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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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Curtis JA, Borders JC, Perry SE, Dakin AE, Seikaly ZN, Troche MS. Visual Analysis of Swallowing Efficiency and Safety (VASES): A Standardized Approach to Rating Pharyngeal Residue, Penetration, and Aspiration During FEES. Dysphagia 2021; 37:417-435. [PMID: 33837841 DOI: 10.1007/s00455-021-10293-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
The primary aim of this study was to describe the development of the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized method to rate pharyngeal residue, penetration, and aspiration during FEES. As a secondary aim, we explored the feasibility of training novices to interpret FEES using VASES. Literature review and consensus panel discussions were used to develop standardized rules for VASES. A training protocol was developed and criterion ratings were established. Twenty-five novice raters completed VASES training and pre-/post-training assessments. Statistical analyses were used to examine pre- to post-training differences in the accuracy, reliability, and time to rate each video clip using VASES. Four sets of VASES rules were developed, including 'what', 'where', 'when', and 'how' to rate FEES. Large, significant post-training improvements in rating accuracy were observed across all seven VASES outcome measures (Cohen's d range 0.74-1.59). Additionally, inter-rater reliability increased for four of the seven outcome measures, and the amount of time to rate each video clip decreased from 2.6 min pre-training to 1.5 min post-training. VASES is a standardized FEES rating method used to enhance the subjective analysis of pharyngeal residue, penetration, and aspiration. It can be feasibly taught to novice raters with a high level of success and may be an effective method to analyze swallowing safety and efficiency in clinical and research practices. Future research is needed to test the validity of VASES by examining its relationship with other validated FEES rating scales.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA.
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Sarah E Perry
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA.,New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Zeina N Seikaly
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
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3
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Park KD, Kim TH, Lee SH. The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review. Int J Nurs Stud 2020; 107:103588. [PMID: 32408200 DOI: 10.1016/j.ijnurstu.2020.103588] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dysphagia in patients with stroke can cause serious complications, such as aspiration and pneumonia, that often lead to increase in mortality and length of hospitalization. Several screening tests for dysphagia have been developed and are used in clinical practice to prevent dysphagia complications. The Gugging Swallowing Screen is 1 such screening test. It is suggested for use in the assessment of the ability of patients to swallow fluid and non-fluid foods separately. It also promotes effective communication between healthcare providers. OBJECTIVES We aimed to investigate the validity and benefit of the Gugging Swallowing Screen. DESIGN This was a systematic review. DATA SOURCE We sourced data from electronic databases including Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, KoreaMed, Research Information Sharing Service, and Korean studies Information Service System. REVIEW METHODS We conducted a systematic review of electronic databases. We included studies published in English and Korean up to November 2018 that pertained to the Gugging Swallowing Screen. We designed strategies that included Medical Subject Headings and keywords, such as "dysphagia," "swallowing," "assessment," "screening," and "GUSS," used alone or in combination. RESULTS Of the 297 studies that appeared in the search result, 219 articles were reviewed by 2 independent reviewers after duplicate studies were eliminated. Finally, 8 articles were included in this study. With regard to validity, the Gugging Swallowing Screen had a pooled sensitivity of 0.97 (95% confidence interval: 0.93-0.99), a pooled specificity of 0.67 (95% confidence interval: 0.59-0.74), and an area under the receiver operating characteristic curve of 0.9381. With regard to benefit, early systematic dysphagia screening using Gugging Swallowing Screen performed by nurses reduced both screening time and pneumonia rate compared to the control group (p = 0.004). The incidence of X-ray-verified pneumonia was significantly lower in the Gugging Swallowing Screen group than in the clinical screening group (p ˂ 0.01), but no significant difference was observed in the incidence of pneumonia compared to the value predicted using the 10 mL water swallowing test. CONCLUSIONS The Gugging Swallowing Screen is a reliable and sensitive tool for screening dysphagia. Early and systematic assessment can prevent aspiration and pneumonia. However, further studies are needed to confirm the effectiveness of this tool.
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Affiliation(s)
- Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Tae Hee Kim
- Department of Rehabilitation Medicine, On Hospital, Busan, Republic of Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, 191, Hambangmoe-ro, Yeonsu-gu, Incheon 21936, Republic of Korea.
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Miller CK, Willging JP. Fiberoptic Endoscopic Evaluation of Swallowing in Infants and Children: Protocol, Safety, and Clinical Efficacy: 25 Years of Experience. Ann Otol Rhinol Laryngol 2019; 129:469-481. [PMID: 31845586 DOI: 10.1177/0003489419893720] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The application of fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric dysphagia protocol requires specialized knowledge of pediatric conditions that result in dysphagia, recognition of normal and abnormal laryngopharyngeal anatomy and function across ages, and the ability to identify maturational changes in anatomy and function of the aerodigestive tract that pertain to airway protection and swallowing function. METHODS Over the past 25 years, we have performed over 7,000 collaborative Otolaryngology and Speech-Language Pathology FEES examinations in patients ranging from 2 days of age to young adults. During this time period, we have monitored the safety of the procedure, explored the feasibility and utility of FEES across conditions, compared and contrasted FEES to the videofluoroscopic evaluation of swallowing (VFSS), and developed specific pediatric FEES protocols with operational definitions for identification and interpretation of swallowing parameters. RESULTS FEES has proved to be a safe procedure in patients across ages. There have been no significant adverse events. FEES is comparable to the VFSS in the assessment of events before and after the swallow. It provides unique information regarding laryngopharyngeal anatomy and function, airway protection integrity, sensory threshold, and secretion management ability, as well as pharyngeal swallowing dynamics and the efficacy of compensatory swallowing strategies. CONCLUSIONS There are specific indications and contraindications for pediatric FEES, and unique components that characterize the pediatric FEES protocols across ages and conditions. FEES procedures performed jointly by an Otolaryngologist and Speech-Language pathologist offer a team approach to interpretation and management recommendations.
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Affiliation(s)
- Claire Kane Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jay Paul Willging
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Langmore SE. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia 2017; 32:27-38. [DOI: 10.1007/s00455-016-9775-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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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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7
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Scheeren B, Marchiori E, Pereira J, Meirelles G, Alves G, Hochhegger B. Pulmonary computed tomography findings in patients with chronic aspiration detected by videofluoroscopic swallowing study. Br J Radiol 2016; 89:20160004. [PMID: 27226217 DOI: 10.1259/bjr.20160004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To demonstrate CT findings in patients with chronic aspiration compared with a control group without aspiration, as detected by the videofluoroscopic swallowing study (VFSS). METHODS This retrospective, observational study included patients with and without diagnoses of aspiration confirmed by VFSS, who underwent CT examination of the lungs between 2010 and 2014. Two radiologists blinded to the presence of aspiration reviewed the images to detect the presence of any abnormality. Consensus was reached with a third radiologist. CT pulmonary findings (bronchial thickening, bronchiolectasis, centrilobular nodules, ground-glass opacities, atelectasis, consolidation and air trapping) were compared between the groups using the χ(2) test, with a significance level of 0.05. RESULTS A total of 56 patients (28 patients with diagnoses of aspiration; 52% male, mean age 65 ± 15 years) were included in the study. Patients with aspiration were more likely to than those in the control group to demonstrate atelectasis, centrilobular nodules, bronchiolectasis, consolidation and ground-glass opacities (all p < 0.05), with a significant predilection for the lower lobes (p < 0.001). Bronchial wall thickening and air trapping did not differ between groups. CONCLUSION Atelectasis, centrilobular nodules, bronchiolectasis, consolidation and ground-glass opacities occurred more frequently in patients with aspiration than in those without aspiration, with a pronounced tendency for distribution in the lower lobes. ADVANCES IN KNOWLEDGE CT findings of aspiration are very important, as pulmonary symptoms may be the first manifestation of this disorder. Knowledge of these findings is essential to enable the early diagnosis of aspiration disorders and prevent lung damage.
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Affiliation(s)
- Betina Scheeren
- 1 Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Edson Marchiori
- 2 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Giordano Alves
- 2 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Hochhegger
- 1 Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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8
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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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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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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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12
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Fernandes AMF, Duprat ADC, Eckley CA, Silva LD, Ferreira RB, Tilbery CP. Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz J Otorhinolaryngol 2013; 79:460-5. [PMID: 23929146 PMCID: PMC9442424 DOI: 10.5935/1808-8694.20130082] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 04/30/2013] [Indexed: 11/20/2022] Open
Abstract
Multiple sclerosis is a neurological disease that involves swallowing disorders. Many studies have shown an association between neurological and swallowing performance, but results have been conflicting. Objective To identify the frequency of dysphagia in patients with multiple sclerosis and neurological indicators that can represent the performance of swallowing. Method In this study (cross-sectional) 120 Multiple Sclerosis patients underwent Functional Assessment of Swallowing by flexible nasal-pharyngo-laryngoscopy and the results were compared with the scores of the rating scales: (Clinical Evolving Forms of Disease, Functional Disability Scale for and Scale Systems Extended Functional Disability [Kurtzke Expanded Disability Status Scale]). Results Dysphagia was found in 90% of patients. Among the clinical forms of the disease, the progressive forms (primary progressive and secondary progressive) were more frequently associated with severe dysphagia, while the relapsing-remitting form presented more often mild and moderate dysphagia. Regarding the Disability Scale for Functional Systems, cerebellar function, brainstem function and mental health were associated with dysphagia, especially in the severe form. Regarding the Extended Functional Disability Scale, higher scores were associated with severe dysphagia. Conclusion Dysphagia is common in MS patients, especially in those with greater impairment of neurological functions.
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13
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Ulualp S, Brown A, Sanghavi R, Rivera-Sanchez Y. Assessment of laryngopharyngeal sensation in children with dysphagia. Laryngoscope 2013; 123:2291-5. [PMID: 23564272 DOI: 10.1002/lary.24024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 11/07/2012] [Accepted: 01/08/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess laryngopharyngeal sensation, prevalence of laryngopharyngeal sensory deficit and abnormal swallowing function parameters in children with dysphagia. STUDY DESIGN Retrospective chart review. METHODS The medical records of children who underwent flexible endoscopic evaluation of swallowing with sensory testing (FEESST) were reviewed. Laryngopharyngeal sensory threshold (LPST) was assessed based on the threshold intensity of air pulse stimulation eliciting laryngeal adductor reflex. Swallowing function parameters including pharyngeal residue, hypopharyngeal pooling of secretions, premature spillage, laryngeal penetration, and aspiration were evaluated. Prevalence of abnormal swallowing function parameters in children with normal and impaired LPST was compared. RESULTS Forty children with dysphagia (28 male, 12 female; age range, 3 months to 17 years) underwent FEESST. LPST was normal in six patients, moderately impaired in 20 patients, and severely impaired in 10 patients. LPST could not be measured in four patients. Children showed one or more abnormal swallowing function parameters. The prevalence of abnormal swallowing parameters in patients with normal LPST was lower than that of patients with moderately or severely impaired LPST (P < .05). The prevalence of pharyngeal residue, hypopharyngeal pooling of secretions, and spillage in patients with severely impaired LPST was higher than that of patients with moderately impaired LPST (P < .05). CONCLUSIONS The majority of children with dysphagia have impaired LPST. The prevalence of abnormal swallowing function parameters in children with normal LPST is lower than that in children with moderately or severely impaired LPST. Prevalence of aspiration tends to increase when the abnormal swallowing function parameters are associated with severely impaired LPST.
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Affiliation(s)
- Seckin Ulualp
- Departments of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, U.S.A; Pediatric Airway and Swallowing Disorders Program, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, U.S.A
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Kang Y, Chun MH, Lee SJ. Evaluation of salivary aspiration in brain-injured patients with tracheostomy. Ann Rehabil Med 2013; 37:96-102. [PMID: 23525725 PMCID: PMC3604240 DOI: 10.5535/arm.2013.37.1.96] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/29/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the useful tool for evaluating salivary aspiration in brain-injured patients with tracheostomy. METHODS Radionuclide salivagram and laryngoscopy was done in 27 brain-injured patients with tracheostomy. During salivagram, (99m)Tc sulfur colloid was placed sublingually in the supine position, and 50-minute dynamic images and 2-hour delayed images were obtained. Salivary aspiration was detected when the tracer was entered into the major airways or lung parenchyma. Laryngoscopy was done by otolaryngologists, and saliva aspiration, saliva pooling, and vocal cord palsy were evaluated. Videofluoroscopic swallowing study was done in patients who were able to undergo the test. RESULTS The detection rate of salivary aspiration was 44.4% with salivagram, and 29.6% with laryngoscopy. The correlation of the two tests was 70.4%. Of the laryngoscopy findings, salivary pooling had significant correlation with positive salivagram results (p=0.04). Frequent need of suction correlated with salivary aspiration in both salivagram (p=0.01) and laryngoscopy (p=0.01). Patients with negative results in salivagram or laryngoscopy had higher rates of progressing to oral feeding or tapering tracheostomy. Two patients developed aspiration pneumonia, and both patients only showed aspiration in salivagram. CONCLUSION Brain-injured patients with tracheostomy have a high risk of salivary aspiration. Evaluation of salivary aspiration is important, as it may predict aspiration pneumonia and aids in clinical decisions of oral feeding or tracheostomy removal. Salivagram is more sensitive than laryngoscopy, but laryngoscopy may be useful for evaluating structural abnormalities or for follow-up examinations to assess the changes.
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Affiliation(s)
- Yujeong Kang
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lee WS, Lee SH, Park YH, Lee JW, Kwon KH, Kim SW, Kim YH. Effectiveness of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Swallowing Disorders -A Systematic Review-. BRAIN & NEUROREHABILITATION 2013. [DOI: 10.12786/bn.2013.6.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Worl-Sook Lee
- The National Evidence-based Healthcare Collaborating Agency, Center for New Health Technology Assessment, Korea
| | - Seon-Heui Lee
- The National Evidence-based Healthcare Collaborating Agency, Center for New Health Technology Assessment, Korea
| | - Young Hak Park
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The Catholic University of Korea, Korea
| | | | - Kee Hwan Kwon
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Korea
| | - Sang Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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Swallowing dysfunction in trauma patients with cervical spine fractures treated with halo-vest fixation. ACTA ACUST UNITED AC 2011; 70:46-8; discussion 48-50. [PMID: 21217480 DOI: 10.1097/ta.0b013e318203e3b8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED ACKGROUND:: Cervical spine fractures are common in traumatically injured patients. The halo-vest brace is a common treatment used for these fractures. We hypothesize that the use of halo-vest fixation is associated with a high incidence of dysphagia in trauma patients. METHODS All trauma patients at our Level I Trauma Center from August 2005 to August 2007 were analyzed retrospectively via the trauma registry (N=3,702). Included were adult patients with cervical spine fractures treated with halo-vests and evaluated formally by speech-language pathologists for dysphagia and aspiration. Patients were categorized into mild, moderate, and severe dysphagia. RESULTS Of the 3,702 patients, 369 (10%) had cervical spine fractures from blunt trauma and 56 met inclusion criteria. Of these, 19 (34%) had no evidence of swallowing dysfunction and the remaining 37 (66%) had evidence of dysphagia. Thirteen (23%) exhibited symptoms of aspiration. There were no significant differences in age, gender, Injury Severity Score, arrival Revised Trauma Score, or arrival Glasgow Coma Scale score on presentation. Dysphagia is associated with longer intensive care unit stays (p=0.019) and trends toward a longer hospital stay (p=0.083). In trauma patients with halo-vests, increasing severity of dysphagia from mild to moderate is associated with longer ventilator days (p=0.005), intensive care unit days (p=0.001), and hospital length of stay (p=0.015). CONCLUSIONS Patients with cervical fractures treated with halo-vest fixation have a significantly high incidence of dysphagia and aspiration. Dysphagia in trauma patients treated with halo-vests for c-spine fractures is common, associated with worse outcomes, and difficult to predict. Therefore, all of these patients should be formally evaluated for dysphagia.
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Swallowing dysfunction related to obstructive sleep apnea: a nasal fibroscopy pilot study. Sleep Breath 2011; 15:209-13. [DOI: 10.1007/s11325-010-0474-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/29/2010] [Accepted: 12/23/2010] [Indexed: 11/26/2022]
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Terré R, Mearin F. Prospective evaluation of oro-pharyngeal dysphagia after severe traumatic brain injury. Brain Inj 2009; 21:1411-7. [DOI: 10.1080/02699050701785096] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Szczesniak MM, Rommel N, Dinning PG, Fuentealba SE, Cook IJ, Omari TI. Intraluminal impedance detects failure of pharyngeal bolus clearance during swallowing: a validation study in adults with dysphagia. Neurogastroenterol Motil 2009; 21:244-52. [PMID: 18761629 DOI: 10.1111/j.1365-2982.2008.01180.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multichannel intraluminal impedance (MII) detects bolus flow through a healthy pharynx. The aim of this study was to determine whether the technique detects bolus flow and retention in patients with pharyngeal dysphagia; develop appropriate impedance-based criteria for assessing patients and to provide some preliminary insights into the clinical utility of the technique. Pharyngo-oesophageal pressure and impedance were recorded simultaneously with videofluoroscopy (VF) during swallows in six patients with dysphagia. Agreement, as to the presence or absence of bolus material, between the VF and MII was expressed using the Cohen's Kappa statistic. To test whether the impedance criteria for the detection of bolus passage in dysphagia could be improved, a Kappa statistic was calculated in an iterative process for a range of impedance values (100%-0%) defining bolus head entry and bolus tail clearance from the pharynx. Bolus presence according to the MII criteria previously derived by us in healthy controls demonstrated a modest correlation with VF when applied to this dysphagia population [0.37, 0.5 and 0.58 in the hypopharynx, upper oesophageal sphincter (UOS) and proximal oesophagus respectively]. In the patient population, the optimal impedance criteria were 50% for bolus head entry and 20% for bolus tail clearance. Adopting these criteria demonstrated enhanced agreement between VF and impedance; yielding Kappa coefficients of 0.42 in the hypopharynx, 0.54 in the UOS and 0.62 in the proximal oesophagus. With the adoption of appropriate criteria, pharyngeal impedance measurement can accurately detect bolus passage and failed or impaired clearance during swallowing in patients with dysphagia.
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Affiliation(s)
- M M Szczesniak
- Department of Gastroenterology, University of NSW and St George Hospital, Sydney, NSW, Australia.
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Tabaee A, Johnson PE, Gartner CJ, Kalwerisky K, Desloge RB, Stewart MG. Patient-controlled comparison of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) and videofluoroscopy. Laryngoscope 2006; 116:821-5. [PMID: 16652095 DOI: 10.1097/01.mlg.0000214670.40604.45] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare the results of videofluoroscopy (VFS) with flexible endoscopic evaluation of swallowing with sensory testing (FEESST) in dysphagia testing. METHODS The authors conducted a retrospective review of data collected over a 4-year period at a tertiary care medical center. The FEESST and VFS results for patients receiving both examinations within a 2-week period were compared with respect to swallowing function. Comparisons were categorized as full agreement, minor disagreement that would not result in a significant difference in diet recommendations, and major disagreement that would result in a significant difference in diet recommendations. Kappa with quadratic weighting was calculated to evaluate the inter-test agreement. RESULTS Fifty-four patients met inclusion criteria and were reviewed. Forty-one percent of patients were not eating by mouth at the time of FEESST and the mean interval between the two examinations was 5 days. Laryngeal examination revealed edema/erythema in 93%, impaired pharyngeal squeeze in 66%, decreased laryngopharyngeal sensation in 82%, and absent laryngeal adductor reflex in 30%. FEESST with all consistencies revealed pooling in 89%, penetration in 83%, and aspiration in 65% of patients. VFS revealed pooling in 65%, penetration in 67%, and aspiration in 54% of patients. Comparison of FEESST and VFS revealed full agreement in 52%, minor disagreement in 13%, and major disagreement in 35% of patients. A weighted kappa value of 0.324 signified only "fair" agreement between the two tests. CONCLUSIONS FEESST and VFS may not represent comparable tests of dysphagia. Further comparative studies of tests of swallowing function are required to determine the ideal approach to dysphagia testing.
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Affiliation(s)
- Abtin Tabaee
- Department of Otolaryngology-Head and Neck Surgery, The New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA.
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Gomes GF, Campos AC, Pisani JC, Macedo ED, Vieira MC. Diagnostic methods for the detection of anterograde aspiration in enterally fed patients. Curr Opin Clin Nutr Metab Care 2004; 7:285-92. [PMID: 15075920 DOI: 10.1097/00075197-200405000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of aspiration and its origin in patients on enteral tube feeding is challenging to the physician and provides an important means to prevent pneumonia. This review examines the most recent studies and developments in the field with an approach to the technical aspects of diagnostic methods. RECENT FINDINGS The methods more commonly used to detect anterograde aspiration in clinical practice are fiberoptic endoscopic evaluation of swallowing and modified barium swallowing. Recent studies have shown that although these methods may provide the diagnosis of aspiration, their use for clinical monitoring is not appropriate. The studies comparing fiberoptic endoscopic evaluation of swallowing and modified barium swallowing have demonstrated that both tests present similar sensitivity, specificity and predictive values. SUMMARY The different methods used to diagnose anterograde aspiration are appropriate for clinical practice, with a low complication rate and few contraindications. In most instances, the early diagnosis of aspiration and evaluation of other factors such as laryngeal sensibility, may predict the occurrence of aspiration pneumonia.
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Affiliation(s)
- Guilherme F Gomes
- Department of Gastroenterology, Federal University of Parana and Hospital Nossa Senhora das Graças, Curitiba, Brazil
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Doria S, Abreu MAB, Buch R, Assumpção R, Nico MAC, Ekcley CA, Duprat A, Costa HO. Estudo comparativo da deglutição com nasofibrolaringoscopia e videodeglutograma em pacientes com acidente vascular cerebral. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0034-72992003000500008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Os distúrbios da deglutição são bastante freqüentes nos pacientes neurológicos e naqueles com doenças ou seqüelas de cirurgia de cabeça e pescoço, sendo causa de importante morbidade e mortalidade. Apesar do videodeglutograma (VD) ser considerado o exame de escolha para a avaliação dos distúrbios da deglutição, este exame apresenta limitações em algumas situações clínicas, além de expor o doente à radiação e ao risco de aspiração do contraste. Em anos recentes, têm sido também utilizadas fibras ópticas flexíveis para avaliar os pacientes com disfagia e outras queixas relacionadas à deglutição. OBJETIVO: Análise comparativa entre os dados obtidos pela NFL e VD em relação a parâmetros estudados por ambos métodos. FORMA DE ESTUDO: Caso controle. MATERIAL E MÉTODO: Foram avaliados prospectivamente 12 pacientes com seqüela de acidente vascular cerebral isquêmico, no período de janeiro a maio de 2002, por meio do estudo dinâmico da deglutição com nasofibrolaringoscopia (NFL) e VD, sendo os resultados comparados estatisticamente. RESULTADOS: Enquanto o VD permite a análise da fase preparatória oral e oral da deglutição e o início da fase faríngea, a NFL permite estudo da sensibilidade e mobilidade faringo-laríngea, além da visualização direta do alimento. Através do teste estatístico McNemar, nenhum dos parâmetros analisados apresentou divergência estatisticamente significante (p<0,05) quando comparados os resultados na NFL e VD. CONCLUSÕES: A análise comparativa entre os dados obtidos pelo NFL e VD em relação a parâmetros avaliados por ambos métodos, em pacientes com disfagia, mostraram não haver diferenças significativas entre eles.
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Prospective, Randomized Outcome Study of Endoscopy Versus Modified Barium Swallow in Patients With Dysphagia. Laryngoscope 2002. [DOI: 10.1097/00005537-200202000-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aviv JE, Sataloff RT, Cohen M, Spitzer J, Ma G, Bhayani R, Close LG. Cost-effectiveness of Two Types of Dysphagia Care in Head and Neck Cancer: A Preliminary Report. EAR, NOSE & THROAT JOURNAL 2001. [DOI: 10.1177/014556130108000818] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a prospective, preliminary study to compare the cost-effectiveness of two different instrument-based techniques for diagnosing and managing dysphagia in 30 consecutive hospitalized patients with head and neck cancer. The two techniques are videofluoroscopy via modified barium swallow (MBS) and videoendoscopy via flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Medicare was the primary insurer of all patients. Fifteen of these patients had their dysphagia diagnosed and managed by MBS and the other 15 by FEESST. Cost-effectiveness was assessed by determining the average Medicare reimbursement for each procedure. We found that the mean reimbursements were $451.01 (± $50.55) for MBS and $321.23 (± $3.01) for FEESST. The mean reimbursement for FEESST was significantly lower than that for MBS (p< 0.0001; Mann-Whitney U test). We conclude that FEESST appears to be more cost-effective than MBS for the inpatient management of dysphagia in patients with head and neck cancer.
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Affiliation(s)
- Jonathan E. Aviv
- Department of Otolaryngology–Head and Neck Surgery, New York Presbyterian Hospital and the College of Physicians and Surgeons, Columbia University, New York City
| | - Robert T. Sataloff
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, and the Department of Otolaryngology–Head and Neck Surgery, Allegheny University Hospitals, Philadelphia
| | - Manderly Cohen
- Department of Otolaryngology–Head and Neck Surgery, New York Presbyterian Hospital and the College of Physicians and Surgeons, Columbia University, New York City
| | - Jaclyn Spitzer
- Department of Otolaryngology–Head and Neck Surgery, New York Presbyterian Hospital and the College of Physicians and Surgeons, Columbia University, New York City
| | - Guoguang Ma
- Division of Biostatistics, Department of Public Health, New York Presbyterian Hospital and the College of Physicians and Surgeons, Columbia University, New York City
| | - Rajendra Bhayani
- Department of Otolaryngology–Head and Neck Surgery, New York Presbyterian Hospital and the College of Physicians and Surgeons, Columbia University, New York City
| | - Lanny G. Close
- Department of Otolaryngology–Head and Neck Surgery, New York Presbyterian Hospital and the College of Physicians and Surgeons, Columbia University, New York City
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Abstract
Oropharyngeal dysphagia is a cause of major morbidity and mortality, particularly in the ever-increasing aged population, following stroke, or after extensive head and neck surgery such as for cancer. Videoendoscopy has become a useful tool in the evaluation and treatment of oropharyngeal dysphagia, and it is particularly suited to patients who may be unable to tolerate videofluoroscopy. This paper reviews the current literature regarding the technique of videoendoscopic evaluation and outlines various indications for its use.
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Affiliation(s)
- D M Staff
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin Dysphagia Institute, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Aviv JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope 2000; 110:563-74. [PMID: 10764000 DOI: 10.1097/00005537-200004000-00008] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Aspiration pneumonia is a significant cause of morbidity and mortality in both acute and long-term care settings While there are many reasons for patients to develop aspiration pneumonia, there exists a strong association between difficulty swallowing, or dysphagia, and the development of aspiration pneumonia The modified barium swallow test (MBS) and endoscopic evaluations of swallowing are considered to be the most comprehensive tests used to evaluate and manage patients with dysphagia in an effort to reduce the incidence of pneumonia. The purpose of this study was to provide an initial investigation of whether flexible endoscopic evaluation of swallowing with sensory testing (FEESST) or MBS is superior as the diagnostic test for evaluating and guiding the behavioral and dietary management of outpatients with dysphagia. FEESST combines the standard endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. STUDY DESIGN Randomized, prospective cohort outcome study in a hospital-based outpatient setting. METHODS One hundred twenty-six outpatients with dysphagia were randomly assigned to either FEESST or MBS as the diagnostic test used to guide dietary and behavioral management (postural changes, small bites and sips, throat clearing). The outcome variables were pneumonia incidence and pneumonia-free interval. The patients were enrolled for 1 year and followed for 1 year. RESULTS Seventy-eight MBS examinations were performed in 76 patients with 14 patients (18.41%) developing pneumonia; 61 FEESST examinations were performed in 50 patients with 6 patients (12.0%) developing pneumonia These differences were not statistically significant (chi2 = 0.93, P = .33). In the MBS group the median pneumonia-free interval was 47 days; in the FEESST group the median pneumonia-free interval was 39 days Based on Wilcoxon's signed-rank test, this difference was not statistically significant (z = 0.04, P = .96). CONCLUSION Whether dysphagic outpatients have their dietary and behavioral management guided by the results of MBS or of FEESST, their outcomes with respect to pneumonia incidence and pneumonia-free interval are essentially the same.
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Affiliation(s)
- J E Aviv
- Department of Otolaryngology--Head and Neck Surgery, Columbia-Presbyterian Center, New York Presbyterian Hospital, New York, USA
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Abstract
The clinical bedside swallow evaluation and videofluoroscopy routinely have been used for dysphagia management. This article explores clinical issues for dysphagia management in the population with brain injury in the acute rehabilitation setting. Citing the dysphagia, cognitive, and other relevant issues present in the population with brain injury, the use of fiberoptic endoscopy to address dysphagia assessment and intervention is presented. Factors for decision making, a retrospective review of recent studies, and relevant cases are discussed.
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Affiliation(s)
- P Hoppers
- Baylor Institute for Rehabilitation, Department of Physical Medicine and Rehabilitation, Dallas, Texas 75246, USA
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Périé S, Coiffier L, Laccourreye L, Hazebroucq V, Chaussade S, St Guily JL. Swallowing disorders in paralysis of the lower cranial nerves: a functional analysis. Ann Otol Rhinol Laryngol 1999; 108:606-11. [PMID: 10378531 DOI: 10.1177/000348949910800614] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of skull base tumors may cause disabling swallowing disorders. To assess the mechanisms of swallowing disorders involved in such cases, we performed functional examinations: a videoendoscopic swallowing study and simultaneous manometry and videofluoroscopy in 7 patients. This study shows that the main mechanism of the swallowing disorders was a disturbance of the pharyngeal stage, including a decrease of pharyngeal propulsion, reduced laryngeal closure, and cricopharyngeal dysfunction, which led to aspiration. Decreased pharyngeal propulsion was found in 6 patients, with a very high correlation between fiberoscopy and simultaneous manometry-fluoroscopy. The responsibility of the upper esophageal sphincter in swallowing disorders was more difficult to assess. The role of the upper esophageal sphincter and pharyngeal propulsion in the onset of the problem is discussed in regard to the cricopharyngeal myotomy.
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Affiliation(s)
- S Périé
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculté de Médecine, Saint Antoine, Université Paris VI, Hôpital Tenon, France
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Schurr MJ, Ebner KA, Maser AL, Sperling KB, Helgerson RB, Harms B. Formal swallowing evaluation and therapy after traumatic brain injury improves dysphagia outcomes. THE JOURNAL OF TRAUMA 1999; 46:817-21; discussion 821-3. [PMID: 10338398 DOI: 10.1097/00005373-199905000-00009] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of swallowing dysfunction after brain injury is unknown. The efficacy of dysphagia therapy is also unknown. We reviewed our experience to define the incidence of swallowing dysfunction and efficacy of therapeutic intervention. METHODS Patients with brain injury sustained between January of 1996 and December of 1997 were reviewed. All were screened with trials of oral intake. Abnormal findings were confirmed with a videofluoroscopic swallow study. Standard therapies included diet, posture, and behavior modifications. RESULTS A total of 47 patients were evaluated. Bedside evaluations were normal in 14 patients, 2 patients had overt aspiration and underwent gastrostomy, and 31 patients were referred for a videofluoroscopic swallow study (66%). The videofluoroscopic swallow study was abnormal in 22 of 31 patients (71%). Of these, 4 additional patients required gastrostomy, 13 patients had laryngeal penetration or minor aspiration responsive to dysphagia therapy and were fed. Five other patients had silent aspiration and were fed by means of nasogastric tube; these five patients responded to dysphagia therapy and were able to resume oral intake. CONCLUSION Dysphagia is common after severe head injury. With formal swallowing service intervention, aspiration is avoided. Therapeutic interventions can be used to restore oral intake.
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Affiliation(s)
- M J Schurr
- Department of Surgery, University of Wisconsin Hospital, Madison 53792, USA.
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Périé S, Dernis HP, Monceaux G, Angelard B, St Guily JL. The "sign of the rising tide" during swallowing fiberoscopy: a specific manifestation of Zenker's diverticulum. Ann Otol Rhinol Laryngol 1999; 108:296-9. [PMID: 10086625 DOI: 10.1177/000348949910800314] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pooling of secretions in the hypopharynx is a common sign of an impaired upper esophageal sphincter. Until now, no specific manifestation, observed by flexible laryngoscopy, of Zenker's diverticulum has been reported. Direct visualization of the diverticulum can be missed during flexible laryngoscopic examination. In this series of 12 patients with hypopharyngeal diverticulum, we have described a manifestation of Zenker's diverticulum obtained on videofiberoscopy during cream swallowing. We have called it the "sign of the rising tide" because it describes the backup of cream visible in the hypopharynx as a wave after its complete disappearance. Barium swallow study is necessary to confirm the presumptive diagnosis. This relevant manifestation seems to be specific for Zenker's diverticulum, since it is not observed in other upper esophageal sphincter disorders, and it disappears when surgical treatment is successful.
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Affiliation(s)
- S Périé
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Tenon, Université Paris VI, France
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31
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Périé S, Laccourreye L, Flahault A, Hazebroucq V, Chaussade S, St Guily JL. Role of videoendoscopy in assessment of pharyngeal function in oropharyngeal dysphagia: comparison with videofluoroscopy and manometry. Laryngoscope 1998; 108:1712-6. [PMID: 9818831 DOI: 10.1097/00005537-199811000-00022] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of the current report is to evaluate the ability of videoendoscopic swallowing study in assessing pharyngeal propulsion and aspiration episodes when compared with videofluoroscopy and manometry. STUDY DESIGN Prospective study. METHODS Thirty-four patients with oropharyngeal dysphagia underwent videoendoscopy of swallowing to assess pharyngeal propulsion as pathologic or nonpathologic, and aspiration. These features were compared with those found on manometry and videofluoroscopy, which were considered as the reference examinations. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy were estimated, with their 95% confidence intervals. RESULTS A total agreement between videoendoscopy and videofluoroscopy was found in 76.4% of cases for pharyngeal propulsion and in 82.3% for aspiration. This rate for pharyngeal propulsion reached 82.3% between videoendoscopy and manometry. Moreover, in 24 cases (70.5%) in which videofluoroscopy and manometry agreed for pharyngeal propulsion, 22 were assessed similarly through fiberoscopy. When using fluoroscopy and manometry as reference examinations, videoendoscopy detected nearly 90% (95% confidence interval [CI] = 0.80, 1.0) of impaired pharyngeal propulsion. Concerning aspiration, 70% (95% CI = 0.54, 0.85) of events detected by videoendoscopy were also observed on videofluoroscopy. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy reached a higher rate (90% to 92.8%) when agreement was found between fluoroscopy and manometry. CONCLUSIONS Videoendoscopy is an examination that can be used to detect inexpensively pharyngeal propulsion disorders and aspiration episodes.
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Affiliation(s)
- S Périé
- Service d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou, Faculté de Médecine Saint Antoine, Université Paris VI, Hôpital Tenon, France
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Abstract
This article provides a brief review of the neurophysiology behind the normal swallow. The examination and work-up of a patient with dysphagia is then detailed. Finally, the major neurologic conditions associated with dysphagia are considered.
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Affiliation(s)
- T G Dray
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA
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