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Chabrillac E, Baudel L, Vergez S, Woisard V, Farenc JC, Morisseau M, Dupret-Bories A. Videofluoroscopic swallowing study to detect pharyngeal leak after total (pharyngo-) laryngectomy: Retrospective assessment of a single-institution protocol. Head Neck 2024; 46:740-748. [PMID: 38168752 DOI: 10.1002/hed.27617] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We aimed to assess the effectiveness of a single-institution protocol of videofluoroscopic swallowing study (VFSS) for the detection of pharyngeal leak (PL) and its usefulness to mitigate evolution into subsequent pharyngocutaneous fistula (PCF) after total (pharyngo-) laryngectomy (TL). METHODS This retrospective single-center study was conducted between February 2014 and December 2022. We included all patients who underwent TL and performed a VFSS between Day 7 and Day 14 postoperatively to detect a subclinical PL. RESULTS Two-hundred and forty-eight patients met the inclusion criteria. Among the 186 patients (75%) with a negative VFSS, 11 patients (5.9%) developed a secondary PCF after oral intake resumption (false negative of VFSS). Among the 62 patients (25%) with a positive VFSS, the occurrence of a PCF was avoided in 59.7% of cases. CONCLUSION This study showed a good effectiveness of VFSS in the detection of PL after TL, alongside a usefulness to mitigate evolution into subsequent PCF.
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Affiliation(s)
- Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
- Department of Oncorehabilitation, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
| | - Lucile Baudel
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
- Department of Ear, Nose & Throat Surgery, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Sébastien Vergez
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
- Department of Ear, Nose & Throat Surgery, Toulouse University Hospital - Larrey Hospital, Toulouse, France
| | - Virginie Woisard
- Department of Oncorehabilitation, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
| | - Jean-Claude Farenc
- Department of Oncorehabilitation, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
| | - Mathilde Morisseau
- Department of Biostatistics, Oncopole Claudius Regaud, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
| | - Agnès Dupret-Bories
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
- Department of Ear, Nose & Throat Surgery, Toulouse University Hospital - Larrey Hospital, Toulouse, France
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2
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Nakamori M, Imamura E, Maetani Y, Yoshida M, Yoshikawa M, Nagasaki T, Masuda S, Kayashita J, Mizoue T, Wakabayashi S, Maruyama H, Hosomi N. Prospective Observational Study for the Comparison of Screening Methods Including Tongue Pressure and Repetitive Saliva Swallowing With Detailed Videofluoroscopic Swallowing Study Findings in Patients With Acute Stroke. J Am Heart Assoc 2024; 13:e032852. [PMID: 38293925 PMCID: PMC11056116 DOI: 10.1161/jaha.123.032852] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Simple, noninvasive, and repeatable screening methods are essential for assessing swallowing disorders. We focused on patients with acute stroke and aimed to assess the characteristics of swallowing screening tests, including the modified Mann Assessment of Swallowing Ability score, tongue pressure, and repetitive saliva swallowing test (RSST), compared with detailed videofluoroscopic swallowing study (VFSS) findings to contribute as a helpful resource for their comprehensive and complementary use. METHODS AND RESULTS We enrolled first-ever patients with acute stroke conducting simultaneous assessments, including VFSS, modified Mann Assessment of Swallowing Ability score, tongue pressure measurement, and RSST. VFSS assessed aspiration, laryngeal penetration, oral cavity residue, vallecular residue, pharyngeal residue, and swallowing reflex delay. Screening tests were compared with VFSS findings, and multiple logistic analysis determined variable importance. Cutoff values for each abnormal VFSS finding were assessed using receiver operating characteristic analyses. We evaluated 346 patients (70.5±12.6 years of age, 143 women). The modified Mann Assessment of Swallowing Ability score was significantly associated with all findings except aspiration. Tongue pressure was significantly associated with oral cavity and pharyngeal residue. The RSST was significantly associated with all findings except oral cavity residue. Receiver operating characteristic analyses revealed that the minimum cutoff value for all VFSS abnormal findings was RSST ≤2. CONCLUSIONS The modified Mann Assessment of Swallowing Ability is useful for broadly detecting swallowing disorders but may miss mild issues and aspiration. The RSST, with a score of ≤2, is valuable for indicating abnormal VFSS findings. Tongue pressure, especially in oral and pharyngeal residues, is useful. Combining these tests might enhance accuracy of the swallowing evaluation.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Eiji Imamura
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Yuta Maetani
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Mitsuyoshi Yoshida
- Department of Dentistry and Oral‐Maxillofacial Surgery, School of MedicineFujita Health UniversityToyoakeAichiJapan
- Department of Advanced ProsthodonticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Mineka Yoshikawa
- Department of Advanced ProsthodonticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial RadiologyHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Shin Masuda
- Department of Children SensoryHiroshima Prefectural HospitalHiroshimaJapan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and SciencesPrefectural University of HiroshimaHiroshimaJapan
| | - Tatsuya Mizoue
- Department of NeurosurgerySuiseikai Kajikawa HospitalHiroshimaJapan
| | | | - Hirofumi Maruyama
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Naohisa Hosomi
- Department of NeurologyChikamori HospitalKochiJapan
- Department of Disease Model, Research Institute of Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
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3
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Rho Y, Chon J, Yoo MC, Shim GY, Chung SJ, Soh Y. Acute cricopharyngeal achalasia after general anesthesia in myotonic dystrophy: A case report. Medicine (Baltimore) 2023; 102:e36378. [PMID: 38050269 PMCID: PMC10695545 DOI: 10.1097/md.0000000000036378] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Myotonic dystrophy type 1 (DM-1) is a progressive multisystem genetic disorder that causes myotonia and both distal limb and facial/neck muscle weakness by expanding the CTG repeats of the DMPK gene in chromosome 19q13.3. General anesthesia is indicated in DM-1 patients owing to their sensitivity to anesthetic drugs such as opioids, hypnotics, and neuromuscular blocking agents. PATIENT CONCERNS A 48-year-old male patient underwent a laparoscopic cholecystectomy for gallstones under general anesthesia. He experienced sudden cardiac arrest and respiratory failure the day after surgery. After a thorough review of past medical history, we recognized that 15 years prior, he had been diagnosed with classic type DM-1, but the diagnosis was not self-reported before general anesthesia. Symptoms of severe dysphagia developed subsequently. In a videofluoroscopic swallowing study (VFSS), we observed abrupt aggravation of myotonic dysphagia after general anesthesia. VFSS revealed cricopharyngeal opening dysfunction, with a remaining large residue in the pyriform sinus, resulting in a severe cricopharyngeal achalasia pattern. DIAGNOSIS Acute cricopharyngeal achalasia after general anesthesia. INTERVENTION AND OUTCOME The patient underwent a dysphagia rehabilitation program that included cricopharyngeal opening exercises and functional electrical stimulation. However, no significant improvement was observed in the cricopharyngeal achalasia in a 3-month follow-up VFSS. LESSONS Low body temperature and anesthetic medications such as opioids and hypnotic agents can induce myotonia in the cricopharyngeal muscle.
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Affiliation(s)
- Yunjung Rho
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jinmann Chon
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Myung Chul Yoo
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Ga Yang Shim
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung Joon Chung
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Yunsoo Soh
- Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
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Kim J, Ryu B, Kim Y, Choi Y, Lee E. Comparative Analysis of the Prevalence of Dysphagia in Patients with Mild COVID-19 and Those with Aspiration Pneumonia Alone: Findings of the Videofluoroscopic Swallowing Study. Medicina (Kaunas) 2023; 59:1851. [PMID: 37893569 PMCID: PMC10608040 DOI: 10.3390/medicina59101851] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Patients recovering from mild coronavirus disease (COVID-19) reportedly have dysphagia or difficulty in swallowing. We compared the prevalence of dysphagia between patients diagnosed with mild COVID-19 and those diagnosed with aspiration pneumonia alone. Materials and Methods: A retrospective study was conducted from January 2020 to June 2023 in 160 patients referred for a videofluoroscopic swallowing study (VFSS) to assess for dysphagia. The cohort included 24 patients with mild COVID-19 and aspiration pneumonia, 30 with mild COVID-19 without aspiration pneumonia, and 106 with aspiration pneumonia alone. We reviewed the demographic data, comorbidities, and VFSS results using the penetration-aspiration scale (PAS) and functional dysphagia scale (FDS). Results: In a study comparing patients with mild COVID-19 (Group A) and those with aspiration pneumonia alone (Group B), no significant differences were observed in the baseline characteristics, including the prevalence of dysphagia-related comorbidities between the groups. Group A showed milder dysphagia, as evidenced by lower PAS and FDS scores, shorter oral and pharyngeal transit times (p = 0.001 and p = 0.003, respectively), and fewer residues in the vallecula and pyriform sinuses (p < 0.001 and p < 0.03, respectively). When Group A was subdivided into those with COVID-19 with (Group A1) and without aspiration pneumonia (Group A2), both subgroups outperformed Group B in terms of specific VFSS metrics, such as oral transit time (p = 0.01), pharyngeal transit time (p = 0.04 and p = 0.02, respectively), and residue in the vallecula (p = 0.04 and p = 0.02, respectively). However, Group B showed improved triggering of the pharyngeal swallowing reflex compared with Group A2 (p = 0.02). Conclusion: Mild COVID-19 patients showed less severe dysphagia than those with aspiration pneumonia alone. This finding was consistent across VFSS parameters, even when the COVID-19 group was subdivided based on the status of aspiration pneumonia.
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Affiliation(s)
| | | | | | | | - Eunyoung Lee
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul 02500, Republic of Korea; (J.K.); (B.R.); (Y.K.)
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5
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Cui Q, Wei B, He Y, Zhang Q, Jia W, Wang H, Xi J, Dai X. Findings of a videofluoroscopic swallowing study in patients with dysphagia. Front Neurol 2023; 14:1213491. [PMID: 37609654 PMCID: PMC10441781 DOI: 10.3389/fneur.2023.1213491] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Objective Swallowing examination is crucial in patients with dysphagia. We aimed to compare qualitative and quantitative videofluoroscopic swallowing study (VFSS) results to provide reference for standardizing quantitative parameters. Materials and methods In total, 117 patients with dysphagia were included, 38 with Parkinson's disease and 39 and 40 in convalescence following cerebral hemorrhage and infarction. VFSS was both qualitatively and quantitatively analyzed. Results A significant difference of Oral transit time was found between the oral motor function grades (p < 0.001), also was swallowing reaction times found between swallowing reaction duration grades (p < 0.001), and soft palate lift duration between the soft palate lift grades (p < 0.001). Superior hyoid bone movement (p < 0.001), anterior hyoid bone movement (p < 0.001), hyoid pause time (p < 0.001), and hyoid movement duration (p = 0.032) had significant differences between the hyoid laryngeal complex movement grades, as did the pharyngeal cavity transit time among the cricopharyngeal muscle opening duration grades (p < 0.001). The laryngeal vestibule closure duration differed among the glottic closure grades (p < 0.001). No statistically significant difference in upper esophageal sphincter opening diameter (p = 0.682) or duration (p = 0.682) among the cyclopharyngeal muscle opening duration grades. The pharyngeal area at rest did not significantly differ among the different vallecular residue (p = 0.202) and pyriform sinus residue (p = 0.116) grades. Conclusion Several quantitative parameters can reflect the swallowing assessment process well. Further optimization of quantitative parameters is recommended.
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Affiliation(s)
- Qingjia Cui
- Rehabilitation Centre of Otolaryngology-Head and Neck, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Bing Wei
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan He
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Weiwei Jia
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Haiying Wang
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xin Dai
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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6
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Willemsen ACH, Pilz W, Hoeben A, Hoebers FJP, Schols AMWJ, Baijens LWJ. Oropharyngeal dysphagia and cachexia: Intertwined in head and neck cancer. Head Neck 2023; 45:783-797. [PMID: 36583567 DOI: 10.1002/hed.27288] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/17/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study aims to investigate the relationship between cancer cachexia and oropharyngeal dysphagia (OD) in patients with head and neck cancer (HNC) prior to chemoradiotherapy or bioradiotherapy (CRT/BRT). METHODS A prospective cohort study with patients with HNC undergoing CRT/BRT (2018-2021) was conducted. Body composition and skeletal muscle function were evaluated using bioelectrical impedance analysis, handgrip strength, and the short physical performance battery (SPPB). The M. D. Anderson Dysphagia Inventory (MDADI), Eating Assessment Tool (EAT)-10 questionnaire, and patient characteristics were collected. A standardized videofluoroscopic swallowing study was offered to patients. RESULTS Sixty-six patients were included. Twenty-six patients scored EAT-10 ≥ 3 and seventeen were cachectic. ACE-27 score >1, cachexia, abnormal SPPB-derived repeated chair-stand test, lower MDADI scores, and higher overall stage grouping showed potential predictive value (p ≤ 0.10) for EAT-10 ≥ 3. Using multivariable regression analysis, only cachexia remained a significant predictor of EAT-10 ≥ 3 (HR 9.000 [95%CI 2.483-32.619], p = 0.001). CONCLUSION Cachexia independently predicted the presence of patient-reported OD.
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Affiliation(s)
- Anna C H Willemsen
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Walmari Pilz
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,School for Mental Health and Neuroscience - MHeNs, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ann Hoeben
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frank J P Hoebers
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Laura W J Baijens
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
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7
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Hirasaki M, Takagi D, Umeda Y, Moriwaki M, Katagiri N, Nomoto A, Ohno T, Fujishima I. A Case of Dysphagia and Dysarthria Improved by Flexible-palatal Lift/augmentation Combination Prosthesis. Prog Rehabil Med 2023; 8:20230006. [PMID: 36866153 PMCID: PMC9970843 DOI: 10.2490/prm.20230006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
Background Palatal augmentation prosthesis (PAP) and palatal lift prosthesis (PLP) have been used to improve dysphagia and dysarthria. However, to date, there are few reports on their combined use. We report a quantitative evaluation of the effectiveness of a flexible-palatal lift/augmentation combination prosthesis (fPL/ACP) based on videofluoroscopic swallowing study (VFSS) and speech intelligibility testing. Case An 83-year-old woman was admitted to our hospital with a hip fracture. She developed aspiration pneumonia at 1 month after partial hip replacement. Oral motor function tests revealed a motor deficit of the tongue and soft palate. VFSS showed delayed oral transit, nasopharyngeal reflux, and excessive pharyngeal residue. The cause of her dysphagia was assumed to be pre-existing diffuse large B-cell lymphoma and sarcopenia. To improve the dysphagia, an fPL/ACP was fabricated and applied. It improved the patient's oral and pharyngeal swallowing and speech intelligibility. In addition to prosthetic treatment, rehabilitation and nutritional support allowed her to be discharged. Discussion The effects of fPL/ACP in the present case were similar to those of flexible-PLP and PAP. f-PLP assists in elevation of the soft palate and improved the nasopharyngeal reflux and hypernasal speech. PAP promotes tongue movement and results in improved oral transit and speech intelligibility. Therefore, fPL/ACP may be effective in patients with motor deficits in both the tongue and soft palate. To maximize the effect of the intraoral prosthesis, a transdisciplinary approach with concurrent swallowing rehabilitation, nutritional support, and physical and occupational therapy is necessary.
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Affiliation(s)
- Mami Hirasaki
- Department of Rehabilitation, Mikatahara Bethel-home, Shizuoka, Japan
| | - Daisuke Takagi
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Yoshiko Umeda
- Department of Dentistry, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Motoki Moriwaki
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Norimasa Katagiri
- Department of Rehabilitation Medicine, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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Abstract
Objective Dysphagia is common in patients with cervical osteophytes. We aimed to
determine whether head rotation as a compensatory technique is effective for
dysphagia caused by unilateral cervical osteophytes. Methods We retrospectively analyzed videofluoroscopic swallowing study (VFSS) data
obtained in one university hospital. Patients whose VFSS showed pharyngeal
stasis by mechanical obstruction due to cervical osteophytes were selected.
They were divided into a unilateral skewed osteophyte group and a diffuse
central osteophyte group as confirmed by laryngoscopy or computed
tomography. The effect of head rotation on swallowing was investigated.
Fisher’s exact test was used for statistical analysis. Results Among 2876 patients who underwent VFSSs, we identified 48 patients with
osteophyte-induced dysphagia. The osteophytes were centrally located in 36
patients and unilateral in the remaining 12. Ten of the patients with
unilateral osteophytes showed improvement when they swallowed with head
rotation toward the osteophyte side, but none of the patients with central
osteophytes showed effective swallowing. A statistically significant
relationship was found between swallowing with head rotation and skewed
cervical osteophytes. Conclusion Swallowing with head rotation was safe, easy, and effective for patients with
dysphagia caused by unilateral cervical osteophytes. We advise attempting
this method prior to considering surgical approaches.
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Affiliation(s)
- Minsu Seo
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
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Abstract
The methods of measuring laryngeal elevation during swallowing are time-consuming. We aimed to propose a quick-to-use neural network (NN) model for measuring laryngeal elevation quantitatively using anatomical structures auto-segmented by Mask region-based convolutional NN (R-CNN) in videofluoroscopic swallowing study. Twelve videofluoroscopic swallowing study video clips were collected. One researcher drew the anatomical structure, including the thyroid cartilage and vocal fold complex (TVC) on respective video frames. The dataset was split into 11 videos (4686 frames) for model development and one video (532 frames) for derived model testing. The validity of the trained model was evaluated using the intersection over the union. The mean intersections over union of the C1 spinous process and TVC were 0.73 ± 0.07 [0-0.88] and 0.43 ± 0.19 [0-0.79], respectively. The recall rates for the auto-segmentation of the TVC and C1 spinous process by the Mask R-CNN were 86.8% and 99.8%, respectively. Actual displacement of the larynx was calculated using the midpoint of the auto-segmented TVC and C1 spinous process and diagonal lengths of the C3 and C4 vertebral bodies on magnetic resonance imaging, which measured 35.1 mm. Mask R-CNN segmented the TVC with high accuracy. The proposed method measures laryngeal elevation using the midpoint of the TVC and C1 spinous process, auto-segmented by Mask R-CNN. Mask R-CNN auto-segmented the TVC with considerably high accuracy. Therefore, we can expect that the proposed method will quantitatively and quickly determine laryngeal elevation in clinical settings.
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Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Bo Mi Kwon
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | | | | | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
- Center for Neuroscience Research, Institute of Biomedical Science & Technology, Konkuk University, Seoul, Korea
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10
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Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
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11
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Takagi D, Ohno T, Moriwaki M, Katagiri N, Umeda Y, Tohara H, Nomoto A, Fujishima I. Effect of dentures on pharyngeal swallowing function in patients with dysphagia. Geriatr Gerontol Int 2021; 21:907-912. [PMID: 34355487 DOI: 10.1111/ggi.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/02/2021] [Accepted: 07/18/2021] [Indexed: 01/09/2023]
Abstract
AIM Dentures play an important role in improving masticatory and oropharyngeal swallowing functions in some edentulous patients without dysphagia. However, few studies have been conducted on patients with dysphagia. This study investigated the effect of dentures on pharyngeal swallowing function in patients with dysphagia. METHODS Older inpatients with dysphagia who used well-fitting dentures were included in the study. Videofluoroscopic swallowing study findings with and without dentures were compared. Pharyngeal residue and area as spatial, the distance between the maxilla and mandible, hyoid bone/laryngeal displacement, and upper esophageal sphincter opening as kinematics, oral/pharyngeal transit time as temporal measurements, and patient-reported symptoms were evaluated. The primary outcome was the pharyngeal residue measured using the normalized residue ratio scale. Comparisons were made using the paired t-test, Wilcoxon signed-rank test and Fisher's exact test. RESULTS The mean age of the 27 participants was 86.1 ± 6.8 years. The vallecular residue was more in those without dentures (with dentures: 0.01 [0-0.02], without dentures: 0.03 [0-0.08]; P = 0.003). The pyriform sinus residue showed no significant difference. Denture removal significantly increased the pharyngeal area. The distance between the maxilla and mandible decreased in the absence of dentures, and other kinematic measurements showed no significant differences. Oral/pharyngeal transit time was prolonged without dentures. CONCLUSIONS Morphological changes caused by the removal of dentures led to pharyngeal expansion, which may result in increased vallecular residue. A treatment plan that considers the effect of dentures on pharyngeal swallowing function may provide rehabilitation that is more effective. Geriatr Gerontol Int 2021; 21: 907-912.
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Affiliation(s)
- Daisuke Takagi
- Department of Rehabilitation, Seirei Mikatahata General Hospital, Hamamatsu, Japan.,Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Motoki Moriwaki
- Department of Rehabilitation, Seirei Mikatahata General Hospital, Hamamatsu, Japan
| | - Norimasa Katagiri
- Department of Rehabilitation Medicine, Seirei Mikatahata General Hospital, Hamamatsu, Japan
| | - Yoshiko Umeda
- Department of Dentistry, Seirei Mikatahata General Hospital, Hamamatsu, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akiko Nomoto
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
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12
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Kim Y, Kim HI, Park GS, Kim SY, Choi SI, Lee SJ. Reliability of Machine and Human Examiners for Detection of Laryngeal Penetration or Aspiration in Videofluoroscopic Swallowing Studies. J Clin Med 2021; 10:jcm10122681. [PMID: 34207049 PMCID: PMC8233836 DOI: 10.3390/jcm10122681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Computer-assisted analysis is expected to improve the reliability of videofluoroscopic swallowing studies (VFSSs), but its usefulness is limited. Previously, we proposed a deep learning model that can detect laryngeal penetration or aspiration fully automatically in VFSS video images, but the evidence for its reliability was insufficient. This study aims to compare the intra- and inter-rater reliability of the computer model and human raters. The test dataset consisted of 173 video files from which the existence of laryngeal penetration or aspiration was judged by the computer and three physicians in two sessions separated by a one-month interval. Intra- and inter-rater reliability were calculated using Cohen’s kappa coefficient, the positive reliability ratio (PRR) and the negative reliability ratio (NRR). Intrarater reliability was almost perfect for the computer and two experienced physicians. Interrater reliability was moderate to substantial between the model and each human rater and between the human raters. The average PRR and NRR between the model and the human raters were similar to those between the human raters. The results demonstrate that the deep learning model can detect laryngeal penetration or aspiration from VFSS video as reliably as human examiners.
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Affiliation(s)
- Yuna Kim
- Department of Rehabilitation Medicine, Dankook University Hospital, Cheonan 31116, Korea; (Y.K.); (G.S.P.); (S.Y.K.)
| | - Hyun-Il Kim
- Department of Computer Science and Engineering, Dankook University, Yongin 16890, Korea;
| | - Geun Seok Park
- Department of Rehabilitation Medicine, Dankook University Hospital, Cheonan 31116, Korea; (Y.K.); (G.S.P.); (S.Y.K.)
| | - Seo Young Kim
- Department of Rehabilitation Medicine, Dankook University Hospital, Cheonan 31116, Korea; (Y.K.); (G.S.P.); (S.Y.K.)
| | - Sang-Il Choi
- Department of Computer Science and Engineering, Dankook University, Yongin 16890, Korea;
- Department of Computer Engineering, Dankook University, Yongin 16890, Korea
- Correspondence: (S.-I.C.); (S.J.L.)
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, Dankook University Hospital, Cheonan 31116, Korea; (Y.K.); (G.S.P.); (S.Y.K.)
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea
- Correspondence: (S.-I.C.); (S.J.L.)
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13
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Lee BJ, Eo H, Lee C, Park D. Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Choosing the Feeding Method for Stroke Patients with Dysphagia. Healthcare (Basel) 2021; 9:632. [PMID: 34071752 DOI: 10.3390/healthcare9060632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Videofluoroscopic Dysphagia Scale (VDS) is used to predict the long-term prognosis of dysphagia in patients with strokes. However, the inter-rater reliability of the VDS was low in a previous study. To overcome the mentioned limitations of the VDS, the modified version of the VDS (mVDS) was created and clinically applied to evaluate its usefulness in choosing the feeding method for stroke patients with dysphagia. METHODS The videofluoroscopic swallowing study (VFSS) data of 56 stroke patients with dysphagia were collected retrospectively. We investigated the presence of aspiration pneumonia and the selected feeding method. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia after stroke. Univariate logistic regression and receiver operating characteristic analyses were used in the data analysis. RESULTS The inter-rater reliability (Cronbach α value) of the total score of the mVDS was 0.886, which was consistent with very good inter-rater reliability. In all patients with dysphagia, the supratentorial stroke subgroup, and the infratentorial stroke subgroup, the mVDS scores were statistically correlated with the feeding method selected (p < 0.05) and the presence of aspiration pneumonia (p < 0.05). CONCLUSIONS The mVDS can be a useful scale for quantifying the severity of dysphagia, and it can be a useful tool in the clinical setting and in studies for interpreting the VFSS findings in stroke patients with dysphagia. Further studies with a greater number of patients and various stroke etiologies are required for more generalized applications of the mVDS.
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14
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Lee KS, Lee E, Choi B, Pyun SB. Automatic Pharyngeal Phase Recognition in Untrimmed Videofluoroscopic Swallowing Study Using Transfer Learning with Deep Convolutional Neural Networks. Diagnostics (Basel) 2021; 11:diagnostics11020300. [PMID: 33668528 PMCID: PMC7918932 DOI: 10.3390/diagnostics11020300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 01/29/2023] Open
Abstract
Background: Video fluoroscopic swallowing study (VFSS) is considered as the gold standard diagnostic tool for evaluating dysphagia. However, it is time consuming and labor intensive for the clinician to manually search the recorded long video image frame by frame to identify the instantaneous swallowing abnormality in VFSS images. Therefore, this study aims to present a deep leaning-based approach using transfer learning with a convolutional neural network (CNN) that automatically annotates pharyngeal phase frames in untrimmed VFSS videos such that frames need not be searched manually. Methods: To determine whether the image frame in the VFSS video is in the pharyngeal phase, a single-frame baseline architecture based the deep CNN framework is used and a transfer learning technique with fine-tuning is applied. Results: Compared with all experimental CNN models, that fine-tuned with two blocks of the VGG-16 (VGG16-FT5) model achieved the highest performance in terms of recognizing the frame of pharyngeal phase, that is, the accuracy of 93.20 (±1.25)%, sensitivity of 84.57 (±5.19)%, specificity of 94.36 (±1.21)%, AUC of 0.8947 (±0.0269) and Kappa of 0.7093 (±0.0488). Conclusions: Using appropriate and fine-tuning techniques and explainable deep learning techniques such as grad CAM, this study shows that the proposed single-frame-baseline-architecture-based deep CNN framework can yield high performances in the full automation of VFSS video analysis.
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Affiliation(s)
- Ki-Sun Lee
- Medical Science Research Center, Ansan Hospital, Korea University College of Medicine, Ansan-si 15355, Korea
- Correspondence: (K.-S.L.); (S.-B.P.)
| | - Eunyoung Lee
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (E.L.); (B.C.)
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
| | - Bareun Choi
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (E.L.); (B.C.)
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (E.L.); (B.C.)
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Korea
- Brain Convergence Research Center, Korea University College of Medicine, Seoul 02841, Korea
- Correspondence: (K.-S.L.); (S.-B.P.)
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15
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Kim JW, Choi H, Jung J, Kim HJ. Risk factors for aspiration pneumonia in patients with dysphagia undergoing videofluoroscopic swallowing studies: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23177. [PMID: 33181693 PMCID: PMC7668488 DOI: 10.1097/md.0000000000023177] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Prediction of aspiration pneumonia development in at-risk patients is vital for implementation of appropriate interventions to reduce morbidity and mortality. Unfortunately, studies utilizing a comprehensive approach to risk assessment are still lacking. The objective of this study was to analyze the clinical features and videofluoroscopic swallowing study (VFSS) findings that predict aspiration pneumonia in patients with suspected dysphagia.Medical records of 916 patients who underwent VFSS between September 2014 and June 2018 were retrospectively analyzed. Patients were divided into either a pneumonia group or a non-pneumonia group based on diagnosis of aspiration pneumonia. Clinical information and VFSS findings were evaluated.One hundred seven patients (11.7%) were classified as having pneumonia. Multivariate analysis indicated that aspiration during the 2- cubic centimeter thick-liquid trial of VFSS (odds ratio [OR] = 3.23, 95% confidence interval [CI]: 1.93-5.41), smoking history (OR = 2.63, 95% CI: 1.53-4.53), underweight status (OR = 2.27, 95% CI: 1.31-3.94), abnormal pharyngeal delay time (OR = 1.60, 95% CI: 1.01-2.53), and a Penetration-Aspiration Scale level of 8 (OR = 3.73, 95% CI: 2.11-6.59) were significantly associated with aspiration pneumonia development. Integrated together, these factors were used to develop a predictive model for development of aspiration pneumonia (DAP), with a sensitivity of 82%, specificity of 56%, and an area under the receiver operating characteristic curve of 0.73.The best predictors for DAP included videofluoroscopic findings of aspiration during a 2-cubic centimeter thick-liquid trial, prolonged pharyngeal delay time, a Penetration-Aspiration Scale level of 8, history of smoking, and underweight status. These 5 proposed determinants and the associated DAP score are relatively simple to assess and may constitute a clinical screening tool that can readily identify and improve the management of patients at risk for aspiration pneumonia.
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16
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Kim KL, Park GY, Kwon DR, Kwon DY, Kwak SG, Cho HK. Airway invasion in non-neurologically ill patients with dysphagia: Contributing factors and associated problems during swallowing process. A retrospective observational study. Medicine (Baltimore) 2020; 99:e22977. [PMID: 33157940 PMCID: PMC7647595 DOI: 10.1097/md.0000000000022977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Dysphagia can occur among patients receiving medical care despite having no history of neurologic disease. The current study aimed to investigate factors contributing to airway invasion among non-neurologically ill patients with dysphagia.This retrospective study included 52 non-neurologically ill patients who complained of swallowing difficulty and consulted the Department of Rehabilitation Medicine for videofluoroscopic swallowing studies between January 2018 and June 2019. Patients were then divided into 2 groups according to the presence of airway invasion (penetration or aspiration) based on videofluoroscopic swallowing study findings, with group 1 (n = 26) consisting of patients with airway invasion and group 2 (n = 26) consisting of those without airway invasion. Demographic information, functional ambulation ability within the past 3 months, presence of community acquired pneumonia (CAP), nutritional status, degree of dehydration, history of intensive care unit stay, history of endotracheal intubation, and videofluoroscopic dysphagia scale were reviewed.Patients with airway invasion exhibited decreased functional ambulation ability, greater incidence of CAP, and lower serum albumin concentration than patients without airway invasion (P < .05). Airway invasion among non-neurologically ill patients was significantly associated with functional ambulation ability [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.14-11.19; P = .03], serum albumin concentration under 3.5 g/dL (OR, 4.90; 95% CI, 1.39-17.32; P = .01), and presence of CAP (OR, 5.06; 95% CI, 1.56-16.44; P = .01). Groups 1 and 2 had a videofluoroscopic dysphagia scale score of 37.18 and 16.17, respectively (P < .05). Moreover, bolus formation, tongue-to-palate contact, premature bolus loss, vallecular residue, coating of pharyngeal wall, and aspiration score differed significantly between both groups (P < .05).Airway invasion among non-neurologically ill patients was related to decreased functional ambulation ability, lower serum albumin concentration, and presence of CAP. The results presented herein can help guide clinical management aimed at preventing airway invasion among non-neurologically ill patients.
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Affiliation(s)
- Kang Lip Kim
- Department of Physical Medicine and Rehabilitation
| | | | | | - Do Yun Kwon
- Department of Physical Medicine and Rehabilitation
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Republic of Korea
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17
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Dewan K, Clarke JO, Kamal AN, Nandwani M, Starmer HM. Patient Reported Outcomes and Objective Swallowing Assessments in a Multidisciplinary Dysphagia Clinic. Laryngoscope 2020; 131:1088-1094. [PMID: 33103765 DOI: 10.1002/lary.29194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dysphagia encompasses a complex compilation of symptoms which often differ from findings of objective swallowing evaluations. The purpose of this investigation was to compare the results of subjective dysphagia measures to objective measures of swallowing in patients evaluated in a multidisciplinary dysphagia clinic. STUDY DESIGN Prospective cohort study. METHODS The study cohort included all patients evaluated in the multidisciplinary dysphagia clinic over 24 months. Participants were evaluated by a multidisciplinary team including a laryngologist, gastroenterologist, and speech-language pathologist. Evaluation included a videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), and transnasal esophagoscopy (TNE). Data collected included diet (FOIS), Eating Assessment Tool (EAT-10) score, Reflux symptom index (RSI) score, and the findings of the VFSS exam. RESULTS A total of 75 patients were included in the analysis. The average EAT-10 score was 16.3 ± 2.1, RSI was 21.4 ± 0.6, and FOIS score was 6.0 ± 1.33. VFSS revealed impairments in the oral phase in 40% of the cohort, pharyngeal in 59%, and esophageal in 49%. Abnormalities were noted in one phase for 32%, in 2 phases in 32%, and three phases in 18%. Patients with abnormal pharyngeal findings on VFSS had significantly higher EAT-10 scores (P = .04). Patients with abnormal oral findings on VFSS were noted to have significantly lower FOIS scores (P = .03). CONCLUSIONS Data presented here demonstrate a relationship between patient reported symptoms and objective VFSS findings in a cohort of patients referred for multidisciplinary swallowing assessment suggesting such surveys are helpful screening tools but inadequate to fully characterize swallowing impairment. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1088-1094, 2021.
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Affiliation(s)
- Karuna Dewan
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Afrin N Kamal
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Monica Nandwani
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Heather M Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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18
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Chang KH, Tzeng YT, Wey JH, Liu YJ, Lin YN, Chung WK. Pneumonia in Parkinson's disease: barium aspiration in videofluoroscopic swallowing study. Respirol Case Rep 2020; 8:e00546. [PMID: 32140228 PMCID: PMC7049666 DOI: 10.1002/rcr2.546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/07/2022] Open
Abstract
Barium aspiration into the tracheobronchial tree is a remarkable warning sign of dysphagia-related aspiration pneumonia. Clinical swallowing assessment is warranted for patients with aspiration pneumonia and videofluoroscopic swallowing study is a good add-on tool for dysphagia treatment plan. In patients with Parkinson's disease, dysphagia is often overlooked due to atypical presentations.
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Affiliation(s)
- Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital Taipei Medical University Taipei Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition Taipei Medical University Taipei Taiwan.,Taipei Neurological Institute Taipei Medical University New Taipei City Taiwan
| | - Yu-Tien Tzeng
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital Taipei Medical University Taipei Taiwan
| | - Jing-Hwa Wey
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital Taipei Medical University Taipei Taiwan.,Taipei Neurological Institute Taipei Medical University New Taipei City Taiwan
| | - Yuan-Jun Liu
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital Taipei Medical University Taipei Taiwan.,Taipei Neurological Institute Taipei Medical University New Taipei City Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital Taipei Medical University Taipei Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition Taipei Medical University Taipei Taiwan.,Taipei Neurological Institute Taipei Medical University New Taipei City Taiwan
| | - Wen-Kuei Chung
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital Taipei Medical University Taipei Taiwan.,Taipei Neurological Institute Taipei Medical University New Taipei City Taiwan.,Department of Neurosurgery, Wan Fang Hospital Taipei Medical University Taipei Taiwan
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19
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Kwon S, Sim J, Park J, Jung Y, Cho KH, Min K, Kim M, Kim JM, Im SH. Assessment of Aspiration Risk Using the Mann Assessment of Swallowing Ability in Brain-Injured Patients With Cognitive Impairment. Front Neurol 2019; 10:1264. [PMID: 31866926 PMCID: PMC6906202 DOI: 10.3389/fneur.2019.01264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/14/2019] [Indexed: 11/27/2022] Open
Abstract
Objectives: The purposes of this study are to determine whether there is a correlation between the Mann Assessment of Swallowing Ability (MASA) and modified MASA (mMASA) according to various cognitive status and to investigate whether the cognitive status of patients with brain damage affects the prediction of aspiration using the MASA. Methods: We retrospectively assessed 146 dysphagic patients with brain lesion due to various causes. Dysphagia was assessed using the MASA and mMASA. According to the videofluoroscopic swallowing study results, patients were divided into two groups: aspirators and non-aspirators. Patients were classified into four groups according to cognitive function according to the Korean version of Mini-mental State Examination scores: normal (>24), mild (21–24), moderate (10–20), and severe (<10) cognitive impairment. The correlation between the MASA and mMASA scores according to cognitive function were analyzed. The sensitivity, specificity, and positive and negative predictive values of the MASA scores for predicting aspiration were assessed. Results: The MASA and mMASA scores showed a significant positive correlation in all cognition groups. In patients with more severe cognitive impairment MASA scores had high sensitivity and low specificity for prediction of aspiration. On the other hand, the MASA scores had low sensitivity and high specificity for prediction of aspiration in the normal and mild cognitive impairment groups. Conclusions: The MASA and mMASA scores correlated with each other in patients with various levels of cognitive function. Interestingly, this study results demonstrated that patients with good cognitive function may have false negative results of MASA screening due to low sensitivity. Thus, when interpreting the MASA results, the impact of cognitive status should be taken into consideration.
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Affiliation(s)
- Shinyoung Kwon
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Jaehoon Sim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Joonhyun Park
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Youngsoo Jung
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Kye Hee Cho
- Department of Rehabilitation Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Sang Hee Im
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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20
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Lee JT, Park E, Jung TD. Automatic Detection of the Pharyngeal Phase in Raw Videos for the Videofluoroscopic Swallowing Study Using Efficient Data Collection and 3D Convolutional Networks †. Sensors (Basel) 2019; 19:s19183873. [PMID: 31500332 PMCID: PMC6767274 DOI: 10.3390/s19183873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022]
Abstract
Videofluoroscopic swallowing study (VFSS) is a standard diagnostic tool for dysphagia. To detect the presence of aspiration during a swallow, a manual search is commonly used to mark the time intervals of the pharyngeal phase on the corresponding VFSS image. In this study, we present a novel approach that uses 3D convolutional networks to detect the pharyngeal phase in raw VFSS videos without manual annotations. For efficient collection of training data, we propose a cascade framework which no longer requires time intervals of the swallowing process nor the manual marking of anatomical positions for detection. For video classification, we applied the inflated 3D convolutional network (I3D), one of the state-of-the-art network for action classification, as a baseline architecture. We also present a modified 3D convolutional network architecture that is derived from the baseline I3D architecture. The classification and detection performance of these two architectures were evaluated for comparison. The experimental results show that the proposed model outperformed the baseline I3D model in the condition where both models are trained with random weights. We conclude that the proposed method greatly reduces the examination time of the VFSS images with a low miss rate.
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Affiliation(s)
- Jong Taek Lee
- Artificial Intelligence Application Research Section, Electronics and Telecommunications Research Institute (ETRI), Daegu 42994, Korea;
| | - Eunhee Park
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea;
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence:
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea;
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
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Abstract
RATIONALE Swallowing apraxia is defined as dysfunction in oral phase caused by the deficit in the coordination of tongue, lip, and chin movements, without motor weakness, sensory loss, and cognitive decline and has not been reported yet. PATIENT CONCERNS A 69-year-old male with personal medical history of ischemic stroke about 10 years ago newly developed right striatocapular infarction. He had a problem in the oral phase of swallowing after recurrent ischemic strokes. DIAGNOSES He was diagnosed as swallowing apraxia via bed side examination and videofluoroscopic swallowing study. INTERVENTION Videofluoroscopic swallowing study was done in this case. OUTCOMES Symptoms and findings of VFSS were not improved after 2 months treatment. LESSONS This case implies that a clinician should be alert to swallowing apraxia as a possible cause when a patient with recurrent strokes complains of oral phase dysfunction of swallowing and considers proper diagnostic option such as videofluoroscopic swallowing study.
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Yi YG, Oh BM, Yang S, Shin HI. Oral Feeding Challenges in Children With Tracheostomy Can Improve Feeding Outcomes, Even With the Finding of Aspiration. Front Pediatr 2019; 7:362. [PMID: 31555626 PMCID: PMC6737036 DOI: 10.3389/fped.2019.00362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
It has been suggested that oral feeding trial has therapeutic implications for improving oral-motor and swallowing function in infants and young children fed via an enteral tube or gastrostomy. This study aimed to investigate whether oral feeding challenges in children with tracheostomy could improve feeding outcomes, even with the finding of aspiration compared to those who did not receive oral feeding at all. Children (age <7 years) with tracheostomy who had thin fluid aspiration on videofluoroscopic swallowing study (VFSS) were included in this retrospective study. Enrolled children were then divided into two feeding method groups according to the physician's decision at the time of VFSS: oral feeding (OF) group and non-oral feeding (NOF) group. Data were obtained from 47 children (median age: 49.75 months, interquartile range [IQR]: 24.08-79.42). The incidence of pneumonia within 1 year after the VFSS was not different between NOF (n = 17) and OF (n = 30) groups. In OF group, 11 subjects achieved full oral feeding and 16 subjects were in partial oral feeding status 1 year after the VFSS. On the contrary, only one subject achieved full oral feeding and 5 subjects were in partial oral feeding status in NOF group (p < 0.001). Initial and follow-up penetration-aspiration scale on VFSS were different only in the OF group (p = 0.003). These results suggest that oral feeding challenges might be attempted even with the findings of aspiration in infants or young children with tracheostomy.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Women's University Seoul Hospital, Ewha Women's University School of Medicine, Seoul, South Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
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Abstract
This study aimed to investigate the reliability and validity of the Functional Oral Intake Scale (FOIS) for infants. Infants (age, <1 year) who underwent a videofluoroscopic swallowing study (VFSS) were included in this retrospective study. Their nutrition records at the time of the VFSS were separately evaluated by two raters using the five-point FOIS for infants. Categorical swallowing and aspiration impairment scale data were also obtained from the VFSS. The inter-rater reliability of the FOIS for infants was high (95.5% absolute agreement) among the 201 evaluated infants, and this scale was significantly correlated with aspiration severity in the VFSS. We also investigated whether infants with partial oral feeding (POF) at the FOIS evaluation had achieved full oral feeding within 1 year of the evaluation and used this information to estimate whether the caloric contribution, as well as consistency of oral feeding, affected the feeding outcomes. This analysis included 33 infants who were receiving both oral and tube feeding (i.e., POF). Among them, 26 infants achieved full oral feeding (FOF) without tube feeding after 1 year. Their initial contribution from oral feeding was higher than that in infants who still maintained POF after 1 year (28.46 ± 22.79 vs. 6.00 ± 5.45%, p < 0.001). The five-point FOIS for infants, which reflected the expansion of their oral diet with growth, had adequate reliability and validity. The caloric contribution as well as consistency of oral feeding could be used to distinguish FOIS levels 2 and 3, which correspond to the POF status in infants.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Abstract
Objective The present study was performed to investigate the relationships between swallowing outcomes and lesion location, bolus characteristics, and age in patients with subcortical stroke. PATIENTS Patients with subcortical and insular stroke (mean age, 57.38 ± 12.71 years) were investigated. All patients (n = 21) completed both brain magnetic resonance imaging studies and videofluoroscopic swallowing studies. Main Outcome Measures The oral transit duration, pharyngeal transit duration (PTD), laryngeal response duration, and Penetration-Aspiration Scale (PAS) score were applied to examine the efficiency of propulsion and airway protection in three swallowing tasks. Path analyses were performed to assess the relationships between swallowing outcomes and lesion location, age, bolus viscosity, and bolus volume. Results Caudate nucleus (CN) lesions were associated with higher PAS scores. Insular lesions were associated with a longer PTD. Advanced age was associated with a longer PTD. Bolus viscosity significantly moderated the association between CN lesions and higher PAS scores. Conclusions In the present cohort, CN lesions impacted airway protection and insular lesions impacted pharyngeal transit. An increased bolus viscosity reduced the aspiration severity. These results suggest that lesion location is an important indicator to predict subsequent dysphagia in patients with subcortical stroke.
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Affiliation(s)
- Ikjae Im
- 1 Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea.,2 Swallowing Research Laboratory, University of Central Florida, Orlando, FL, USA
| | - Je-Pyo Jun
- 1 Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea
| | - Seungbae Hwang
- 5 Department of Radiology, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- 1 Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea.,3 Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Jeonju, Republic of Korea.,4 Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Hashizume A, Banno H, Katsuno M, Hijikata Y, Yamada S, Inagaki T, Suzuki K, Sobue G. Quantitative Assessment of Swallowing Dysfunction in Patients with Spinal and Bulbar Muscular Atrophy. Intern Med 2017; 56:3159-3165. [PMID: 29021456 PMCID: PMC5742386 DOI: 10.2169/internalmedicine.8799-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to evaluate swallowing dysfunction in patients with spinal and bulbar muscular atrophy and to identify the most appropriate method of assessing swallowing dysfunction using a videofluoroscopic swallowing study. Methods In the videofluoroscopic swallowing study, patients were instructed to swallow 3 mL of 40% weight/volume barium sulfate twice, and the pharyngeal residue was measured. We used three different methods to quantify the pharyngeal barium residue and an eight-point scale to evaluate the laryngeal penetration leading to aspiration pneumoniae. Patients We assessed 111 patients with spinal and bulbar muscular atrophy who weren't undergoing disease-specific treatment. Results Our results showed that the pharyngeal barium residue after initial swallowing correlated better with the bulbar-related functional rating scales than that after multiple deglutition. This correlation was vague when the data from patients whose barium residue was >50% were eliminated. In addition, evaluating the pharyngeal residue after initial swallowing proved to be the most sensitive method with regard to laryngeal penetration. Conclusion This study showed that the pharyngeal barium residue after initial swallowing was the most appropriate parameter for quantitatively assessing the degree of dysphagia using a videofluoroscopic swallowing study and suggests that this method may predict laryngeal penetration and aspiration in patients with spinal and bulbar muscular atrophy.
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Affiliation(s)
- Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Haruhiko Banno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Yasuhiro Hijikata
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Shinichiro Yamada
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Tomonori Inagaki
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Keisuke Suzuki
- Department of Clinical Research, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Japan
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26
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Abstract
OBJECTIVE A detailed knowledge of dysphagia outcomes in lateral medullary infarct (LMI) patients would enable proper establishment of swallowing therapy goals and strategies. However, little is known about the impact of infarct location on dysphagia outcomes in patients with LMI. METHODS Twenty patients with rostral LMI (rostral group) and 20 patients with caudal LMI (caudal group) participated in the study. All patients underwent swallowing therapy, which included compensatory treatments and strengthening exercises, for >3 months. Dysphagia evaluation was performed twice (during the subacute stage and six months after stroke onset) using videofluoroscopic swallowing studies. Dysphagia degree was assessed using the functional dysphagia scale (FDS), the penetration-aspiration scale (PAS) and the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale. RESULTS In the subacute stage, the rostral group had significantly higher FDS and PAS scores and a significantly lower ASHA NOMS score than the caudal group. Patients from both groups showed significant improvement from the initial evaluation to the six-month evaluation. There were no significant differences in these scale scores between the two groups at the six-month evaluation. CONCLUSION In the subacute stage, patients in the rostral group had more severe dysphagia than those in the caudal group. Dysphagia improved in both groups after 3-6 months of swallowing therapy. At six months after onset, there were no significant differences in dysphagia severity between the two groups. Recovery from dysphagia after LMI was observed regardless of the infarct location.
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Affiliation(s)
- Min Ho Chun
- a Asan Medical Center, Department of Physical Medicine and Rehabilitation , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Daeha Kim
- b Department of Physical Medicine and Rehabilitation , Eson Hospital , Ulsan , Republic of Korea
| | - Min Cheol Chang
- c Department of Physical Medicine and Rehabilitation , College of Medicine, Yeungnam University , Daegu , Republic of Korea
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Kocdor P, Siegel ER, Giese R, Tulunay-Ugur OE. Characteristics of dysphagia in older patients evaluated at a tertiary center. Laryngoscope 2014; 125:400-5. [PMID: 25196400 DOI: 10.1002/lary.24917] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/08/2014] [Accepted: 08/11/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine laryngoscopic and videofluoroscopic swallowing study (VFSS) findings in geriatric patients with dysphagia; to evaluate management. STUDY DESIGN Retrospective chart review. METHODS Patients over 65 years old complaining of dysphagia, seen at a tertiary laryngology clinic, were included. Head and neck cancer and stroke patients were excluded. Demographics, laryngoscopic findings, swallowing studies, and treatment modalities were reviewed. RESULTS Sixty-five patients were included. Mean age was 75 years old (range = 66-97) with female predominance of 67.6%. Weight loss was seen in 9.2% of the patients. Whereas 52.3% of the patients complained of solid food dysphagia, 53.8% were choking on food. On laryngoscopy, 15.3% of the patients had pooling in the pyriform sinuses, 30.7% had glottic gap, 18.4% had vocal fold immobility, and 3% had hypomobility. VFSS showed that 38.4% of the patients had pharyngoesophageal dysphagia, 20% had oropharyngeal dysphagia, 20% had pharyngeal dysphagia, and 20% had a normal study. In addition, 41.5% of the patients showed laryngeal penetration and 18.4% showed aspiration. Surgical intervention was employed in 29.2% of the patients in the form of botulinum toxin injection, esophageal dilatation, cricopharyngeal myotomy, vocal fold injection, diverticulectomy, and percutaneous endoscopic gastrostomy. Whereas 21.5% of the patients received swallowing therapy, 61.5% underwent diet modification. As a result, 80% of the patients needed some type of treatment. CONCLUSIONS Swallowing problems in older patients are not uncommon. The clinician needs to be diligent to inquire about dysphagia because a large number of these patients will require treatment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pelin Kocdor
- Department of Otolaryngology Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
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28
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Aslam M, Vaezi MF. Dysphagia in the elderly. Gastroenterol Hepatol (N Y) 2013; 9:784-795. [PMID: 24772045 PMCID: PMC3999993] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Elderly patients are inherently predisposed to dysphagia predominately because of comorbid health conditions. With the aging of the population in the United States, along with the increased prevalence of obesity and gastroesophageal reflux disease, healthcare providers will increasingly encounter older patients with either oropharyngeal or esophageal disease and complaints of dysphagia. Useful tests to evaluate dysphagia include the videofluoroscopic swallowing study and the fiberoptic endoscopic evaluation of swallowing. Swallow rehabilitation is useful to help patients compensate for swallowing difficulty and ultimately help strengthen the neuromusculature involved in swallowing.
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Affiliation(s)
- Muhammad Aslam
- Dr Aslam is a research assistant professor and Dr Vaezi is a professor of medicine in the Division of Gastroenterology, Hepatology, and Nutrition at Vanderbilt University Medical Center in Nashville, Tennessee
| | - Michael F Vaezi
- Dr Aslam is a research assistant professor and Dr Vaezi is a professor of medicine in the Division of Gastroenterology, Hepatology, and Nutrition at Vanderbilt University Medical Center in Nashville, Tennessee
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29
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Abstract
OBJECTIVE To better understand the life expectancy of patients who have an abnormal videofluoroscopic swallowing study. DESIGN Retrospective cohort study. The common starting point was the time of the severely abnormal swallowing study. Hospital charts were reviewed for clinical variables of potential prognostic significance by reviewers blinded to the outcome of interest, survival time. SETTING A university-affiliated, community teaching hospital. PATIENTS One hundred forty-nine hospitalized patients who were deemed nonoral feeders based on their swallowing study. Patients excluded were those with head, neck, or esophageal cancer, or those undergoing a thoracotomy procedure. MEASUREMENTS AND MAIN RESULTS Clinical and demographic variables and time until death or censoring were measured. Overall 1-year mortality was 62%. Multivariable Cox proportional hazards analyses identified four variables that independently predicted death: advanced age, reduced serum albumin concentration, disorientation to person, and higher Charlson comorbidity score. Eighty patients (54%) subsequently underwent placement of a percutaneous endoscopic gastrostomy (PEG) tube after their swallowing study. CONCLUSIONS Mortality is high in patients with severely abnormal swallowing studies. Common clinical variables can be used to identify groups of patients with particularly poor prognoses. This information may help guide discussions regarding possible PEG placement.
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Affiliation(s)
- M E Cowen
- St. Joseph Mercy Hospital, Ann Arbor, Mich 48106, USA
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