A new standardized measure of symptoms associated with salivary duct obstruction was recently developed by researchers, including UCSF otolaryngologists Jolie Chang, MD, FACS, and William R. Ryan, MD, FACS, and UCSF medical student Arushi Gulati. Based on input from patients with sialadenitis and physicians who treat the condition, the obstructive Salivary Problem Impact Test (SPIT) is shorter and easier for patients to understand than previous such tools. The research team found that the test had excellent construct validity and test-retest reliability.
“Our goal was to make sure we were asking the right questions, the ones that matter the most to patients,” Chang said. “In this multiphase study, we received feedback directly from interviews and focus groups with patients and experts.”
The first test based on patient input
Patients with chronic obstructive sialadenitis regularly experience salivary gland discomfort and swelling, which can impair eating, speaking and mood. “Sialendoscopy has revolutionized treatment for this condition,” Chang said. “We can treat it minimally invasively with long-lasting positive patient outcomes, and we are able to preserve salivary glands.”
Chang and the UCSF Salivary Gland Surgery Center team frequently treat patients with salivary duct stones or stenosis – common causes of sialadenitis. “We wanted to track how these patients did over time and realized that we needed to update, optimize and validate a clinical tool that captures what’s important to both patients and providers,” she continued. “The older tools were designed with no patient input and were not validated.”
For the study, the researchers created the SPIT by identifying common symptoms noted on previous obstructive sialadenitis patient-reported outcome measures. The new test was then assessed by patients and expert physicians to ensure that it included the most relevant symptoms and concerns.
“We asked patients to make sure it was readable, understandable and easy to use,” Chang said. “We then piloted the test with patients who had the disease and a control group to determine if it was capturing the symptoms we expected and had temporal reliability. These were our first validation steps. Now we're going to use this tool to follow patients at a few different institutions.”
The SPIT can be downloaded from the center’s website. “We encourage physicians to use it to understand how their patients are doing after surgery,” Chang said.
Specialty referral center for salivary gland disorders
Several years ago, Chang, Ryan and the UCSF otolaryngology – head and neck surgery team began the work that eventually resulted in the SPIT. They developed the Chronic Obstructive Sialadenitis Symptoms Questionnaire and regularly surveyed patients to evaluate the short- and long-term effects of sialendoscopic surgeries. Many patients reported significant improvements following surgery. “UCSF was one of the first centers to understand prospectively whether the interventions we were doing were benefiting patients,” Chang said.
“UCSF is recognized as a specialty referral center for salivary obstruction and related disorders,” she continued. “Our team is highly collaborative with other disciplines. For example, patients with thyroid cancer who’ve been treated with radioactive iodine may experience salivary gland problems. We partner with our endocrinology colleagues to treat these patients.”
Chang and Ryan co-chair a biennial CME course on sialendoscopy and surgery for salivary obstruction that features didactic lectures and a hands-on lab for skills and equipment practice with expert guidance.
To learn more
UCSF Salivary Gland Surgery Center at Mount Zion
Phone: (415) 353-2757 | Fax: (415) 353-2603
