Oropharyngeal dysphagia

Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire

INTRODUCTION/AIMS

Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharyngeal dysphagia in various NMD groups and diseases. Finally, we compared results of this screening with those from their corresponding medical records for eventual "clinical history" of dysphagia.

METHODS

We asked patients to fill in the SSQ during follow-up outpatient visits at our neuromuscular reference center. A total score above the cutoff score of 118.5 out of 1700 was indicative of oropharyngeal dysphagia.

RESULTS

Of the 304 adult patients assessed for eligibility, 201 NMD patients (96 women and 105 men, aged 49.0 ± 16.2 years) were included and tested in this study. Oropharyngeal dysphagia was detected in 45% of all the NMD patients when using the SSQ, whereas only 12% had a positive medical record for dysphagia. The median SSQ scores for patients with myotonic syndromes (including myotonic dystrophy type 1), with amyotrophic lateral sclerosis, and with facioscapulohumeral dystrophy were above the cutoff score. The SSQ scores obtained revealed distinct oropharyngeal dysphagia characteristics in the different NMD groups and diseases.

DISCUSSION

The SSQ tests positively for oropharyngeal dysphagia in a higher proportion of NMD patients compared with their medical records. The distinct oropharyngeal dysphagia characteristics we revealed in different NMD groups and diseases may help to elaborate adapted clinical approaches in the management of oropharyngeal dysphagia.

Neuro-Muscular Dentistry: the "diamond" concept of electro-stimulation potential for stomato-gnathic and oro-dental conditions

Oro-Pharyngeal Dysphagia - or simply dysphagia - is the difficulty (persistent) in swallowing/passing food and/or liquid from the mouth to the pharynx into the esophagus and finally the stomach; a deglutition disorder (a symptom, by definition, often due to neuro-degenerative/−muscular, drug-induced or localized structural pathologies such as head and neck tumors, lesions and associated surgical and/or radiation injuries) linked to severe consequences on Quality of Life (QoL), including malnutrition, dehydration, and even sudden death. Likewise, Temporo-Mandibular Jaw and Joint disorder(s) – or simply TMD – is a multifactorial etiological condition, regularly encountered in the dental office. Whether due to malocclusion, bruxism, stress and/or trauma, TMD destabilizes the whole cranio-mandibular system structurally and functionally, via affecting mastication, teeth, supporting structures, comfort and aesthetics, and thus, QoL, again. While several treatment regimens do exist for such conditions, some of which have been standardized for use over the years, most continue to lack proper evidence-based literature support. Hence, (1) caution is to be exercised; and (2) the need for alternative therapeutic strategies is amplified, subsequently, the door for innovation is wide open. Indeed, neuromuscular electrical stimulation or “NMES”, is perhaps a fine example. Herein, we present the interested oro-dental health care provider with an up-dated revision of this therapeutic modality, its potential benefits, risks and concerns, to best handle the dysphagic patient: an intra-disciplinary approach or strategy bridging contemporary dentistry with speech and language therapy; a rather obscure and un-discovered yet critical allied health profession. A pre-clinical and clinical prospectus on employing inventive NMES-based regimens and devices to manage TMD is also highlighted.

Involvement of swallowing therapy is associated with improved long-term survival in patients with post-stroke dysphagia

BACKGROUND

The effects of swallowing therapy (ST) on long-term clinical outcomes in patients with post-stroke dysphagia (PSD) remain unclear.

AIM

This study explores the effect of ST, initiated within 6 months of the stroke onset, on long-term pneumonia-free and overall survival rates in PSD patients.

DESIGN

Retrospective cohort study.

SETTING

Longitudinal Health Insurance Database.

POPULATION

The study included 2994 eligible PSD patients between 2005 and 2013.

METHODS

Among the scrutinized PSD patients, ST was initiated during the nasogastric intubation (NGI) period and was implemented by physician discretion. Therefore, subjects who underwent ST were classified into the ST-intervention (STI) group and those without ST were classified into the non-ST (NST) group. Propensity score matching (PSM) was used to match age, sex, pneumonia events during the NGI period, the Charlson comorbidity index, and the National Institutes of Health Stroke Scale between the two groups. We started to follow all selected PSD patients 6 months after the onset of stroke for four years. Multivariable adjusted Cox regression and Kaplan-Meier estimations were conducted to assess the effects of ST and the ST duration on pneumonia-free and overall survival.

RESULTS

Overall, 1497 PSD patients aged approximately 68 years in each group were selected in this study. The pneumonia-free survival rate in STI subjects was 57.4% and was significantly greater (P=0.003) than that (54.2%) in NST subjects during the follow-up (F/U). A significantly improved (P<0.0001) overall survival rate was observed in STI subjects (75.0%) compared to NST subjects (63.7%) during the F/U. In STI subjects, ST duration ≥ 1 month was significantly (P=0.009) associated with reduced pneumonia incidence compared to those with ST duration<1 month.

CONCLUSIONS

Participation of ST within 6 months of the stroke onset is associated with decreased pneumonia incidence and improved long-term survival in selected PSD patients. In the selected STI subjects, longer ST duration may be valuable in pneumonia prevention.

CLINICAL REHABILITATION IMPACT

This study reveals that ST initiated within 6 months of the stroke onset may be associated with improved long-term survival in selected PSD patients.

Nutrition in the stroke patient

Malnutrition is common both before and after stroke, with dysphagia adding to nutrition risk. Many patients require specialized nutrition support in the acute phase and beyond when swallowing function does not improve or return to allow for nutrition autonomy. When neurologic deficits improve, assessment of the swallowing function, introduction of dysphagia diets, and specialized swallowing techniques are used to transition away from enteral feeding tubes to oral diets. This article reviews the evaluation and treatment of dysphagia, use of specialized nutrition support, strategies for weaning enteral tube feedings, and the impact of nutrition on quality of life in the stroke patient population.

Radiographic evaluation of complex dysphagic patients: comparison with videoendoscopic technique

Swallowing is a highly coordinated sequence of physiologic events. Many disease processes affect the patient's ability to have a functional swallow. The traditional videofluoroscopic swallowing study is an effective and established method for evaluating these patients and is the current examination of choice. Videoendoscopic evaluation is a safe and affordable procedure that can be used in an outpatient or office setting. It can also be a complementary technique, allowing direct visualization of pharyngeal structures and aspiration. We discuss the use of both techniques.