), showed greater reductions in penetration-aspiration severity (p = 0.001-0.031) and pharyngeal residue (p < 0.001-0.050), and reached functional oral intake significantly earlier than controls (10.44 ± 1.50 vs. 24.36 ± 3.77 days, p < 0.001). Nasogastric tube duration was also shorter in the study group (9.25 ± 2.10 vs. 20.40 ± 3.80 days, p < 0.001). These improvements were also reflected in EORTC QLQ-C30 and QLQ-H&N35 scores, with earlier recovery in functional domains and reduced symptom burden in the study group. In conclusion, structured preoperative swallowing therapy significantly accelerates postoperative swallowing recovery, improves airway protection, reduces postoperative enteral feeding dependence, and facilitates earlier return to oral intake following partial laryngectomy. These findings support the integration of structured preoperative swallowing therapy into routine perioperative dysphagia management for patients undergoing partial laryngectomy.