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Bartolome G, Starrost U, Schröter-Morasch H, Schilling B, Fischbacher L, Kues L, Graf S, Ziegler W. Validation of the munich swallowing score (mucss) in patients with neurogenic dysphagia: A preliminary study. NeuroRehabilitation 2021; 49:445-457. [PMID: 34180423 DOI: 10.3233/nre-210011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Munich Swallowing Score (MUCSS) is a clinician rated scale for the assessment of the functional level of swallowing saliva/secretions, food and liquids. The MUCSS consists of two eight-point subscales, MUCSS-Saliva and MUCSS-Nutrition. In a previous article, content validity and interrater reliability were described. OBJECTIVE The aim of the present study was to investigate criterion validity and sensitivity to change of the MUCSS. METHODS The research was conducted at a tertiary care academic hospital. Data were collected retrospectively in a cohort of 100 acute and subacute neurologic patients. Criterion validity was judged by comparison to the Gugging Swallowing Screen (GUSS), the Barthel Index (BI), Early Rehabilitation Barthel Index (ERI), Extended Barthel Index (EBI) and also by comparison to three physiological scales drawn from FEES videos: The Penetration - Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale (YPR) and the Murray Secretion Scale (MSS). Changes in oral intake and saliva swallowing were followed up for three months. RESULTS Between MUCSS and scores directly reflecting dysphagic symptoms (GUSS, PAS, YPR, MSS, ERI), strong to moderate correlations were found, weaker but statistically significant associations were seen with global measures of disability (BI isolated, EBI-subscale cognitive functions). MUCSS was sensitive to positive change of saliva swallowing and oral intake during the recovery period. CONCLUSIONS These preliminary data suggest that the MUCCS is a valid scale and may be appropriate for documenting clinical change in swallowing abilities of patients with neurogenic dysphagia.
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Affiliation(s)
- G Bartolome
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - U Starrost
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - H Schröter-Morasch
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - B Schilling
- Department of Otorhinolaryngology/Phoniatrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - L Fischbacher
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - L Kues
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - S Graf
- Department of Otorhinolaryngology/Phoniatrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - W Ziegler
- Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Steffen A, Jost W, Bäumer T, Beutner D, Degenkolb-Weyers S, Groß M, Grosheva M, Hakim S, Kahl KG, Laskawi R, Lencer R, Löhler J, Meyners T, Rohrbach-Volland S, Schönweiler R, Schröder SC, Schröder S, Schröter-Morasch H, Schuster M, Steinlechner S, Urban R, Guntinas-Lichius O. [Hypersalivation - Update of the S2k guideline (AWMF) in short form]. Laryngorhinootologie 2019; 98:388-397. [PMID: 31167292 DOI: 10.1055/a-0874-2406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This update presents recent changes and innovation in the treatment of hypersalivation.Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, saliva aspiration, and oro-motor deficiencies. Clinical screening tools and diagnostics such as fiberoptic endoscopic evaluation of swallowing generate important data on therapy selection and control. Many cases profit from swallowing therapy programmes in order to activate compensation mechanisms as long compliances is given. In children with hypotonic oral muscles, oral stimulation plates can induce a relevant symptom release because of the improved lip closure. The pharmacologic treatment improved for pediatric cases as glycopyrrolate fluid solution (Sialanar®) is now indicated for hypersalivation within the E. U. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Here, a phase III trial is completed for Incobotulinum toxin A and, in the U. S., is indicated for the treatment of adult patients with chronic hypersalivation. Surgical treatment should be reserved for isolated cases. External radiation is judged as a safe and effective therapy when using modern 3 D techniques to minimize tissue damage. Therapy effects and symptom severity has to be followed, especially in cases with underlying neurodegenerative disease.
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Affiliation(s)
| | | | - Tobias Bäumer
- Universitätsklinikum Münster Klinik für Psychiatrie und Psychotherapie
| | - Dirk Beutner
- Wissenschaftliches Institut für angewandte HNO-Heilkunde HNO-Praxis Bad Bramstedt
| | | | - Martin Groß
- Evangelische Hochschule Berlin Pflege- und Gesundheitswissenschaften
| | | | | | - Kai G Kahl
- Dr. von Haunersches Kinderspital Ludwig-Maximilians-Universität München Pädiatrische Neurologie und Entwicklungsneurologie
| | - Rainer Laskawi
- Ludwig-Maximilians-Universität München, Medizinische Fakultät, Institut für Phonetik und Sprachverarbeitung
| | - Rebekka Lencer
- Klinikum der Universität München, Klinik für Hals-, Nasen- und Ohrenheilkunde
| | | | - Thekla Meyners
- HELIOS Fachklinik Schleswig, Psychiatry and Psychosomatik Medicine
| | | | | | | | - Sebastian Schröder
- Georg-August-Universität Göttingen, Universitätsmedizin Klinik für Hals-Nasen-Ohrenheilkunde
| | - Heidrun Schröter-Morasch
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Fakultät, Studiengang B. Sc. Logopädie
| | - Maria Schuster
- Evangelisches Krankenhaus Oldenburg Klinik für Neurologische Intensivmedizin und Frührehabilitation
| | - Susanne Steinlechner
- Uniklinik Köln Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie Köln
| | - Roland Urban
- Universität zu Lübeck, Klinik für Kiefer- und Gesichtschirurgie
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Steffen A, Jost W, Bäumer T, Beutner D, Degenkolb-Weyers S, Groß M, Grosheva M, Hakim S, Kahl KG, Laskawi R, Lencer R, Löhler J, Meyners T, Rohrbach-Volland S, Schönweiler R, Schröder SC, Schröder S, Schröter-Morasch H, Schuster M, Steinlechner S, Urban R, Guntinas-Lichius O. Hypersalivation: update of the German S2k guideline (AWMF) in short form. J Neural Transm (Vienna) 2019; 126:853-862. [DOI: 10.1007/s00702-019-02000-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
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Abstract
Dysphagias, together with the diseases resulting therefrom, severely reduce patients' quality of life and substantially increase the costs of public health, making efficient therapy a prime concern. Among pathophysiologically oriented diagnostic procedures, the endoscopic examination of swallowing has emerged within the past 20 years as an indispensable standard examination with high sensitivity and specificity. Thus, every ears, nose, and throat (ENT) physician and phoniatric specialist should be familiar with this procedure, in order to ensure widest possible access to it, not only in hospitals but also in outpatient settings and in healthcare establishments. In this article, the preconditions, execution, and evaluation of the endoscopic examination are described and its relevance for immediate or long-term therapeutic treatment is discussed.
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Affiliation(s)
- H Schröter-Morasch
- Entwicklungsgruppe Klinische Neuropsychologie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Kölner Platz 1, 80804, München, Deutschland,
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6
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Steffen A, Beutner D, Hakim SG, Jost W, Kahl K, Laskawi R, Lencer R, Mall V, Mehrhoff FW, Meyners T, Schönweiler R, Schröder S, Schröter-Morasch H, Schuster M, Steinlechner S, Winterhoff J, Zenk J, Guntinas-Lichius O. Hypersalivation – Ersterstellung der S2k-Leitlinie (AWMF) in gekürzter Darstellung. Laryngorhinootologie 2014. [DOI: 10.1055/s-0033-1357200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A. Steffen
- HNO-Klinik, Lübeck, Universität zu Lübeck, Lübeck
| | - D. Beutner
- Klinik und Poliklinik für HNO-Heilkunde, Uniklinik Köln, Köln
| | - SG. Hakim
- Klinik für Kiefer- und Gesichtschirurgie, Universität zu Lübeck, Lübeck
| | - W. Jost
- Fachbereich Neurologie, Stiftung Deutsche Klinik für Diagnostik, Wiesbaden,
| | - K. Kahl
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover
| | - R. Laskawi
- HNO-Klinik, Universitätsmedizin Göttingen, Göttingen
| | - R. Lencer
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Münster
| | - V. Mall
- Kinderzentrum München, München
| | | | - T. Meyners
- Klinik für Strahlentherapie, Universität zu Lübeck, Lübeck
| | | | - S. Schröder
- Pädiatrische Neurologie und Entwicklungsneurologie, Dr. von Haunersches Kinderspital Ludwig-Maximilians-Universität München, München
| | - H. Schröter-Morasch
- Entwicklungsgruppe Klinische Neuropsychologie, Städtisches Klinikum München, München
| | - M. Schuster
- Klinik und Poliklinik für HNO-Heilkunde, Ludwig-Maximilians-Universität München, München
| | - S. Steinlechner
- Psychiatry and Psychosomatik Medicine, HELIOS Fachklinik Schleswig, Schleswig
| | - J. Winterhoff
- HNO-Klinik, Universitätsmedizin Göttingen, Göttingen
| | - J. Zenk
- Hals-Nasen-Ohren-Klinik, Kopf-und Halschirurgie, Universität Erlangen, Erlangen
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7
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Steffen A, Beutner D, Hakim S, Jost W, Kahl KG, Laskawi R, Lencer R, Mall V, Mehrhoff FW, Meyners T, Schönweiler R, Schröder S, Schröter-Morasch H, Schuster M, Steinlechner S, Winterhoff J, Zenk J, Guntinas-Lichius O. [Hypersalivation - inauguration of the S2k Guideline (AWMF) in short form]. Laryngorhinootologie 2013; 92:515-22. [PMID: 23900923 DOI: 10.1055/s-0033-1343414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This reduces social interaction chances and burdens daily care. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, and saliva aspiration. Therefore, a multidisciplinary S2k guideline was developed. Diagnostic tools such as fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing studies generate important data on therapy selection and control. Especially traumatic and oncologic cases profit from swallowing therapy programmes in order to activate compensation mechanisms. In children with hypotonic oral muscles, oralstimulation plates can induce a relevant symptom release because of the improved lip closure. In acute hypersalivation, the pharmacologic treatment with glycopyrrolate and scopolamine in various applications is useful but its value in long-term usage critical. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Surgical treatment should be reserved for isolated cases. External radiation is judged as ultima ratio. Therapy effects and symptom severity has to be followed, especially in neurodegenerative cases. The resulting xerostomia should be critically evaluated by the responsible physician regarding oral and dental hygiene.
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Affiliation(s)
- A Steffen
- HNO-Klinik, Lübeck, Universität zu Lübeck, Lübeck
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Schröter-Morasch H, Ziegler W. Rehabilitation of impaired speech function (dysarthria, dysglossia). GMS Curr Top Otorhinolaryngol Head Neck Surg 2005; 4:Doc15. [PMID: 22073063 PMCID: PMC3201013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Speech disorders can result (1) from sensorimotor impairments of articulatory movements = dysarthria, or (2) from structural changes of the speech organs, in adults particularly after surgical and radiochemical treatment of tumors = dysglossia. The decrease of intelligibility, a reduced vocal stamina, the stigmatization of a conspicuous voice and manner of speech, the reduction of emotional expressivity all mean greatly diminished quality of life, restricted career opportunities and diminished social contacts. Intensive therapy based on the pathophysiological facts is absolutely essential: Functional exercise therapy plays a central role; according to symptoms and their progression it can be complemented with prosthetic and surgical approaches. In severe cases communicational aids have to be used. All rehabilitation measures have to take account of frequently associated disorders of body motor control and/or impairment of cognition and behaviour.
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Affiliation(s)
- Heidrun Schröter-Morasch
- Abteilung Neuropsychologie, Städtisches Klinikum München GmbH, Krankenhaus München-Bogenhausen, München, Deutschland,*To whom correspondence should be addressed: Heidrun Schröter-Morasch, Abteilung Neuropsychologie, Städtisches Klinikum München GmbH, Krankenhaus München-Bogenhausen, Englschalkinger Str. 77, D-81925 München, Deutschland, Tel.: +49-89-92702437, Fax: +49-89-92702089, E-mail:
| | - Wolfram Ziegler
- Abteilung Neuropsychologie, Städtisches Klinikum München GmbH, Krankenhaus München-Bogenhausen, München, Deutschland
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Schröter-Morasch H, Ziegler W. [Speech dysfunction. Reconstructive procedures in speech dysfunction (dysarthria, dysglossia)]. Laryngorhinootologie 2005; 84 Suppl 1:S213-20. [PMID: 15846553 DOI: 10.1055/s-2005-861145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Schröter-Morasch
- Abt. Neuropsychologie, Städtisches Klinikum München GmbH, Krankenhaus Bogenhausen, Englschalkingerstrasse 77, 81925 Munich.
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Schröter-Morasch H. Laryngeale Bewegungsstörungen nach ZNS-Läsionen und ihre funktionelle Relevanz. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schröter-Morasch H, Bartolome G, Troppmann N, Ziegler W. Values and limitations of pharyngolaryngoscopy (transnasal, transoral) in patients with dysphagia. Folia Phoniatr Logop 1999; 51:172-82. [PMID: 10450024 DOI: 10.1159/000021495] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During the last decade, videoendoscopic evaluation of structures and sensorimotor functions of the pharynx and larynx has been established as a valuable tool in the assessment of dysphagia. This method is feasible at a very early stage and in critically ill patients, is not invasive and frequently repeatable. Several authors described the high sensitivity and specificity of this method in detecting the presence of the most important symptoms of swallowing dysfunction: retention, penetration and aspiration. In our study of 39 patients with neurogenic dysphagia, we found high agreement between the results of videoendoscopic and videofluoroscopic examination regarding the registration of the most critical symptom, i.e. aspiration. Moreover, we observed patients who aspirated only their saliva and whose endoscopically verified aspiration problem remained undetected by radiographic examination, probably due to the lower sensory input of saliva as compared to a contrast medium. Since the detection of aspiration of saliva is of high clinical relevance for pulmonary function, the endoscopic examination turned out to be superior, in this particular respect, to the radiographic examination. However, the method fails to provide sufficient information regarding the cause of the observed symptoms or the amount of aspirated material. Six patients in our study exhibited, in addition to the neurological signs, structural changes (diverticula, pouches) or unexpected functional esophageal disturbances (persistent opening of the upper esophageal sphincter, retrograde peristalsis) which could only be detected by radiographic examination. The two methods should therefore be considered complementary.
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Affiliation(s)
- H Schröter-Morasch
- Department of Neuropsychology, City Hospital Bogenhausen, Munich, Germany
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12
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Schröter-Morasch H, Bartolome G. Swallowing disorders: pathophysiology and rehabilitation of neurogenic dysphagia. NeuroRehabilitation 1998. [DOI: 10.3233/nre-1998-10302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Heidrun Schröter-Morasch
- Department of Neuropsychology and Department of Physical Medicine and Medical Rehabilitation, City Hospital Munich-Bogenhausen, Englschalkingerstr. 77, D-81925 Munich, Germany
| | - Gudrun Bartolome
- Department of Neuropsychology and Department of Physical Medicine and Medical Rehabilitation, City Hospital Munich-Bogenhausen, Englschalkingerstr. 77, D-81925 Munich, Germany
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13
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Schröter-Morasch H. Swallowing disorders: pathophysiology and rehabilitation of neurogenic dysphagia. NeuroRehabilitation 1998. [DOI: 10.1016/s1053-8135(97)00060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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