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Hou Q, Yao L, Ou J. Research hotspot and frontiers in post-stroke dysphagia: A bibliometric study and visualisation analysis. J Eval Clin Pract 2024; 30:703-715. [PMID: 38652528 DOI: 10.1111/jep.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Dysphagia, a common complication after stroke, significantly hampers the recovery process of patients, both due to dysphagia itself and the additional complications it causes. Although a large number of articles have been published on post-stroke dysphagia (PSD), bibliometric analysis in this field is still lacking. This study aimed to provide a comprehensive understanding of the research hotspots and trends in PSD, thereby guiding future research efforts. METHODS The Web of Science Core Collection (WoSCC) database was searched for articles related to PSD from 2003 to 2022. Data were visualised and analysed using CiteSpace and VOSviewer. RESULTS A total of 3102 publications were included in the scientometric analysis, with a gradual increase in the number of papers published each year. The United States emerged as the country with the highest number of publications (625 articles), while the University of Manchester led with the most publications among institutions (67 articles). Notably, Dysphagia was both the most published (254 articles) and the most cited journal (11,141 citations). Among authors, Hamdy S emerged as the most prolific (52 articles), with Martino R being the most cited (1042 citations). CONCLUSION Based on our findings, we anticipate that research hotspots in PSD will mainly focus on complications due to PSD such as stroke-associated pneumonia, stroke-related sarcopenia. Additionally, exploration into the mechanisms and parameters of noninvasive brain stimulation techniques for the treatment of PSD, as well as the rehabilitation needs of patients with PSD, are expected to be key focal points in future research endeavours.
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Affiliation(s)
- Qinzhi Hou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liqing Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jibing Ou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Zhu H, Liang W, Zhu J, He X, Zou P, Yang K, Li G, Liao B, Deng H, Liang Z, Zhao J, Zhao Z, Chen J, He Q, Ning W. Nomogram to predict ventilator-associated pneumonia in large vessel occlusion stroke after endovascular treatment: a retrospective study. Front Neurol 2024; 15:1351458. [PMID: 38803642 PMCID: PMC11129686 DOI: 10.3389/fneur.2024.1351458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Ventilator-Associated Pneumonia (VAP) severely impacts stroke patients' prognosis after endovascular treatment. Hence, this study created a nomogram to predict the occurrence of VAP after endovascular treatment. Methods The individuals with acute ischemic stroke and large vessel occlusion (AIS-LVO) who received mechanical ventilation and endovascular therapy between July 2020 and August 2023 were included in this retrospective study. The predictive model and nomogram were generated by performing feature selection optimization using the LASSO regression model and multifactor logistic regression analysis and assessed the evaluation, verification and clinical application. Results A total of 184 individuals (average age 61.85 ± 13.25 years, 73.37% male) were enrolled, and the rate of VAP occurrence was found to be 57.07%. Factors such as the Glasgow Coma Scale (GCS) score, duration of stay in the Intensive Care Unit (ICU), dysphagia, Fazekas scale 2 and admission diastolic blood pressure were found to be associated with the occurrence of VAP in the nomogram that demonstrating a strong discriminatory power with AUC of 0.862 (95% CI, 0.810-0.914), and a favorable clinical net benefit. Conclusion This nomogram, comprising GCS score, ICU duration, dysphagia, Fazekas scale 2 and admission diastolic blood pressure, can aid clinicians in predicting the identification of high-risk patients for VAP following endovascular treatment in large vessel occlusion stroke.
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Affiliation(s)
- Huishan Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Wenfei Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingling Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Xiaohua He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Pengjuan Zou
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Kangqiang Yang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Guoshun Li
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Bin Liao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Huiquan Deng
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zichong Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jiasheng Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zhan Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingyi Chen
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Qiuxing He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weimin Ning
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
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Pinho J, Meyer T, Mall B, Maring B, Döpp A, Becker J, Wehner A, Thissen S, Schumann-Werner B, Nikoubashman O, Wiesmann M, Schulz JB, Werner CJ, Reich A. Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients. Ann Clin Transl Neurol 2024; 11:757-767. [PMID: 38217067 DOI: 10.1002/acn3.51998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE The aims of the study were to (1) characterize the findings of flexible endoscopic evaluation of swallowing (FEES) in stroke patients undergoing mechanical thrombectomy (MT); (2) analyse the screening performance of the Standardized Swallowing Assessment (SSA); and (3) study the impact of FEES-defined dysphagia on 3-month outcomes. METHODS This single-centre study was based on a local registry of consecutive acute ischaemic stroke patients undergoing MT during a 1-year period. Patients received FEES within 5 days of admission regardless of the result of dysphagia screening. We compared baseline demographic and clinical characteristics of patients with and without FEES-defined dysphagia. We collected 3-month modified Rankin Scale (mRS) and individual index values of the European Quality of Life 5 Dimensions (EQ-5D-iv). Using univariable and multivariable regression analyses we predicted 3-month outcomes for presence of dysphagia and for FEES-defined dysphagia severity. RESULTS We included 137 patients with a median age of 74 years, 43.1% were female, median NIHSS was 12 and successful recanalization was achieved in 92.7%. Stroke-associated pneumonia occurred in 8% of patients. FEES-defined dysphagia occurred in 81% of patients. Sensitivity of the SSA as a dysphagia screening was 67%. Presence of dysphagia and increasing severity of dysphagia were independently associated with increasing 3-month mRS score. Increasing dysphagia severity dysphagia was independently associated with lower EQ-5D-iv. INTERPRETATION Early FEES-defined dysphagia occurs in four in every five patients undergoing MT. SSA has a suboptimal dysphagia screening performance. Presence of dysphagia and increasing dysphagia severity predict worse functional outcome and worse health-related quality-of-life.
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Affiliation(s)
- João Pinho
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Tareq Meyer
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Bettina Mall
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Bettina Maring
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Annalena Döpp
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Johanna Becker
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Anneke Wehner
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Sara Thissen
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Beate Schumann-Werner
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
- Department of Neurology and Geriatrics, Johanniter-Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Cornelius J Werner
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
- Department of Neurology and Geriatrics, Johanniter-Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
| | - Arno Reich
- Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
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Agarwal K, Kumar P, S N, Kumar P, Garg A, Nigam J, N S S. Feasibility of Achieving Dose Constraints for Dysphagia Aspiration-Related Structures and Its Clinical Significance in Intensity-Modulated Radiotherapy Planning of Head and Neck Cancer. Cureus 2024; 16:e53769. [PMID: 38465172 PMCID: PMC10922219 DOI: 10.7759/cureus.53769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Dysphagia is commonly seen in patients with head and neck cancers after undergoing chemoradiotherapy and is often under-reported and also not given clinical importance. The quality of life of the patients can be significantly improved if the required dose constraints to the dysphagia aspiration-related structures (DARS) are achieved. The present study was conducted in order to determine the feasibility of achieving the dose constraints to DARS between the standard intensity-modulated radiotherapy (st-IMRT) arm and the dysphagia-optimized IMRT (do-IMRT) arm. Material and methods Sixty patients with head and neck cancer were recruited and randomized into two groups: In one group called the st-IMRT, constraints were not given to DARS, and in the other group called the do-IMRT, constraints were given to DARS. Treatment was given in the form of chemoradiation with a dose of 70 Gy in 35 fractions by IMRT technique, over seven weeks, 2 Gy per fraction along with weekly concurrent Cisplatin (35 mg/m2) in both the groups. Step and shoot IMRT setup was used for planning, and the system used for planning was Eclipse 13.6 (Varian Medical System, Inc., Palo Alto, CA, US); progressive resolution optimizer algorithm was used for optimization, and Anisotropic Analytical Algorithm algorithm was used for dose calculation. Truebeam was used for treatment delivery. DARS dosimetric parameters assessed were Dmean, V30, V50, V60, V70, D50, and D80. Radiation-induced toxicities to the skin, mucosa, larynx, salivary gland, and dysphagia and hematological toxicities were assessed in between both the groups during and after radiotherapy up to six months based on Common Terminology Criteria for Adverse Effects v5.0. p-values were calculated using the unpaired T-test. Results In the cohort of 60 patients with head and neck cancers, 95% were males. Dosimetric parameters of the planning target volume (PTV) were compared but were not found to be significant. In the dosimetry of the organs at risk, a p-value of some structures was found to be significant although the doses received were well within the tolerable limits in both arms. DARS dosimetry V60 and V70 of the inferior constrictor muscle was found to be statistically significant (p=0.01 and 0.008, respectively). V60 and V70 of larynx were also statistically significant (p=0.009 and 0.000, respectively). V70 and D50 of cricopharyngeus were found to be statistically significant (p=0.01 and 0.03, respectively), V30 and V60 for combined pharyngeal constrictor muscles were found to be statistically significant (p=0.02 and 0.01), and lastly, V60 for combined DARS was also significant (p=0.004). Post-treatment 33.3% of patients in the st-IMRT arm required Ryle's tube placement. No grade 4 toxicities were seen in either arm regarding hematological toxicities, acute or chronic radiation-induced toxicities. In site-wise comparison of doses, the p-value was not found to be significant in patients with oropharyngeal and oral cavity carcinomas but was found to be statistically significant in the larynx and hypopharynx subsites. Conclusion The feasibility of achieving dose constraints to the DARS was seen in cases of laryngeal and hypopharyngeal cancers where the constrictor muscles were at a distance from the PTV. Further, the feasibility of achieving dose constraints may be seen in lower-dose prescriptions either in postoperative cases or in low-risk clinical target volume nodal volumes.
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Affiliation(s)
- Karishma Agarwal
- Radiation Oncology, SRMS (Shri Ram Murti Smarak) Institute of Medical Sciences, Bareilly, IND
| | - Piyush Kumar
- Radiation Oncology, SRMS (Shri Ram Murti Smarak) Institute of Medical Sciences, Bareilly, IND
| | - Navitha S
- Radiation Oncology, SRMS (Shri Ram Murti Smarak) Institute of Medical Sciences, Bareilly, IND
| | - Pavan Kumar
- Radiation Oncology, SRMS (Shri Ram Murti Smarak) Institute of Medical Sciences, Bareilly, IND
| | - Ayush Garg
- Radiation Oncology, SRMS (Shri Ram Murti Smarak) Institute of Medical Sciences, Bareilly, IND
| | - Jitendra Nigam
- Radiation Oncology, SRMS (Shri Ram Murti Smarak) Institute of Medical Sciences, Bareilly, IND
| | - Silambarasan N S
- Radiation Oncology, SRMS (Shri Ram Murti Smarak) Institute of Medical Sciences, Bareilly, IND
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Jamróz B, Sobol M, Chmielewska-Walczak J, Milewska M, Niemczyk K. The risk factors for silent aspiration: A retrospective case series and literature review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38301043 DOI: 10.1111/1460-6984.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
AIM Evidence shows that 20%-30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. MATERIALS AND METHODS We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 - neurological diseases (n = 93), G2 - head and neck surgery (n = 200), G3 - gastroenterological diseases (n = 94) and G4 - other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. RESULTS There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX-X). CONCLUSIONS Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery. WHAT THIS PAPER ADDS What is already known on the subject Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%-30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work? Post-treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination.
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Affiliation(s)
- Barbara Jamróz
- Clinical Department of Otolaryngology, National Medical Institute of the Interior and Administration, Warsaw, Poland
| | - Maria Sobol
- Department of Biophysics, Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Milewska
- Department of Clinical Dietetics, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Otorhinolaryngology, Head and Neck Surgery Department, Medical University of Warsaw, Warsaw, Poland
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Thiem U, Jäger M, Stege H, Wirth R. Diagnostic accuracy of the 'Dysphagia Screening Tool for Geriatric Patients' (DSTG) compared to Flexible Endoscopic Evaluation of Swallowing (FEES) for assessing dysphagia in hospitalized geriatric patients - a diagnostic study. BMC Geriatr 2023; 23:856. [PMID: 38097922 PMCID: PMC10722677 DOI: 10.1186/s12877-023-04516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Oropharyngeal dysphagia is highly prevalent among hospitalized geriatric patients. The screening instruments used to date have been evaluated primarily in stroke patients. This diagnostic study aimed to validate a new screening instrument for oropharyngeal dysphagia, the 'Dysphagia Screening Tool for Geriatric Patients' (DSTG), as compared to one of the gold standards, flexible endoscopic evaluation of swallowing (FEES). MATERIALS AND METHODS Geriatric inpatients admitted to five geriatric hospitals in Germany were consecutively evaluated using both DSTG and FEES in random order and by different evaluators blinded to the results of the other evaluation. In the FEES examination, a score of more than 3 on Rosenbek's Penetration Aspiration Scale was considered evidence of clinically relevant oropharyngeal dysphagia. Sensitivity, specificity and further measures of test performance were calculated for DSTG. RESULTS The 53 volunteers recruited were on average 85 years of age, 56.6% were women. Twenty patients (37.7%) were diagnosed with dysphagia using FEES. Of these, 12 were screened as positive on DSTG. Of the 33 FEES negative patients, 4 tested positive on DSTG. The following test parameters were calculated for DSTG: sensitivity: 0.60, 95% confidence interval [0.39 ; 0.78], specificity 0.88 [0.73 ; 0.95], positive predictive value 0.75 [0.51 ; 0.90], negative predictive value 0.78 [0.63 ; 0.89], positive likelihood ratio 4.95 [1.85 ; 13.27], negative likelihood ratio 0.46 [0.26 ; 0.79]. In a receiver-operator characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.77 [0.62 ; 0.91]. No adverse events occurred. CONCLUSION The DSTG appears to be a valid instrument for screening of oropharyngeal dysphagia in geriatric inpatients.
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Affiliation(s)
- Ulrich Thiem
- Albertinen-Haus Hamburg, Sellhopsweg 18-22, 22459, Hamburg, Germany.
- Geriatrics and Gerontology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Martin Jäger
- Hüttenhospital gemeinnützige GmbH, Am Marksbach 28, 44269, Dortmund, Germany
| | - Holger Stege
- Department of Geriatrics, ukrb University Clinic Ruppin-Brandenburg, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Rainer Wirth
- Department of Geriatrics, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
- Chair of Geriatrics, Ruhr-University Bochum, Bochum, Germany
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Tamai T, Yoshimi K, Nakagawa K, Yanagida R, Okumura T, Yamaguchi K, Ishii M, Nagasawa Y, Tohara H. Usefulness of a newly developed endoscope for the observation of the posterior tracheal wall. Laryngoscope Investig Otolaryngol 2023; 8:963-969. [PMID: 37621293 PMCID: PMC10446257 DOI: 10.1002/lio2.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Videoendoscopic evaluation of swallowing is an objective swallowing function evaluation method used in dysphagia rehabilitation. However, it is anatomically difficult to detect the entry of foreign substances through the posterior tracheal wall using a conventional endoscope (CE). In this study, we developed an endoscope that can observe the posterior tracheal wall and investigated its reliability and validity in healthy adults. Methods Twenty healthy adults were included. The trachea was observed from inside the larynx using a CE and a portable, flexible two-step angulation endoscope (two-AE) with a two-step curved shaft tip. The visibility of the anterior and posterior walls was recorded. The time from the endoscope tip entering the larynx to the posterior tracheal wall was measured. Additionally, discomfort events were assessed after the examination. McNemar's test and a paired t-test were used for statistical analysis. Kappa coefficients and concordance rates were calculated. Results The anterior tracheal wall was observed using both endoscopes. The posterior tracheal wall was significantly observed in 18 participants with the two-AE (p < .001), compared to only three of 20 participants with the CE. The time to observation of the posterior tracheal wall for examiners 1 and 2 was 13.3 ± 6.5 and 12.0 ± 6.7 s, respectively, with no difference between groups (p = .400). The kappa coefficients of examiners 1 and 2 and between the examiners were 0.444, 0.643, and 0.643, respectively, with concordance rates of 90%, 95%, and 95%, respectively. Conclusion Regardless of the examiner's years of experience, we observed that the two-AE could observe the posterior tracheal wall. Level of Evidence Step 5.
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Affiliation(s)
- Tomoe Tamai
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Takuma Okumura
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
- Department of Dentistry and Oral SurgeryHokuto HospitalObihiro‐shiJapan
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Miki Ishii
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Yuki Nagasawa
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
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Sharaf OM, Hao KA, Demos DS, Plowman EK, Ahmed MM, Jeng EI. Utility of Fiberoptic Endoscopic Evaluation of Swallowing After Left Ventricular Assist Device Implantation. Cureus 2023; 15:e42291. [PMID: 37609102 PMCID: PMC10441160 DOI: 10.7759/cureus.42291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
Objective Dysphagia following cardiac surgery is common and associated with adverse outcomes. Among patients receiving left ventricular assist devices (LVAD), we evaluated the impact of fiberoptic endoscopic evaluation of swallowing (FEES) on outcomes. Methods A single-center pilot study was conducted in adults (≥18 years of age) undergoing durable LVAD (February 2019 - January 2020). Six patients were prospectively enrolled, evaluated, and underwent FEES within 72 hours of extubation-they were compared to 12 control patients. Demographic, surgical, and postoperative outcomes were collected. Unpaired two-sided t-tests and Fisher's exact tests were performed. Results Baseline characteristics were similar between groups. Intraoperative criteria including duration of transesophageal echo (314 ± 86 min) and surgery (301 ± 74 min) did not differ. The mean time of intubation was comparable (57.3 vs. 68.7 hours, p=0.77). In the entire cohort, 30-day, one-year, two-year, and three-year mortality were 0%, 5.6%, 5.6%, and 16.7%, respectively. Sixty-seven percent of the patients that underwent FEES had inefficient swallowing function. The FEES group trended to a shorter hospital length of stay (LOS) (29.1 vs. 46.6 days, p=0.098), post-implantation LOS (25.3 vs 30.7 days, p=0.46), and lower incidence of postoperative pneumonia (16.7% vs. 50%, p=0.32) and sepsis (0% vs. 33.3%, p=0.25). Conclusion FEES did not impact 30-day, one-year, two-year, or three-year mortality. Though not statistically significant, patients who underwent FEES trended toward shorter LOS and lower postoperative pneumonia and sepsis rates. Additionally, we report a higher incidence of dysphagia among patients undergoing FEES despite comparable baseline risk factors with controls.
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Affiliation(s)
- Omar M Sharaf
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Kevin A Hao
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Daniel S Demos
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Emily K Plowman
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida Health, Gainesville, USA
| | - Eric I Jeng
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
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Rudisch DM, Krasko MN, Burdick R, Broadfoot CK, Rogus-Pulia N, Ciucci MR. Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:176-187. [PMID: 37608845 PMCID: PMC10441627 DOI: 10.1007/s40141-023-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Purpose of Review Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions. Recent Findings Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hall- mark signs and diagnosis. While dysphagia often presents already in the prodrome, it is not routinely addressed in standard neurology examinations. Summary Dysphagia in PD can result in compromised efficiency and safety of swallowing, which significantly contributes to malnutrition and dehydration, decrease quality of life, and increase mortality. The heterogeneous clinical presentation of PD complicates diagnostic procedures which often leads to delayed treatment. Research has advanced our knowledge of mechanisms underlying PD, but dysphagia is still largely understudied, especially in the prodromal stage.
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Affiliation(s)
- Denis Michael Rudisch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Maryann N Krasko
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Ryan Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Courtney K Broadfoot
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
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10
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Potente P, Buoite Stella A, Vidotto M, Passerini M, Furlanis G, Naccarato M, Manganotti P. Application of Ultrasonography in Neurogenic Dysphagia: A Systematic Review. Dysphagia 2023; 38:65-75. [PMID: 35556172 PMCID: PMC9873712 DOI: 10.1007/s00455-022-10459-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 04/22/2022] [Indexed: 01/28/2023]
Abstract
Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary to reduce the risk of penetration and aspiration, and to early start rehabilitation protocols. Among the methods that can be used to evaluate dysphagia and its components, ultrasound imaging has been suggested to support the evaluation of dysphagia by providing measures of both static and dynamic anatomical components. The aim of this systematic review is to evaluate the usefulness of ultrasonography in neurogenic dysphagia according to current literature. From 2000 to 2020, 633 studies with the appropriate search terms for ultrasound and dysphagia were identified. After screening them, 10 studies were included in the qualitative analysis. Patients with the following neurologic conditions were studied with ultrasonography for dysphagia: Parkinson's disease, muscle dystrophy, amyotrophic lateral sclerosis, and stroke. The main outcomes of ultrasonography were swallowing muscles thickness (e.g., tongue), and dynamic measures such as hyoid displacement. The different protocols used in the studies, as well as their outcomes, did not allow to provide standard procedures and normative or cut-off values in the presented diseases. Because there are a variety of tools, methods, and techniques that have been used in the studies that were reviewed, it is difficult to evaluate them using established standards. However, ultrasonography correlates well with clinical evaluation of dysphagia and therefore has prognostic and rehabilitation potential. Future studies should aim to develop and utilize a common interdisciplinary protocol that includes standard procedures and outcomes to define normative values applicable in the different conditions.
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Affiliation(s)
- Paola Potente
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Monica Vidotto
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Michelle Passerini
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
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11
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Weng W, Imaizumi M, Murono S, Zhu X. Expert-level aspiration and penetration detection during flexible endoscopic evaluation of swallowing with artificial intelligence-assisted diagnosis. Sci Rep 2022; 12:21689. [PMID: 36522385 PMCID: PMC9753025 DOI: 10.1038/s41598-022-25618-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Flexible endoscopic evaluation of swallowing (FEES) is considered the gold standard in diagnosing oropharyngeal dysphagia. Recent advances in deep learning have led to a resurgence of artificial intelligence-assisted computer-aided diagnosis (AI-assisted CAD) for a variety of applications. AI-assisted CAD would be a remarkable benefit in providing medical services to populations with inadequate access to dysphagia experts, especially in aging societies. This paper presents an AI-assisted CAD named FEES-CAD for aspiration and penetration detection on video recording during FEES. FEES-CAD segments the input FEES video and classifies penetration, aspiration, residue in the vallecula, and residue in the hypopharynx based on the segmented FEES video. We collected and annotated FEES videos from 199 patients to train the network and tested the performance of FEES-CAD using FEES videos from other 40 patients. These patients consecutively underwent FEES between December 2016 and August 2019 at Fukushima Medical University Hospital. FEES videos were deidentified, randomized, and rated by FEES-CAD and laryngologists with over 15 years of experience in performing FEES. FEES-CAD achieved an average Dice similarity coefficient of 98.6[Formula: see text]. FEES-CAD achieved expert-level accuracy performance on penetration (92.5[Formula: see text]), aspiration (92.5[Formula: see text]), residue in the vallecula (100[Formula: see text]), and residue in the hypopharynx (87.5[Formula: see text]) classification tasks. To the best of our knowledge, FEES-CAD is the first CNN-based system that achieves expert-level performance in detecting aspiration and penetration.
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Affiliation(s)
- Weihao Weng
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan.
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Xin Zhu
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan.
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12
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Handgrip strength predicts early postoperative dysphagia after thoracoscopic-laparoscopic esophagectomy in male patients with esophageal cancer. Esophagus 2022; 19:586-595. [PMID: 35661285 DOI: 10.1007/s10388-022-00925-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dysphagia after esophagectomy, especially in the early postoperative period, remains a severe complication. The association between sarcopenia and dysphagia has received attention in geriatric non-cancer populations. This study aimed to determine the associations between sarcopenia parameters and early postoperative dysphagia after esophagectomy. METHODS This retrospective observational study included 201 consecutive male patients undergoing thoracoscopic-laparoscopic esophagectomy (TLE) for esophageal cancer between October 2018 and December 2020. We used three sarcopenia parameters: handgrip strength (HGS), skeletal muscle index, and gait speed. Postoperative swallowing function was assessed by videofluoroscopy using the penetration-aspiration scale (PAS; range 1-8). Logistic regression analyses were used to predict factors associated with postoperative aspiration (PAS 6-8). Furthermore, we compared values in patients with symptomatic aspiration (PAS 6-7) and with silent aspiration (PAS 8). RESULTS Aspiration occurred in 38 of 201 patients (18.9%). On multivariate analysis, significant predictors of aspiration included age [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.05-1.17; p < 0.001], low HGS (OR 3.05; 95% CI 1.06-8.78; p = 0.039), upper third esophageal cancer (OR 2.79; 95% CI 1.03-7.54; p = 0.044) and recurrent laryngeal nerve palsy (OR 2.98; 95% CI 1.26-7.06; p = 0.013). Furthermore, among patients with aspiration (PAS 6-8), low HGS was significantly associated with silent aspiration (OR 6.43; 95% CI 1.06-39.00; p = 0.043). CONCLUSIONS Low HGS was significantly associated with early postoperative aspiration and impairment of airway protective reflexes after TLE.
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13
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Krishnamurthy R, Balasubramanium RK, Premkumar PK. Systematic Review and Meta-Analysis of Dysphagia and Associated Pneumonia in Patients With Stroke From India: A Call to Arms. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:502-514. [PMID: 34982940 DOI: 10.1044/2021_ajslp-21-00175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to determine the prevalence of reported dysphagia and associated pneumonia risk among patients with stroke in India. METHOD We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome of interest was dysphagia and pneumonia among patients with stroke in India. Two review authors independently assessed the quality of studies using the Newcastle-Ottawa Scale and extracted related data. Meta-analysis was performed for frequency of dysphagia, associated pneumonia, and its relative risk using a random-effects model. Statistical heterogeneity was computed using the I2 index. RESULTS A total of 3,644 titles were screened, and only eight studies met our inclusion criteria. Based on data from these studies, we calculated the pooled prevalence of dysphagia (47.71%; 95% confidence interval [CI] [20.49%, 70.92%], p < .001) and pneumonia (20.43%; 95% CI [10.73%, 30.14%], p < .001) for patients with stroke in India. We found that the relative risks of pneumonia in patients with stroke and dysphagia versus those patients with stroke and no dysphagia was 9.41 (95% CI [5.60, 15.80], p < .001). Data on length of hospital stay and rates of mortality secondary to pneumonia are also presented. CONCLUSIONS Despite the high incidence of dysphagia and associated pneumonia, the methodological quality of studies is fair and there is little research focused on epidemiological data. We call to arms to those SLPs working with patients with stroke in India to become proactive in both clinical practice and research domains. Supplemental Material https://doi.org/10.23641/asha.17701022.
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Affiliation(s)
- Rahul Krishnamurthy
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Manipal Academy of Higher Education, India
| | - Radish Kumar Balasubramanium
- Manipal Academy of Higher Education, India
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, India
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14
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Zhang Z, Mao S, Coyle J, Sejdić E. Automatic annotation of cervical vertebrae in videofluoroscopy images via deep learning. Med Image Anal 2021; 74:102218. [PMID: 34487983 DOI: 10.1016/j.media.2021.102218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 01/07/2023]
Abstract
Judging swallowing kinematic impairments via videofluoroscopy represents the gold standard for the detection and evaluation of swallowing disorders. However, the efficiency and accuracy of such a biomechanical kinematic analysis vary significantly among human judges affected mainly by their training and experience. Here, we showed that a novel machine learning algorithm can with high accuracy automatically detect key anatomical points needed for a routine swallowing assessment in real-time. We trained a novel two-stage convolutional neural network to localize and measure the vertebral bodies using 1518 swallowing videofluoroscopies from 265 patients. Our network model yielded high accuracy as the mean distance between predicted points and annotations was 4.20 ± 5.54 pixels. In comparison, human inter-rater error was 4.35 ± 3.12 pixels. Furthermore, 93% of predicted points were less than five pixels from annotated pixels when tested on an independent dataset from 70 subjects. Our model offers more choices for speech language pathologists in their routine clinical swallowing assessments as it provides an efficient and accurate method for anatomic landmark localization in real-time, a task previously accomplished using an off-line time-sinking procedure.
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Affiliation(s)
- Zhenwei Zhang
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - James Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ervin Sejdić
- The Edward S. Rogers Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada.
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15
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Björkman K, Pietarinen P, Mäkitie A, Markkanen-Leppänen M. Fibre-optic endoscopic evaluation of swallowing as a second-stage diagnostic tool in 117 patients with dysphagia. Clin Otolaryngol 2021; 46:1106-1109. [PMID: 33787059 DOI: 10.1111/coa.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/07/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kajsa Björkman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petra Pietarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mari Markkanen-Leppänen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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16
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Velasco LC, Imamura R, Rêgo APV, Alves PR, da Silva Peixoto LP, de Oliveira Siqueira J. Sensitivity and Specificity of Bedside Screening Tests for Detection of Aspiration in Patients Admitted to a Public Rehabilitation Hospital. Dysphagia 2020; 36:821-830. [PMID: 33052481 DOI: 10.1007/s00455-020-10198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
Early detection of dysphagia and specifically aspiration is essential to prevent and reduce complications of hospitalized patients in rehabilitation centers. Bedside screening test are often used to evaluate swallowing disorders, but their results may be questionable due to insufficient and inconsistent sensitivity and specificity. To compare the sensitivity and specificity of various bedside screening tests for detecting aspiration in hospitalized rehabilitation patients. A prospective observational study was performed in 150 consecutive patients of a tertiary rehabilitation hospital. Patients were evaluated regarding clinical predictors for aspiration, maximum phonation time (MPT), Eating Assessment Tool 10 (EAT-10) questionnaire, tongue strength and endurance (Iowa Oral Performance Instrument [IOPI]) and a swallowing test (Volume-Viscosity Swallow Test [V-VST]). Flexible Endoscopic Evaluation of Swallowing (FEES) was the reference test. Of the 144 patients included, 22% aspirated on FEES. Previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex were significantly associated with aspiration. The sensitivity, specificity and accuracy for V-VST (83.3%, 72.6%, 74.8%, respectively) and EAT-10 (82.8%, 57.7%, 62.8%, respectively) to detect aspiration were superior than those of other methods. Maximum tongue strength on IOPI and MPT presented high sensitivity but low specificity to detect aspiration. Clinical predictors of aspiration (previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex) associated with either V-VST or EAT-10 may be good screening methods to detect aspiration in patients hospitalized in a rehabilitation center.
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Affiliation(s)
- Leandro Castro Velasco
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua T-14, número 1529, apartamento 2301, bloco Monet, Goiânia, GO, CEP 74230-130, Brasil.
| | - Rui Imamura
- Department of Otorhinolaryngology, School of Medicine, University of São Paulo, Avenida Padre Pereira de Andrade, 545, apto 153-F, Boacava, São Paulo, 05469-000, Brazil
| | - Ana Paula Valeriano Rêgo
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Avenida T-4, número 550, Condomínio Ilhas Do Caribe, apartamento 1303, Bloco A, Setor Bueno, Goiânia, Goiás, 74230030, Brazil
| | - Priscilla Rabelo Alves
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua 230, número 978, Condomínio Quinta Vila Boa, apartamento 303, Bloco C, Setor Vila Jaraguá, Goiânia, Goiás, 74655130, Brazil
| | - Lorena Pacheco da Silva Peixoto
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua Vitória, número 265, Residencial Veneza, apartamento 601, Setor Alto da Glória, Goiânia, Goiás, 74815745, Brazil
| | - José de Oliveira Siqueira
- Department of Pathology, School of Medicine, University of São Paulo, Rua Catuaba, número 595, Vila Alpina, São Paulo, 03208000, Brazil
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17
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Choi Y, Kim M, Lee B, Yang X, Kim J, Kwon D, Lee SE, Kim H, Nam SI, Hong S, Yang G, Na DL, You H. Development of an Ultrasonic Doppler Sensor-Based Swallowing Monitoring and Assessment System. SENSORS 2020; 20:s20164529. [PMID: 32823533 PMCID: PMC7472343 DOI: 10.3390/s20164529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
Existing swallowing evaluation methods using X-ray or endoscopy are qualitative. The present study develops a swallowing monitoring and assessment system (SMAS) that is nonintrusive and quantitative. The SMAS comprises an ultrasonic Doppler sensor array, a microphone, and an inertial measurement unit to measure ultrasound signals originating only from swallowing activities. Ultrasound measurements were collected for combinations of two viscosity conditions (water and yogurt) and two volume conditions (3 mL and 9 mL) from 24 healthy participants (14 males and 10 females; age = 30.5 ± 7.6 years) with no history of swallowing disorders and were quantified for 1st peak amplitude, 2nd peak amplitude, peak-to-peak (PP) time interval, duration, energy, and proportion of two or more peaks. The peak amplitudes and energy significantly decreased by viscosity and the PP time interval and duration increased by volume. The correlation between the time measures were higher (r = 0.78) than that of the amplitude measures (r = 0.30), and the energy highly correlated with the 1st peak amplitude (r = 0.86). The proportion of two or more peaks varied from 76.8% to 87.9% by viscosity and volume. Further research is needed to examine the concurrent validity and generalizability of the ultrasonic Doppler sensor-based SMAS.
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Affiliation(s)
- Younggeun Choi
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Minjae Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Baekhee Lee
- Body Test Team 3, Hyundai Motor Company, Hwaseong 18280, Korea;
| | - Xiaopeng Yang
- School of Artificial Intelligence and Computer Science, Jiangnan University, Wuxi 214122, China;
| | - Jinwon Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Dohoon Kwon
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang 37659, Korea;
| | - HyangHee Kim
- Graduate Program in Speech-Language Pathology, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Seok In Nam
- Graduate School of Social Welfare, Yonsei University, Seoul 03722, Korea;
| | - Saewon Hong
- R&D Research Team, Digital Echo Co., Hwaseong 18385, Korea;
| | - Giltae Yang
- R&D Research Team, SEED Tech. Co., Bucheon 14523, Korea;
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Heecheon You
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
- Correspondence: ; Tel.: +82-54-279-2210
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18
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Zhang M, Li C, Zhang F, Han X, Yang Q, Lin T, Zhou H, Tang M, Zhou J, Shi H, Hui Y, Xiong M, Pang L, Wang B, Feng Z, Li Z, Cao C, Lu X, Ding Y, Shen S, Xu Z, Yu F, Chen C, Meng L, Liao G, Zhang J, Sasegbon A, Dou Z. Prevalence of Dysphagia in China: An Epidemiological Survey of 5943 Participants. Dysphagia 2020; 36:339-350. [PMID: 32458145 DOI: 10.1007/s00455-020-10138-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/16/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence of dysphagia among an older population and patients with stroke, head and neck cancers (HNCs) or neurodegenerative diseases (NDDs) in China, to identify the factors associated with this condition, and to explore the relationship between dysphagia and nutritional status. METHODS This study included participants 65 years and older living in the community or in nursing homes and patients who had sustained a stroke, HNC, or NDD also recruited in hospitals from 14 provinces of China. The presence of dysphagia was determined by use of a questionnaire, water swallowing test, and/or a videofluoroscopic swallowing study. Logistic regression analysis was used to assess the possible associated risk factors. Body mass index was assessed as an indicator of malnutrition. RESULTS A total of 5943 persons met the inclusion criteria and 2341 (39.4%) were identified with dysphagia, including the following: 51.14% of patients with stroke, 34.4% in HNCs, 48.3% in NDDs, and 19.2% of otherwise healthy older adults. The elderly with comorbidity (OR = 2.90, p < 0.01) and stroke patients (OR = 2.27, p < 0.01) were significantly more likely to exhibit signs of dysphagia. Dysphagic participants were at significantly greater risk of malnutrition (OR = 1.91, p < 0.01) compared to those without dysphagia. CONCLUSION Dysphagia is prevalent in China among older individuals and people who have suffered a stroke, HNCs, or NDDs. The prevalence of dysphagia increases steadily with increasing age and presence of comorbid disease. People with dysphagia are more likely to suffer from malnutrition.
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Affiliation(s)
- Mengqing Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Fang Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xiaoxiao Han
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Qinglu Yang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Huichang Zhou
- Department of Rehabilitation Medicine, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Min Tang
- Department of Neurological Rehabilitation Medicine, Ningbo Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Jungui Zhou
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangzhou, Guangdong, China
| | - Hongling Shi
- Department of Rehabilitation Medicine, Third People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yanping Hui
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shanxi, China
| | - Mingfeng Xiong
- Department of Rehabilitation Medicine, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ling Pang
- Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University, Jilin, Changchun, China
| | - Baolan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinjiang University and Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhanfei Li
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Changbing Cao
- Department of Rehabilitation Medicine, Fujian Longyan Longgang Hospital, Longyan, Fujian, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanyuan Ding
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shukun Shen
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyue Xu
- Department of Rehabilitation Medicine, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Fan Yu
- Department of Rehabilitation Medicine, Shanghai General Hospital, Shanghai, China
| | - Chen Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Ling Meng
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinxin Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, China.
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Urabe M, Hashimoto T, Kikuchi T, Michiwaki Y, Koike T. Estimation of Muscle Activity Change under Different Bolus Conditions using Musculoskeletal Model of Swallowing. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5314-5317. [PMID: 31947056 DOI: 10.1109/embc.2019.8857661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Swallowing, deglutition, is realized by highly coordinated activities of many nerves and muscles, but it is hard to observe directly due to intracorporal movement, and there is a limitation to the number of muscles that can be percutaneously measured. In addition, since there are few studies on the mechanical analysis of the swallowing movement, the detailed muscle activity pattern during swallowing has not yet been clarified. To tackle this problem from the viewpoint of biomechanics, we have been developing the musculoskeletal model of swallowing which can estimate the activities of swallowing-related muscles based on the movements of hyoid bone and thyroid cartilage. In this paper, we analyzed the activities of swallowing-related muscles under two different bolus conditions: bolus of water and nectar thickened liquid to investigate the effect of physical property of bolus in the activities of swallowing-related muscles.
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Yoshida M, Kagaya H, Kamakura Y, Miura Y, Saitoh E, Okawa Y, Sanada H. Safety and the effectiveness of a new education program for nurses to assess swallowing function using fiberoptic endoscopic evaluation of swallowing (FEES). Jpn J Nurs Sci 2019; 17:e12313. [PMID: 31883217 DOI: 10.1111/jjns.12313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 09/16/2019] [Accepted: 10/31/2019] [Indexed: 01/21/2023]
Abstract
AIM Nurses have the potential to perform fiberoptic endoscopic evaluation of swallowing (FEES) in Japan, which can aid in their provision of swallowing care appropriate to individual patients' swallowing functions. We aimed to confirm the safety and effectiveness of a new nursing education program on FEES by examining its impact on autonomy in performing FEES and accuracy in observing bolus swallowing. METHODS In this prospective descriptive study, we developed a FEES education program comprising three phases: (a) obtaining knowledge and skills through e-leaning and a practical workshop; (b) becoming proficient in skills for assessing healthy adults through self-learning; and (c) obtaining clinical competence through 30 cases of on-the-job training (OJT). The trends in autonomy and in accuracy of FEES were evaluated by the data during OJT. RESULTS Of the three certified nurses in dysphagia nursing, a trainee completed 30 cases of OJT and the other two trainees experienced 20 cases and 10 cases, respectively without any adverse event. Autonomy in the four major FEES skills gradually increased over the OJT. The correct answer rate, sensitivity, and specificity of the penetration-aspiration scale and severity of residue in the pyriform sinus and epiglottis valley were above 95% at the first 10 cases of OJT among three trainees and they were 100% after the 11th case of OJT. CONCLUSIONS Our results suggest that the developed education program helped nurses with experience being present at FEES obtain sufficient knowledge and skills to appropriately and safely perform FEES with 30 cases of OJT.
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Affiliation(s)
- Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yayoi Kamakura
- Faculty of Nursing, Japanese Red Cross Toyota College of Nursing, Aichi, Japan
| | - Yuka Miura
- Department of Imaging Nursing Science, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yohei Okawa
- Global Nursing Research Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Gerontological Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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21
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Abdelrahman AS, Abdeldayem EH, Bassiouny S, Elshoura HM. Role of ultrasound in evaluation of pharyngeal dysphagia in children with cerebral palsy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0014-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Coffey MM, Tolley N, Howard D, Hickson M. Double Blind Study Investigating the Effect of Different Voice Prostheses on Ease of Swallowing and Residue Post Laryngectomy. Dysphagia 2018; 33:616-626. [PMID: 29460049 PMCID: PMC6132872 DOI: 10.1007/s00455-018-9880-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 01/30/2018] [Indexed: 11/25/2022]
Abstract
Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.
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Affiliation(s)
- Margaret M Coffey
- Imperial College Healthcare Trust, SLT Department, Charing Cross Hospital, Ground Floor, South Wing, Fulham Palace Road, London, W6 8RF, UK.
| | - Neil Tolley
- Imperial College Healthcare Trust, ENT Department, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - David Howard
- Imperial College Healthcare Trust, ENT Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8QX, UK
| | - Mary Hickson
- Institute of Health and Community, Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK
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23
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Grabljevec K, Singh R, Denes Z, Angerova Y, Nunes R, Boldrini P, Delargy M, Laxe S, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for Adults with Acquired Brain Injury. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2018; 54:971-979. [PMID: 30160441 DOI: 10.23736/s1973-9087.18.05502-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) is damage to the brain that occurs after birth caused either by a traumatic or by a nontraumatic injury. The rehabilitation process following ABI should be performed by a multi-professional team, working in an interdisciplinary way, with the aim of organizing a comprehensive and holistic approach to persons with every severity of ABI. This Evidence Based Position Paper represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with ABI. The aim was to formulate recommendations on the PRM physician's professional practice for persons with ABI in order to promote their functioning and enhance quality of life. METHODS This paper has been developed according to the methodology defined by the Professional Practice Committee of the UEMS-PRM Section: a systematic literature search has been performed in PubMed and Core Clinical Journals. On the basis of the selected papers, recommendations have been made as a result of five Delphi rounds. RESULTS The literature review as well as thirty-one recommendations are presented. CONCLUSIONS The expert consensus is that structured, comprehensive and holistic rehabilitation program delivered by the multi-professional team, working in an interdisciplinary way, with the leadership and coordination of the PRM physician, is likely to be effective, especially for those with severe disability after brain injury.
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Affiliation(s)
- Klemen Grabljevec
- Department for Acquired Brain Injury Rehabilitation, University Rehabilitation Institute, Ljubljana, Slovenia -
| | - Rajiv Singh
- Unit of Osborn Neurorehabilitation, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK.,Faculty of Medicine, Dentistry and Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zoltan Denes
- National Institute for Medical Rehabilitation, Budapest, Hungary
| | - Yvona Angerova
- Department of Rehabilitation Medicine, Charles University, Prague, Czech Republic.,The First Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | - Renato Nunes
- Centro de Reabilitação do Norte, Francelos, Porto, Portugal
| | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy
| | - Mark Delargy
- National Rehabilitation Hospital, Dublin, Ireland
| | - Sara Laxe
- Unit of Neurorehabilitation, Guttmann Institute Foundation, University Institute of Neurorehabilitation affiliated to UAB, Badalona, Barcelona, Spain.,Autonomous University of Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain
| | - Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Enrique Varela Donoso
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University, Madrid, Spain.,UEMS PRM Committee for Professional Practice Chairman
| | - Nicolas Christodoulou
- Limassol Center of Physical and Rehabilitation Medicine, Cyprus.,UEMS PRM Section President
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Tsukagoshi K, Hashimoto T, Koike T. Simultaneous Measurement of Swallowing Sound and Mechanomyogram of Submental Muscle with PVDF Film. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3310-3313. [PMID: 30441097 DOI: 10.1109/embc.2018.8512959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The difficulty of swallowing, called dysphagia, causes aspiration pneumonia which is particularly a big health concern in aging society. Therefore, prevention and treatment of dysphagia would contribute to extending healthy-life and QOL of elderly people and decreasing healthcare cost. Conventional reliable methods for evaluating swallowing function require special equipment and are not suitable for long-term monitoring at home or welfare facilities. Therefore, various kinds of quantitative assessment method using biological signals such as swallowing sound, electromyography, and so forth have been proposed as a non-invasive and accessible method. The goal of this study is to realize comprehensive quantitative assessment of swallowing function using multiple biological signals simultaneously measured by a single sensor device. In this study, we propose the use of PolyVinylidene DiFluoride (PVDF) film to measure both mechanomyogram (MMG) signal for evaluating muscle activity and swallowing sound for detecting swallowing sequence. In our previous study, we confirmed PVDF film can detect MMG signal of swallowing-related muscles. We conducted experiments to confirm that PVDF film can detect swallowing sound in this study. The experimental results indicated that swallowing sound can be measured in parallel with MMG signal at the same position by changing frequency band of the signal of PVDF film.
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25
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Farneti D, Fattori B, Bastiani L. The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:201-206. [PMID: 28516963 PMCID: PMC5463509 DOI: 10.14639/0392-100x-1126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
Oral FEES (O-FEES) is an endoscopic procedure conceived to directly visualise the oral phase of swallowing. In the perspective of clinical use, the feasibility, safety and acceptability of O-FEES has been evaluated. Subsequently, the procedure was compared with the radiological gold standard. The acceptability of O-FEES was compared to that of FEES using a 10 point questionnaire submitted to a sample of 52 outpatients complaining of swallowing disorders. Repeated measure analysis of variance (rm-ANOVA) models were used to test the mean difference of acceptability in the same subjects after FEES and O-FEES. Subsequently, another sample of 8 male outpatients underwent a simultaneous O-FEES and videofluoroscopic study (VFSS). The inter-rater reliability using 10 radiological landmarks, compared to O-FEES, was blindly determined between two raters. Inter-rater agreement between the two judges for O-FEES and VFSS scores was assessed with the single score intra-class correlation coefficient (ICC). Differences between FEES and O-FEES answers for each question and among all the items considered overall were statistically significant (rm-ANOVA; F-statistic p < 0.001). The inter-rater agreement concerning endoscopic and radiological evaluations between the two raters showed strong values of intra-class correlation coefficient (ICC) (95% confidence interval): 0.875 (0.373-0.979) and 0.921 (0.542-0.986), respectively. The Bland-Altman test showed a bias of -0.24 (95% limits of agreement; -1.77 to +1.19), which suggests that both methods produced almost identical results. In clinical practice and compared with FEES, O-FEES is a well tolerated and safe procedure. Compared with the radiological gold standard, O-FEES offers reliable information about oral preparation and oral propulsion of the bolus.
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Affiliation(s)
- D Farneti
- Audiology and Phoniatry Service, Infermi Hospital, Rimini, Italy
| | - B Fattori
- ENT Audiology Phoniatry Unit, University of Pisa, Italy
| | - L Bastiani
- Institute of Clinical Physiology, National Council of Research (CNR), Pisa, Italy
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26
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Suntrup-Krueger S, Minnerup J, Muhle P, Claus I, Schröder JB, Marian T, Warnecke T, Kalic M, Berger K, Dziewas R. The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register. Cerebrovasc Dis 2018. [PMID: 29533960 DOI: 10.1159/000487811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early dysphagia screening and appropriate management are recommended by current guidelines to reduce complications and case fatality in acute stroke. However, data on the potential benefit of changes in dysphagia care on patient outcome are limited. Our objective was to assess the degree of implementation of dysphagia guidelines and determine the impact of modifications in dysphagia screening and treatment practices on disease complications and outcome in stroke patients over time. METHODS In this prospective register-based study ("Stroke Register of Northwestern Germany"), all adult stroke patients admitted to 157 participating hospitals between January, 2008 and December, 2015 were included (n = 674,423). Dysphagia incidence upon admission, the proportion of patients receiving a standardized swallowing screening, and the percentage of dysphagic patients being referred to a speech language therapist (SLT) for treatment were obtained per year. Pneumonia rate, modified Rankin Scale (mRS) at discharge, and in-hospital mortality were compared between groups of dysphagic vs. non-dysphagic patients over time. RESULTS Screening proportions continuously increased from 47.2% in 2008 to 86.6% in 2015. But the proportion diagnosed with dysphagia remained stable with about 19%. The number of dysphagic patients receiving SLT treatment grew from 81.6 up to 87.0%. Pneumonia incidence was higher in dysphagic stroke cases (adjusted OR 5.4 [5.2-5.5], p < 0.001), accompanied by a worse mRS at discharge (adjusted OR for mRS ≥3: 3.1 [3.0-3.1], p < 0.001) and higher mortality (adjusted OR 3.1 [3.0-3.2], p < 0.001). The order of magnitude of these end points did not change over time. CONCLUSION Although advances have been made in dysphagia care, prevalent screening and treatment practices remain insufficient to reduce pneumonia rate, improve functional outcome, and decrease case fatality in dysphagic stroke patients. More research is urgently needed to develop more effective swallowing therapies.
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Affiliation(s)
| | - Jens Minnerup
- Department of Neurology, University of Muenster, Muenster, Germany
| | - Paul Muhle
- Department of Neurology, University of Muenster, Muenster, Germany
| | - Inga Claus
- Department of Neurology, University of Muenster, Muenster, Germany
| | | | - Thomas Marian
- Department of Neurology, University of Muenster, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology, University of Muenster, Muenster, Germany
| | - Marianne Kalic
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology, University of Muenster, Muenster, Germany
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28
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Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur Arch Otorhinolaryngol 2017; 275:443-449. [PMID: 29124360 DOI: 10.1007/s00405-017-4801-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES). MATERIALS AND METHODS One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis; (2) pharyngeal residue; (3) penetration; (4) aspiration; (5) laryngeal sensitivity. RESULTS Twenty-one percent of subjects declared previous choking, 10% coughing, and 7% throat clearing, 39% had pharyngeal residue; 6% saliva stasis; 9% penetration; 2% aspiration; and 92% laryngeal sensitivity present. Thirty-three percent showed pharyngeal residue without saliva stasis, while only 6% showed positivity for both (p = 0.003). CONCLUSIONS Our data suggest that health care professionals should be aware that among an apparently healthy population, some subjects may have swallowing disorders without clinical complaints and that a nasolaryngoscopy exam may not be enough to predict dysphagia. We suggest that FEES should be performed to look for surrogate of dysphagia such as pharyngeal residue, laryngeal penetration, and aspiration.
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Caviedes I, Fernandez-Bussy S, Labarca G, Herth FJF. Clinical screening of oropharyngeal dysphagia: standard of care. Eur Respir J 2017; 50:50/2/1701030. [PMID: 28860270 DOI: 10.1183/13993003.01030-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Ivan Caviedes
- Servicio y Laboratorio Broncopulmonar, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sebastian Fernandez-Bussy
- Servicio de Neumología Intervencionista, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile.,Complejo Asistencial Dr Víctor Ríos Ruiz, Los Ángeles, Chile
| | - Felix J F Herth
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany
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30
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Predictive Value of the New Zealand Secretion Scale (NZSS) for Pneumonia. Dysphagia 2017; 33:115-122. [DOI: 10.1007/s00455-017-9841-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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Takuya H, Keita T, Takuji K. Quantitative assessment of swallowing activity by MMG measurement with PVDF film. IEEE Int Conf Rehabil Robot 2017; 2017:1477-1481. [PMID: 28814028 DOI: 10.1109/icorr.2017.8009456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Difficulty of swallowing, called dysphagia, leads to aspiration pneumonia which is particularly a big health concern in aging societies. Therefore, prevention and treatment of dysphagia would contribute to extending healthy-life and QOL of elderly people and decreasing healthcare cost. Robotics technologies are expected as one of the effective methods to solve the problem in terms of detecting malfunction in swallowing and recovering swallowing function. The aim of this study is to investigate muscle activity during normal swallowing using mechanomyography (MMG) with PolyVinylidene DiFluoride (PVDF) film which is a ferroelectrics polymer. Measurement of MMG signal during voluntary isometric contraction of the biceps brachii muscle was conducted to confirm whether PVDF film can detect MMG signal. In the experiment, surface electromyography (sEMG) was also measured as a reference to estimate muscle activity for comparison. Then, activities of swallowing muscles during normal swallowing with different volume of bolus were measured using MMG signal. As the result, it was confirmed that swallowing activity can be quantified by the detected MMG signal from different region of neck.
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Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial. Dysphagia 2017; 32:487-500. [PMID: 28444488 PMCID: PMC5515964 DOI: 10.1007/s00455-017-9790-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022]
Abstract
Evidence supporting prophylactic swallow exercises for patients with head and neck cancer (HNC) has not been universally demonstrated. This RCT examined diet level, feeding tube use, swallow function, and quality of life (QOL) of patients undergoing chemoradiotherapy who performed prophylactic swallowing exercises. Sixty HNC patients were randomized into exercise versus control groups. Swallowing, oromotor, toxicity, and QOL data were recorded (baseline, 3, 6, 12, 24 months). Physiological swallow function was examined at baseline and 3 months. Swallow exercises were completed twice daily. Oral intake at 3 months was 10% better in the exercise group, which was not statistically significant (p = 0.49). Significant (p < 0.05) differences in secondary outcomes including oromotor function, pharyngeal impairment, oral pharyngeal swallow efficiency, and incisal opening were noted at early time points (3–6 months) in the exercise group. Possible positive early improvements in swallow function are associated with swallowing exercises, although these improvements are not significant longer term.
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Kuo CW, Allen CT, Huang CC, Lee CJ. Murray secretion scale and fiberoptic endoscopic evaluation of swallowing in predicting aspiration in dysphagic patients. Eur Arch Otorhinolaryngol 2017; 274:2513-2519. [PMID: 28286927 DOI: 10.1007/s00405-017-4522-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
The objective of this retrospective review is to evaluate the ability of the Murray secretion scale to predict aspiration as determined by fiberoptic endoscopic evaluation of swallowing. Patients with dysphagia undergoing a fiberoptic endoscopic evaluation of swallowing study between January 2013 and November 2015 from a single, tertiary care institution were retrospectively reviewed. The Murray secretion scale and penetration aspiration scale on fiberoptic endoscopic evaluation of swallowing examination were determined. Spearman's correlation analysis, sensitivity, specificity, predictive values, and relative risk evaluating the relationship between the Murray secretion scale and aspiration on fiberoptic endoscopic evaluation of swallowing were calculated. Subgroups of head and neck cancer patients, penetration group, and aspiration group were also analyzed. The mean age of the cases (N = 212) was 62.4 years. Eighty percent were male. There was a strong correlation between Murray secretion scale grade and penetration aspiration scale score (r = 0.785, p < 0.001). The sensitivity and specificity of a Murray secretion scale grade 2 or higher in predicting aspiration were 74 and 90%, respectively. Individuals with a Murray secretion scale grade of 2 or higher were 13.6 times more likely to aspirate than patients with a lower Murray secretion scale grade. All subgroups showed similar trend. Determination of a Murray secretion scale grade, determined by flexible nasopharyngoscopy, may predict patients at high risk for aspiration. In clinical scenarios where more complete assessments of aspiration risk are immediately impossible or impractical, the Murray secretion scale grade may add valuable information to assist in clinical decision-making in patients with dysphagia.
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Affiliation(s)
- Chia-Wei Kuo
- Department of Otolaryngology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Road, Shih-Lin District, Taipei, Taiwan
| | - Clint Tanner Allen
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chu-Chun Huang
- Department of Otolaryngology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Road, Shih-Lin District, Taipei, Taiwan
| | - Chia-Jung Lee
- Department of Otolaryngology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Road, Shih-Lin District, Taipei, Taiwan. .,Medical School, Fu-Jen Catholic University, Taipei, Taiwan.
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Nienstedt JC, Müller F, Nießen A, Fleischer S, Koseki JC, Flügel T, Pflug C. Narrow Band Imaging Enhances the Detection Rate of Penetration and Aspiration in FEES. Dysphagia 2017; 32:443-448. [DOI: 10.1007/s00455-017-9784-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
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ICU-Related Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Park WY, Lee TH, Ham NS, Park JW, Lee YG, Cho SJ, Lee JS, Hong SJ, Jeon SR, Kim HG, Cho JY, Kim JO, Cho JH, Lee JS. Adding Endoscopist-Directed Flexible Endoscopic Evaluation of Swallowing to the Videofluoroscopic Swallowing Study Increased the Detection Rates of Penetration, Aspiration, and Pharyngeal Residue. Gut Liver 2016; 9:623-8. [PMID: 25473074 PMCID: PMC4562779 DOI: 10.5009/gnl14147] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia. We evaluated whether the addition of endoscopist-directed flexible endoscopic evaluation of swallowing (FEES) to VFSS could improve the detection rates of penetration, aspiration, and pharyngeal residue, compared the diagnostic efficacy between VFSS and endoscopist-directed FEES and assessed the adverse events of the FEES. METHODS In single tertiary referral center, a retrospective analysis of prospectively collected data was conducted. Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012. RESULTS The agreement in the detection of penetration and aspiration between VFSS and FEES of viscous food (κ=0.34; 95% confidence interval [CI], 0.15 to 0.53) and liquid food (κ=0.22; 95% CI, 0.02 to 0.42) was "fair." The agreement in the detection of pharyngeal residue between the two tests was "substantial" with viscous food (κ=0.63; 95% CI, 0.41 to 0.94) and "fair" with liquid food (κ=0.37; 95% CI, 0.10 to 0.63). Adding FEES to VFSS significantly increased the detection rates of penetration, aspiration, and pharyngeal residue. No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing. CONCLUSIONS This study demonstrated that the addition of endoscopist-directed FEES to VFSS increased the detection rates of penetration, aspiration, and pharyngeal residue.
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Affiliation(s)
- Won Young Park
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Nam Seok Ham
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ji Woong Park
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yang Gyun Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Jin Cho
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Joon Seong Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Joo Young Cho
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin Oh Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun Hyung Cho
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Biostatistical Consulting Unit, Soonchunhyang University College of Medicine, Seoul, Korea
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Swallowing Disorders in Severe Brain Injury in the Arousal Phase. Dysphagia 2016; 31:511-20. [PMID: 27090424 DOI: 10.1007/s00455-016-9707-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
The objective of this study was to determine the clinical characteristics of swallowing disorders in severe brain injury in the arousal phase after coma. Between December 1, 2013 and June 30, 2014, eleven patients with severe acquired brain injury who were admitted to rehabilitation center (Male 81.8 %; 40.7 ± 14.6 years) were included in the study. Evaluation of swallowing included a functional examination, clinical functional swallowing test, and naso-endoscopic swallowing test. All patients had swallowing disorders at admission. The first functional swallowing test showed oral (77.8 %) and pharyngeal (66.7 %) food bolus transport disorders; and alterations in airway protection mechanisms (80 %). Swallowing test under endoscopic control showed a disorder in swallowing coordination in 55.6 % of patients tested. Seven (63.6 %) patients resumed oral feeding within an average of 6 weeks after admission to rehabilitation center and 14 weeks after acquired brain injury. Six (85.7 %) of these seven patients continued to require modified solid and liquid textures. Swallowing disorders are a major concern in severe brain injury in the arousal phase. Early bedside assessment of swallowing is essential for detection of swallowing disorders to propose appropriate medical rehabilitation care to these patients in a state of altered consciousness.
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Sakamoto T, Horiuchi A, Makino T, Kajiyama M, Tanaka N, Hyodo M. Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets. World J Gastrointest Endosc 2016; 8:288-294. [PMID: 27014424 PMCID: PMC4804186 DOI: 10.4253/wjge.v8.i6.288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/21/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To identify the cut-off value for predicting the ability of elderly patients with dysphagia to swallow pureed diets using a new endoscopy scoring method.
METHODS: Endoscopic swallowing evaluation of pureed diets were done in patients ≥ 65 years with dysphagia. The Hyodo-Komagane score for endoscopic swallowing evaluation is expressed as the sum (0-12) of four degrees (0-3) with four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by “white-out” following swallowing of test jelly; and (4) pharyngeal clearance after swallowing of test jelly. We used receiver operating characteristic (ROC) curve analysis to retrospectively analyze the association between the total score and successful oral intake of pureed diets.
RESULTS: One hundred and seventy-eight patients were enrolled including 113 men (63%), mean age 83 years (range, 66-98). One hundred and twenty-six patients (71%) were able to eat pureed diets during the observation period (mean ± SD, 19 ± 14 d). In ROC analysis, the cut-off value of the score for eating the pureed diets was 7 (sensitivity = 0.98; specificity = 0.91).
CONCLUSION: The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.
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Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, Havard D, McFarlane M, McLauglin C, Randall M, Robson K, Scutt P, Smith C, Smithard D, Sprigg N, Warusevitane A, Watkins C, Woodhouse L, Bath PM. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke 2016; 11:399-411. [PMID: 27006423 DOI: 10.1177/1747493016639057] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022]
Abstract
Post-stroke dysphagia (a difficulty in swallowing after a stroke) is a common and expensive complication of acute stroke and is associated with increased mortality, morbidity, and institutionalization due in part to aspiration, pneumonia, and malnutrition. Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months. Although multiple advances have been made in the hyperacute treatment of stroke and secondary prevention, the management of dysphagia post-stroke remains a neglected area of research, and its optimal management, including diagnosis, investigation and treatment, have still to be defined.
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Affiliation(s)
| | - Christine Roffe
- Stroke Research, University Hospital of North Midlands, Keele University, UK
| | | | | | - Carol A Fairfield
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Shaheen Hamdy
- Institute of Inflammation and Repair, University of Manchester, UK
| | - Di Havard
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | | | | | | | - Katie Robson
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Craig Smith
- Stroke and Vascular Research Centre, University of Manchester, UK
| | - David Smithard
- Elderly Medicine, Princess Royal University Hospital, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | | | - Caroline Watkins
- College of Health and Wellbeing, University of Central Lancashire, UK
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
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Pisegna JM, Langmore SE. Parameters of Instrumental Swallowing Evaluations: Describing a Diagnostic Dilemma. Dysphagia 2016; 31:462-72. [DOI: 10.1007/s00455-016-9700-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/23/2016] [Indexed: 12/26/2022]
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41
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Marks SL, Douthitt KL, Belafsky PC. Feasibility of flexible endoscopic evaluation of swallowing in healthy dogs. Am J Vet Res 2016; 77:294-9. [PMID: 26919601 DOI: 10.2460/ajvr.77.3.294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess feasibility of flexible endoscopic evaluation of swallowing (FEES) in awake dogs, determine whether specific variables associated with the oropharyngeal phase of swallowing can be recognized, and evaluate the safety and tolerability of FEES. ANIMALS 6 healthy client-owned large- and giant-breed adult dogs. PROCEDURES A topical anesthetic was applied to the nasal passage of each dog, and a fiberoptic endoscope was passed transnasally until the tip of the scope was positioned in the oropharynx. All dogs voluntarily drank colored water followed by consumption of a commercial canned diet and then a kibble diet mixed with food color. During each swallow, laryngeal and pharyngeal anatomic structures were evaluated and depth of bolus flow prior to the pharyngeal phase of swallowing was assessed. Evidence of bolus retention in the vallecula or pyriform sinuses and laryngeal penetration of the bolus were recorded. RESULTS FEES was completed without major adverse events and was tolerated well by all 6 dogs. Mild, self-limiting epistaxis was noted for 2 dogs. The nasopharynx, oropharynx, and hypopharynx were observed in all dogs; movement of food boluses through the esophagus was observed in 2 dogs, and food boluses in the stomach were visible in 1 dog. Pharyngeal and laryngeal function was considered physiologically normal in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE FEES appeared to be a feasible diagnostic tool for use in large- and giant-breed dogs. Studies are warranted in dogs with oropharyngeal dysphagia to determine whether FEES can be tolerated and whether it can augment videofluoroscopy findings.
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Dziewas R, Glahn J, Helfer C, Ickenstein G, Keller J, Ledl C, Lindner-Pfleghar B, G Nabavi D, Prosiegel M, Riecker A, Lapa S, Stanschus S, Warnecke T, Busse O. Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC MEDICAL EDUCATION 2016; 16:70. [PMID: 26911194 PMCID: PMC4766659 DOI: 10.1186/s12909-016-0587-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has not yet been established. RESULTS The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational programme is applicable to other clinicians and speech-language therapists with expertise in dysphagia as well. CONCLUSION The systematic education in carrying out FEES across a variety of different professions proposed by this curriculum will help to spread this instrumental approach and to improve dysphagia management.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Jörg Glahn
- Department of Neurology, Johannes Wesling Klinikum Minden, Minden, Germany.
| | - Christine Helfer
- ENT and Neurology Departments, Vivantes Klinikum Neukölln, Berlin, Germany.
| | - Guntram Ickenstein
- Department of Neurology and Stroke Unit, HELIOS Klinikum Aue, Aue, Germany.
| | - Jochen Keller
- St. Martinus Hospital, Clinic for Acute Geriatrics, Düsseldorf, Germany.
| | | | | | - Darius G Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany.
| | | | - Axel Riecker
- Department of Neurology, University of Ulm, Ulm, Germany.
- Reha Nova, Clinic for neurological and neurosurgical rehabilitation, Cologne, Germany.
| | - Sriramya Lapa
- Department of Neurology, ZNN, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
| | | | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Otto Busse
- DSG and DGN Office, Reinhardtstraße 27 C, 10117, Berlin, Germany.
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Neubauer PD, Hersey DP, Leder SB. Pharyngeal Residue Severity Rating Scales Based on Fiberoptic Endoscopic Evaluation of Swallowing: A Systematic Review. Dysphagia 2016; 31:352-9. [PMID: 26753927 DOI: 10.1007/s00455-015-9682-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022]
Abstract
Identification of pharyngeal residue severity located in the valleculae and pyriform sinuses has always been a primary goal during fiberoptic endoscopic evaluation of swallowing (FEES). Pharyngeal residue is a clinical sign of potential prandial aspiration making an accurate description of its severity an important but difficult challenge. A reliable, validated, and generalizable pharyngeal residue severity rating scale for FEES would be beneficial. A systematic review of the published English language literature since 1995 was conducted to determine the quality of existing pharyngeal residue severity rating scales based on FEES. Databases were searched using controlled vocabulary words and synonymous free text words for topics of interest (deglutition disorders, pharyngeal residue, endoscopy, videofluoroscopy, fiberoptic technology, aspiration, etc.) and outcomes of interest (scores, scales, grades, tests, FEES, etc.). Search strategies were adjusted for syntax appropriate for each database/platform. Data sources included MEDLINE (OvidSP 1946-April Week 3 2015), Embase (OvidSP 1974-2015 April 20), Scopus (Elsevier), and the unindexed material in PubMed (NLM/NIH) were searched for relevant articles. Supplementary efforts to identify studies included checking reference lists of articles retrieved. Scales were compared using qualitative properties (sample size, severity definitions, number of raters, and raters' experience and training) and psychometric analyses (randomization, intra- and inter-rater reliability, and construct validity). Seven articles describing pharyngeal residue severity rating scales met inclusion criteria. Six of seven scales had insufficient data to support their use as evidenced by methodological weaknesses with both qualitative properties and psychometric analyses. There is a need for qualitative and psychometrically reliable, validated, and generalizable pharyngeal residue severity rating scales that are anatomically specific, image-based, and easily learned by both novice and experienced clinicians. Only the Yale Pharyngeal Residue Severity Rating Scale, an anatomically defined and image-based tool, met all qualitative and psychometric criteria necessary for a valid, reliable, and generalizable vallecula and pyriform sinus severity rating scale based on FEES.
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Affiliation(s)
- Paul D Neubauer
- Department of Surgery, Section of Otolaryngology, Yale School of Medicine, P.O. Box 208041, New Haven, CT, USA
| | - Denise P Hersey
- Cushing/Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Steven B Leder
- Department of Surgery, Section of Otolaryngology, Yale School of Medicine, P.O. Box 208041, New Haven, CT, USA.
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Arens C, Herrmann IF, Rohrbach S, Schwemmle C, Nawka T. Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc02. [PMID: 26770277 PMCID: PMC4702052 DOI: 10.3205/cto000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Swallowing disorders are frequent. The main concern is mortality due to aspiration-induced pneumonia and malnutrition. In addition, quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract, and sequelae of tumor treatment in the head and neck region are the main pathologic entities. Predominantly ENT physicians and phoniatricians are asked for diagnostics and therapy, and will coordinate the interdisciplinary treatment according to the endoscopic findings. A differentiated approach in history, diagnostics, and symptom-oriented treatment is necessary for these mostly complex disorders. Integration of non-medical staff such as speech therapists, physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over in close cooperation. In particular, an interdisciplinary cooperation with the staff of intensive care medicine is essential. The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists. Endoscopy is a medical service that is basically not delegable. Consequently, substitution of the physician is excluded.
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Affiliation(s)
- Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Magdeburg, Otto-von-Guericke-University Magdeburg, Germany
| | | | - Saskia Rohrbach
- Department of Audiology and Phoniatrics, Charité - University Medicine of Berlin, Germany
| | - Cornelia Schwemmle
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Magdeburg, Otto-von-Guericke-University Magdeburg, Germany
| | - Tadeus Nawka
- Department of Audiology and Phoniatrics, Charité - University Medicine of Berlin, Germany
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Pluschinski P, Zaretsky Y, Almahameed A, Koseki JC, Leinung M, Girth L, Wagenblast J, Sader R, Stöver T, Hey C. [Secretion scale by Murray et al. for FEES®: comparison of reliability and validity of the German long and short version]. DER NERVENARZT 2015; 85:1582-7. [PMID: 25476187 DOI: 10.1007/s00115-014-4192-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accumulation of secretions in the hypopharynx, aditus laryngis and trachea constitute a cardinal trait of oropharyngeal dysphagia. For the evaluation of the degree of severity a 4-point secretion scale by Murray et al. is used internationally in a long and a short version. However, a validated German translation of the long version of this scale does not yet exist. Also, it has not yet been scientifically proven that both versions of the scale are equally valid. OBJECTIVES This study aimed at the validation of the German translation of the long version of the secretion scale by Murray et al. and at a comparison of reliability and validity of the short and long versions. MATERIAL AND METHODS A total of 40 videos of fiberoptic endoscopic evaluation of swallowing (FEES(®)), 10 for each severity level, were rated by 4 otorhinolaryngologists (ENT specialists) independently and with different randomizations for examination of the reliability and validity. Two rating sessions for each of the scale versions were conducted. Intrarater and interrater reliability as well as the agreement of the ratings with a reference standard were analyzed. RESULTS Both the intrarater reliability (Spearman correlations: ρs > 0.840***) and the interrater reliability (Krippendorff's alpha: α > 0.850) yielded very good results and the concurrent validity was highly significant (ρs > 0.981***). DISCUSSION The German translation of the secretion scale by Murray et al. can be considered reliable and valid, with comparable test accuracy of the short and long versions. Hence, the scale can be recommend for the graduation of pharyngolaryngotracheal secretions and should be integrated into the standardized evaluation of FEES(®) diagnostics for clinical and scientific purposes.
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Affiliation(s)
- P Pluschinski
- Schwerpunkt für Phoniatrie und Pädaudiologie, Klinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, Haus 7A, 60590, Frankfurt am Main, Deutschland,
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Videoendoscopic Evaluation of Swallowing After Thyroidectomy: 7 and 60 Days. Dysphagia 2015; 30:496-505. [PMID: 26087901 DOI: 10.1007/s00455-015-9628-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
Deglutition complaints are frequent after thyroidectomy. The purpose of this study was to follow-up on patients with thyroidectomy indication to compare the videoendoscopic evaluation of swallowing on the seventh day (early postoperative, EPO) and on the 60th day after thyroidectomy, (late postoperative, LPO) and to compare patients that evolved with normal laryngeal mobility (NLM) and abnormal laryngeal mobility (ALM). Nasofibroscopic evaluation was performed preoperatively (PRE), on the EPO and LPO. Two groups were compared: ALM and NLM. The majority of people were women, age bracket 46-65, who underwent total thyroidectomy and with high frequency of carcinoma. 30 out of the 54 patients in the study had change in swallowing (55 %). Dysphagia occurred in 87 % (13/15) of patients with ALM in the EPO and remained in 67 % of them in the LPO. In the NLM group, dysphagia occurred in 44 % (17/39) in EPO and 25 % in LPO. There was a statistical difference between PRE and EPO, and PRE and LPO (P < 0,001). In the ALM group, liquid penetration and aspiration were identified in 33 % of the cases during EPO (P = 0,014); retention of food occurred in 87 % in EPO and in 60 % in LPO (P < 0,001). Dysphagia occurs in patients after thyroid surgery (regardless of larynx mobility alteration) and characterized by stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.
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47
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The Yale Pharyngeal Residue Severity Rating Scale: An Anatomically Defined and Image-Based Tool. Dysphagia 2015; 30:521-8. [DOI: 10.1007/s00455-015-9631-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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48
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Hey C, Pluschinski P, Pajunk R, Almahameed A, Girth L, Sader R, Stöver T, Zaretsky Y. Penetration-Aspiration: Is Their Detection in FEES ® Reliable Without Video Recording? Dysphagia 2015; 30:418-22. [PMID: 25943296 DOI: 10.1007/s00455-015-9616-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
Penetration-aspiration is known as the main finding in deglutition-disordered patients with implications for diagnostics and therapeutic management. Reliable detection of penetration-aspiration is given with fiberoptic endoscopic evaluation of swallowing (FEES(®)) as one of the gold standards in instrumental swallowing evaluation. The advice to implement video recording in FEES(®) to assure quality in identifying penetration-aspiration is often ignored, especially in bed-side settings. Thus, the aim of this study was to compare reliability and validity in detecting penetration-aspiration events with and without video recording. Eighty FEES(®) sequences, ten per severity grade of the Penetration-Aspiration Scale by Rosenbek et al., were rated by four blinded ENTs with two different methods. The first method simulated the evaluation without video recording (Method A), and the second one with video recording (Method B). Rating was performed twice per setting with 2 weeks in between and every time newly randomized. Intra- and inter-rater reliability as well as validity were analyzed for both evaluation methods. R-to-Z transformation was used to reveal the more reliable method and ordinal regression to determine potential rating influences. Method B demonstrated higher intra- and inter-rater reliability values than Method A and was revealed as more reliable in identifying penetration-aspiration according to r-to-Z transformation (Z = -2.92, p = .004). Ordinal regression detected a significant influence of the evaluation method choice on the rating results (p = .016). As Method B turned out to be more reliable than Method A in detecting penetration-aspiration, the presented study recommends the implementation of video recording in swallowing diagnostics.
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Affiliation(s)
- Christiane Hey
- Department of Phoniatrics and Pediatric Audiology, University of Frankfurt/Main, Theodor-Stern-Kai 7, House 7A, 60590, Frankfurt am Main, Germany,
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Arens C, Herrmann IF, Rohrbach S, Schwemmle C, Nawka T. [Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children and adults]. Laryngorhinootologie 2015; 94 Suppl 1:S306-S354. [PMID: 25860495 DOI: 10.1055/s-0035-1545298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and AdultsSwallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.
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Affiliation(s)
- C Arens
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Magdeburg AöR, Otto-von-Guericke-Universität, Magdeburg
| | | | - S Rohrbach
- Klinik für Audiologie und Phoniatrie, Charité - Universitätsmedizin Berlin, Berlin
| | - C Schwemmle
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Magdeburg AöR, Otto-von-Guericke-Universität, Magdeburg
| | - T Nawka
- Klinik für Audiologie und Phoniatrie, Charité - Universitätsmedizin Berlin, Berlin
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Dysphagia--a common, transient symptom in critical illness polyneuropathy: a fiberoptic endoscopic evaluation of swallowing study*. Crit Care Med 2015; 43:365-72. [PMID: 25377021 DOI: 10.1097/ccm.0000000000000705] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Critical illness polyneuropathy is a common disorder in the neurological ICU. Dysphagia is well known to deteriorate outcome in the ICU. The prevalence of dysphagia in critical illness polyneuropathy is not known. The aim of this study was to evaluate the prevalence of dysphagia in critical illness polyneuropathy using fiberoptic endoscopic evaluation of swallowing. DESIGN Prospective, cohort study. SETTING Neurological rehabilitation ICU. PATIENTS Twenty-two patients with critical illness polyneuropathy. INTERVENTIONS Clinical swallowing examination and serial fiberoptic endoscopic evaluation of swallowing (days 3, 14, and 28 after admission). MEASUREMENTS AND MAIN RESULTS Swallowing of saliva, pureed consistencies, and liquids was tested using fiberoptic endoscopic evaluation of swallowing at three different time points. The penetration-aspiration scale by Rosenbek et al and the secretion severity rating scale by Murray et al were used for grading. Functional outcome after rehabilitation was assessed using the functional independence measure.: Pathologic swallowing was found in 20 of 22 patients (91%). Hypesthesia of laryngeal structures was found in 17 of 22 patients (77%) during the first fiberoptic endoscopic evaluation of swallowing. Over the 4-week follow-up period, laryngeal hypesthesia resolved in 75% of affected cases. Pureed consistencies were swallowed safely in 18 of 22 cases (82%), whereas liquids and saliva showed high aspiration rates (13 of 17 [78%] and 10 of 22 [45%], respectively). Swallowing function recovered completely in 21 of 22 (95%) within 4 weeks. CONCLUSIONS Dysphagia is frequent among patients with critical illness polyneuropathy treated in the ICU. Old age, chronic obstructive pulmonary disease, the mode of mechanical ventilation, the prevalence of tracheal tubes, and behavioral "learned nonuse" may all be contributing factors for the development of dysphagia in critical illness polyneuropathy. Complete recovery occurs in a high percentage of affected individuals within 4 weeks.
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