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Wei L, Sulian L, Tonglian L, Yan Z, Zongchao L. Anterior Cervical Spine Surgery Complicated With Dysphagia. Orthop Nurs 2023; 42:297-303. [PMID: 37708527 DOI: 10.1097/nor.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Anterior cervical spine surgery is a common type of neck surgery in orthopaedics. Swallowing disorder is one of the most common complications after surgery. It is characterized by food entering the esophagus from the mouth through the pharynx. The process of reaching the stomach is hampered and leads to increases in a range of risk factors that affect the health of the patient. This article reviews relevant literature reports from recent years retrieved from various national and international medical databases, aiming to find more economical, effective, and simple perioperative nursing strategies for patients with cervical anterior surgery through evidence-based thinking and methods, with the aim of developing a personalized care model that is easy to implement and has a long-lasting effect and a wide range of rehabilitation benefits to better serve patients.
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Affiliation(s)
- Liu Wei
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Li Sulian
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Li Tonglian
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Zhang Yan
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Liu Zongchao
- Liu Wei, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Sulian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Li Tonglian, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Zhang Yan, MM, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Liu Zongchao, MD, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Donohue C, Robison R, DiBiase L, Anderson A, Vasilopoulos T, Plowman EK. Comparison of Validated Videofluoroscopic Outcomes of Pharyngeal Residue: Concordance Between a Perceptual, Ordinal, and Bolus-Based Rating Scale and a Normalized Pixel-Based Quantitative Outcome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2510-2517. [PMID: 35749660 PMCID: PMC9584126 DOI: 10.1044/2022_jslhr-21-00659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study compared the concordance between two validated videofluoroscopic pharyngeal residue outcome scales used in clinical and research settings: the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) and the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) percent residue metric. METHOD Two trained raters completed independent and blinded videofluoroscopic ratings of both DIGEST efficiency and ASPEKT percent pharyngeal residue outcomes for bolus trials of 5 cc Varibar thin liquid (n = 223), thin liquid comfortable cup sips (n = 223), and 5 cc Varibar thin honey (n = 223). Spearman's rho and Kruskal-Wallis analyses were performed for each bolus type. RESULTS Significant associations between DIGEST and ASPEKT pharyngeal residue outcomes were noted for 5 cc thin (r = .54, p < .001), cup sip thin (r = .41, p < .001), and 5 cc thin honey (r = .60, p < .001) bolus trials. ASPEKT percent residue increased across worsening DIGEST efficiency ordinal scale levels, with a main effect for each bolus type. Post hoc analysis revealed significant differences in the ASPEKT percent residue values between each DIGEST pairwise comparison for the thin cup sip bolus trial and for each pairwise comparison except between the moderate-to-severe (less than half vs. majority) ordinal levels for the 5 cc thin and 5 cc honey bolus trials, p < .05. CONCLUSIONS Perceptual, ordinal (DIGEST) and quantitative, pixel-based (ASPEKT) videofluoroscopic pharyngeal residue outcomes were associated in this data set of 669 bolus trials. Future research is warranted to confirm these results.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
| | - Raele Robison
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Medicine, University of Wisconsin–Madison
| | - Lauren DiBiase
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Amber Anderson
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | | | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Department of Neurology, University of Florida, Gainesville
- Department of Surgery, University of Florida, Gainesville
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Coutts KA. Dysphagia in cervical spinal cord injury: How international literature trends can guide South African practice patterns - A scoping review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1542. [PMID: 34192210 PMCID: PMC8182465 DOI: 10.4102/sajp.v77i1.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/15/2021] [Indexed: 11/01/2022] Open
Abstract
Background The limited data regarding dysphagia in high-level spinal cord injuries (SCIs) stem from economically developed countries. Dysphagia is prevalent in patients with cervical SCI; however, in a South African context, speech-language pathologists (SLPs) are not seen as key when managing this population. This may result in patients not being screened or identified early, leading to possible complications. The literature could provide useful insight on how best to address this clinical gap. Objectives The aim of my study was to conduct a scoping review on the description of dysphagia, the risk factors for developing dysphagia post-SCI and the practice patterns of team members working with dysphagia in cervical SCIs. Methods A five-step scoping review was undertaken. Data were analysed by using descriptive statistics as well as a thematic analysis by using a top-down approach. Results Through the process of screening according to the inclusion and exclusion criteria, 25 articles were included. Primarily, the pharyngeal phase was affected, which can lead to an aspiration pneumonia. The key risk factors were the presence of a tracheostomy tube, the use of ventilation and anterior spinal cord surgery. There was little mention regarding specific practice patterns, but an interdisciplinary approach was suggested as the most efficient model. Conclusions Specific guidelines and management options need to be considered for a South African context, given the high incidence of trauma-related injuries. There needs to be locally produced research, providing suggestions on how different team members can screen and identify dysphagia within this population. Solutions need to be unique, and contextually responsive and appropriate. Clinical implications The team members and the roles of these different team members need to be re-examined in order to ensure the early identification and management of cervical SCI patients who are at risk of developing a dysphagia.
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Affiliation(s)
- Kim A Coutts
- Department of Speech Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
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Sensitivity of the surrogate analysis method to synchronization and conduction velocity of muscular fibers. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Choi Y, Kim M, Lee B, Yang X, Kim J, Kwon D, Lee SE, Kim H, Nam SI, Hong S, Yang G, Na DL, You H. Development of an Ultrasonic Doppler Sensor-Based Swallowing Monitoring and Assessment System. SENSORS 2020; 20:s20164529. [PMID: 32823533 PMCID: PMC7472343 DOI: 10.3390/s20164529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
Existing swallowing evaluation methods using X-ray or endoscopy are qualitative. The present study develops a swallowing monitoring and assessment system (SMAS) that is nonintrusive and quantitative. The SMAS comprises an ultrasonic Doppler sensor array, a microphone, and an inertial measurement unit to measure ultrasound signals originating only from swallowing activities. Ultrasound measurements were collected for combinations of two viscosity conditions (water and yogurt) and two volume conditions (3 mL and 9 mL) from 24 healthy participants (14 males and 10 females; age = 30.5 ± 7.6 years) with no history of swallowing disorders and were quantified for 1st peak amplitude, 2nd peak amplitude, peak-to-peak (PP) time interval, duration, energy, and proportion of two or more peaks. The peak amplitudes and energy significantly decreased by viscosity and the PP time interval and duration increased by volume. The correlation between the time measures were higher (r = 0.78) than that of the amplitude measures (r = 0.30), and the energy highly correlated with the 1st peak amplitude (r = 0.86). The proportion of two or more peaks varied from 76.8% to 87.9% by viscosity and volume. Further research is needed to examine the concurrent validity and generalizability of the ultrasonic Doppler sensor-based SMAS.
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Affiliation(s)
- Younggeun Choi
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Minjae Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Baekhee Lee
- Body Test Team 3, Hyundai Motor Company, Hwaseong 18280, Korea;
| | - Xiaopeng Yang
- School of Artificial Intelligence and Computer Science, Jiangnan University, Wuxi 214122, China;
| | - Jinwon Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Dohoon Kwon
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang 37659, Korea;
| | - HyangHee Kim
- Graduate Program in Speech-Language Pathology, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Seok In Nam
- Graduate School of Social Welfare, Yonsei University, Seoul 03722, Korea;
| | - Saewon Hong
- R&D Research Team, Digital Echo Co., Hwaseong 18385, Korea;
| | - Giltae Yang
- R&D Research Team, SEED Tech. Co., Bucheon 14523, Korea;
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Heecheon You
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang 37673, Korea; (Y.C.); (M.K.); (J.K.); (D.K.)
- Correspondence: ; Tel.: +82-54-279-2210
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Segmentation of cervical intervertebral disks in videofluorography by CNN, multi-channelization and feature selection. Int J Comput Assist Radiol Surg 2020; 15:901-908. [PMID: 32306186 DOI: 10.1007/s11548-020-02145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Dysphagia has a large impact on the society because it is a risk factor of malnutrition and aspiration pneumonia, and therefore, it is necessary to elucidate the entire mechanism of dysphagia. In this study, we propose a segmentation method of cervical intervertebral disks (CIDs) in videofluorography (VF) by use of patch-based convolutional neural network (CNN), our multi-channelization (MC) method and image feature selection. METHODS Twenty image filters are individually applied to a VF frame image to generate feature images. One color image, called a multi-channelized image, is generated by setting three selected feature images to its red, green and blue channels. Patch-based CNN is applied to the MC image, and the segmentation accuracy of CIDs is evaluated by the pixel-based F-measure. The combination of the three feature images is optimized by the simulated annealing method. RESULTS The proposed method was applied to actual VF dataset consisting of 19 patients and 39 healthy participants. The segmentation accuracy was 59.3% in the F-measure when Sobel and morphological top-hat filters were selected in MC, whereas it was 56.2% when original frame images were used. CONCLUSION The experimental results demonstrated that the proposed method was able to segment CIDs from actual VF and also that the MC method was able to increase the segmentation accuracy by approximately 3%. In this study, LeNet was used as CNN. One of our future tasks is to use other CNNs.
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Superior Laryngeal Nerve Palsy in Revision Anterior Cervical Surgery. J Am Acad Orthop Surg 2020; 28:e181-e184. [PMID: 31246644 DOI: 10.5435/jaaos-d-18-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Most spine surgeons routinely obtain preoperative ENT evaluation of recurrent laryngeal nerve function when contemplating revision anterior approaches to the cervical spine to avoid the potentially catastrophic consequences of bilateral vocal cord palsy. By contrast, there is less awareness of the potential for superior laryngeal nerve (SLN) injury-although a bilateral injury can, like bilateral injuries of the recurrent laryngeal nerve, have serious clinical consequences. This case report describes a 74-year-old man who, after a contralateral revision anterior approach to the upper cervical spine, developed bilateral SLN injury causing aspiration pneumonia and respiratory failure. We discuss risk factors associated with subclinical SLN injury and define at-risk patients who would benefit from preoperative SLN screening before revision anterior cervical surgery.
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Galluzzi F, Garavello W. Dysphagia following uncomplicated thyroidectomy: a systematic review. Eur Arch Otorhinolaryngol 2019; 276:2661-2671. [PMID: 31414222 DOI: 10.1007/s00405-019-05599-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/08/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Dysphagia after uncomplicated thyroidectomy is commonly reported and it includes a broad spectrum of swallowing complaints. Though various causes have been hypothesized, it remains not completely understood. METHODS A systematic review was performed to identify studies concerning dysphagia post uncomplicated thyroid surgery. A qualitative analysis of data extracted was conducted. RESULTS We have included 16 studies of which 15 are prospective and one are retrospective. The number of subjects varied from 12 to 254, the mean age from 39 to 54 years with an overall prevalence of females. The duration of the follow-up ranges from 1 month to 4 years. All the included trials documented postoperative dysphagia, 12 of which have detected it in the early postoperative period. Considering long-term follow-up period, 12 studies reported an overall improvement of swallow symptoms. The instrumental findings revealed non-specific alterations of swallowing. CONCLUSIONS Dysphagia after uncomplicated thyroidectomy can arise early in the postoperative period resolving spontaneously in the first year. Diagnostic methods failed to identify the physio pathological mechanism of swallow alteration leaving this condition still unclear. Since these symptoms can reduce patient's quality of life, we suggest an appropriate education before thyroid surgery.
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Affiliation(s)
- Francesca Galluzzi
- Department of Otorhinolaryngology, San Gerardo Hospital, Via Pergolesi, 33, 20052, Monza, MI, Italy.
| | - Werner Garavello
- Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Mulheren RW, Inamoto Y, Odonkor CA, Ito Y, Shibata S, Kagaya H, Gonzalez-Fernandez M, Saitoh E, Palmer JB. The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging. Dysphagia 2019; 34:665-672. [PMID: 30637511 DOI: 10.1007/s00455-018-09968-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/31/2018] [Indexed: 01/23/2023]
Abstract
Pharyngeal residue, the material that remains in the pharynx after swallowing, is an important marker of impairments in swallowing and prandial aspiration risk. The goals of this study were to determine whether the 2D area of post-swallow residue accurately represents its 3D volume, and if the laterality of residue would affect this association. Thirteen patients with dysphagia due to brainstem stroke completed dynamic 320-detector row computed tomography while swallowing a trial of 10 ml honey-thick barium. 3D volumes of pharyngeal residue were compared to 2D lateral and anterior-posterior areas, and a laterality index for residue location was computed. Although the anteroposterior area of residue was larger than the lateral area, the two measures were positively correlated with one another and with residue volume. On separate bivariate regression analyses, residue volume was accurately predicted by both lateral (R2 = 0.91) and anteroposterior (R2 = 0.88) residue areas, with limited incidence of high residuals. Half of the sample demonstrated a majority of pharyngeal residue lateralized to one side of the pharynx, with no effect of laterality on the association between areas and volume. In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation.
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Affiliation(s)
- Rachel W Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan. .,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
| | - Charles A Odonkor
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Yuriko Ito
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Marlis Gonzalez-Fernandez
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Jeffrey B Palmer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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Effect of Different Viscosities on Pharyngeal Pressure During Swallowing: A Study Using High-Resolution Manometry. Arch Phys Med Rehabil 2017; 98:487-494. [DOI: 10.1016/j.apmr.2016.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/02/2016] [Indexed: 01/20/2023]
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Hutcheson KA, Barrow MP, Barringer DA, Knott JK, Lin HY, Weber RS, Fuller CD, Lai SY, Alvarez CP, Raut J, Lazarus CL, May A, Patterson J, Roe JWG, Starmer HM, Lewin JS. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): Scale development and validation. Cancer 2016; 123:62-70. [PMID: 27564246 DOI: 10.1002/cncr.30283] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/11/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) is the universal framework for toxicity reporting in oncology trials. The objective of this study was to develop a CTCAE-compatible modified barium swallow (MBS) grade for the purpose of grading pharyngeal dysphagia as a toxicity endpoint in cooperative-group organ-preservation trials for head and neck cancer (HNC). It was hypothesized that a 5-point, CTCAE-compatible MBS grade (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]) based on the interaction of pharyngeal residue and laryngeal penetration/aspiration ratings would be feasible and psychometrically sound. METHODS A modified Delphi exercise was conducted for content validation, expert consensus, and operationalization of DIGEST criteria. Two blinded raters scored 100 MBSs conducted before or after surgical or nonsurgical organ preservation. Intrarater and interrater reliability was tested with weighted κ values. Criterion validity against oropharyngeal swallow efficiency (OPSE), the Modified Barium Swallow Impairment Profile (MBSImP™©), the MD Anderson Dysphagia Inventory (MDADI), and the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) was assessed with a 1-way analysis of variance and post hoc pairwise comparisons between DIGEST grades. RESULTS Intrarater reliability was excellent (weighted κ = 0.82-0.84) with substantial to almost perfect agreement between raters (weighted κ = 0.67-0.81). DIGEST significantly discriminated levels of pharyngeal pathophysiology (MBSImP™©: r = 0.77; P < .0001), swallow efficiency (OPSE: r = -0.56; P < .0001), perceived dysphagia (MDADI: r = -0.41; P < .0001), and oral intake (PSS-HN diet: r = -0.49; P < .0001). CONCLUSIONS With the development of DIGEST, the MBS rating has been adapted to the CTCAE nomenclature of ordinal toxicity grading used in oncology trials. DIGEST offers a psychometrically sound measure for HNC clinical trials and investigations of toxicity profiles, dose responses, and predictive modeling. Cancer 2017;62-70. © 2016 American Cancer Society.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Denise A Barringer
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jodi K Knott
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heather Y Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clare P Alvarez
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janhavi Raut
- University of Texas Health Science Center, School of Public Health, Houston, Texas
| | - Cathy L Lazarus
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annette May
- Department of Oncology Speech Pathology, University of Florida Health Cancer Center-Orlando Health, Orlando, Florida
| | - Joanne Patterson
- Speech and Language Therapy Department, Sunderland City Hospitals National Health Service Foundation Trust, Sunderland, United Kingdom.,Institute of Health and Society, University of Newcastle, Newcastle Upon Tyne, United Kingdom
| | - Justin W G Roe
- Therapies Department, Royal Marsden National Health Service Foundation Trust, London, United Kingdom.,Speech and Language Therapy Department, Imperial College Healthcare National Health Service Trust, London, United Kingdom.,Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Heather M Starmer
- Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Park D, Oh Y, Ryu JS. Findings of Abnormal Videofluoroscopic Swallowing Study Identified by High-Resolution Manometry Parameters. Arch Phys Med Rehabil 2015; 97:421-8. [PMID: 26505655 DOI: 10.1016/j.apmr.2015.10.084] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/18/2015] [Accepted: 10/01/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify the parameters of high-resolution manometry (HRM) with a significant correlation to abnormal findings of videofluoroscopic swallowing study (VFSS). DESIGN Prospective study. SETTING Hospital rehabilitation department. PARTICIPANTS Patients with dysphagia symptoms (N=40). INTERVENTION Participants were evaluated once using VFSS in neutral head position and evaluated twice using HRM with 5mL of thin fluid. MAIN OUTCOME MEASURES HRM parameters included maximal pressure, area integral, rise time, duration of the velopharynx and tongue base, maximal pressure of pre-upper esophageal sphincter (UES), low pharynx, cricopharyngeus, minimal UES pressure, UES activity time, and nadir UES duration. HRM parameters were compared with the findings of VFSS. Receiver operating characteristic analysis was performed to obtain the cutoff value, sensitivity, and specificity of HRM parameters for the prediction of findings of VFSS. RESULTS The maximum pressure of the velopharynx showed a significantly positive prediction for most abnormal parameters of VFSS in the pharyngeal phase. Nadir UES pressure duration was significant for impaired laryngeal elevation, residue at pyriformis sinus, and combination of penetration and aspiration. The maximum pressure of the velopharynx <180.0 showed 100% sensitivity and 75% specificity for the presence of penetration and aspiration, and the cutoff point of 178.8 showed 86.7% sensitivity and 75% specificity for the presence of subglottic aspiration. CONCLUSIONS This study identified significant HRM parameters that are highly specific for individual abnormalities of VFSS, suggesting the cutoff value, sensitivity, and specificity. Because HRM could inform the quantitative measurement of pharyngeal weakness, the cutoff value for HRM parameters could be used to predict aspiration in patients with pharyngeal weakness.
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Affiliation(s)
- Donghwi Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Yoongul Oh
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea.
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Crespo AN, Kimaid PA, Machado Júnior AJ, Wolf AE. Laryngeal Electromyography: Are the Results Reproducible? J Voice 2015; 29:498-500. [DOI: 10.1016/j.jvoice.2014.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/08/2014] [Indexed: 10/23/2022]
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Videoendoscopic Evaluation of Swallowing After Thyroidectomy: 7 and 60 Days. Dysphagia 2015; 30:496-505. [PMID: 26087901 DOI: 10.1007/s00455-015-9628-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
Deglutition complaints are frequent after thyroidectomy. The purpose of this study was to follow-up on patients with thyroidectomy indication to compare the videoendoscopic evaluation of swallowing on the seventh day (early postoperative, EPO) and on the 60th day after thyroidectomy, (late postoperative, LPO) and to compare patients that evolved with normal laryngeal mobility (NLM) and abnormal laryngeal mobility (ALM). Nasofibroscopic evaluation was performed preoperatively (PRE), on the EPO and LPO. Two groups were compared: ALM and NLM. The majority of people were women, age bracket 46-65, who underwent total thyroidectomy and with high frequency of carcinoma. 30 out of the 54 patients in the study had change in swallowing (55 %). Dysphagia occurred in 87 % (13/15) of patients with ALM in the EPO and remained in 67 % of them in the LPO. In the NLM group, dysphagia occurred in 44 % (17/39) in EPO and 25 % in LPO. There was a statistical difference between PRE and EPO, and PRE and LPO (P < 0,001). In the ALM group, liquid penetration and aspiration were identified in 33 % of the cases during EPO (P = 0,014); retention of food occurred in 87 % in EPO and in 60 % in LPO (P < 0,001). Dysphagia occurs in patients after thyroid surgery (regardless of larynx mobility alteration) and characterized by stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.
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Dysphagia associated with cervical spine and postural disorders. Dysphagia 2014; 28:469-80. [PMID: 23959456 DOI: 10.1007/s00455-013-9484-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 07/11/2013] [Indexed: 02/07/2023]
Abstract
Difficulties with swallowing may be both persistent and life threatening for the majority of those who experience it irrespective of age, gender, and race. The purpose of this review is to define oropharyngeal dysphagia and describe its relationship to cervical spine disorders and postural disturbances due to either congenital or acquired disorders. The etiology and diagnosis of dysphagia are analyzed, focusing on cervical spine pathology associated with dysphagia as severe cervical spine disorders and postural disturbances largely have been held accountable for deglutition disorders. Scoliosis, kyphosis–lordosis, and osteophytes are the primary focus of this review in an attempt to elucidate the link between cervical spine disorders and dysphagia. It is important for physicians to be knowledgeable about what triggers oropharyngeal dysphagia in cases of cervical spine and postural disorders. Moreover, the optimum treatment for dysphagia, including the use of therapeutic maneuvers during deglutition, neck exercises, and surgical treatment, is discussed.
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Comparison of dysphagia between cervical artificial disc replacement and fusion: data from a randomized controlled study with two years of follow-up. Spine (Phila Pa 1976) 2013; 38:E1507-10. [PMID: 23883828 DOI: 10.1097/brs.0b013e3182a516ef] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized controlled trial. OBJECTIVE To determine and explain any differences in self-reported dysphagia between patients treated with artificial disc replacement and anterior cervical decompression and fusion (ACDF). SUMMARY OF BACKGROUND DATA Dysphagia after anterior cervical spine surgery has in previous studies been evaluated regarding different influencing factors. Surgical technique, number of treated levels, and type of implant has been shown to be of possible importance. METHODS One hundred thirty-six patients from a randomized controlled trial between artificial disc replacement and ACDF in 1 or 2 surgical levels were evaluated regarding dysphagia. Evaluation was done with the dysphagia short questionnaire preoperatively, at 4 weeks, 3 months, and 1 and 2 years postoperatively. Reconstruction in the artificial disc replacement group was performed with the Discover artificial disc. Bone graft and anterior plating was used in the ACDF group. Type of implant was blinded to the patients and the surgeon until time of implantation. RESULTS Demographics and dysphagia short questionnaire levels were similar in both groups preoperative. At 4 weeks of follow-up postoperatively, dysphagia was significantly higher in both groups than baseline levels, P < 0.01. No significant differences were seen between the groups until follow-up at 2 years, which showed significantly higher dysphagia short questionnaire levels in the ACDF group, P = 0.04. The difference was statistically significant in both patients treated with 1- and 2-level surgery, P = 0.029 and P = 0.032, respectively. A logistic regression model showed a stronger association to type of implant than to number of surgical levels. Duration of surgery was highly associated to number of surgical levels but did not differ significantly between types of implant. CONCLUSION Long-term postoperative dysphagia could be explained by bulk of implant or decreased motion in the cervical spine. However, it is doubtful if differences between the groups in this study can be interpreted as a clinically important difference. LEVEL OF EVIDENCE 2.
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Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia 2012; 28:167-77. [PMID: 23089830 DOI: 10.1007/s00455-012-9426-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 09/20/2012] [Indexed: 01/14/2023]
Abstract
Post-swallow residue is considered a sign of swallowing impairment. Existing methods for capturing post-swallow residue (perceptual and quantitative) have inherent limitations. We employed several different perceptual and quantitative (ratio) methods for measuring post-swallow residue on the same 40 swallows and addressed the following questions: (1) Do perceptual and quantitative methods demonstrate good agreement? (2) What differences in precision are apparent by measurement method (one-dimensional, two-dimensional, and circumscribed area ratios)? (3) Do residue ratios agree strongly with residue area measures that are anatomically normalized? Based on the findings of this series of questions, a new method for capturing residue is proposed: the Normalized Residue Ratio Scale (NRRS). The NRRS is a continuous measurement that incorporates both the ratio of residue relative to the available pharyngeal space and the residue proportionate to the size of the individual. A demonstration of this method is presented to illustrate the added precision of the NRRS measurement in comparison to other approaches for measuring residue severity.
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