Study objective: Impaired laryngeal protective function
can result in intractable aspiration requiring surgical treatment.
There are, however, few reports evaluating the satisfaction of patients
and the efficacy of surgical therapy. The purpose of this study is to
determine whether surgery for intractable aspiration is beneficial for
alleviating depression and improving the mood of patients who have
undergone surgical treatment and whether patients and their families
are satisfied with the therapy.
Patients and study
design: Seven patients with recurrent aspiration pneumonia that
could not be controlled by appropriate medical therapies participated
in the study. These patients had no hope of recovering laryngeal
function. Six underwent laryngectomy and one underwent laryngotracheal
separation. After surgery, we evaluated the efficacy of the therapy and
the patients’ satisfaction with the therapy.
The following clinical variables concerning surgical procedure were
examined: operation time, time until oral intake, videofluorographic
study, and surgical complications. The treatment methods including
feeding status were also examined before and after surgery. In
addition, the following markers were examined to evaluate the efficacy
of the surgery: score of aspiration pneumonia, body mass index, total
protein, albumin, hematocrit, WBC count, C-reactive protein,
erythrocyte sedimentation rate, and the Barthel Index, an indicator of
daily activity. Furthermore, the grade of depression and mood, and
satisfaction of patients and their caretakers among family members were
scored by the Zung self-rating depression scale, a 20-picture face
scale, and the visual analog scale.
surgical therapy, we confirmed by videofluorography that aspiration was
completely prevented. No surgical complications occurred. By 18 ± 6
days, all seven patients were able to ingest a meal orally. The need
for extensive medical care and repeated hospitalizations became
unnecessary after surgery. The control of pneumonia and albumin
improved significantly. The grade of depression and mood of patients
and their families also improved significantly. Satisfaction scores of
patients receiving therapy were very high.
Conclusions: Our study shows that surgical therapy to
prevent aspiration improves the depression and mood of patients and
their families as well as feeding status and clinical outlook. Surgical
therapy for patients with intractable aspiration is effective and