Dysphagia after laryngectomy can be complex to evaluate because surgery permanently changes swallowing anatomy and physiology. A structured, consensus-based approach can help clinicians assess symptoms more consistently, connect patient experience with observable findings, and support more individualized care.
Why structured assessment matters
Following laryngectomy, patients may experience residue, backflow, increased effort, pressure during swallowing, or changes in comfort and confidence when eating and drinking. Standard dysphagia assessment tools may not fully reflect these laryngectomy-specific issues.
Consensus-based frameworks for clinical swallow examination and videofluoroscopic swallow study can give clinicians a clearer structure for identifying what to ask, observe, measure, and document during assessment.
Where these frameworks originated
The preliminary clinical swallow examination (CSE) and videofluoroscopic swallow study (VFSS) frameworks were developed through research led by clinicians and researchers at the Royal Brisbane & Women's Hospital and The University of Queensland in Australia. Drawing on the expertise of experienced laryngectomy clinicians, the project used a structured consensus process to identify the assessment tasks, measures, and observations considered most important for evaluating dysphagia after laryngectomy.
How eDelphi methodology supports consensus
The preliminary frameworks were developed using an eDelphi process, a structured method for building agreement among experienced clinicians. In the first round, clinicians generated assessment items based on common swallowing symptoms reported after laryngectomy. These items were then reviewed and rated across additional rounds.
Items reached consensus when a high proportion of participants rated them as critically important for inclusion. This approach helped reduce variation and identify the tasks, measures, and observations considered most relevant for laryngectomy dysphagia assessment.
Core components of CSE and VFSS
The clinical swallow examination framework emphasizes patient history and interview questions, including medical and swallowing history, symptom patterns, voice prosthesis function, distress, quality of life, and social participation. It also includes targeted swallow tasks, clinical observations, and decisions about onward referral.
The VFSS framework adds direct visualization of anatomy and swallowing function. Key areas include anatomical observations, swallow tasks using different bolus types or strategies, observations of residue and backflow, spontaneous swallow count, and multidisciplinary communication with head and neck or ENT teams.
A patient-centered approach in clinical practice
Used together, patient-reported outcomes, CSE, and VFSS can create a practical assessment sequence. Patient-reported tools can identify symptoms before the visit. The CSE can explore those symptoms in more detail. VFSS can then help explain the underlying anatomy and physiology when instrumental assessment is needed.
This sequence supports patient-centered care by comparing what the patient reports with what the clinician observes. For example, the patient’s sensation of residue can be compared with imaging findings, helping guide education, compensatory strategies, follow-up, and individualized goals.
Benefits for research and future care
For research, consensus frameworks can improve consistency across studies and help define which laryngectomy-specific assessment items should be documented. They may also support future work to develop validated measures for swallowing efficiency, residue, anatomical reference points, and changes over time.
Further development is needed, especially for VFSS measurement, clinician training, and adaptation in different care settings. As these frameworks evolve, they may help clinicians make assessment more consistent while still tailoring care to each patient’s anatomy, symptoms, priorities, and goals.