Amyloid Deposition in the Upper Aerodigestive Tract, A Single Institute Experience

Objectives: The purpose of this study is to evaluate clinical information, laboratory results, and pathologic findings of patients with amyloidosis involving larynx, oral cavity, and pharynx from our institute. Methods: A total of 39 specimens from 28 patients were retrieved from 2000 to 2020. Data collection included clinical presentation, radiographic, laboratory results, and pathologic findings. Results: A total of 12 patients had laryngeal amyloidosis and true vocal cord was the most common location. Protein electrophoresis detected monoclonal protein in 10% (1/10) of patients tested. Two patients had hematopoietic disorder (2/12, 17%) and another patient had a peptide profile consistent with amyloid transthyretin (ATTR) detected by mass spectrometry. Twelve patients showed amyloidosis in the oral cavity with 75% involving the tongue. Monoclonal protein was found in 89% of cases tested. Nine patients (9/12, 75%) had systematic involvement including 6 with hematopoietic malignancy and 3 with biopsy-confirmed systemic light chain amyloidosis. Compared to the laryngeal amyloidosis, amyloid deposition in oral cavity had a significant higher association with systematic disease (P < .01). Pharyngeal amyloidosis was seen in 7 patients. Three of 6 patients tested (3/6, 50%) were found to have biopsy-confirmed hematopoietic malignancy. Conclusions: Laryngeal amyloidosis is mostly a localized disease. Amyloidosis involving oral cavity is associated with significantly higher risk of systematic involvement which warrants a comprehensive laboratory, radiographic, and pathologic workup. There is limited data about pharynx amyloidosis. Oropharynx and hypopharynx amyloidosis appear to be more likely associated with underlying hematologic malignancy compared to nasopharynx involvement.

Case Report: Immunotherapy for low-grade myofibroblastic sarcoma of the pharynx

Low-grade myofibroblastic sarcoma (LGMS) characterized by the increased proliferation of myofibroblasts is a rare type of malignant myofibroblastic tumor that frequently occurs in the head and neck region. Presently, there is no consensus regarding the treatment of LGMS. Here, we report a rare case of LGMS of the pharynx in a 40-year-old male admitted to our hospital. The patient underwent resection for a right metastatic lesion and parapharyngeal mass. However, he had recurrence and multiple metastases without a surgical indication. Then the patient received the treatment of anlotinib plus pembrolizumab for 4 cycles, and there was a partial response (PR) to the treatment. Due to the adverse reaction of anlotinib, the patient subsequently received monotherapy of pembrolizumab for 22 cycles and achieved a complete response (CR). As the first case report of the immunotherapy for LGMS, our study highlights that this strategy may be of great significance to the treatment of LGMS.

Delayed pathological finding of a small fish bone causing a purulent cyst in the pharynx: a case report

We describe the case of a patient who swallowed a small fish bone and felt it lodge in her pharynx, but failed to seek medical attention in a timely manner. One week later, no foreign body was found in the hypopharynx or larynx, but a small purulent cyst was present in the epiglottic vallecula. A computed tomography scan showed a high-density area on the lingual surface of the epiglottis, which was considered to represent an embedded fish bone. A week later, the patient's discomfort had subsided, and flexible videoendoscopy showed that the purulent cyst in the epiglottic vallecula had disappeared. We surmise that the purulent cyst had ruptured spontaneously and the foreign body had been discharged. This represents an example of how an impacted small foreign body may be spontaneously discharged from the body.

KTP laser alone or combined with bleomycin for pharyngolaryngeal hemangioma: a lesion grade-based determination of prognosis

BACKGROUND

No standard potassium titanyl phosphate (KTP) laser treatment strategy is available yet for pharyngolaryngeal hemangioma.

OBJECTIVES

To explore the therapeutic effect of KTP laser, alone or combined with bleomycin injection, for pharyngolaryngeal hemangioma.

MATERIAL AND METHODS

This observational study included patients with pharyngolaryngeal hemangioma treated between May 2016 and November 2021: KTP laser under local anesthesia, KTP laser under general anesthesia, or KTP laser combined with bleomycin injection under general anesthesia.

RESULTS

A total of 60 patients were recruited, including 17, 19, and 24 patients with grade 1, 2, and 3 hemangiomas, respectively. A total of 21 patients underwent KTP laser under local anesthesia, 31 underwent KTP laser under general anesthesia, and 8 underwent KTP laser under general anesthesia combined with bleomycin. The cure rates were 100%, 89.5%, and 20.8% for grade 1, 2, and 3 lesions, respectively. The prognosis was significantly different among the grades of hemangioma (p < .001).

CONCLUSION

KTP laser treatment might be an effective treatment for adult patients with pharyngolaryngeal hemangioma. The size of the hemangioma might be the major factor influencing the prognosis. The method of anesthesia and whether it was combined with bleomycin injection might not affect the prognosis.

Systematic Microbiome Dysbiosis Is Associated with IgA Nephropathy

IgA nephropathy (IgAN) is reportedly associated with microbial dysbiosis. However, the microbiome dysregulation of IgAN patients across multiple niches remains unclear. To gain a systematic understanding of microbial dysbiosis, we conducted large-scale 16S rRNA gene sequencing in IgAN patients and healthy volunteers across 1,732 oral, pharynx, gut, and urine samples. We observed a niche-specific increase of several opportunistic pathogens, including Bergeyella and Capnocytophaga in the oral and pharynx, whereas some beneficial commensals decreased in IgAN patients. Similar alterations were also observed in the early versus advanced stage of chronic kidney disease (CKD) progression. Moreover, Bergeyella, Capnocytophaga, and Comamonas in the oral and pharynx were positively associated with creatinine and urea, indicating renal lesions. Random forest classifiers were developed by using the microbial abundance to predict IgAN, achieving an optimal accuracy of 0.879 in the discovery phase and 0.780 in the validation phase. IMPORTANCE This study provides microbial profiles of IgAN across multiple niches and underlines the potential of these biomarkers as promising, noninvasive tools with which to differentiate IgAN patients for clinical applications.

The dynamics of deglutition during head rotation using dynamic 320-row area detector computed tomography

Objective

We aimed to elucidate the dynamics of deglutition during head rotation by acquiring 320-row area detector computed tomography (320-ADCT) images and analyzing deglutition during head rotation.

Methods

This study included 11 patients experiencing globus pharyngeus. A 320-ADCT was used to acquire images in two types of viscosity (thin and thick), with the head rotated to the left. We measured the movement time of deglutition-related organs (soft palate, epiglottis, upper esophageal sphincter [UES], and true vocal cords) and pharyngeal volume (bolus ratio at the start of UES opening [Bolus ratio], pharyngeal volume contraction ratio [PVCR], and pharyngeal volume before swallowing [PVBS]). A two-way analysis of variance was performed for statistical analysis, and all items were compared for significant differences in terms of head rotation and viscosity. EZR was used for all statistical analyses (p-value <.05).

Results

Head rotation significantly accelerated the onset of epiglottis inversion and UES opening compared with no head rotation. The duration of epiglottis inversion with the thin viscosity fluid was significantly longer. The bolus ratio increased significantly with thick viscosity. There was no significant difference in viscosity and head rotation in terms of PVCR. PVBS increased significantly with head rotation.

Conclusion

The significantly earlier start of epiglottis inversion and UES opening due to head rotation could be caused by: (1) swallowing center; (2) pharyngeal volume; and (3) pharyngeal contraction force. Thus, we plan to further analyze swallowing with head rotation by combining swallowing CT with manometry and examine its relationship with pharyngeal contraction force.

Level of Evidence

3b.

The role of oral and pharyngeal motor exercises in post-stroke recovery: A scoping review

OBJECTIVE

To analyze intervention goals, protocols, and outcome measures used for oral and pharyngeal motor exercises in post-stroke recovery.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsychINFO, and Cochrane databases were searched in September 2022.

METHODS

Studies were included if they (1) recruited post-stroke adult patients, (2) administered exercises for the oral and/ or pharyngeal muscles, and (3) reported results at baseline and post-exercise. The extracted data included intervention goals, protocols, and outcomes. All outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF).

RESULTS

A total of 26 studies were identified. Their intervention goals aimed to rehabilitate a broad spectrum of muscle groups within the oral cavity and pharynx and to improve the functions of swallowing, speech, facial expressions, or sleep breathing. Protocol duration ranged from 1 to 13 weeks, with various exercise repetitions (times per day) and frequency (days per week). Half of the studies reported using feedback to support the training, and these studies varied in the feedback strategy and technology tool. A total of 37 unique outcome measures were identified. Most measures represented the body functions and body structure component of the ICF, and several of these measures showed large treatment effects.

CONCLUSIONS

This review demonstrated inconsistency across published studies in intervention goals and exercise protocols. It has also identified current limitations and provided recommendations for the selection of outcome measures while advancing a multidisciplinary view of oral and pharyngeal exercises in post-stroke recovery across relevant functions.

The Hospital Frailty Risk Score and outcomes in head and neck cancer surgery

OBJECTIVE

This study aimed to assess if the Hospital Frailty Risk Score (HFRS) could predict outcomes for older people undergoing head and neck procedures.

DESIGN

A retrospective cohort study of patients admitted between April 2008 and February 2020, undergoing head and neck procedures defined as major resections using procedural codes.

SETTING

The analysis was performed using data from the NHS Secondary Uses Service (SUS) electronic database.

PARTICIPANTS

A number of 7479 patients were selected based on an age of 75 years and above and an admission associated with a diagnostic code associated with a head and neck cancer. Based on HFRS, 5153 patients were risk-stratified into mild, moderate, and severe frailty risk.

MAIN OUTCOME MEASURES

The relationships between frailty risk and length of stay, readmission rate, and mortality were quantified using descriptive statistics.

RESULTS

Severely frail patients had a median length of stay of 9 days compared to 3 for mildly frail patients. Twenty-seven percentage of severely frail patients were readmitted within 30 days of surgery. Rising levels of frailty correlate with a higher risk of death following surgery which is maintained in longer term mortality at 1 year and until the data were extracted in March 2022. Fifty percentage of moderately frail patients and 66% of severely frail patients had died in hospital by the end of the study period.

CONCLUSION

The results quantify the relationship between frailty and adverse health outcomes. This information could be used to identify those that might benefit from holistic assessment, aid prognostication, commissioning, and service planning.

Oropharyngeal cavity floor morphology in Eretmochelys imbricata (Testudines: Cheloniidae) hatchlings and evolutionary implications

Morphological studies of the oropharyngeal cavity of chelonians have become an interesting tool in the understanding of evolutionary processes associated with feeding habits in aquatic animals and the transition from aquatic to terrestrial forms. In this context, the aim of the present study was to describe the oropharyngeal cavity floor morphology of hawksbill sea turtle (Eretmochelys imbricata) hatchlings. Ten dead hatchlings of undefined sex were obtained from nests hatched on the coast of the state of Rio Grande do Norte, Brazil. The heads of each specimen were fixed, dissected, and analyzed at the macroscopic and microscopic levels. The oropharyngeal cavity floor of the hawksbill sea turtle hatchlings is formed by the tongue, pharynx, floor muscles, and hyolingual skeleton, delimited in the rostral and lateral directions by a keratinized beak, called the rhamphotheca, and in the caudal region at the limit between the pharynx and the esophagus. The tongue muscles and the muscles that support the floor of the oral cavity comprise the following: m. hypoglossohyoideus, m. hypoglossoglossus, m. hyoglossus, m. genioglossus, m. constrictor laryngis, m. geniohyoideus pars lateralis, and m. intermandibularis. The oropharyngeal cavity floor mucosa is formed by keratinized stratified squamous epithelium and the lamina propria is formed by loose connective tissue. The floor mucosa is devoid of taste buds. We believe that the basic oropharyngeal cavity floor characteristics in hawksbill sea turtle hatchlings may comprise indications that these animals are plesiomorphic and that semiaquatic and terrestrial turtles may have undergone adaptations to feed out of water.

The influence of mouth opening on pharyngeal pressure loss and its underlying mechanism: A computational fluid dynamic analysis

Objective: During inspiration, mechanical energy generated from respiratory muscle produces a negative pressure gradient to fulfill enough pulmonary ventilation. The pressure loss, a surrogate for energy loss, is considered as the portion of negative pressure without converting into the kinetic energy of airflow. Mouth opening (MO) during sleep is a common symptom in patients with obstructive sleep apnoea-hypopnea syndrome (OSAHS). This study aimed to evaluate the effects of mouth opening on pharyngeal pressure loss using computational fluid dynamics (CFD) simulation. Methods: A total of four subjects who were morphologically distinct in the pharyngeal characteristics based on Friedman tongue position (FTP) grades were selected. Upper airway computed tomography (CT) scan was performed under two conditions: Mouth closing (MC) and mouth opening, in order to reconstruct the upper airway models. computational fluid dynamics was used to simulate the flow on the two different occasions: Mouth closing and mouth opening. Results: The pharyngeal jet was the typical aerodynamic feature and its formation and development were different from mouth closing to mouth opening in subjects with different Friedman tongue position grades. For FTP I with mouth closing, a pharyngeal jet gradually formed with proximity to the velopharyngeal minimum area plane (plane_Amin). Downstream the plane_Amin, the jet impingement on the pharyngeal wall resulted in the frictional loss associated with wall shear stress (WSS). A rapid luminal expansion led to flow separation and large recirculation region, corresponding to the interior flow loss. They all contributed to the pharyngeal total pressure loss. While for FTP I with mouth opening, the improved velopharyngeal constriction led to smoother flow and a lower total pressure loss. For FTP IV, the narrower the plane_Amin after mouth opening, the stronger the jet formation and its impingement on the pharyngeal wall, predicting a higher frictional loss resulted from higher WSS. Besides, a longer length of the mouth opening-associated constant constrictive segment was another important morphological factor promoting frictional loss. Conclusion: For certain OSAHS patients with higher Friedman tongue position grade, mouth opening-related stronger jet formation, more jet breakdown and stronger jet flow separation might contribute to the increased pharyngeal pressure loss. It might require compensation from more inspiratory negative static pressure that would potentially increase the severity of OSAHS.

Effects of the GABA(B) agonist baclofen on volitional swallowing in normal subjects

The GABA(B) receptor agonist baclofen is known to suppress the rate of spontaneous swallowing but not pharyngeal muscle contraction. The extent to which baclofen may alter volitional swallowing is not currently known. We investigated the effects of baclofen in healthy subjects, hypothesizing that baclofen exposure would alter volume-regulation and/or piecemeal deglutition behaviors during volitional swallowing attempts. Pharyngeal high-resolution manometry impedance (P-HRM-I) protocol was used to assess swallowing function of 22 healthy adult volunteers (median 29 years) who were investigated on two occasions, receiving 40 mg baclofen (oral) 1 h before study, or placebo (randomized). Standard swallow function variables recommended by the pharyngeal HRM Working Group were derived for 5 ml, 10 ml, and 20 ml volumes of thin and extremely thick liquid challenges. Multiple swallow behaviors, comprising two swallows <5 s apart, were characterized. The spontaneous swallow rate was also determined. Baclofen exposure had no overall significant effect on swallow variables. Upper esophageal sphincter pressure was weaker during exposure to baclofen, during both the pre-deglutitive and post-deglutitive phases of the swallow (p < 0.05 during thick liquid swallows). Piecemeal swallows, where the bolus is separated in two potions, were significantly more common during 20 ml boluses (p = 0.002). Baclofen decreased the frequency of piecemeal deglutition overall. Baclofen has limited to no effect on volitional swallowing measures, however, does reduce the likelihood of initiation of piecemeal deglutition to large volume challenges.

Examining the Use of an Artificial Intelligence Model to Diagnose Influenza: Development and Validation Study

BACKGROUND

The global burden of influenza is substantial. It is a major disease that causes annual epidemics and occasionally, pandemics. Given that influenza primarily infects the upper respiratory system, it may be possible to diagnose influenza infection by applying deep learning to pharyngeal images.

OBJECTIVE

We aimed to develop a deep learning model to diagnose influenza infection using pharyngeal images and clinical information.

METHODS

We recruited patients who visited clinics and hospitals because of influenza-like symptoms. In the training stage, we developed a diagnostic prediction artificial intelligence (AI) model based on deep learning to predict polymerase chain reaction (PCR)-confirmed influenza from pharyngeal images and clinical information. In the validation stage, we assessed the diagnostic performance of the AI model. In additional analysis, we compared the diagnostic performance of the AI model with that of 3 physicians and interpreted the AI model using importance heat maps.

RESULTS

We enrolled a total of 7831 patients at 64 hospitals between November 1, 2019, and January 21, 2020, in the training stage and 659 patients (including 196 patients with PCR-confirmed influenza) at 11 hospitals between January 25, 2020, and March 13, 2020, in the validation stage. The area under the receiver operating characteristic curve for the AI model was 0.90 (95% CI 0.87-0.93), and its sensitivity and specificity were 76% (70%-82%) and 88% (85%-91%), respectively, outperforming 3 physicians. In the importance heat maps, the AI model often focused on follicles on the posterior pharyngeal wall.

CONCLUSIONS

We developed the first AI model that can accurately diagnose influenza from pharyngeal images, which has the potential to help physicians to make a timely diagnosis.

Role of surgical hyoid bone repositioning in modifying upper airway collapsibility

Background: Surgical hyoid bone repositioning procedures are being performed to treat obstructive sleep apnea (OSA), though outcomes are highly variable. This is likely due to lack of knowledge regarding the precise influence of hyoid bone position on upper airway patency. The aim of this study is to determine the effect of surgical hyoid bone repositioning on upper airway collapsibility. Methods: Seven anaesthetized, male, New Zealand White rabbits were positioned supine with head/neck position controlled. The rabbit's upper airway was surgically isolated and hyoid bone exposed to allow manipulation of its position using a custom-made device. A sealed facemask was fitted over the rabbit's snout, and mask/upper airway pressures were monitored. Collapsibility was quantified using upper airway closing pressure (Pclose). The hyoid bone was repositioned within the mid-sagittal plane from 0 to 5 mm (1 mm increments) in anterior, cranial, caudal, anterior-cranial (45°) and anterior-caudal (45°) directions. Results: Anterior displacement of the hyoid bone resulted in the greatest decrease in Pclose amongst all directions (p = 0.002). Pclose decreased progressively with each increment of anterior hyoid bone displacement, and down by -4.0 ± 1.3 cmH₂O at 5 mm. Cranial and caudal hyoid bone displacement did not alter Pclose (p > 0.35). Anterior-cranial and anterior-caudal hyoid bone displacements decreased Pclose significantly (p < 0.004) and at similar magnitudes to the anterior direction (p > 0.68). Conclusion: Changes in upper airway collapsibility following hyoid bone repositioning are both direction and magnitude dependent. Anterior-based repositioning directions have the greatest impact on reducing upper airway collapsibility, with no effect on collapsibility by cranial and caudal directions. Findings may have implications for guiding and improving the outcomes of surgical hyoid interventions for the treatment of OSA.

Lipoid Proteinosis of the Pharynx and Larynx: A Case Report

Lipoid proteinosis (LP) is a rare inherited multisystem disease. Classical clinical features include beaded eyelid papules, laryngeal infiltration, and neurological symptoms. Here, we report the diagnosis and treatment of a female patient with LP in order to improve physician awareness and understanding of this disease.

Reliability of Acoustic Pharyngometry and Rhinometry Examination in Children and Adolescents

OBJECTIVES

The aim of this cross-sectional study was to examine the method error and reliability of acoustic pharyngometry and rhinometry in children and adolescents and to describe the feasibility of these methods in a young population.

MATERIAL AND METHODS

The study sample included 35 healthy subjects in the age of 9 to 14 years. The subjects were randomly recruited for the present project in the period from June 2021 to February 2022. Repeated measurements of the upper airway dimensions in standing mirror position were performed by the use of Acoustic Pharyngometer and Rhinometer. Volume (cm³), calculated resistance (cm H₂O/L/min), mean area (cm²), minimum cross-sectional area (MCA, cm²) and distance to MCA (cm) were examined. Method errors and reliability coefficients were evaluated using Dahlberg's formula and the Houston reliability coefficient. The feasibility of the methods were analysed using paired t-test and estimated by difference in drop-out rates.

RESULTS

No systematic error exhibited in the repeated measurements except volume in the left nostril (P = 0.017). The method errors of the acoustic pharyngometry and rhinometry were betweeen 0.0002 to 0.069 and 0.001 to 0.082 respectively. The Houston reliability coefficient for both methods were between 0.952 to 0.999. The acoustic pharyngometry was significantly more feasible compared to rhinometry (P < 0.001).

CONCLUSIONS

The study shows that acoustic pharyngometry and rhinometry in the standing mirror position are reliable methods, with acoustic pharyngometry being even more feasible than rhinometry, which is why it is recommended to practice the methods with children and ensure reliability of results before registering measurements.

Pharyngeal timing and particle transport defects in Caenorhabditis elegans feeding mutants

The nematode C. elegans uses rhythmic muscle contractions (pumps) of the pharynx, a tubular feeding organ, to filter, transport, and crush food particles. A number of feeding mutants have been identified, including those with slow pharyngeal pumping rate, weak muscle contraction, defective muscle relaxation, and defective grinding of bacteria. Many aspects of these pharyngeal behavioral defects and how they affect pharyngeal function are not well understood. For example, the behavioral deficits underlying inefficient particle transport in 'slippery' mutants have been unclear. Here we use high speed video microscopy to describe pharyngeal pumping behaviors and particle transport in wild-type animals and in feeding mutants. Different 'slippery' mutants exhibit distinct defects including weak isthmus contraction, failure to trap particles in the anterior isthmus, and abnormal timing of contraction and relaxation in pharyngeal compartments. Our results show that multiple deficits in pharyngeal timing or contraction can cause defects in particle transport.

Genetic encoding of an esophageal motor circuit

Motor control of the striated esophagus originates in the nucleus ambiguus (nAmb), a vagal motor nucleus that also contains upper airway motor neurons and parasympathetic preganglionic neurons for the heart and lungs. We disambiguate nAmb neurons based on their genome-wide expression profiles, efferent circuitry, and ability to control esophageal muscles. Our single-cell RNA sequencing analysis predicts three molecularly distinct nAmb neuron subtypes and annotates them by subtype-specific marker genes: Crhr2, Vipr2, and Adcyap1. Mapping the axon projections of the nAmb neuron subtypes reveals that Crhr2^nAmb neurons innervate the esophagus, raising the possibility that they control esophageal muscle function. Accordingly, focal optogenetic stimulation of cholinergic Crhr2⁺ fibers in the esophagus results in contractions. Activating Crhr2^nAmb neurons has no effect on heart rate, a key parasympathetic function of the nAmb, whereas activating all of the nAmb neurons robustly suppresses heart rate. Together, these results reveal a genetically defined circuit for motor control of the esophagus.

Primary motor neurons for the esophagus reside in the nucleus ambiguus (nAmb) of the hindbrain, but little is known about their molecular identity. Coverdell et al. find that the nAmb comprises three molecularly and anatomically distinct neuron subtypes, one of which selectively innervates and can contract esophageal muscle.

Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant?

INTRODUCTION

In oropharyngeal dysphagia, impaired pharyngoesophageal junction (PEJ) opening is reflected by an elevated hypopharyngeal intrabolus pressure (IBP), quantifiable using pharyngeal high-resolution manometry with impedance (P-HRM-I). Transient intrabolus pressurization (TP) phenomena are not sustained and last for only a brief period. We hypothesized that TP patterns reflect impaired coordination between timing of hypopharyngeal bolus arrival and PEJ relaxation.

METHODS

A retrospective audit was conducted of P-HRM-I datasets; 93 asymptomatic Controls and 214 Patients with differing etiological/clinical backgrounds were included. TP patterns were examined during 10ml liquid swallows. TP was defined by a simultaneous, non-sustained, pressurization wave spanning from the velo-/meso-pharynx to PEJ. The coordination between deglutitive pharyngeal bolus distension and PEJ relaxation timing was assessed using timing variables; (i) Distention-Contraction Latency (DCL, s) and (ii) PEJ Relaxation Time (RT, s). Resultant flow resistance was quantified (IBP, mmHg).

RESULTS

TP swallows were observed in 87 (28%) cases. DCL was not significantly different in relation to TP, while PEJ relaxation time was shorter, and IBP was higher during TP swallows. In Patients RT-DCL time difference correlated with IBP (r -0.368, p < 0.01).

CONCLUSION

Bolus distension and PEJ relaxation were miss-timed during TP swallows, impeding bolus flow and leading to a brief period of pressurization of the pharyngeal chamber by muscular propulsive forces. While TP swallows were identified in both Controls and Patients, increased IBPs were most apparent for Patient swallows indicating that the extent of IBP increase may differentiate pathological TP swallows.

Obstructive Sleep Apnea: characterization of the obstructive site and type of collapse

Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.

Three-Dimensional Pharyngeal Airway Space Changes Following Isolated Mandibular Advancement Surgery in 120 Patients: A 1-Year Follow-up Study

Lack of evidence exists related to the three-dimensional (3D) pharyngeal airway space (PAS) changes at follow-up after isolated bilateral sagittal split osteotomy (BSSO) advancement surgery. The present study assessed the 3D PAS changes following isolated mandibular advancement at a follow-up period of 1 year. A total of 120 patients (40 males, 80 females, mean age: 26.0 ± 12.2) who underwent BSSO advancement surgery were recruited. Cone-beam computed tomography (CBCT) scans were acquired preoperatively (T0), immediately following surgery (T1), and at 1 year of follow-up (T2). The volume, surface area, and minimal cross-sectional area (mCSA) of the airway were assessed. The total airway showed a 38% increase in volume and 13% increase in surface area from T0 to T1, where the oropharyngeal region showed the maximum immediate change. At T1−T2 follow-up, both volumetric and surface area showed a relapse of less than 7% for all sub-regions. The mCSA showed a significant increase of 71% from T0 to T1 (p < 0.0001), whereas a non-significant relapse was observed at T1−T2 (p = 0.1252). The PAS remained stable at a follow-up period of 1 year. In conclusion, BSSO advancement surgery could be regarded as a stable procedure for widening of the PAS with maintenance of positive space at follow-up.

Molecular Characterization of Staphylococcus aureus Strains Isolated from Mobile Phones

The widespread use of mobile phones (MP) among healthcare personnel might be considered as an important source of contamination. One of the most pathogenic bacteria to humans is Staphylococcus aureus, which can be transmitted through the constant use of MP. Nevertheless, which specific type of strains are transmitted and which are their sources have not been sufficiently studied. The aim of this study is to determine the source of contamination of MP and characterize the corresponding genotypic and phenotypic properties of the strains found. Nose, pharynx, and MP samples were taken from a group of health science students. We were able to determinate the clonality of the isolated strains by pulsed-field gel electrophoresis (PFGE) and spa gene typing (spa-type). Adhesin and toxin genes were detected, and the capacity of biofilm formation was determined. Several of the MP exhibited strains of S. aureus present in the nose and/or pharynx of their owners. methicillin-susceptible Staphylococcus aureus (MSSA), hospital-acquired methicillin-resistant S. aureus (HA-MRSA), and community-acquired methicillin-resistant S. aureus (CA-MRSA) strains were found, which indicated a variety of genotypes. This study concludes that MP can be contaminated with the strains of S. aureus present in the nose and/or pharynx of the owners; these strains can be of different types and there is no dominant genotype.

Systematic interpretation of confocal laser endomicroscopy: larynx and pharynx confocal imaging score

OBJECTIVE

Development and validation of a confocal laser endomicroscopy (CLE) classification score for the larynx and pharynx.

METHODS

Thirteen patients (154 video sequences, 9240 images) with laryngeal or pharyngeal SCC were included in this prospective study between October 2020 and February 2021. Each CLE sequence was correlated with the gold standard of histopathological examination. Based on a dataset of 94 video sequences (5640 images), a scoring system was developed. In the remaining 60 sequences (3600 images), the score was validated by four CLE experts and four head and neck surgeons who were not familiar with CLE.

RESULTS

Tissue homogeneity, cell size, borders and clusters, capillary loops and the nucleus/cytoplasm ratio were defined as the scoring criteria. Using this score, the CLE experts obtained an accuracy, sensitivity, and specificity of 90.8%, 95.1%, and 86.4%, respectively, and the CLE non-experts of 86.2%, 86.4%, and 86.1%. Interobserver agreement Fleiss' kappa was 0.8 and 0.6, respectively.

CONCLUSIONS

CLE can be reliably evaluated based on defined and reproducible imaging features, which demonstrate a high diagnostic value. CLE can be easily integrated into the intraoperative setting and generate real-time, in-vivo microscopic images to demarcate malignant changes.

Effects of oral screen exercise on orofacial and pharyngeal activity: An exploratory study using videofluoroscopy and surface electromyography in healthy adults

Objective

The oral screen is a device commonly used for treatment of orofacial disorders. The objective of this exploratory study was to examine the effect of oral screen exercise on the muscle activity in the lips, submental complex, masseter muscle, and kinematic activity of the tongue base, soft palate, pharynx, and larynx in healthy adults. This was compared with the kinematic activity during a dry swallow. It was hypothesized that not only the lip musculature but also other structures in the oral and pharyngeal cavities are activated while using an oral screen device.

Method

Ten healthy subjects used an oral screen during examination with videofluoroscopy and surface electromyography (EMG). Three different instructions for oral screen application and a dry swallow were examined.

Results

The lip muscles showed the highest activity during oral screen exercise. The other muscle groups were activated to a lesser degree. The pattern of activation differed between individuals. Compared with a dry swallow, the range of motion of the tongue base, posterior pharyngeal wall, and the larynx was significantly smaller during oral screen activation. No major differences were found between three different instructions.

Conclusion

This study indicates that the lips and submental complex and, to a lesser degree, oral, pharyngeal, and laryngeal structures are activated with the oral screen, but the pattern of activation varied between individuals. In comparison to the activity during a dry swallow, range of motion during oral screen exercise is small.

Anatomical mechanism for protecting the airway in the largest animals on earth

Separation of respiratory and digestive tracts in the mammalian pharynx is critical for survival. Food must be kept out of the respiratory tract, and air must be directed into the respiratory tract when breathing.¹ Cetaceans have the additional problem of feeding while underwater. Lunge-feeding baleen whales (rorquals) open the mouth while swimming at high speeds to engulf a volume of prey-laden water as large as their own body² and experience tremendous forces as water floods the mouth. How the respiratory tract is protected in the pharynx during engulfment and while swallowing a massive slurry of tiny living prey remains unknown, despite its importance to survival. By dissecting adult and fetal fin whales, we determined that a large musculo-fatty structure passively seals the oropharyngeal channel. This "oral plug" is not observed in other animals, and its position indicates it must be shifted to allow swallowing; it is a part of the soft palate and can only shift posteriorly and dorsally. Elevation of the oral plug allows food transfer to the pharynx and protects the upper airways from food entry. The laryngeal inlet in the floor of the pharynx is sealed by laryngeal cartilages, and the muscular laryngeal sac moves upward into the laryngeal cavity, completely occluding the airway. The pharynx is dedicated to the digestive tract during swallowing, with no connection between upper and lower airways. These adaptations to facilitate swallowing were a critical development in the evolution of large body size in these, the largest animals on earth.