Dysphagia After Total Laryngectomy: An Exploratory Study and Clinical Phase II Rehabilitation Trial with the Novel Swallowing Exercise Aid (SEA 2.0)

The aims of this exploratory study and clinical phase II trial were to assess the specific nature and extent of dysphagia in laryngectomized patients with self-reported dysphagia, and its rehabilitation potential using the novel Swallowing Exercise Aid (SEA 2.0). Twenty laryngectomized patients participated in a six-week exercise program with the SEA 2.0. Exercises consisted of Chin Tuck Against Resistance (CTAR), Jaw Opening Against Resistance (JOAR), and Effortful Swallow Against Resistance, conducted three times per day. Swallowing was assessed at baseline (T0), six (T1) and 14 (T2) weeks, consisting of patient-reported outcomes, BMI, videofluoroscopy, swallowing capacity, and muscle strength measurements. Dysphagia significantly impacts quality of life, with impaired swallowing speed and bolus propulsion as main reported issues. Subjective dysphagia parameters, swallowing capacity, and pharyngeal residue clearance were reduced, but BMI was normal. Muscle and tongue strength were within normal ranges. All participants managed to use the SEA 2.0. Adherence was 95%. At T1, subjective swallowing parameters (MDADI and EAT-10) showed clinically relevant improvements. Objectively, CTAR and JOAR strength increased with 27.4 and 20.1 Newton, respectively. Also, swallowing capacity (from 2.4 g/s to 3.8 g/s) and pharyngeal residue clearance improved. At T2, results were slightly lower than at T1, but still better than at baseline. Dysphagia in laryngectomized patients affects quality of life, but swallowing can be improved with a six-week rehabilitation program using the novel SEA 2.0. Adherence was excellent and several subjective and objective swallowing parameters improved.

Comparative Study Between Peristomal Patches in Patients with Definitive Tracheostomy

Introduction  To prevent or diminish pulmonary problems in laryngectomized patients, continuous use of a heat and moisture exchanger (HME) is recommended. Therefore, automatic speaking valves are also often combined with an HME to enable hands-free speech. In order to keep these devices in place, most commonly, peristomal patches are used.

Objective  This prospective clinical 2 × 2 crossover study aims at assessing the added value of a new patch for HME application, the Provox StabiliBase OptiDerm (SBO). The device combines the stable and conical base of the Provox StabiliBase with the skin-friendlier hydrocolloid Provox OptiDerm (OD) patch.

Methods  Thirty-two laryngectomized patients were included in this multicenter study. Participants were asked to compare SBO to OD, and to the patch they normally use. The primary outcome measure was patient preference.

Results  Overall, 60% of the participants had preference for their normally used patch, 23% preferred the SBO and 17% indicated no preference. When comparing the SBO to the OD, 43% preferred the SBO, 40% the OD and 17% had no preference.

Conclusion  Most patients preferred their normally used patch and SBO was favored by a subgroup. Provox StabiliBase OptiDerm seems to be a valuable addition to the existing patches and further increases patients' options for HME application.

The cost-effectiveness of TheraBite® as treatment for acute myogenic temporomandibular disorder

OBJECTIVE

Temporomandibular disorder (TMD) is a very common and costly pain problem concerning the temporomandibular joint. A previous study has shown that for the treatment of acute myogenic TMD, TheraBite® (TB) offers a faster and greater effect than usual care consisting of physical therapy (PT). This study estimates the cost-effectiveness of TB compared to PT.

METHODS

Differences in costs and quality-adjusted life-years (QALYs) between TB and PT are analyzed using a decision model.

RESULTS

The point estimate for the incremental cost-effectiveness ratio is -28,068 EUR (-30,191 USD) per QALY (dominant) for TB versus PT. At the willingness-to-pay ratio of 20,000 EUR (21,513 USD) per QALY, TB has a 97% probability of being cost-effective compared to PT.

CONCLUSION

TB is expected to be cost-effective compared to PT for the treatment of acute myogenic TMD, offering faster recovery of quality of life for patients, at a lower cost to society.

Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial, comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise

AIMS

To compare in a randomized controlled clinical trial (RCT) the application of the TheraBite® (TB) Jaw Motion Rehabilitation System with a standard physical therapy (PT) exercise regimen for the treatment of myogenic temporomandibular disorder (TMD).

METHODOLOGY

Myogenic TMD patients were randomized for the use of the TB device or for standard PT. Mandibular function was assessed with the mandibular function impairment questionnaire (MFIQ). Pain was evaluated using a visual analog scale, and maximum inter-incisor (mouth) opening (MIO) was measured using the disposable TB range of motion scale.

RESULTS

Of the 96 patients randomized (46 TB, 50 standard PT exercises), 38 actually started with the TB device and 41 with the standard PT exercises. After six-week follow-up, patients using the TB device reported a significantly greater functional improvement (MFIQ score) than the patients receiving regular PT exercises (P = 0.0050). At 6 weeks, no significant differences in pain, and active or passive MIO were found between the two groups. At 3 months, patients in both treatment groups did equally well, and showed a significant improvement in all parameters assessed.

CONCLUSIONS

This RCT on myogenic TMD treatment, comparing standard PT with passive jaw mobilization using the TheraBite Jaw Motion Rehabilitation System®, shows that both treatment modalities are equally effective in relieving myogenic TMD symptoms, but that the use of the TB device has the benefit of achieving a significantly greater functional improvement within the first week of treatment.

Early changes in the glycopeptides of human B-lymphocytes after Epstein-Barr virus infection in vitro

Human B lymphocytes obtained from healthy donors were infected with Epstein-Barr virus in vitro. From the initiation of infection to the final establishment of a permanent lymphoblastoid cell line, fucosyl glycopeptides of the cell surface were investigated. In order of appearance the following events took place: expression of Epstein-Barr virus-determined nuclear antigen, mitotic activity of the cells and specific glycopeptide alterations on the cell surface. This specific alteration in glycopeptides, as determined by gel filtration, is manifested by the appearance of fast-eluting glycopeptides and was similar to that found on Burkitt lymphoma cells. Neither pokeweed-mitogen-stimulated B lymphocytes nor exponentially growing normal T lymphocytes exposed fast-eluting glycopeptides on their surfaces. Therefore, it is concluded that the appearance of these fast-eluting glycopeptides on the surface of lymphoblastoid cells after EBV infection is not the result of culture conditions or conditions of growth as such. The similarity with glycopeptides derived from Burkitt lymphoma cells, and the observation that a considerable proportion of the B cells becomes immortalized, are discussed.

An immunofluorescence technique with counterstain on fixed cells for the detection of antibodies to human herpesviruses; antibody patterns in patients with Hodgkin's disease and nasopharyngeal carcinoma

An indirect immunofluorescence (IF) test on fixed cells with Evans' blue counterstain is described for all four human herpesviruses, i.e., herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Comparison with immunodiffusion (ID) for HSV-2 and with ID and complement fixation (CF) for VZV and CMV demonstrated the specificity and high sensitivity of the IF test. Also introduced is a modification of the anti-complement immunofluorescence (ACIF) test for EBV-determined nuclear antigen (EBNA), permitting simultaneous titration of antibodies to this nuclear antigen and of the anti-nuclear factor (ANF). Seroepidemiological studies of these viruses in patients with Hodgkin's disease (HD) in the Netherlands revealed the following pattern: (1) in nodular sclerosing (NS) HD there is a 4-fold (significant) elevation in antibody titer to EBV-VAC, but no elevation to EBV-EA and EBNA; (2) in mixed cellularity (MC) HD a 10-fold (significant) elevation to both EBV-VCA and EA, but no elevation to EBNA is found compared to the control groups. These patterns in NS and MC HD are different from the pattern in nasopharyngeal carcinoma (NPC) which manifests elevations in antibody titers to EBV-VCA and EA as well as to EBNA. Antibody titers to HSV, VZV and CMV are not significantly elevated in either HD or NPC.

Immunofluorescence and anti-complement immunofluorescence absorption tests for quantitation of Epstein-Barr virus-associated antigens

Immunofluorescence absorption methods are described which permit quantitative estimation and differentiation of Epstein-Barr virus (EBV)-associated antigens (virus capsid antigen, VCA, early antigen, EA and EBV-determined nuclear antigen, EBNA) in cell extracts. EBNA was present in all cell lines (producer and non-producer) which carried the EBV-genome, while VCA and EA were present in producer lines only. All the antigens were absent from a lymphoid cell line (MOLT-4) which lacked the EBV-genome, as well as from leukemia cells from peripheral blood. The techniques demonstrated antigenic identity of the various antigens when prepared from different cell lines.

Elevated immunofluorescence antibody titers to several herpesviruses in Burkitt's lymphoma patients: are high titers unique?

Antibody titers for viral capsid antigens of all four human herpesviruses were measured by immunofluorescence in the sera of 16 Burkitt's lymphoma (BL) PATIENTS, 16 AGE-, SEX-, AND LOCALITY-MATCHED CONTROLS, AND 136 FAMILY MEMBERS FROM THE West Nile District of Uganda. Among family members, titers greater than 1:4 were found in 98% for herpes simplex virus (HSV), 86% for varicella-zoster virus (VZV), 100% FOR CYTOMEGALOVIRUS (CMV), AND 94% FOR Epstein-Barr (EBV). Titers in patients averaged approximately equal to 2 logs (fourfold) higher than those in matched controls for EBV, VZV, and CMV (P EQUALS 0.001); titers for HSV were only slightly higher in cancer patients. The mothers of patients had someuhat higher EBV titers (0.05 smaller than or equal to P SMALLER THAN OR EQUAL TO 0.01) than the mothers of controls, but no other differences between patient and control families were found. By immunofluorescence, a method which apparently has not been used for all four human herpesviruses in BL patients, the patients had elevated antibody titers not only to EBV but also to CMV and VZV. The elevated titers to three of the four human herpesviruses were not due to serologic cross reactions.