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Graham K, Reedy EL, Lee JJ, Norton ES, Arunachalam A, Tomic R, Martin-Harris B. Respiratory-swallow patterning and oropharyngeal swallowing impairment in patients undergoing evaluation for lung transplant. Neurogastroenterol Motil 2024:e14912. [PMID: 39223932 DOI: 10.1111/nmo.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Although swallowing impairment is prevalent following lung transplantation, baseline respiratory and swallowing characteristics are often overlooked. Respiratory disease processes may predispose lung transplant candidates to altered respiratory-swallow patterning and swallowing impairment. METHODS This cross-sectional study included patients referred for a Modified Barium Swallow Study during lung transplant evaluation. Swallowing impairment was measured using the Modified Barium Swallow Impairment Profile and Penetration-Aspiration Scale. Respiratory plethysmographic signals synchronized with videofluoroscopy were analyzed to determine phase patterning, pause duration, and rate. Mixed-effects logistic regression was used to identify linkages between respiratory and swallowing measures. KEY RESULTS Fifty patients were included and demonstrated delayed swallow initiation (49/50), oral residue (37/50), incomplete pharyngoesophageal segment opening (35/50), and esophageal retention (43/50). Airway invasion occurred infrequently (10/50). Atypical respiratory patterning was significantly associated with impairment in pharyngeal swallow initiation (OR [95% CI] = 1.76 [1.16, 2.68], p = 0.009), laryngeal elevation (OR [95% CI] = 1.45 [1.01, 2.07], p = 0.044), and laryngeal vestibular closure (OR [95% CI] = 2.57 [1.48, 4.46], p < 0.001). Increased pause duration was associated with impaired initiation (OR [95% CI] = 2.24 [1.20, 4.16], p = 0.011), laryngeal elevation (OR [95% CI] = 1.18 [1.03, 1.36], p = 0.018), laryngeal closure (OR [95% CI] = 1.28 [1.9, 1.50], p = 0.003), and tongue base retraction (OR [95% CI] = 1.33 [1.13, 1.56], p < 0.001). CONCLUSIONS & INFERENCES Patients undergoing evaluation for lung transplant demonstrated impaired swallowing and phase patterning. Preliminary findings implicate the need for further evaluation of respiratory-swallow coordination and its potential role in swallowing impairment before and after lung transplantation.
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Affiliation(s)
- Kahla Graham
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, Illinois, USA
| | - Erin L Reedy
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, Illinois, USA
- Edward J. Hines, Jr. Veterans Affairs Medical Center, Hines, Illinois, USA
| | - Jungwha Julia Lee
- Department of Preventive Medicine (Biostatistics), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth Spencer Norton
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, Illinois, USA
- Department of Medical Social Sciences and Institute for Innovations in Developmental Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ambalavanan Arunachalam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rade Tomic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, Illinois, USA
- Edward J. Hines, Jr. Veterans Affairs Medical Center, Hines, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Gandhi P, Mancopes R, Steele CM. Videofluoroscopic Swallowing Studies: A Proposed Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-10. [PMID: 39151053 DOI: 10.1044/2023_ajslp-22-00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE The videofluoroscopic swallowing study (VFSS) is used widely in dysphagia research. However, variations exist in the conduct and interpretation of VFSS, including differences in contrast agents, food and fluid consistencies tested, patient positioning, intervention strategies trialed, fluoroscopy settings, resolution, and image storage solutions. It cannot be assumed that VFSS exams yield directly comparable results across different studies. It is essential that relevant elements of VFSS be clearly reported in research. The goal of this article is to outline optimal VFSS reporting as part of the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a critical appraisal tool intended to promote rigor and transparency in dysphagia research. METHOD We developed a set of 27 questions regarding the rigor and transparency of VFSS reporting, based on review of previous research articles. These were reviewed by all members of the FRONTIERS Framework collaborative, to determine which questions were mandatory, unnecessary, or needed revision, prior to inclusion in the final critical appraisal tool. RESULTS The final FRONTIERS Framework tool contains 20 questions and seven subquestions regarding VFSS. These are grouped into four themes: patient/participant positioning, equipment and recording settings, contrast agents, and rating methods, including operational definitions and reliability. CONCLUSIONS The VFSS section of the FRONTIERS Framework tool is intended to facilitate and promote rigorous and transparent reporting of all elements that may influence the interpretation of VFSS in research. This critical appraisal tool can also be used to guide research design and the evaluation of study outcomes contributing to best practices in the field of dysphagia research.
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Affiliation(s)
- Pooja Gandhi
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Renata Mancopes
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Catriona M Steele
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Canada Research Chair in Swallowing and Food Oral Processing, University of Toronto, Ontario
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Bonilha HS, Reedy EL, Wilmskoetter J, Nietert PJ, Martin-Harris B. Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies. Dysphagia 2024; 39:632-641. [PMID: 38265506 PMCID: PMC11239744 DOI: 10.1007/s00455-023-10643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 01/25/2024]
Abstract
Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.
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Affiliation(s)
- Heather Shaw Bonilha
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA.
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Room 202B, Columbia, SC, 29208, USA.
| | - Erin L Reedy
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
| | - Janina Wilmskoetter
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- College of Medicine, Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 606, Charleston, SC, 29425-2503, USA
| | - Paul J Nietert
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon Street, MSC 835, Charleston, SC, 29425-2503, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Feinberg School of Medicine, Otolaryngology - Head & Neck Surgery, Radiation Oncology, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
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McGrattan K, Cerchiari A, Conway E, Berti B, Finkel R, Muntoni F, Mercuri E. Bulbar function in spinal muscular atrophy (SMA): State of art and new challenges. 21st July 2023, Rome, Italy. Neuromuscul Disord 2024; 38:44-50. [PMID: 38565000 DOI: 10.1016/j.nmd.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
Progressive bulbar involvement is frequent in spinal muscular atrophy, with prevalence and severity of deficits associated with type. The report provides an overview of the presentations made at the workshop grouped into 4 sessions: the first section was dedicated to videofluoroscopy with a revision of the existing protocols and discussion on which one should be used in routine clinical practice and in research settings. The second session was dedicated to interprofessional routine assessments of bulbar function, with a review of the recent clinical tools specifically developed for SMA. The third section was focused on the assessments performed by speech and language therapists/pathologists in the new SMA phenotypes. The last section focused on how the new therapies have changed the approach in rehabilitation for bulbar dysfunction. Finally, we present the consensus that was achieved on these aspects and possible action points from these.
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Affiliation(s)
- Katlyn McGrattan
- Department of Speech-Language-Hearing Sciences, University of Minnesota, USA
| | - Antonella Cerchiari
- Management and Diagnostic Innovations & Clinical Pathways Research Area, Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children's Hospital, Rome, Italy
| | - Eleanor Conway
- Department of Developmental Neuroscience, Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Beatrice Berti
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Richard Finkel
- Center for Experimental Neurotherapeutics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Francesco Muntoni
- Department of Speech-Language-Hearing Sciences, University of Minnesota, USA; Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eugenio Mercuri
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Pediatric Neurology Unit, Catholic University, Rome, Italy.
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Frakking TT, David M, Chang AB, Sarikwal A, Humphries S, Day S, Weir KA. Influence of frame rate in detecting oropharyngeal aspiration in paediatric videofluoroscopic swallow studies - An observational study. Eur J Radiol 2024; 170:111275. [PMID: 38142573 DOI: 10.1016/j.ejrad.2023.111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES The videofluoroscopic swallow study (VFSS), currently the gold standard for assessing aspiration in children, incurs radiation. Adhering to the ALARA principle is crucial in minimising radiation dose whilst obtaining accurate diagnostic information in children. International adult VFSS guidelines recommend a capture rate of 30 frames per second (fps). Higher capture rates increase radiation yet there is limited evidence on best practice VFSS capture rates in children, particularly on thin fluid consistency-the fastest viscosity with the highest potential for missed aspiration on slower capture rates. We aimed to determine if image acquisition at 30fps versus 15fps alters the accuracy of detecting aspiration when assessing thin fluids during paediatric VFSS. MATERIALS & METHODS Seventeen speech language pathologists (SLPs) blindly rated a total of 2,356 swallow loops for the presence/absence of aspiration from VFSS recordings of 13 infants/children drinking thin fluids. 76 swallow loops were randomly presented at 15 versus 30fps, on two occasions. Area under receiver operating curve (aROCs) was used to compare the accuracy of aspiration ratings at 15 versus 30fps compared to a comparison set. The intraclass correlation coefficient (ICC) was used to examine rater reliability. RESULTS Accuracy for detecting aspiration was near-identical at 15fps (aROC:0.97; 95%CI:0.96-0.97) and 30fps (0.96; 95%CI 0.96-0.97). Good inter-rater (ICC:0.82; 95%CI:0.72-0.89) and intra-rater reliability among the raters (ICC:0.89; 95%CI:0.82-0.93) was found. CONCLUSION Using 15fps in paediatric VFSS when assessing thin fluid consistency aspiration provides a similar detection rate to using 30fps. As 15fps would have a lower radiation dose than 30fps, we recommend using 15fps when undertaking VFSS in children. CLINICAL RELEVANCE STATEMENT Adhering to the ALARA principles, a capture rate of 15fps should be used in paediatric VFSS for assessment on thin fluids.
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Affiliation(s)
- Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, McKean St, Caboolture 4510, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, The University of Queensland, Herston 4101, Queensland, Australia; Speech Pathology Department, Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Queensland, Australia; School of Health Sciences & Social Work, Griffith University, 1 Parklands Drive, Southport, Gold Coast 4222, Queensland, Australia
| | - Michael David
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, New South Wales, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, 501 Stanley St, South Brisbane, 4101, Queensland, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina 0811, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, 4101, Queensland, Australia
| | - Anubhav Sarikwal
- I-MED Radiology Network, Caboolture Hospital, McKean St, Caboolture 4510, Queensland, Australia
| | - Seiji Humphries
- Research Development Unit, Caboolture Hospital, Queensland Health, McKean St, Caboolture 4510, Queensland, Australia
| | - Sarah Day
- Speech Pathology and Audiology Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture 4510, Queensland, Australia; University of Newcastle, College of Health, Medicine and Wellbeing, School of Health Sciences, University Drive, Callaghan, NSW 2308, Australia
| | - Kelly A Weir
- School of Health Sciences & Social Work, Griffith University, 1 Parklands Drive, Southport, Gold Coast 4222, Queensland, Australia; Department of Audiology & Speech Pathology, University of Melbourne, 550 Swanston St, Carlton 3053, Victoria, Australia; Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia.
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Reedy EL, Simpson AN, O'Rourke AK, Bonilha HS. Characterizing Swallowing Impairment in a Post-Lung Transplant Population. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1236-1251. [PMID: 37000923 DOI: 10.1044/2023_ajslp-22-00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Lung transplant recipients carry significant pre- and post-lung transplant dysphagia risk factors related to altered respiratory-swallow coordination as well as acute injury and decompensation resulting in the acute post-lung transplant recovery period. However, we are only beginning to understand the potential physiological contributors to altered swallowing in this population. METHOD A retrospective, cross-sectional, cohort study of post-lung transplant patients was performed. All participants received a modified barium swallow study (MBSS) as part of standard care during their acute hospitalization using the Modified Barium Swallow Impairment Profile (MBSImP) protocol and scoring metric. A combination of MBSImP scores, Penetration-Aspiration Scale (PAS) scores, Functional Oral Intake Scale (FOIS) scores, International Dysphagia Diet Standardization Initiative (IDDSI) scale levels, and the time from lung transplant to MBSS was collected, as well as measures of swallowing impairment and swallowing-related outcomes. Differences in swallowing physiology and swallowing-related outcomes between participants with typical versus atypical PAS were explored. RESULTS Forty-two participants met our prespecified inclusion criteria. We identified atypical laryngeal penetration and/or aspiration in 52.4% of our post-lung transplant cohort. Silent aspiration occurred in 75% of those patients who aspirated. Comparing typical versus atypical PAS scores, we found statistically significant associations with laryngeal elevation (Component 8), p < .0001; anterior hyoid excursion (Component 9), p = .0046; epiglottic movement (Component 10), p = .0031; laryngeal vestibule closure (Component 11), p < .0001; pharyngeal stripping (Component 12), p = .0058; pharyngeal total scores, p = .0001; FOIS scores, p = .00264; and IDDSI liquid levels, p = .0009. CONCLUSIONS Swallowing impairment resulting in abnormal bolus invasion is prevalent in post-lung transplant patients. Airway invasion in this cohort was related to pharyngeal swallow impairment and resulted in modified oral intake. Our findings help expand upon prior literature, which only reported the incidence of aspiration and pathological laryngeal penetration. Our results suggest that the potential for aerodigestive system impairment and negative sequela should not be underestimated in the post-lung transplant population.
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Affiliation(s)
- Erin L Reedy
- Health Sciences and Research, The Medical University of South Carolina, Charleston
| | - Annie N Simpson
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA
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Ingleby HR, Bonilha HS, Steele CM. A Tutorial on Diagnostic Benefit and Radiation Risk in Videofluoroscopic Swallowing Studies. Dysphagia 2023; 38:517-542. [PMID: 34254167 DOI: 10.1007/s00455-021-10335-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
The videofluoroscopic swallowing study (VFSS) is a key tool in assessing swallowing function. As with any diagnostic procedure, the probable benefits of the study must be weighed against possible risks. The probable benefit of VFSS is an accurate assessment of swallowing function, enabling patient management decisions potentially leading to improved patient health status and quality of life. A possible (though highly unlikely) risk in VFSS is carcinogenesis, arising from the use of ionizing radiation. Clinicians performing videofluoroscopic swallowing studies should be familiar with both sides of the risk benefit equation in order to determine whether the study is medically justified. The intent of this article is to provide the necessary background for conversations about benefit and risk in videofluoroscopic swallowing studies.
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Affiliation(s)
- Harry R Ingleby
- Division of Medical Physics, CancerCare Manitoba; Departments of Radiology and Physics & Astronomy, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada.
| | - Heather S Bonilha
- Departments of Rehabilitation Sciences; Health Science and Research; and Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Catriona M Steele
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Dhar SI, Nativ-Zeltzer N, Starmer H, Morimoto LN, Evangelista L, O'Rourke A, Fritz M, Rameau A, Randall DR, Cates D, Allen J, Postma G, Kuhn M, Belafsky P. The American Broncho-Esophagological Association Position Statement on Swallowing Fluoroscopy. Laryngoscope 2023; 133:255-268. [PMID: 35543231 DOI: 10.1002/lary.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop an expert consensus statement on the clinical use of swallowing fluoroscopy in adults that reduces practice variation and identifies opportunities for quality improvement in the care of patients suffering from swallowing impairment. METHODOLOGY A search strategist reviewed data sources (PubMed, Embase, Cochrane, Web of Science, Scopus) to use as evidence for an expert development group to compose statements focusing on areas of controversy regarding swallowing fluoroscopy. Candidate statements underwent two iterations of a modified Delphi protocol to reach consensus. RESULTS A total of 2184 publications were identified for title and abstract review with 211 publications meeting the criteria for full text review. Of these, 148 articles were included for review. An additional 116 publications were also included after reviewing the references of the full text publications from the initial search. These 264 references guided the authors to develop 41 candidate statements in various categories. Forty statements encompassing patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study and esophagram techniques, and interpretation of swallowing fluoroscopy met criteria for consensus. One statement on esophagram technique reached near-consensus. CONCLUSIONS These 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults can guide the development of best practices, improve quality and safety of care, and influence policy in both the outpatient and inpatient settings. The lack of consensus on some aspects of esophagram technique likely reflects gaps in knowledge and clinical practice variation and should be a target for future research. Laryngoscope, 133:255-268, 2023.
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Affiliation(s)
- Shumon Ian Dhar
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | | | - Lisa Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Ashli O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Mark Fritz
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Anaïs Rameau
- The Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, U.S.A
| | - Derrick R Randall
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Jacqueline Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory Postma
- Department of Otolaryngology-Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Maggie Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Peter Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
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Khalifa Y, Donohue C, Coyle JL, Sejdic E. Autonomous Swallow Segment Extraction Using Deep Learning in Neck-Sensor Vibratory Signals From Patients With Dysphagia. IEEE J Biomed Health Inform 2023; 27:956-967. [PMID: 36417738 PMCID: PMC10079637 DOI: 10.1109/jbhi.2022.3224323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dysphagia occurs secondary to a variety of underlying etiologies and can contribute to increased risk of adverse events such as aspiration pneumonia and premature mortality. Dysphagia is primarily diagnosed and characterized by instrumental swallowing exams such as videofluoroscopic swallowing studies. videofluoroscopic swallowing studies involve the inspection of a series of radiographic images for signs of swallowing dysfunction. Though effective, videofluoroscopic swallowing studies are only available in certain clinical settings and are not always desirable or feasible for certain patients. Because of the limitations of current instrumental swallow exams, research studies have explored the use of acceleration signals collected from neck sensors and demonstrated their potential in providing comparable radiation-free diagnostic value as videofluoroscopic swallowing studies. In this study, we used a hybrid deep convolutional recurrent neural network that can perform multi-level feature extraction (localized and across time) to annotate swallow segments automatically via multi-channel swallowing acceleration signals. In total, we used signals and videofluoroscopic swallowing study images of 3144 swallows from 248 patients with suspected dysphagia. Compared to other deep network variants, our network was superior at detecting swallow segments with an average area under the receiver operating characteristic curve value of 0.82 (95% confidence interval: 0.807-0.841), and was in agreement with up to 90% of the gold standard-labeled segments.
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10
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Bonilha HS, Canon CL, O'Rourke A, Tipnis S, Martin-Harris B. Stakeholder Perspectives on Radiation Use and Interdisciplinary Collaboration in Adult Modified Barium Swallow Studies. Dysphagia 2023; 38:23-32. [PMID: 35461361 DOI: 10.1007/s00455-022-10447-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/28/2022] [Indexed: 01/27/2023]
Abstract
The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations, the MBSS uses ionizing radiation with related radiation risks. Thus, the procedures and protocols related to MBSSs must balance the benefit of the diagnostic information gained with the risk of radiation exposure. This requires complex decision-making for any given clinician but becomes complicated due to the interprofessional nature of conducting MBSSs, namely the direct involvement of both the speech-language pathologist and radiologist with indirect involvement of the medical physicist and the referring physician. This editorial provides the perspectives of the various stakeholder groups related to radiation use in adult MBSSs, identifies barriers to conducting MBSSs in an evidence-based manner, and suggests areas for improvement.
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Affiliation(s)
- Heather Shaw Bonilha
- Departments of Rehabilitation Sciences, Health Science and Research, and Otolaryngology - Head and Neck Surgery, College of Health Professions, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Ashli O'Rourke
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29451, USA
| | - Sameer Tipnis
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Departments of Otolaryngology - Head and Neck Surgery and Radiation Oncology, Feinberg School of Medicine, Northwestern University, Evanston, IL, 60208, USA
- Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA
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Zhang PP, Yuan Y, Lu DZ, Li TT, Zhang H, Wang HY, Wang XW. Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis. Dysphagia 2023; 38:145-158. [PMID: 35849209 PMCID: PMC9873714 DOI: 10.1007/s00455-022-10486-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023]
Abstract
The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value is still controversial. In this systematic review and meta-analysis, we estimated and compared the diagnostic accuracy of EAT-10 cutoff values of 2 and 3 for screening dysphagia. We searched the PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WANFANG, and VIP databases from May 2008 to March 2022. The meta-analysis included 7 studies involving 1064 subjects from 7 different countries. Two studies were classified as high quality and five studies as medium quality. With an EAT-10 cutoff value of 2, using flexible endoscopic evaluation of swallowing or video fluoroscopic swallowing study as the gold standard, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.89 (95% confidence interval [CI] 0.82-0.93), 0.59 (95% CI 0.39-0.77), 2.17 (95% CI 1.38-3.42), 0.19 (95% CI 0.13-0.29), and 11.49 (95% CI 5.86-22.53), respectively. When a cutoff of 3 was used, these values were 0.85 (95% CI 0.68-0.94), 0.82 (95% CI 0.65-0.92), 4.84 (95% CI 1.72-13.50), 0.18 (95% CI 0.07-0.46), and 26.24 (95% CI 5.06-135.95), respectively. Using EAT-10 cutoff values of 2 and 3, the areas under the curve were 0.873 (95% CI 0.82-0.93) and 0.903 (95% CI 0.88-0.93), respectively, showing good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, a cutoff of 3 is recommended for EAT-10 due to better diagnostic accuracy.
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Affiliation(s)
- Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Ying Yuan
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - De-Zhi Lu
- School of Medical, Shanghai University, 99 Shangda Road, Shanghai, China
| | - Ting-Ting Li
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hui Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hong-Ying Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China.
- Rehabilitation Department, Affiliated Hospital of Weifang Medical College, 518 Fuyuan Street, Weifang, Shandong, China.
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12
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Reedy EL, Simpson AN, O'Rourke AK, Bonilha HS. Abnormal Esophageal Clearance Identified During Modified Barium Swallow Study in an Acute Poststroke Cohort. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2643-2662. [PMID: 36179218 DOI: 10.1044/2022_ajslp-22-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Dysphagia impacts many poststroke survivors with wide-ranging prevalence in the acute and chronic phases. One relatively unexplored manifestation of poststroke swallowing impairment is that of primary or co-occurring esophageal dysphagia. The incidence of esophageal dysphagia in this population is unknown despite the shared neuroanatomy and physiology with the oropharynx. We aimed to determine the presence of abnormal esophageal clearance in an acute poststroke sample using the Modified Barium Swallow Impairment Profile (MBSImP) Component 17 (esophageal clearance) as our outcome measure. METHOD We performed a retrospective, cross-sectional, cohort study of 57 poststroke patients with acute, first-ever, ischemic strokes. All participants received a modified barium swallow study (MBSS) using the MBSImP protocol and scoring metrics. Swallowing impairment was determined using a combination of MBSImP scores and Penetration-Aspiration Scale scores. Swallowing outcome measures were collected including Functional Oral Intake Scale and International Dysphagia Diet Standardization Initiative (IDDSI) scores. We performed tests of association and logistic regression analysis to determine if statistically significant associations exist between judgments of esophageal clearance and other swallowing impairments and/or swallowing outcome measures. RESULTS In our study of poststroke patients who received an MBSS as part of their care, 57.9% had abnormal esophageal clearance. Statistically significant associations were also identified in measures of pharyngeal physiology (MBSImP scores) and swallowing outcome measures (IDDSI scores and alternate means of nutrition). CONCLUSIONS Abnormal esophageal clearance was identified in greater than half of our poststroke patients. There is a dearth of scientific research regarding esophageal function poststroke. While esophageal visualization during the MBSS is not diagnostic of esophageal impairment, it may serve as an indicator for those poststroke patients who require dedicated esophageal testing to best determine the full nature of their swallowing pathophysiology and make the most effective treatment recommendations.
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Affiliation(s)
- Erin L Reedy
- Health Sciences and Research, Medical University of South Carolina, Charleston
| | - Annie N Simpson
- Health Sciences and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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13
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Miles A, Dharmarathna I, Fuller L, Jardine M, Allen J. Developing a Protocol for Quantitative Analysis of Liquid Swallowing in Children. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1244-1263. [PMID: 35302872 DOI: 10.1044/2021_ajslp-20-00337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Objective measures in videofluoroscopic swallow studies (VFSSs) can quantify swallow biomechanics. There are a wide array of validated measures studied in infants, children, and adults. There is a need for a pediatric VFSS protocol that consists of a small number of vital, time efficient, and clinically relevant measures. In this study, we aimed to establish a standard protocol for quantitative VFSS analysis in children. METHOD Protocol development began with a systematic literature review, which identified 22 quantitative and eight descriptive measures available in the literature. A pediatric VFSS database of 553 children was collected using a standardized VFSS protocol. Studies were evaluated using the 30 previously reported measures covering displacement and timing parameters as well as penetration-aspiration and residue. Measures were tested for rater reliability and internal consistency. Measures meeting acceptable values for protocol inclusion were included in the final protocol (Cronbach's alpha > .53). RESULTS Interrater and intrarater reliability of 17 measures met acceptable reliability levels. During internal consistency testing, we removed six further measures based on Cronbach's alpha levels indicating that two or more measures were equivalent in measuring the same aspect of swallow biomechanics in children. A VFSS protocol of reliable, valid, and obtainable objective quantitative (n = 6) and descriptive measures (n = 3) with separate protocols for young infants (≤ 9 months) and older children was established. CONCLUSIONS A standardized quantitative VFSS protocol for children has been developed to suit two age groups (≤ 9 and > 9 months old). Consistent VFSS administration and reporting support assessment over time and across disease groups. Future research should focus on how this information can be used by clinicians to produce individualized treatment plans for children with swallowing impairment.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Isuru Dharmarathna
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Laura Fuller
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Marie Jardine
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Jacqui Allen
- Department of Surgery, The University of Auckland, New Zealand
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14
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Alkhuwaiter M, Davidson K, Hopkins-Rossabi T, Martin-Harris B. Scoring the Penetration-Aspiration Scale (PAS) in Two Conditions: A Reliability Study. Dysphagia 2022; 37:407-416. [PMID: 33880656 PMCID: PMC8528890 DOI: 10.1007/s00455-021-10292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
A widely applied metric for identifying airway invasion events is the Penetration-Aspiration Scale (PAS). PAS scores are often included as primary outcome measures in clinical interventional studies, applied to characterize airway protection in a particular disease, used to establish a normal referent for control group comparisons without dysphagia, and as determinants or predictors of clinical outcomes. Despite the widespread use of the PAS, there is variability in scoring condition. One common method used in research studies includes rater scores applied to each single swallow that occurred during a modified barium swallow study (MBSS) of the same patient. A second common method includes raters scoring single swallow segments that have been spliced from full MBSS from different patients. These single swallow segments are then randomly distributed and the rater is blinded to all swallows that occurred during that patient MBSS. The potential effects of different scoring conditions on rater reliability and score accuracy have not been studied and may have high relevance for the conclusion drawn from the result. The primary aim of this investigation is to determine the impact of two scoring conditions on rater reliability and score accuracy: 1. Contextual, unblinded scoring condition and 2. Randomized, blinded condition. Results of the present study show that no statistically significant differences in PAS rater reliability and score accuracy were found between the two scoring conditions. If findings from this pilot study are reproduced in larger sample sizes, the time and intensity involved in splicing and randomizing MBSS for scoring may not be necessary.
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Affiliation(s)
- Munirah Alkhuwaiter
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
| | - Kate Davidson
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Theresa Hopkins-Rossabi
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
- Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, USA
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15
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Understanding differences in practices and preferences during videofluoroscopic swallow studies: A survey of radiologists and speech language pathologists in the United States. Clin Imaging 2022; 83:144-151. [DOI: 10.1016/j.clinimag.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/13/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
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16
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Edwards A, Froude E, Sharpe G, Carding P. Training for videofluoroscopic swallowing analysis: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:529-539. [PMID: 33586519 DOI: 10.1080/17549507.2020.1861327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To synthesise the available evidence relating to best practice in training videofluoroscopy and barium swallow analysts. METHOD The review was conducted according to the PRISMA statement and registered in PROSPERO (CRD42017053744). Data were extracted from nine databases. Studies were included if they described training approaches for clinicians or students of any profession learning to interpret videofluoroscopic (VFSS) or barium swallow studies and were written in English. The methods were heterogeneous and a metanalysis was not possible; a narrative review is presented. RESULT Sixteen studies were eligible, including those designed to evaluate the influence of training as well as those that described training as part of validating an assessment tool or method. The quality of the studies was assessed with the Hawker scale and assigned an NHMRC rating. While the evidence was low quality (NHMRC level IV), training consistently improved the accuracy and reliability of clinicians and students conducting VFSS. No studies reported the outcome of training for barium swallow analysis. There was significant variability in the dose, method, and setting of training. CONCLUSION To elucidate best practice in VFSS analysis to ensure training is cost effective and results in accurate diagnosticians requires further research.
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Affiliation(s)
- Ann Edwards
- School of Allied Health, Australian Catholic University (Brisbane), Virginia, Australia
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Elspeth Froude
- Faculty of Health Sciences, Australian Catholic University (Sydney), North Sydney, Australia
| | - Gabriella Sharpe
- School of Allied Health, Australian Catholic University (Brisbane), Virginia, Australia
| | - Paul Carding
- School of Allied Health, Australian Catholic University (Brisbane), Virginia, Australia
- Oxford Institute of Nursing, Midwifery, and Allied Health Research, Oxford Brookes University, Oxford, UK
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17
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Reedy EL, Herbert TL, Bonilha HS. Visualizing the Esophagus During Modified Barium Swallow Studies: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:761-771. [PMID: 33734825 PMCID: PMC8758321 DOI: 10.1044/2020_ajslp-20-00255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/18/2020] [Accepted: 12/08/2020] [Indexed: 05/09/2023]
Abstract
Purpose Despite the emphasis on using evidence-based practice for patient care, as clinicians, we sometimes find that there is insufficient evidence to support our clinical practices. One example of this is the "contentious" inclusion of routine, standardized visualization of the esophagus during modified barium swallow studies (MBSSs). This review sought to investigate the evidence for inclusion of routine esophageal visualization during the MBSS, a practice that is supported by the long-established interrelationship between all aspects of the oral, pharyngeal, and esophageal swallowing continuum. Method Searches were conducted in PubMed, Scopus, and CINAHL databases. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to identify articles that met prespecified inclusion and exclusion terms. Results Five articles were included in this review, which identified that esophageal findings were present in 48.67% of those participants whose MBSS included esophageal visualization. Conclusion This review supports a standardized, validated, reliable visualization protocol of the esophagus during the MBSS as a critical component to the accurate diagnosis and formulation of treatment recommendations for patients with swallowing disorders.
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Affiliation(s)
- Erin L. Reedy
- Health Sciences and Research, Medical University of South Carolina, Charleston
| | - Teri Lynn Herbert
- Academic Affairs Faculty, Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
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18
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Duncan DR, DiFilippo C, Kane M, Lurie M, McSweeney ME, Rosen RL. Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires. J Pediatr Gastroenterol Nutr 2021; 72:372-377. [PMID: 33264182 PMCID: PMC9765758 DOI: 10.1097/mpg.0000000000002987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I-GERQ-R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS). METHODS We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi-EAT-10 and I-GERQ-R as a quality initiative to address parental feeding concerns. I-GERQ-R results were compared with Pedi-EAT-10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1-way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results. RESULTS One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi-EAT-10 and I-GERQ-R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I-GERQ-R had relative risk 1.148 (95% confidence interval [CI] 1.043-1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04). CONCLUSIONS I-GERQ-R and the Pedi-EAT-10 are highly correlated. I-GERQ-R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Courtney DiFilippo
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Madeline Kane
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Margot Lurie
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Maireade E. McSweeney
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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19
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Mao S, Sabry A, Khalifa Y, Coyle JL, Sejdic E. Estimation of laryngeal closure duration during swallowing without invasive X-rays. FUTURE GENERATIONS COMPUTER SYSTEMS : FGCS 2021; 115:610-618. [PMID: 33100445 PMCID: PMC7584133 DOI: 10.1016/j.future.2020.09.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Laryngeal vestibule (LV) closure is a critical physiologic event during swallowing, since it is the first line of defense against food bolus entering the airway. Identifying the laryngeal vestibule status, including closure, reopening and closure duration, provides indispensable references for assessing the risk of dysphagia and neuromuscular function. However, commonly used radiographic examinations, known as videofluoroscopy swallowing studies, are highly constrained by their radiation exposure and cost. Here, we introduce a non-invasive sensor-based system, that acquires high-resolution cervical auscultation signals from neck and accommodates advanced deep learning techniques for the detection of LV behaviors. The deep learning algorithm, which combined convolutional and recurrent neural networks, was developed with a dataset of 588 swallows from 120 patients with suspected dysphagia and further clinically tested on 45 samples from 16 healthy participants. For classifying the LV closure and opening statuses, our method achieved 78.94% and 74.89% accuracies for these two datasets, suggesting the feasibility of implementing sensor signals for LV prediction without traditional videofluoroscopy screening methods. The sensor supported system offers a broadly applicable computational approach for clinical diagnosis and biofeedback purposes in patients with swallowing disorders without the use of radiographic examination.
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Affiliation(s)
- Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - Aliaa Sabry
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
- Department of Bioengineering, Swanson School of Engineering Department of Biomedical Informatics, School of Medicine Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA 15260 USA
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20
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Dodrill P. Evaluating Feeding and Swallowing in Infants and Children. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Bonilha HS, Martin-Harris B, O'Rourke AK, Tipnis SV. Radiation exposure in modified barium swallow studies. Curr Opin Otolaryngol Head Neck Surg 2020; 28:371-375. [PMID: 33027137 PMCID: PMC7788513 DOI: 10.1097/moo.0000000000000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The modified barium swallow study (MBSS) is an X-ray examination of swallowing used to detect the presence and type impairment, aspiration risk, and to develop intervention plans. In this review, we will cover the use of ionizing radiation in MBSSs and review recent literature concerning radiation exposure and cancer risks to patients undergoing MBSSs. Lastly, we will discuss the clinical implications of these findings. RECENT FINDINGS Recent literature confirms that the MBSS is a low-dose examination and that reducing pulse rate negatively impacts diagnostic accuracy. Importantly, cancer risks to adults undergoing MBSSs were also reported to be low. SUMMARY An adult undergoing MBSS using a standardized, valid protocol, like the Modified Barium Swallow Impairment Profile (MBSImP), has low-radiation exposure and very low associated cancer risks. MBSSs should be used whenever relevant to adult patient care without undue concern regarding radiation exposure. Children also have low radiation exposure from MBSSs; however, cancer risks from that exposure remain unknown. Best practices in radiation safety must always be followed. Reducing pulse rates in the adult or pediatric population to reduce radiation exposure is not a valid strategy because of the resulting reduction in diagnostic accuracy.
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Affiliation(s)
- Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston, South Carolina
- Department of Otolaryngology-Head and Neck Surgery
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | | | - Sameer V Tipnis
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
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22
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Sabry A, Mahoney AS, Mao S, Khalifa Y, Sejdić E, Coyle JL. Automatic Estimation of Laryngeal Vestibule Closure Duration Using High- Resolution Cervical Auscultation Signals. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2020; 5:1647-1656. [PMID: 35937555 PMCID: PMC9355454 DOI: 10.1044/2020_persp-20-00073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Safe swallowing requires adequate protection of the airway to prevent swallowed materials from entering the trachea or lungs (i.e., aspiration). Laryngeal vestibule closure (LVC) is the first line of defense against swallowed materials entering the airway. Absent LVC or mistimed/ shortened closure duration can lead to aspiration, adverse medical consequences, and even death. LVC mechanisms can be judged commonly through the videofluoroscopic swallowing study; however, this type of instrumentation exposes patients to radiation and is not available or acceptable to all patients. There is growing interest in noninvasive methods to assess/monitor swallow physiology. In this study, we hypothesized that our noninvasive sensor- based system, which has been shown to accurately track hyoid displacement and upper esophageal sphincter opening duration during swallowing, could predict laryngeal vestibule status, including the onset of LVC and the onset of laryngeal vestibule reopening, in real time and estimate the closure duration with a comparable degree of accuracy as trained human raters. Method The sensor-based system used in this study is high-resolution cervical auscultation (HRCA). Advanced machine learning techniques enable HRCA signal analysis through feature extraction and complex algorithms. A deep learning model was developed with a data set of 588 swallows from 120 patients with suspected dysphagia and further tested on 45 swallows from 16 healthy participants. Results The new technique achieved an overall mean accuracy of 74.90% and 75.48% for the two data sets, respectively, in distinguishing LVC status. Closure duration ratios between automated and gold-standard human judgment of LVC duration were 1.13 for the patient data set and 0.93 for the healthy participant data set. Conclusions This study found that HRCA signal analysis using advanced machine learning techniques can effectively predict laryngeal vestibule status (closure or opening) and further estimate LVC duration. HRCA is potentially a noninvasive tool to estimate LVC duration for diagnostic and biofeedback purposes without X-ray imaging.
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Affiliation(s)
- Aliaa Sabry
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Amanda S. Mahoney
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, PA
- Department of Biomedical Informatics, School of Medicine Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, PA
| | - James L. Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
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23
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Patel T, Clemmens C, Bradburn K, Beckstrand M, McGhee H, McKelvey K, Simmons C, Hill J, McGrattan KE. Effect of a standardized fluoroscopic procedural approach on fluoroscopy time during infant modified barium swallow studies. Int J Pediatr Otorhinolaryngol 2020; 138:110396. [PMID: 33152985 DOI: 10.1016/j.ijporl.2020.110396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pediatric dysphagia is a term used to describe dysfunctional feeding and swallowing in infants and children. It is estimated that about 1% of children in the United States are affected by these swallowing problems annually. The modified barium swallow study (MBSS) is considered by many as the gold standard in oropharyngeal swallowing assessment. Despite its diagnostic benefits, MBSS exposes infants to ionizing radiation, which carries potentially deleterious long-term effects for the pediatric population. OBJECTIVES Test the effect of a standardized MBSS procedural protocol on fluoroscopy time when compared to a non-standardized procedural approach. MATERIALS AND METHODS A retrospective review of infants ≤12 months who underwent a MBSS between 2011 and 2017 was conducted. Charts were reviewed for fluoroscopy time, age, primary diagnosis, MBSS indication, and severity of swallowing deficits. Infants were categorized as non-protocol or standardized protocol based on the utilized method of videofluoroscopic swallow study execution. RESULTS A total of 1378 MBSS' were included in the analysis. Swallow studies conducted using the standardized procedural protocol had significantly shorter fluoroscopy times (1.5 min) when compared to non-protocol group (2.0 min) (p < 0.001). Patients who aspirated had significantly longer fluoroscopy times when compared to patients who did not aspirate across both groups (p < 0.001). CONCLUSION Fluoroscopy time is influenced by both procedural and patient factors. Use of a standardized fluoroscopic procedural protocol appears to reduce fluoroscopy time and variability across patients.
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Affiliation(s)
- Terral Patel
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Clarice Clemmens
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Kathryn Bradburn
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
| | - Michael Beckstrand
- College of Liberal Arts Research Support, University of Minnesota, 101 Pleasant Street SE, Minneapolis, MN, 55455, USA.
| | - Heather McGhee
- Department of Speech Language Pathology, Medical University of Seouth Carolina, 131 Ashley Ave, Charleston, SC, 29425, USA.
| | - Keeley McKelvey
- Department of Speech Language Pathology, Medical University of Seouth Carolina, 131 Ashley Ave, Charleston, SC, 29425, USA.
| | - Cephus Simmons
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA.
| | - Jeanne Hill
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA.
| | - Katlyn Elizabeth McGrattan
- Department of Speech Language Hearing Science, University of Minnesota, 164 Pillsbury Drive, SE, Minneapolis, MN, 55455, USA.
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Mann D, Benbow JH, Gower NL, Trufan S, Watson M, Colcord ME, Squires MH, Raj VS, Hill JS, Salo JC. Swallowing dysfunction after minimally invasive oesophagectomy. BMJ Support Palliat Care 2020; 12:235-242. [PMID: 33093039 DOI: 10.1136/bmjspcare-2020-002626] [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: 08/06/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Patients undergoing oesophagectomy frequently experience malnutrition, which in combination with the catabolic effects of surgery can result in loss of muscle mass and function. Safe swallowing requires preservation of muscle mass. Swallowing dysfunction puts postoperative patients at risk for aspiration and pneumonia. Modified Barium Swallow Study (MBSS) enables assessment of postoperative swallowing impairments. The current study assessed incidence and risk factors associated with swallowing dysfunction and restricted diet at discharge in patients after oesophagectomy in a high-volume surgical centre. METHODS Patients with an MBSS after oesophagectomy were identified between March 2015 to April 2020 at a high-volume surgical centre. Swallowing was quantitatively evaluated on MBSS with the Rosenbek Penetration-Aspiration Scale (PAS). Muscle loss was evaluated clinically with preoperative hand grip strength (HGS). Univariable and multivariable logistic and linear regression analyses were performed. RESULTS 129 patients (87% male; median age 66 years) underwent oesophagectomy with postoperative MBSS. Univariate analysis revealed older age, preoperative feeding tube, lower preoperative HGS and discharge to non-home were associated with aspiration or penetration on MBSS. Age and preoperative feeding tube remained as independent predictors in the multivariable analysis. Both univariate and multivariable analyses revealed increased age and preoperative feeding tube were associated with diet restrictions at discharge. CONCLUSIONS Swallowing dysfunction after oesophagectomy is correlated with increased age and need for preoperative enteral feeding tube placement. Further research is needed to understand the relationship between muscle loss and aspiration with the goal of enabling preoperative physiological optimisation and patient selection.
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Affiliation(s)
- Della Mann
- Department of Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jennifer H Benbow
- LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Nicole L Gower
- LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Sally Trufan
- Department of Biostatistics, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Michael Watson
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Madison E Colcord
- LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Malcolm H Squires
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Levine Cancer Institute, Charlotte, North Carolina, USA.,Department of Supportive Care, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Joshua S Hill
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jonathan C Salo
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
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Avoiding the Downward Spiral After Stroke: Early Identification and Treatment of Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Martin-Harris B, Canon CL, Bonilha HS, Murray J, Davidson K, Lefton-Greif MA. Best Practices in Modified Barium Swallow Studies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1078-1093. [PMID: 32650657 PMCID: PMC7844340 DOI: 10.1044/2020_ajslp-19-00189] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 05/22/2023]
Abstract
Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cheri L. Canon
- Department of Radiology, The University of Alabama at Birmingham School of Medicine
| | - Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Joseph Murray
- Audiology and Speech-Language Pathology Service, VA Ann Arbor Healthcare System, MI
| | - Kate Davidson
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Maureen A. Lefton-Greif
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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Boaden E, Nightingale J, Bradbury C, Hives L, Georgiou R. Clinical practice guidelines for videofluoroscopic swallowing studies: A systematic review. Radiography (Lond) 2020; 26:154-162. [DOI: 10.1016/j.radi.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
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Shay EO, Meleca JB, Anne S, Hopkins B. Natural history of silent aspiration on modified barium swallow studies in the pediatric population. Int J Pediatr Otorhinolaryngol 2019; 125:116-121. [PMID: 31295702 DOI: 10.1016/j.ijporl.2019.06.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/16/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the natural history of silent aspiration in the pediatric population. METHODS Retrospective chart review of patients (age < 3 years) who underwent modified barium swallow studies (MBSS), between January 1, 2007, to December 31, 2017, were studied to compare comorbidities and determine course of resolution in those with silent aspiration. RESULTS A total of 148 charts were reviewed. Patients that underwent surgical intervention for laryngeal anomalies causing silent aspiration and those with overt aspiration or oral aversion were excluded. Of the 56 patients in the study, 25 had silent aspiration and 31 demonstrated no silent aspiration on MBSS. There was a higher rate of overall comorbidities amongst silent aspirators (96.0% vs. 48.4%, p=0.003) in comparison to patients with no silent aspiration on MBSS. Silent aspirators had higher rates of cerebral palsy (16.0% vs. 0%, p=0.034), and seizures (36.0% vs. 3.2%, p=0.003). Of the 20 patients with silent aspiration with an MBSS completed beyond the initial one, 13 (65.0%) experienced resolution, 5 (20.0%) did not experience resolution by age 5, and 2 (10.0%) had unknown resolution due to being lost to follow up or not yet reaching age 5. No statistically significant associations were found between comorbidities, gender, presence of a gastrostomy tube and resolution. CONCLUSIONS Silent aspiration in children is associated with neurological comorbidities, particularly cerebral palsy and seizures. More than half of the patients with silent aspiration spontaneously resolve over time. Expectant management, close surveillance, and clinical assessments can be considered in these patients on an individual basis.
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Affiliation(s)
- Elizabeth O Shay
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Joseph B Meleca
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA
| | - Brandon Hopkins
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA
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Galgano S, Gauntt D, Boyd M, Trahan D, Jackson B, Koehler R, Canon C, McNamara M, Zarzour J. Trade-off between pulse rate and radiation dose during modified barium swallow examination: what is the reality? Clin Radiol 2019; 74:736.e9-736.e12. [DOI: 10.1016/j.crad.2019.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/31/2019] [Indexed: 11/26/2022]
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He Q, Perera S, Khalifa Y, Zhang Z, Mahoney AS, Sabry A, Donohue C, Coyle JL, Sejdic E. The Association of High Resolution Cervical Auscultation Signal Features With Hyoid Bone Displacement During Swallowing. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1810-1816. [PMID: 31443032 PMCID: PMC6746228 DOI: 10.1109/tnsre.2019.2935302] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Recent publications have suggested that high-resolution cervical auscultation (HRCA) signals may provide an alternative non-invasive option for swallowing assessment. However, the relationship between hyoid bone displacement, a key component to safe swallowing, and HRCA signals is not thoroughly understood. Therefore, in this work we investigated the hypothesis that a strong relationship exists between hyoid displacement and HRCA signals. Videofuoroscopy data was collected for 129 swallows, simultaneously with vibratory/acoustic signals. Horizontal, vertical and hypotenuse displacements of the hyoid bone were measured through manual expert analysis of videofluoroscopy images. Our results showed that the vertical displacement of both the anterior and posterior landmarks of the hyoid bone was strongly associated with the Lempel-Ziv complexity of superior-inferior and anterior-posterior vibrations from HRCA signals. Horizontal and hypotenuse displacements of the posterior aspect of the hyoid bone were strongly associated with the standard deviation of swallowing sounds. Medial-Lateral vibrations and patient characteristics such as age, sex, and history of stroke were not significantly associated with the hyoid bone displacement. The results imply that some vibratory/acoustic features extracted from HRCA recordings can provide information about the magnitude and direction of hyoid bone displacement. These results provide additional support for using HRCA as a non-invasive tool to assess physiological aspects of swallowing such as the hyoid bone displacement.
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Mao S, Zhang Z, Khalifa Y, Donohue C, Coyle JL, Sejdic E. Neck sensor-supported hyoid bone movement tracking during swallowing. ROYAL SOCIETY OPEN SCIENCE 2019; 6:181982. [PMID: 31417694 PMCID: PMC6689594 DOI: 10.1098/rsos.181982] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/10/2019] [Indexed: 06/10/2023]
Abstract
Hyoid bone movement is an important physiological event during swallowing that contributes to normal swallowing function. In order to determine the adequate hyoid bone movement, clinicians conduct an X-ray videofluoroscopic swallowing study, which even though it is the gold-standard technique, has limitations such as radiation exposure and cost. Here, we demonstrated the ability to track the hyoid bone movement using a non-invasive accelerometry sensor attached to the surface of the human neck. Specifically, deep neural networks were used to mathematically describe the relationship between hyoid bone movement and sensor signals. Training and validation of the system were conducted on a dataset of 400 swallows from 114 patients. Our experiments indicated the computer-aided hyoid bone movement prediction has a promising performance when compared with human experts' judgements, revealing that the universal pattern of the hyoid bone movement is acquirable by the highly nonlinear algorithm. Such a sensor-supported strategy offers an alternative and widely available method for online hyoid bone movement tracking without any radiation side-effects and provides a pronounced and flexible approach for identifying dysphagia and other swallowing disorders.
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Affiliation(s)
- Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Zhenwei Zhang
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Cara Donohue
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA 15260, USA
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Mulheren RW, González-Fernández M. Swallow Screen Associated With Airway Protection and Dysphagia After Acute Stroke. Arch Phys Med Rehabil 2019; 100:1289-1293. [PMID: 30684489 DOI: 10.1016/j.apmr.2018.12.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The goal was to examine the outcomes of an existing swallow screen protocol in comparison to results from a formal videofluoroscopic protocol. DESIGN Prospective cohort study. SETTING Acute hospital. PARTICIPANTS Patients after acute stroke (N=48). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Johns Hopkins Hospital Brain Rescue Unit 3 oz Swallow Screen was implemented by nursing staff upon admission. Videofluoroscopy was conducted within 72 hours of diagnostic neuroimaging and initial swallow screen. Predictive values of the bedside swallow screen (pass/fail) for clinical judgment of dysphagia on videofluoroscopy (presence/absence) were calculated. Overall impairment scores from the Modified Barium Swallowing Impairment Profile were analyzed with respect to swallow screen results. RESULTS Thirteen participants failed the swallow screen, and 35 passed. Of the 35 patients who passed the swallow screen, 15 were clinically diagnosed with dysphagia on videofluoroscopy. Although pass/fail of the swallow screen was not a significant predictor of presence/absence of dysphagia, a logistic regression model including components of Laryngeal Elevation, Laryngeal Vestibule Closure, and Anterior Hyoid Excursion, and sex was statistically significant for swallow screen outcome. CONCLUSION The results of this study suggest that a swallow screen of aspiration risk can identify patients with the most need for videofluoroscopic evaluation and dysphagia management. Additionally, patients who fail a swallow screen are more likely to present with physiologic impairments related to airway protection on videofluoroscopy.
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Affiliation(s)
- Rachel W Mulheren
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Im HW, Kim SY, Oh BM, Han TR, Seo HG. Radiation Dose During Videofluoroscopic Swallowing Studies and Associated Factors in Pediatric Patients. Dysphagia 2019; 35:84-89. [DOI: 10.1007/s00455-019-10006-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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Rebrion C, Zhang Z, Khalifa Y, Ramadan M, Kurosu A, Coyle JL, Perera S, Sejdic E. High-Resolution Cervical Auscultation Signal Features Reflect Vertical and Horizontal Displacements of the Hyoid Bone During Swallowing. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 7:1800109. [PMID: 30701145 PMCID: PMC6345415 DOI: 10.1109/jtehm.2018.2881468] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
Millions of people across the globe suffer from swallowing difficulties, known as dysphagia, which can lead to malnutrition, pneumonia, and even death. Swallowing cervical auscultation, which has been suggested as a noninvasive screening method for dysphagia, has not been associated yet with any physical events. In this paper, we have compared the hyoid bone displacement extracted from the videofluoroscopy images of 31 swallows to the signal features extracted from the cervical auscultation recordings captured with a tri-axial accelerometer and a microphone. First, the vertical displacement of the anterior part of the hyoid bone is related to the entropy rate of the superior–inferior swallowing vibrations and to the kurtosis of the swallowing sounds. Second, the vertical displacement of the posterior part of the hyoid bone is related to the bandwidth of the medial–lateral swallowing vibrations. Third, the horizontal displacements of the posterior and anterior parts of the hyoid bone are related to the spectral centroid of the superior–inferior swallowing vibrations and to the peak frequency of the medial–lateral swallowing vibrations, respectively. At last, the airway protection scores and the command characteristics were associated with the vertical and horizontal displacements, respectively, of the posterior part of the hyoid bone. Additional associations between the patients’ characteristics and auscultations’ signals were also observed. The hyoid bone maximal displacement is a cause of swallowing vibrations and sounds. High-resolution cervical auscultation may offer a noninvasive alternative for dysphagia screening and additional diagnostic information.
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Affiliation(s)
- Cedrine Rebrion
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of PittsburghPittsburghPA15261USA
| | - Zhenwei Zhang
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of PittsburghPittsburghPA15261USA
| | - Yassin Khalifa
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of PittsburghPittsburghPA15261USA
| | - Mona Ramadan
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of PittsburghPittsburghPA15261USA
| | - Atsuko Kurosu
- Department of the Communication Science and DisordersSchool of Health and Rehabilitation SciencesUniversity of PittsburghPittsburghPA15260USA
| | - James L Coyle
- Department of the Communication Science and DisordersSchool of Health and Rehabilitation SciencesUniversity of PittsburghPittsburghPA15260USA
| | - Subashan Perera
- Division of Geriatric MedicineDepartment of MedicineUniversity of PittsburghPittsburghPA15261USA
| | - Ervin Sejdic
- Department of Electrical and Computer EngineeringSwanson School of EngineeringUniversity of PittsburghPittsburghPA15261USA
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Standardization of Radiologic Procedures for Pediatric Videofluoroscopic Swallow Studies: A Service-based Quality Improvement Initiative. Pediatr Qual Saf 2018; 3:e123. [PMID: 31334455 PMCID: PMC6581479 DOI: 10.1097/pq9.0000000000000123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/11/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction The videofluoroscopic swallow study (VFSS) remains the primary method to evaluate swallowing function in infants and children. However, limited standards exist to guide the image acquisition during pediatric VFSSs, leading to inadequate images, variable assessment quality, and potential for suboptimal diagnostic accuracy. The goal of this quality improvement project was to standardize the radiological procedure for radiologists at our institution. Methods A multidisciplinary team of project leaders established 3 imaging standards to target (magnification, the field of view, and pulse repetition rate), based on the best available evidence. The team used the Institute for Healthcare Improvement's Model for Improvement to guide the project, identified key drivers, and implemented specific interventions. Project leaders observed a total of 170 VFSS examinations, performed by radiology faculty, fellows, and residents over 24 months. The primary outcome for this project was physician compliance with 3 established imaging standards: field of view, magnification, and pulse repetition rate. Project leaders collected data without the radiologists' knowledge, and also recorded average radiation exposure as a balancing measure during this process. Results At baseline, compliance with all 3 criteria was 20%. Following interventions designed to improve radiologist performance with the 3 identified standards, the compliance rate reached 100% for the last 50 recorded VFSSs. During this same time, there was no meaningful increase in average radiation exposure compared with the 6 months before the implementation of this project. Conclusions Compliance with standardized image acquisition of VFSSs can be accomplished using a systematic quality improvement protocol targeting simple, inexpensive interventions.
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Duncan DR, Mitchell PD, Larson K, Rosen RL. Presenting Signs and Symptoms do not Predict Aspiration Risk in Children. J Pediatr 2018; 201:141-146. [PMID: 29960768 PMCID: PMC6412137 DOI: 10.1016/j.jpeds.2018.05.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/02/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine if any presenting symptoms are associated with aspiration risk, and to evaluate the reliability of clinical feeding evaluation (CFE) in diagnosing aspiration compared with videofluoroscopic swallow study (VFSS). STUDY DESIGN We retrospectively reviewed records of children under 2 years of age who had evaluation for oropharyngeal dysphagia by CFE and VFSS at Boston Children's Hospital and compared presenting symptoms, symptom timing, and CFE and VFSS results. We investigated the relationship between symptom presence and aspiration using the Fisher exact test and stepwise logistic regression with adjustment for comorbidities. CFE and VFSS results were compared using the McNemar test. Intervals from CFE to VFSS were compared using the Student t test. RESULTS A total of 412 subjects with mean (±SD) age 8.9 ± 6.9 months were evaluated. No symptom, including timing relative to meals, predicted aspiration on VFSS. This lack of association between symptoms and VFSS results persisted even in the adjusted multivariate model. The sensitivity of CFE for predicting aspiration by VFSS was 44%. Patients with a reassuring CFE waited 28.2 ± 8.5 days longer for confirmatory VFSS compared with those with a concerning CFE (P < .05). CONCLUSIONS Presenting symptoms are varied in patients with aspiration and cannot be relied upon to determine which patients have aspiration on VFSS. The CFE does not have the sensitivity to consistently diagnose aspiration so a VFSS should be performed in persistently symptomatic patients.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Paul D. Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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Earl VJ, Badawy MK. Radiation Exposure to Staff and Patient During Videofluoroscopic Swallowing Studies and Recommended Protection Strategies. Dysphagia 2018; 34:290-297. [DOI: 10.1007/s00455-018-9945-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/17/2018] [Indexed: 12/27/2022]
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Jones CA, Meisner EL, Broadfoot CK, Rosen SP, Samuelsen CR, McCulloch TM. Methods for measuring swallowing pressure variability using high-resolution manometry. FRONTIERS IN APPLIED MATHEMATICS AND STATISTICS 2018; 4:23. [PMID: 30687729 PMCID: PMC6345545 DOI: 10.3389/fams.2018.00023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Any movement performed repeatedly will be executed with inter-trial variability. Oropharyngeal swallowing is a complex sensorimotor action, and swallow-to-swallow variability can have consequences that impact swallowing safety. Our aim was to determine an appropriate method to measure swallowing pressure waveform variability. An ideal variability metric must be sensitive to known deviations in waveform amplitude, duration, and overall shape, without being biased by waveforms that have both positive and sub-atmospheric pressure profiles. Through systematic analysis of model waveforms, we found a coefficient of variability (CV) parameter on waveforms adjusted such that the overall mean was 0 to be best suited for swallowing pressure variability analysis. We then investigated pharyngeal swallowing pressure variability using high-resolution manometry data from healthy individuals to assess impacts of waveform alignment, pharyngeal region, and number of swallows investigated. The alignment that resulted in the lowest overall swallowing pressure variability was when the superior-most sensor in the upper esophageal sphincter reached half its maximum pressure. Pressures in the tongue base region of the pharynx were least variable and pressures in the hypopharynx region were most variable. Sets of 3 - 10 consecutive swallows had no overall difference in variability, but sets of 2 swallows resulted in significantly less variability than the other dataset sizes. This study identified variability in swallowing pressure waveform shape throughout the pharynx in healthy adults; we discuss implications for swallowing motor control.
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Affiliation(s)
- Corinne A. Jones
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Communication Sciences & Disorders; University of Wisconsin – Madison, Madison, WI, USA D
- Neuroscience Training Program; University of Wisconsin – Madison; Madison, WI, USA
| | - Ellen L. Meisner
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Physical Therapy, Mayo Clinic School of Health Sciences, Rochester, MN, USA
| | - Courtney K. Broadfoot
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Communication Sciences & Disorders; University of Wisconsin – Madison, Madison, WI, USA D
| | - Sarah P. Rosen
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
| | - Christine R. Samuelsen
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
| | - Timothy M. McCulloch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin – Madison, Madison, WI, USA
- Department of Communication Sciences & Disorders; University of Wisconsin – Madison, Madison, WI, USA D
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Developing competent videofluoroscopic swallowing study analysts. Curr Opin Otolaryngol Head Neck Surg 2018; 26:162-166. [DOI: 10.1097/moo.0000000000000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xinou E, Chryssogonidis I, Kalogera-Fountzila A, Panagiotopoulou-Mpoukla D, Printza A. Longitudinal Evaluation of Swallowing with Videofluoroscopy in Patients with Locally Advanced Head and Neck Cancer After Chemoradiation. Dysphagia 2018; 33:691-706. [DOI: 10.1007/s00455-018-9889-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
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Sun J, Li Z. Study on the Correlation between Barium Radiography and Pulmonary Infection rate in the Evaluation of Swallowing Function. Clinics (Sao Paulo) 2018; 73:e182. [PMID: 29924183 PMCID: PMC5996437 DOI: 10.6061/clinics/2018/e182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/15/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To compare the results respectively obtained from the utilization of 60% barium sulfate suspension and Iohexol as contrast agents for videofluoroscopic swallowing studies and the relationship between the clinical application of the two kinds of contrast agents and the incidence of pneumonia. METHODS Sixty cases of stroke patients with dysphagia were selected in rehabilitation department of our hospital, and the gender, age, position of the disease, and stroke nature between groups had no significant difference. Among which, 30 patients who were administered 350 mgI/ml Iohexol, and the other 30 patients with 60% barium sulfate suspension as contrast agent. We performed videofluoroscopic swallowing studies with barium 60% versus Iohexol within 1 week after admission and 2 weeks after admission. RESULTS After 2 weeks in hospital, the aspiration pneumonia incidence of two groups was statistically significant (p<0.05), the pneumonia incidence of Iohexol group was lower than barium sulfate group which might have a impossble relevance with barium aspiration. CONCLUSIONS During the videofluoroscopic swallowing study of dysphagia after stroke, barium sulfate can enhance the pneumonia incidence, and Iohexol can be widely applied in videofluoroscopic swallowing study.
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Affiliation(s)
- Jie Sun
- Department of Clinical Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, China, 221009
| | - Zeheng Li
- Department of Clinical Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, China, 221009
- *Corresponding author. E-mail:
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First Steps Towards Development of an Instrument for the Reproducible Quantification of Oropharyngeal Swallow Physiology in Bottle-Fed Children. Dysphagia 2017; 33:76-82. [PMID: 28894942 DOI: 10.1007/s00455-017-9834-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
The incidence of feeding/swallowing impairments (deglutition disorders) in young children is rising and poses serious acute and long-term health consequences. Accurate detection and prompt intervention can lessen the impact of dysphagia-induced sequelae. Videofluoroscopic Swallow Studies (VFSSs) are used to make critical decisions for medically fragile children despite procedural variability and the lack of agreed upon measures for interpreting and reporting results. This investigation represents the first steps in the development of a novel tool for the quantification of oropharyngeal swallow physiology from full-length VFSS examinations in bottle-fed children. The Modified Barium Swallow Impairment Profile MBSImP™© served as the conceptual assessment model for development of components and operational score variants to characterize distinguishable VFSS observations. Twenty-four components of swallowing physiology were validated via expert consensus. Training materials included a library of 94 digitized video images comprised of distinct score variants for each component. Materials were disseminated to seven speech-language pathologists (SLPs) who participated in didactic and self-training sessions, and rated components. All SLPs achieved ≥80% reliability criterion after completing two or three training sessions. Agreement for 17 (71%) components was achieved after two sessions. Nutritive sucking/oral and airway-related components were most difficult to distinguish. Three sessions were required for 2 (33%) of the sucking/oral components and 4 (57%) of the airway-related components. These findings support the feasibility to standardize training and reliably score swallowing physiology using precise definitions and unambiguous visual images, and represent preliminary steps towards content validity and reliability of a standardized VFSS tool for bottle-fed children.
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Abstract
OBJECTIVES The aim of the present study was to investigate the prevalence of oropharyngeal dysfunction with resultant aspiration in patients admitted after apparent life-threatening events (ALTE) and to determine whether historical characteristics could predict this oropharyngeal dysphagia and aspiration risk. METHODS We retrospectively reviewed the records of all patients admitted to Boston Children's Hospital between 2012 and 2015 with a diagnosis of ALTE to determine the frequency of evaluation for oropharyngeal dysphagia using video fluoroscopic swallow studies (VFSS) and clinical feeding evaluations, to determine the prevalence of swallowing dysfunction in subjects admitted after ALTE and to compare presenting historical characteristics to swallow study results. RESULTS A total of 188 children were admitted with a diagnosis of ALTE of which 29% (n = 55) had an assessment of swallowing by VFSS. Of those who had a VFSS, 73% (n = 40) had evidence of aspiration or penetration on VFSS. Of all of the diagnostic tests ordered on patients with ALTEs, the VFSS had the highest rate of abnormalities of any test ordered. None of the historical characteristics of ALTE predicted which patients were at risk for aspiration. In patients who had both clinical feeding evaluations and VFSS, observed clinical feedings incorrectly identified 26% of patients as having no oropharyngeal dysphagia when in fact aspiration was present on VFSS. CONCLUSIONS Oropharyngeal dysphagia with aspiration is the most common diagnosis identified in infants presenting with ALTEs. The algorithm for ALTE should be revised to include an assessment of VFSS as clinical feeding evaluations are inadequate to assess for aspiration.
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Jordan Hazelwood R, Armeson KE, Hill EG, Bonilha HS, Martin-Harris B. Identification of Swallowing Tasks From a Modified Barium Swallow Study That Optimize the Detection of Physiological Impairment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1855-1863. [PMID: 28614846 PMCID: PMC5831085 DOI: 10.1044/2017_jslhr-s-16-0117] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 12/29/2016] [Indexed: 05/04/2023]
Abstract
PURPOSE The purpose of this study was to identify which swallowing task(s) yielded the worst performance during a standardized modified barium swallow study (MBSS) in order to optimize the detection of swallowing impairment. METHOD This secondary data analysis of adult MBSSs estimated the probability of each swallowing task yielding the derived Modified Barium Swallow Impairment Profile (MBSImP™©; Martin-Harris et al., 2008) Overall Impression (OI; worst) scores using generalized estimating equations. The range of probabilities across swallowing tasks was calculated to discern which swallowing task(s) yielded the worst performance. RESULTS Large-volume, thin-liquid swallowing tasks had the highest probabilities of yielding the OI scores for oral containment and airway protection. The cookie swallowing task was most likely to yield OI scores for oral clearance. Several swallowing tasks had nearly equal probabilities (≤ .20) of yielding the OI score. CONCLUSIONS The MBSS must represent impairment while requiring boluses that challenge the swallowing system. No single swallowing task had a sufficiently high probability to yield the identification of the worst score for each physiological component. Omission of swallowing tasks will likely fail to capture the most severe impairment for physiological components critical for safe and efficient swallowing. Results provide further support for standardized, well-tested protocols during MBSS.
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Affiliation(s)
- R. Jordan Hazelwood
- Medical University of South Carolina, College of Health Professions, Department of Health Sciences and Research, Charleston
- Medical University of South Carolina, College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Charleston
- Appalachian State University, Beaver College of Heath Sciences, Department of Communication Sciences and Disorders, Boone, NC
| | - Kent E. Armeson
- Medical University of South Carolina, College of Medicine, Department of Public Health Sciences, Charleston
| | - Elizabeth G. Hill
- Medical University of South Carolina, College of Medicine, Department of Public Health Sciences, Charleston
| | - Heather Shaw Bonilha
- Medical University of South Carolina, College of Health Professions, Department of Health Sciences and Research, Charleston
- Medical University of South Carolina, College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Charleston
| | - Bonnie Martin-Harris
- Medical University of South Carolina, College of Health Professions, Department of Health Sciences and Research, Charleston
- Medical University of South Carolina, College of Medicine, Department of Otolaryngology–Head and Neck Surgery, Charleston
- Northwestern University, School of Communication, Department of Communication Sciences and Disorders, Evanston, IL
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Daniels SK, Easterling CS. Continued Relevance of Videofluoroscopy in the Evaluation of Oropharyngeal Dysphagia. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0201-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The Therapeutic Swallowing Study. Dysphagia 2017. [DOI: 10.1007/174_2017_89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Martin-Harris B, Humphries K, (Focht) Garand KL. The Modified Barium Swallow Impairment Profile (MBSImP™©) – Innovation, Dissemination and Implementation. ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig13.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Modified Barium Swallow Impairment Profile (MBSImP™©) is a standardized method for the assessment of swallowing physiology from videofluoroscopic imaging used by teams of speech-language pathologists (SLPs) and radiologists during modified barium swallowing studies (MBSS). The approach is grounded in research and motivated by patient need toward minimizing wide variation in clinical practice and equivocal swallowing assessment findings when attempting to compare assessment results across the continuum of care and between clinical settings. Various methods of scoring are used, which are dependent upon the nature and purpose of the clinical or research question. The MBSImP™© initiated with an National Institute of Health [NIH] supported study has been field tested for 13 years. The standardized method aims to enhance the validity and reliability of swallowing metrics, improve transparency and reproducibility of clinical and research MBSS practices, as well as to optimize patient safety, comfort, expectations, and outcomes. The physiologic study of swallowing impairment using the MBSImP™© has become a program of research that strategically includes a data science initiative using a global registry of quality, safety and outcome metrics.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern UniversityEvanston, IL
| | - Kate Humphries
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South CarolinaCharleston, SC
| | - Kendrea L. (Focht) Garand
- Department of Speech Pathology and Audiology, College of Allied Health Professions, University of South AlabamaMobile, AL
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Henderson M, Miles A, Holgate V, Peryman S, Allen J. Application and Verification of Quantitative Objective Videofluoroscopic Swallowing Measures in a Pediatric Population with Dysphagia. J Pediatr 2016; 178:200-205.e1. [PMID: 27568657 DOI: 10.1016/j.jpeds.2016.07.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/14/2016] [Accepted: 07/28/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the feasibility of obtaining and utilizing objective measures of timing and displacement from videofluoroscopy performed in pediatrics. STUDY DESIGN Children (n = 121; mean age 38 months, range 9 days-21 years, SD 4 years) referred for videofluoroscopy were recruited. All underwent a standardized protocol including a mid-feed 20-second loop recorded at 25 frames per second. Videos were analyzed using objective digital measures of timing and displacement. Radiation dose was recorded. RESULTS Quantitative measures were obtained in all children. Maximum opening of the pharyngoesophageal segment and timing measures were correlated with increasing age. Values were congruent with validated adult data. Mean radiation time was 1.58 minutes (range 0.15-3.47, SD 0.66), and mean radiation dose was 30.16 cGycm2 (range 6.5-85 SD 15.17). Radiation dose (P = .21) and radiation time (P = .72) were not significantly different using the increased frame rate compared with an age-matched cohort (n =100) prior to protocol change. CONCLUSIONS Objective quantitative measures of swallowing measurements can be obtained successfully from pediatric videofluoroscopy performed at high frame rates, without increasing radiation dose. Measures are biologically consistent, reproducible, demonstrate internal cross-correlation, and mirror adult data. These measures have potential to support targeted management and objective monitoring of change by pediatric feeding teams in the future.
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Affiliation(s)
- Mandy Henderson
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand; Speech Science, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, The University of Auckland, Auckland, New Zealand.
| | - Victoria Holgate
- Speech Science, The University of Auckland, Auckland, New Zealand
| | - Sophia Peryman
- Radiology, Waitemata District Health Board, Auckland, New Zealand
| | - Jacqui Allen
- Speech Science, The University of Auckland, Auckland, New Zealand; Otolaryngology, Waitemata District Health Board, Surgery, University of Auckland, Auckland, New Zealand
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Hersh C, Wentland C, Sally S, de Stadler M, Hardy S, Fracchia MS, Liu B, Hartnick C. Radiation exposure from videofluoroscopic swallow studies in children with a type 1 laryngeal cleft and pharyngeal dysphagia: A retrospective review. Int J Pediatr Otorhinolaryngol 2016; 89:92-6. [PMID: 27619036 DOI: 10.1016/j.ijporl.2016.07.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Radiation exposure is recognized as having long term consequences, resulting in increased risks over the lifetime. Children, in particular, have a projected lifetime risk of cancer, which should be reduced if within our capacity. The objective of this study is to quantify the amount of ionizing radiation in care for children being treated for aspiration secondary to a type 1 laryngeal cleft. With this baseline data, strategies can be developed to create best practice pathways to maintain quality of care while minimizing radiation exposure. METHODS Retrospective review of 78 children seen in a tertiary pediatric aerodigestive center over a 5 year period from 2008 to 2013 for management of a type 1 laryngeal cleft. The number of videofluoroscopic swallow studies (VFSS) per child was quantified, as was the mean effective dose of radiation exposure. The 78 children reviewed were of mean age 19.9 mo (range 4 mo-12 years). All children were evaluated at the aerodigestive center with clinical symptomatology and subsequent diagnosis of a type 1 laryngeal cleft. Aspiration was assessed via VFSS and exposure data collected. Imaging exams where dose parameters were not available were excluded. RESULTS The mean number of VFSS each child received during the total course of treatment was 3.24 studies (range 1-10). The average effective radiation dose per pediatric VFSS was 0.16 mSv (range: 0.03 mSv-0.59 mSv) per study. Clinical significance was determined by comparison to a pediatric CXR. At our facility a CXR yields an effective radiation dose of 0.017 mSv. Therefore, a patient receives an equivalent total of 30.6 CXR over the course of management. CONCLUSIONS Radiation exposure has known detrimental effects particularly in pediatric patients. The total ionizing radiation from VFSS exams over the course of management of aspiration has heretofore not been reported in peer reviewed literature. With this study's data in mind, future developments are indicated to create innovative clinical pathways and limit radiation exposure.
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Affiliation(s)
- Cheryl Hersh
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, 275 Cambridge Street POB 3, Boston, MA 02114, United States.
| | - Carissa Wentland
- Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Sarah Sally
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, 275 Cambridge Street POB 3, Boston, MA 02114, United States.
| | - Marie de Stadler
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, 275 Cambridge Street POB 3, Boston, MA 02114, United States.
| | - Steven Hardy
- Pediatric Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - M Shannon Fracchia
- Pediatric Pulmonary Division, Massachusetts General Hospital, 275 Cambridge Street POB 5, Boston, MA 02114, United States.
| | - Bob Liu
- Department of Imaging, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Christopher Hartnick
- Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
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Dudik JM, Coyle JL, El-Jaroudi A, Sun M, Sejdić E. A Matched Dual-Tree Wavelet Denoising for Tri-Axial Swallowing Vibrations. Biomed Signal Process Control 2016; 27:112-121. [PMID: 27152118 DOI: 10.1016/j.bspc.2016.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Swallowing disorders affect thousands of patients every year. Currently utilized techniques to screen for this condition are questionably reliable and are often deployed in non-standard manners, so efforts have been put forth to generate an instrumental alternative based on cervical auscultation. These physiological signals with low signal-to-noise ratios are traditionally denoised by well-known wavelets in a discrete, single tree wavelet decomposition. We attempt to improve this widely accepted method by designing a matched wavelet for cervical auscultation signals to provide better denoising capabilities and by implementing a dual-tree complex wavelet transform to maintain time invariant properties of this filtering. We found that our matched wavelet did offer better denoising capabilities for cervical auscultation signals compared to several popular wavelets and that the dual tree complex wavelet transform did offer better time invariance when compared to the single tree structure. We conclude that this new method of denoising cervical auscultation signals could benefit applications that can spare the required computation time and complexity.
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Affiliation(s)
- Joshua M Dudik
- Department of Electrical and Computer Engineering, Swanson School of Enginering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Amro El-Jaroudi
- Department of Electrical and Computer Engineering, Swanson School of Enginering, University of Pittsburgh, Pittsburgh, PA, USA,
| | - Mingui Sun
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Enginering, University of Pittsburgh, Pittsburgh, PA, USA,
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