Lingual Pressure Dysfunction Contributes to Reduced Swallowing-Related Quality of Life in Parkinson's Disease

Purpose Dysphagia in Parkinson's disease (PD) is a major cause of depression and reduced quality of life (QOL). PD-related dysphagia often involves lingual dysfunction and weak pressure generation. The relation of disordered lingual pressure generation to swallowing-related QOL in persons with PD remains unknown. Method Twenty-four persons with idiopathic PD completed the Swallowing Quality of Life (SWAL-QOL) questionnaire and an evaluation of anterior and posterior tongue strength. Peak pressures were compared to age- and sex-matched controls. The magnitude of and latency to peak pressure were explored in relation to SWAL-QOL scores. Results Persons with PD exhibited significant anterior (p = .019) but not posterior (p = .081) lingual weakness compared to controls. Persons with PD and reduced anterior tongue strength (< 42 kPa) reported lower SWAL-QOL total (p = .043), extended eating durations (p = .025), and a reduced desire to eat (p = .020). Prolonged latency to peak anterior pressure in PD inversely correlated with SWAL-QOL total (r = -.750, p < .001) and served as a significant, independent predictor of 67% of the variance in SWAL-QOL total when controlling for age, sex, and disease stage. Conclusion Overall, SWAL-QOL scores declined in the presence of lingual pressure dysfunction. Lingual weakness and prolonged pressure building patterns secondary to PD, especially of the anterior tongue, may represent clinically relevant disruptions to mealtime behaviors that undermine swallowing-related QOL. These preliminary findings support further investigation of lingual pressure patterns in PD to help identify debilitating dysphagia and develop treatment strategies.

Orofacial pain symptoms and associated disability and psychosocial impact in community-dwelling and institutionalized elderly in Hong Kong

OBJECTIVE

The study investigated the experience of orofacial pain (OFP) symptoms and associated disability and psychosocial impact in community dwelling and institutionalized elderly people in Hong Kong.

METHODS

A community-based cross-sectional survey involving elders aged 60 years and above. Participants were recruited at social centres for the elderly and homes for the aged throughout Hong Kong. Elders who reported OFP symptoms in the previous four weeks took part. Standard questions were asked about OFP conditions in the previous month and the Manchester Orofacial Pain Disability Scale (MOPDS), the Oral Health Impact Profile (OHIP-14) and the General Health Questionnaire (GHQ-12) were administered. The MOPDS was translated and validated for use in Chinese elders.

RESULTS

200 community dwelling and 200 institutionalized elders participated. Toothache was the most common symptom (62.0%) and burning sensation in the tongue was least common (0.5%). The distribution of pain symptoms, pain duration and severity and pain ratings were similar in both groups. The MOPDS (Chinese elders version) had good reliability and construct validity. The MOPDS and OHIP-14 summary scores was significantly higher in the institutionalized elderly (p < 0.001 and p < 0.013, respectively). Psychological distress (GHQ-12 score > or = 4) was more common among the institutionalized elderly (11%) than the community dwelling elderly (4.0%, p = 0.002).

CONCLUSIONS

Orofacial pain symptoms were associated with significant disability and had a detrimental impact on psychological distress level and quality of life, particularly in the institutionalized elderly. There is a need to improve access to professional care and health-related outreach services generally for elderly people in Hong Kong.

Ankyloglossia and effects on breast-feeding, speech problems and mechanical/social issues in children

BACKGROUND

This aim of this study was to define the characteristics of the patients who underwent surgery for ankyloglossia.

PATIENTS AND METHODS

The patients (n = 127) with ankyloglossia underwent surgery between 1987 and 2005. The patients were evaluated for age, gender, complaints, grade, and operative procedures. This study did not cover postoperative evaluation of the procedure.

RESULTS

The ages of the children ranged from 20 days to 7 years, and 84% of them were under 1 year of age. Seventy-two percent were boys; 28% were girls. The most common complaint of the parents of infants under one year of age was breast-feeding (35/84). When the tongue movements of the patients were examined, 57 patients (of whom 18 were over one year of age) had limited tongue mobility. The mean frenulum length of the patients was grade 1 in 72 patients and grade 2 in 55 patients. Ankyloglossia was corrected by frenotomy. Three patients had bleeding from their frenotomy site which resolved with local pressure. General anaesthesia was preferred for 77 patients, and there was a need for suturing in 20 patients.

CONCLUSION

The correction of ankyloglossia at an early age reduces the risk of latent complications. In addition, the early correction will mitigate the feeding- and speech-related concerns of parents and doctors alike.

[The tongue in the formation of articulated speech]

The approach to problems related to the science of language often deviates from standards accepted in linguistics. This article contains comments to the subchapter "The tongues in the formation of articulated speech" from the tetextbook of Prof. Zofia Knychalskiej-Karwan entitles "The tongue. Physiology and pathology".

Ankyloglossia: The Adolescent and Adult Perspective

OBJECTIVES: We sought to characterize examination findings and functional limitations due to ankyloglossia in adolescents and adults and to evaluate frenuloplasty in this group.

STUDY DESIGN: A prospective study was conducted of 15 individuals with ankyloglossia aged 14 to 68 years. Baseline symptoms were recorded by questionnaire, and tongue mobility measures were compared with that of 20 control subjects. Six subjects were reassessed postfrenuloplasty.

RESULTS: Thirteen of 14 patients with uncorrected ankyloglossia (93%) noted symptoms including speech problems (50%) and mechanical limitations (57%), such as difficulty licking the lips. Mean tongue protrusion and elevation at baseline measured 15.5 ± 6.0 mm and 13.6 ± 8.0 mm, respectively, for patients and 32.0 ± 3.9 mm and 30.3 ± 4.9 mm for control subjects ( P < 0.001). Postfrenuloplasty, tongue function improved both subjectively and objectively in 6 of 6 patients, with a mean gain of 9.2 mm for protrusion ( P < 0.05) and 13.0 mm for elevation ( P < 0.001).

CONCLUSION: Symptoms related to ankyloglossia are prevalent in this age group and respond favorably to frenuloplasty.

Self-inflicted tongue ulcer: an unusual form of factitious disorder

Factitious disorders in the buccal cavity are infrequent. A 9-year-old boy with a 5-year history of an artefact ulcer of the tongue is described. Psychiatric evaluation revealed an altered personality structure with a background of psychotic traits. Complete remission was observed with psychiatric management.