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Muniz CR, Borges TGV, Ferreira FR, Brendim MP, Muxfeldt ES. Relationship between Quality of Life and Swallowing in Hypertensive Individuals with Obstructive Sleep Apnea. Dysphagia 2024:10.1007/s00455-024-10783-2. [PMID: 39550520 DOI: 10.1007/s00455-024-10783-2] [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: 05/16/2024] [Accepted: 11/04/2024] [Indexed: 11/18/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is closely associated with resistant hypertension (RHTN). Individuals with OSA may have sensory and muscular alterations in pharyngolaryngeal structures, potentially resulting in oropharyngeal dysphagia. OBJECTIVE One objective of this study was to assess and compare the quality of life (QoL) and swallowing ability of resistant hypertensive patients with and without OSA. Another objective was to evaluate the relationship between QoL and changes in swallowing in patients with RHTN and OSA. METHODS This work was an analytical observational study with a cross-sectional design that included resistant hypertensive patients who were undergoing polysomnography (the gold standard exam for the diagnosis of OSA), fiberoptic endoscopic evaluation of swallowing (FEES), dysphagia risk assessment (Eating Assessment Tool - EAT-10) and QoL assessment in swallowing (Swal-Qol). RESULTS Of the 65 participants, 13 (20%) did not have OSA, 13 (20%) had mild OSA, 18 (27.7%) had moderate OSA, and 21 (32.2%) had severe OSA. Compared with those without OSA, patients with OSA had lower swallowing QoL scores ("burden", "symptoms", and "mental health"). Furthermore, pre premature leakage, onset of the pharyngeal phase in the pyriform sinus, laryngeal penetration, pharyngeal residue and oropharyngeal dysphagia were more prevalent among patients with OSA. CONCLUSION Resistant hypertensive patients with OSA have a greater prevalence of changes in swallowing and worse Swal-QoL scores than those without OSA, although such changes were not shown in the EAT-10. In addition, Swal-Qol is related to swallowing safety impairments among these individuals.
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Affiliation(s)
- Carla Rocha Muniz
- Faculty of Medicine, Department of Internal Medicine, Post graduate Program in Internal Medicine, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9º andar, sala 9E11, Ilha do Fundão CEP, Rio de Janeiro, RJ, 21941-590, Brazil.
| | - Thalyta Georgia Vieira Borges
- Faculty of Medicine, Department of Internal Medicine, Post graduate Program in Internal Medicine, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9º andar, sala 9E11, Ilha do Fundão CEP, Rio de Janeiro, RJ, 21941-590, Brazil
| | - Flavia Rodrigues Ferreira
- Faculty of Medicine, Department of Internal Medicine, Post graduate Program in Internal Medicine, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9º andar, sala 9E11, Ilha do Fundão CEP, Rio de Janeiro, RJ, 21941-590, Brazil
| | - Mariana Pinheiro Brendim
- Faculty of Medicine, Department of Internal Medicine, Post graduate Program in Internal Medicine, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9º andar, sala 9E11, Ilha do Fundão CEP, Rio de Janeiro, RJ, 21941-590, Brazil
| | - Elizabeth Silaid Muxfeldt
- Faculty of Medicine, Department of Internal Medicine, Post graduate Program in Internal Medicine, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9º andar, sala 9E11, Ilha do Fundão CEP, Rio de Janeiro, RJ, 21941-590, Brazil
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Yamano T, Kimura S, Wada K, Omori F, Nakamura A, Fukuyo K. Effectiveness of Outpatient Treatment in Ear, Nose, and Throat Clinics for Dysphagia and the Role of Questionnaires. Cureus 2024; 16:e66369. [PMID: 39246881 PMCID: PMC11378699 DOI: 10.7759/cureus.66369] [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: 08/07/2024] [Indexed: 09/10/2024] Open
Abstract
Background While most research on dysphagia treatment has focused on inpatients, less attention has been given to outpatient settings, particularly in ear, nose, and throat (ENT) clinics. Additionally, while questionnaires are commonly used as screening tools in dysphagia management, their correlation with outcomes such as pneumonia incidence or sustained oral intake is rarely discussed. This study aimed to evaluate the effectiveness of outpatient treatment in ENT clinics for dysphagia, including improvement in subjective symptoms, and to assess the role of the questionnaire. Methodology In total, 59 patients (38 males and 21 females) aged 53-93 years (mean age = 79 years) attended the outpatient swallowing clinic. All participants retained sufficient ability in activities of daily living to independently visit the hospital and could orally ingest food, and none required tube feeding. Subjective symptoms were evaluated using the questionnaire. Swallowing assessments were conducted by an otolaryngologist and via swallowing endoscopy. A speech-language pathologist led the swallowing rehabilitation, which included encouraging family involvement and home practice. Results The most frequent issue reported was munching during meals. Of the 59 patients, 22 underwent continuous outpatient rehabilitation. Of these, 17 (77%) showed improvement; 11 had improvement in both subjective symptoms and fiberoptic endoscopic evaluation of swallowing (FEES) scores, five in subjective symptoms only, and one in FEES scores only. Five patients showed no change/worsening conditions. Conclusions The questionnaire proved useful as a screening tool but fell short in terms of prognosis estimation. The findings suggest that information from the questionnaire should be used to gauge treatment effectiveness, noting that some cases showed improvement in subjective symptoms alone.
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Affiliation(s)
- Takafumi Yamano
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, JPN
| | - Shoichi Kimura
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, JPN
| | - Kaori Wada
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, JPN
| | - Fumitaka Omori
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, JPN
| | - Ayumi Nakamura
- Department of Physical Medicine and Rehabilitation, Fukuyo ENT Clinic, Itoshima, JPN
| | - Kazumasa Fukuyo
- Department of Otolaryngology, Fukuyo ENT Clinic, Itoshima, JPN
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Yamano T, Nishi K, Omori F, Nakamura A, Fukuyo K. Outpatient Treatment of Mild Dysphagia in Ear-Nose-and-Throat Clinics. Cureus 2024; 16:e52395. [PMID: 38361677 PMCID: PMC10867718 DOI: 10.7759/cureus.52395] [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: 01/14/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE Many reports on inpatient dysphagia rehabilitation in acute and convalescent rehabilitation hospitals exist, but there are a few reports on outpatient treatments. Otolaryngologists still take a trial-and-error approach when treating dysphagia. Here, we explore the effectiveness and limitations of outpatient treatment in ear-nose-and-throat (ENT) clinics. METHODS Sixty-four patients (41 males and 23 females) aged 27-101 years (mean 78 years) visited an outpatient clinic specialising in feeding and swallowing conditions (the Fukuyo ENT Clinic). All were able to perform the activities of daily living (ADL) to the extent that outpatient visits were possible; no home visits were made. The weekly outpatient day was staffed by an otolaryngologist and a speech-language-hearing therapist (SLHT). All patients were subjected to fibreoptic endoscopic evaluation of swallowing (FEES), followed by appropriate training as revealed by the examinations. RESULTS Salivary retention in the glottis valley and piriform sinuses improved (both p < 0.05) in 30 patients who underwent repeat FEES; we compared the initial and final figures. In 14 cases in whom maximal tongue pressure (TP) was measured, this was higher at the final than at the first examination (p < 0.01). CONCLUSION Outpatient treatment at ENT clinics for patients who are able to maintain their ADLs to the extent that they are able to walk to a hospital is an option for the treatment of age-related dysphagia. For severe cases, however, house calls and collaboration with the home and nursing care sector will be necessary and should be considered in the future.
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Affiliation(s)
- Takafumi Yamano
- Department of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, JPN
| | - Kensuke Nishi
- Department of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, JPN
| | - Fumitaka Omori
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, JPN
| | - Ayumi Nakamura
- Department of Physical Medicine and Rehabilitation, Fukuyo ENT Clinic, Itoshima, JPN
| | - Kazumasa Fukuyo
- Department of Otorhinolaryngology, Fukuyo ENT Clinic, Itoshima, JPN
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