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Pizzorni N, Rocca S, Eplite A, Monticelli M, Rama S, Mozzanica F, Scarponi L, Schindler A. Fiberoptic endoscopic evaluation of swallowing (FEES) in pediatrics: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 181:111983. [PMID: 38796943 DOI: 10.1016/j.ijporl.2024.111983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES The systematic review aimed to provide an overview of the state-of-art regarding the use of fiberoptic endoscopic evaluation of swallowing (FEES) in pediatrics, specifically investigating FEES feasibility, safety, diagnostic accuracy, and protocols. METHODS Four electronic databases were searched for original studies on the pediatric population that instrumentally assessed swallowing function using FEES. A hand-search of the references of included studies was performed. Data on the population, feasibility of endoscope insertion and bolus trials, adverse events, sensitivity and specificity, and FEES equipment and protocol were extracted. The quality of the studies was assessed using the checklists of the Johanna Briggs Institute. Selection of the studies, data extraction, and quality appraisal were conducted by two independent researchers. RESULTS Eighty-two reports from 81 studies were included. The mean overall quality of the studies was 80 % (17-100 %). The feasibility of endoscope insertion was high (89%-100 %), while the feasibility of bolus trials varied from 40 % to 100 %. Adverse events were excessive crying (8 studies), irritability or agitation (4 studies), transitory oxygen desaturations (3 studies, 1.2-6.7 % of the patients), epistaxis (3 studies, 0.8-3.3 % of the patients), increased heart rate (1 study, 1 patient), vomiting (1 study, 1 patient), hypertonia (1 study), and hypersalivation (1 study). No major complications were reported. Using VFSS as the reference standard, FEES was generally found to be less sensitive (25-94 %) but more specific (75-100 %) for aspiration, whereas the reverse was true for penetration (sensitivity 76-100 %, specificity 44-83 %). FEES protocols were highly heterogeneous with poor reporting. CONCLUSION FEES is a safe, accurate, and generally feasible examination in the pediatric population with suspected dysphagia. However, a consensus on the best FEES protocol for clinical practice and research is currently lacking.
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Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, 20157, Italy
| | - Sara Rocca
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, 20157, Italy.
| | - Angelo Eplite
- UO Otorhinolaryngology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, 20157, Italy
| | - Marta Monticelli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, 20157, Italy
| | - Sibora Rama
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, 20157, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, 20122, Italy; Department of Otorhinolaryngology, San Giuseppe Hospital, IRCCS Multimedica, Milan, 20123, Italy
| | - Letizia Scarponi
- UO Otorhinolaryngology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, 20157, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, 20157, Italy; UO Otorhinolaryngology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, 20157, Italy
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Dziewas R, Warnecke T, Labeit B, Claus I, Muhle P, Oelenberg S, Ahring S, Wüller C, Jung A, von Itter J, Suntrup-Krueger S. Systematic approach to contextualize findings of flexible endoscopic evaluation of swallowing in neurogenic dysphagia- towards an integrated FEES report. Neurol Res Pract 2024; 6:26. [PMID: 38720388 PMCID: PMC11080162 DOI: 10.1186/s42466-024-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
Flexible endoscopic evaluation of swallowing (FEES) is one of the most important methods for instrumental swallowing evaluation. The most challenging part of the examination consists in the interpretation of the various observations encountered during endoscopy and in the deduction of clinical consequences. This review proposes the framework for an integrated FEES-report that systematically moves from salient findings of FEES to more advanced domains such as dysphagia severity, phenotypes of swallowing impairment and pathomechanisms. Validated scales and scores are used to enhance the diagnostic yield. In the concluding part of the report, FEES-findings are put into the perspective of the clinical context. The potential etiology of dysphagia and conceivable differential diagnoses are considered, further diagnostic steps are proposed, treatment options are evaluated, and a timeframe for re-assessment is suggested. This framework is designed to be adaptable and open to continuous evolution. Additional items, such as novel FEES protocols, pathophysiological observations, advancements in disease-related knowledge, and new treatment options, can be easily incorporated. Moreover, there is potential for customizing this approach to report on FEES in structural dysphagia.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrück- Academic Teaching Hospital of the University of Münster, Am Finkenhügel 1, 49076, Osnabrück, Germany.
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany.
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrück- Academic Teaching Hospital of the University of Münster, Am Finkenhügel 1, 49076, Osnabrück, Germany
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Bendix Labeit
- Department of Neurology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Inga Claus
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Paul Muhle
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Stephan Oelenberg
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sigrid Ahring
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Christina Wüller
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Anne Jung
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Jonas von Itter
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
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Pazinatto DB, Brandão MAB, Costa FLP, Favaro MMA, Maunsell R. Role of fiberoptic endoscopic evaluation of swallowing (FEES) in children with suspected dysphagia. J Pediatr (Rio J) 2024:S0021-7557(24)00041-X. [PMID: 38679061 DOI: 10.1016/j.jped.2024.03.008] [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: 11/29/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE To assess FEES findings in defining oral feeding safety in children with suspected dysphagia, comparing them with clinical feeding evaluation results. METHODS This study comprised a case series involving children with suspected dysphagia, referred for evaluation by otolaryngologists and speech-language pathologists (SLPs) at a Brazilian quaternary public university hospital. These children underwent both clinical evaluations and fiberoptic endoscopic evaluation of swallowing (FEES), with a comprehensive collection of demographic and clinical data. Subsequently, the authors performed a comparative analysis of findings from both assessments. RESULTS Most patients successfully completed the FEES procedure (93.7%), resulting in a final number of 60 cases included in the study. The prevalence of dysphagia was confirmed in a significant 88% of these cases. Suspected aspiration on clinical SLP evaluation was present in 34 patients. Of these, FEES confirmed aspiration or penetration in 28 patients. Among the 35 patients with aspiration or penetration on FEES, 7 (20%) had no suspicion on SLP clinical assessment. All seven patients in whom clinical SLP evaluation failed to predict penetration/aspiration had neurological disorders. The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders, while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%). CONCLUSION FEES can diagnose structural anomalies of the upper aerodigestive tract and significantly contribute to the detection of aspiration and penetration in this group of patients with suspected dysphagia, identifying moderate and severe dysphagia even in cases where clinical assessment had no suspicion.
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Affiliation(s)
| | | | | | | | - Rebecca Maunsell
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Curtis JA, Tabor Gray L, Arrese L, Borders JC, Starmer H. Characterizing the Validity of Using VASES to Derive DIGEST-FEES Grades. Folia Phoniatr Logop 2024:1-10. [PMID: 38631299 DOI: 10.1159/000538935] [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: 11/29/2023] [Accepted: 04/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) are two complimentary methods for assessing swallowing during FEES. Whereas VASES is intended to facilitate trial-level ratings of pharyngeal residue, penetration, and aspiration, DIGEST-FEES is intended to facilitate protocol-level impairment grades of swallowing safety and efficiency. The aim of this study was to assess the validity of using VASES to derive DIGEST-FEES impairment grades. METHODS DIGEST-FEES grades were blindly analyzed from 50 FEES - first using the original DIGEST-FEES grading method (n = 50) and then again using a VASES-derived DIGEST-FEES grading method (n = 50). Weighted Kappa (κw) and absolute agreement (%) were used to assess the relationship between the original DIGEST-FEES grades and VASES-derived DIGEST-FEES grades. Spearman's correlations assessed the relationship between VASES-derived DIGEST-FEES grades with measures of construct validity. RESULTS Substantial agreement (κw = 0.76-0.83) was observed between the original and VASES-derived grading methods, with 60-62% of all DIGEST-FEES grades matching exactly, and 92-100% of DIGEST-FEES grades within one grade of each other. Furthermore, the strength of the relationships between VASES-derived DIGEST-FEES grades and measures of construct validity (r = 0.34-0.78) were similar to the strength of the relationships between original DIGEST-FEES grades and the same measures of construct validity (r = 0.34-0.83). CONCLUSION Findings from this study demonstrate substantial agreement between original and VASES-derived DIGEST-FEES grades. Using VASES to derive DIGEST-FEES also appears to maintain the same level of construct validity established with the original DIGEST-FEES. Therefore, clinicians and researchers may consider using VASES to increase the transparency and standardization of DIGEST-FEES ratings. Future research should seek to replicate these findings and explore the simultaneous use of VASES and DIGEST-FEES in a greater sampling of raters and across other patient populations.
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Affiliation(s)
- James A Curtis
- Aerodigestive Innovations Research Lab (AIR), Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Lauren Tabor Gray
- Dr. Kiran C. Patel College of Allopathic Medicine, Center for Collaborative Research, NOVA Southeastern University, Fort Lauderdale, Florida, USA
| | - Loni Arrese
- Department of Speech and Hearing Science, Ohio State University, Columbus, Ohio, USA
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Heather Starmer
- HOPES Lab, Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California, USA
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Gascon L, Bryson PC, Benninger M, Brodsky MB. Assessing Dysphagia in the Adult. Otolaryngol Clin North Am 2024:S0030-6665(24)00044-6. [PMID: 38632000 DOI: 10.1016/j.otc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
This article explores the landscape of dysphagia assessment in adults. Dysphagia, a complex condition affecting the lifespan and many health conditions, significantly compromises individuals' quality of life. Dysphagia is often underdiagnosed, emphasizing the need for comprehensive assessment methods to ensure timely and accurate intervention. It encompasses clinical history, physical examination, clinical and instrumental swallow evaluations. Procedures within each of these modalities are reviewed, highlighting strengths, limitations, and contribution toward a complete understanding of dysphagia, ultimately guiding effective intervention strategies for improved patient outcomes.
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Affiliation(s)
- Laurence Gascon
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center.
| | - Paul C Bryson
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center
| | - Michael Benninger
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center
| | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Costa BOI, Machado LS, Augusto MM, Magalhães DDD, Alves TC, Pernambuco L. Training to Analyze Functional Parameters with Fiberoptic Endoscopic Evaluation of Swallowing: A Scoping Review. Dysphagia 2024; 39:198-207. [PMID: 37592140 DOI: 10.1007/s00455-023-10614-w] [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: 10/06/2022] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
Analyzing fiberoptic endoscopic evaluation of swallowing (FEES) is challenging and requires training to ensure the proficiency of health professionals and improve reliability. This scoping review aims to identify and map the available evidence on training health professionals to analyze FEES functional parameters. The method proposed by the Joanna Briggs Institute and the PRISMA-ScR guidelines were followed. The search was performed in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL databases, and in the gray literature. Two blinded independent reviewers screened articles by title and abstract. Then, they read the full text of the included reports, considering the eligibility criteria. Data were extracted using a standardized form. Six studies met the established eligibility criteria, published between 2009 and 2022, with few participants. All these studies addressed training as part of the process to validate a rating scale. No standardized criteria were observed regarding the selection of experts and participants, training structure, and outcome measures to assess participants' competence. The reviewed literature indicates that training must be developed to equip students and health professionals who treat dysphagia, enabling them to analyze the functional parameters of the FEES, considering variables that may influence the participants' performance.
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Affiliation(s)
- Bianca O I Costa
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil
| | - Liliane S Machado
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil
| | - Milena M Augusto
- Technological Innovation in Health Laboratory (LAIS/UFRN), Universidade Federal do Rio Grande do Norte (UFRN), Av. Nilo Peçanha, 650, Petrópolis, Natal, RN, 59012-300, Brazil
| | - Desiré D D Magalhães
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil
| | - Thaís Coelho Alves
- Dysphagia Research and Rehabilitation Laboratory (LADis/UNESP), Universidade Estadual Paulista (UNESP), Campus I 737, Av. Hygino Muzzi Filho, Marília, SP, 17.525-900, Brazil
| | - Leandro Pernambuco
- Graduate Program in Decision and Health Models (PPGMDS/UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58050-585, Brazil.
- Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Campus I s/n, Conj. Pres. Castelo Branco III, João Pessoa, PB, 58051-900, Brazil.
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Salgado TT, Oliveira CMDS, Gatti M, Silva RGD, Honório HM, Berretin-Felix G. Degree of swallowing impairment in the elderly: clinical and instrumental assessment. Braz J Otorhinolaryngol 2024; 90:101426. [PMID: 38608636 PMCID: PMC11016858 DOI: 10.1016/j.bjorl.2024.101426] [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: 10/08/2023] [Revised: 12/11/2023] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To classifying the degree of swallowing impairment in the elderly, comparing clinical and instrumental assessment. METHODS This is a cross-sectional study with quantitative and qualitative analysis of clinical and instrumental assessment of 37 elderly, aged 60-82 years, of both genders without neurological, oncological or systemic diseases, participated in this study. All participants were submitted to clinical evaluation and their results compared through fiberoptic endoscopic evaluation of swallowing considering liquid, pudding and solid food consistencies. Data were analyzed descriptively and statistically using the analysis of variance test (two-way ANOVA) and Tukey's post hoc test (p < 0.05). RESULTS In the clinical evaluation there was a higher occurrence of moderate swallowing impairment, followed by functional swallowing, while in fiberoptic endoscopic evaluation of swallowing the severity of the impairment was greater for moderate and mild degrees. There was no statistical difference between the clinical and instrumental evaluation methods. However, there was a significant interaction between the variables, with a difference for liquid consistency in the instrumental evaluation method. CONCLUSION Healthy elderly have different degree of swallowing impairment according to food consistency. The clinical assessment using a scale that considers the physiological changes of the elderly, presented results similar to those found in the instrumental examination. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Marina Gatti
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brazil
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Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
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Morris K, Taylor NF, Freeman-Sanderson A. Safety-related outcomes for patients with a tracheostomy and the use of flexible endoscopic evaluation of swallowing (FEES) for assessment and management of swallowing: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-11. [PMID: 38462820 DOI: 10.1080/17549507.2023.2293633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE The purpose of this systematic review was to examine safety-related outcomes for patients with tracheostomy after flexible endoscopic evaluation of swallowing (FEES) to assess and manage their swallow, when compared to other non-instrumental swallow assessments such as clinical swallowing examination (CSE) and/or a modified Evans blue dye test (MEBDT). METHOD Three databases were searched for articles referring to safety-related outcome data for adults with a tracheostomy, who underwent FEES and CSE and/or MEBDT. Articles were screened using predefined inclusion/exclusion criteria. RESULT The search strategy identified 2097 articles; following abstract and full-text screening, seven were included for review. The summary of evidence found low to very low certainty that FEES was associated with improved outcomes across swallow safety, physiological outcomes, tracheostomy cannulation duration, functional outcomes, and detection of upper airway pathologies. CONCLUSION This systematic review demonstrated low to very low certainty evidence from seven heterogeneous studies with low sample sizes that incorporating FEES may be associated with improved safety-related outcomes. There is less evidence supporting the accuracy of other swallow assessments conducted at the point of care (i.e. CSE and MEBDT). Future research requires studies with larger sample sizes and routine reporting of safety-related outcomes with use of FEES.
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Affiliation(s)
- Katherine Morris
- Speech Pathology Department, Eastern Health, Melbourne, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Speech Pathology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Li X, Lu L, Fu X, Li H, Yang W, Guo H, Guo K, Huang Z. Systematic review and meta-analysis of the efficacy and safety of electroacupuncture for poststroke dysphagia. Front Neurol 2023; 14:1270624. [PMID: 38125830 PMCID: PMC10731355 DOI: 10.3389/fneur.2023.1270624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Optimal treatment strategies for post-stroke dysphagia (PSD) remain to be explored. Electroacupuncture (EA) has attracted widespread attention due to its simplicity, cheapness, and safety. However, the efficacy of EA in the treatment of PSD lacks high-level evidence-based medical support. This study aimed to systematically evaluate the clinical value of EA in the treatment of PSD. Methods A total of seven databases were searched for relevant literature. All randomized controlled trials (RCTs) on EA alone or EA combined with other interventions for the treatment of PSD were assessed using the modified Jadad scale. The studies with a score of ≥4 were included. The quality of the included studies was then assessed using the Cochrane Collaboration's tool. The meta-analysis was performed using Rev. Man 5.3 software. Results Twelve studies involving 1,358 patients were included in the meta-analysis. Meta-analysis results showed that the EA group was superior to the control group in terms of clinical response rate (OR = 2.63, 95% CI = 1.97 to 3.53) and videofluoroscopic swallowing study (VFSS) score (MD = 0.73, 95% CI = 0.29 to 1.16). There was no significant difference between the two groups in the standardized swallowing assessment (SSA) score (MD = -3.11, 95% CI = -6.45 to 0.23), Rosenbek penetration-aspiration scale (PAS) score (MD = -0.68, 95% CI = -2.78 to 1.41), Swallowing Quality of Life (SWAL-QOL) score (MD = 13.24, 95% CI = -7.74 to 34.21), or incidence of adverse events (OR = 1.58, 95% CI = 0.73 to 3.38). Conclusion This study shows that EA combined with conventional treatment or other interventions can significantly improve the clinical response rate and VFSS score in patients with PSD without increasing adverse reactions.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=396840.
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Affiliation(s)
- Xuezheng Li
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Lijun Lu
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Xuefeng Fu
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Hao Li
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Wen Yang
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Hua Guo
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou Guangdong, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou Guangdong, China
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Ambrus A, Rovó L, Sztanó B, Burián A, Molnár-Tóth A, Bach Á. [Introduction of fiberoptic endoscopic evaluation of swallowing and increase of the range of indications in our department]. Orv Hetil 2023; 164:1817-1823. [PMID: 37980634 DOI: 10.1556/650.2023.32912] [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: 08/14/2023] [Accepted: 09/16/2023] [Indexed: 11/21/2023]
Abstract
Dysphagia is a disease resulting from preparatory or transport disorder of the swallowing process and it is divided into oropharyngeal and esophageal phases according to the site of the lesion. The ear, nose and throat assessment focuses on the oropharyngeal phase, but differential diagnosis, investigation, and treatment of the cause of dysphagia is often a complex task requiring multidisciplinary approach and collaboration. The method of fiberoptic endoscopic evaluation of swallowing (FEES) has been introduced at the Department of Ear, Nose and Throat and Head-Neck Surgery, University of Szeged, enabling the examination of otorhinolaryngological and neurological disorders of swallowing as well as objective analysis of patients' swallowing quality. The fiberoptic endoscopic evaluation of swallowing is a minimally invasive procedure that allows visualization of the oropharyngeal phase of swallowing. It can identify anatomical abnormalities or neurological disorders causing dysphagia, thus playing a significant role in later patient rehabilitation. We hereby present our experiences in examinations of patients who underwent partial laryngectomy and/or pharyngectomy due to head and neck tumors as well as of those who underwent airway surgery duo to upper airway stenosis. Thanks to our collaboration with the Neurology Department, we also share our experiences gained during the examinations of patients struggling with oropharyngeal swallowing problems of various neurological origins. Orv Hetil. 2023; 164(46): 1817-1823.
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Affiliation(s)
- Andrea Ambrus
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - László Rovó
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - Balázs Sztanó
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - András Burián
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Pécs Magyarország
| | - Alinka Molnár-Tóth
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Neurológiai Klinika Szeged Magyarország
| | - Ádám Bach
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
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12
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Pazinatto DB, Brandão MAB, Costa FLP, Maunsell R. Initial evaluation of a multidisciplinary pediatric aerodigestive program in a Brazilian hospital: challenges and mitigation strategies. J Pediatr (Rio J) 2023; 99:626-634. [PMID: 37414098 PMCID: PMC10594015 DOI: 10.1016/j.jped.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To identify clinical and epidemiological characteristics of children evaluated by the pediatric aerodigestive program at the beginning of its activity, describe challenges in follow-up, and suggest mitigation strategies. METHODS A case series was conducted describing the first 25 patients discussed by the aerodigestive team from a Brazilian quaternary public university hospital between April 2019 and October 2020. The median follow-up was 37 months. RESULTS During the study period 25 children were seen by the group and the median age at first assessment was 45.7 months old. Eight children had a primary airway abnormality, five had a tracheostomy. Nine children had genetic disorders and one had esophageal atresia. Dysphagia was present in 80% of the patients, 68% had a history of chronic or recurrent lung disease, 64% had a gastroenterological diagnosis and 56% had neurological impairment. Moderate to severe dysphagia was identified in 12 children and 7 of these had an exclusive oral diet at the time. The majority of children (72%) had 3 or more comorbidities. Following team discussion, a change in feeding strategy was suggested in 56% of the children. The most frequently ordered exam was pHmetry (44%) and gastrostomy was the surgical procedure with the longest waiting list. CONCLUSIONS Dysphagia was the most frequent issue encountered in this initial group of aerodigestive patients. Pediatricians caring for these children must be involved in aerodigestive team discussions and hospital policies must be revised to facilitate access to exams and procedures needed for this population.
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Affiliation(s)
| | | | | | - Rebecca Maunsell
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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13
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Taniguchi Y, Ono J, Haraguchi M, Tabuchi M, Hisamatsu N, Takahata H, Kondo H, Yamaguchi N, Kumai Y, Nakao K. Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer. Dig Endosc 2023. [PMID: 37908188 DOI: 10.1111/den.14715] [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: 07/24/2023] [Accepted: 10/29/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES The aging population, including patients with superficial esophageal cancer, encounters critical dysphagia- and postoperative pneumonia-related issues. Although endoscopic submucosal dissection (ESD) provides advantages over other modalities, older patients are at higher risk of postoperative pneumonia. Furthermore, the etiologies of pneumonia are complex and include patient- (such as sarcopenia) and treatment- (including ESD) related factors. Therefore, this study evaluated swallowing function in patients with superficial esophageal cancer and identified post-ESD pneumonia-associated factors. METHODS Comprehensive swallowing function and sarcopenia were evaluated in patients pre-ESD and 2 months post-ESD using high-resolution manometry and several swallowing studies by multiple experts. The effects of mucosal resection and sarcopenia on swallowing function changes post-ESD, the relationship between preoperative swallowing function and sarcopenia, and the factors influencing postoperative pneumonia were investigated. RESULTS Twenty patients were included in the study. Patients with preoperative sarcopenia had significantly lower pharyngeal/upper esophageal sphincter and tongue pressures than those without sarcopenia. However, ESD did not worsen pharyngeal or upper esophageal pressure. Post-ESD pneumonia incidence tended to be higher in patients with sarcopenia than in those without sarcopenia. The lower upper esophageal sphincter-integrated relaxation pressure (UES-IRP) was a significant factor in pneumonia development. Furthermore, the receiver operating characteristic curve for UES-IRP in pneumonia yielded an area under the curve of 0.82. CONCLUSIONS Sarcopenia is associated with preoperative dysphagia, which increases post-ESD pneumonia risk. Therefore, postoperative pneumonia incidence is expected to increase with an aging population, making preoperative sarcopenia and swallowing function evaluation crucial.
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Affiliation(s)
- Yasuhiro Taniguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junki Ono
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masafumi Haraguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Maiko Tabuchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriko Hisamatsu
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideaki Takahata
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hisayoshi Kondo
- Biostatistics Section, Division of Scientific Data Registry, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Naoyuki Yamaguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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14
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Wong MKL, Ku PKM, Tong MCF, Lee KYS, Fong R. Endoscopic and observational findings of swallowing of traditional and molded puree in healthy individuals. Dysphagia 2023; 38:1363-1370. [PMID: 36869928 DOI: 10.1007/s00455-023-10565-2] [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: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
Puree is commonly prescribed for patients with mastication and bolus formation difficulties, but its appearance might negatively impact appetite and intake. Molded puree is marketed to be an alternative to traditional puree, but the process of molding puree could alter the properties of the food significantly and lead to different swallowing physiology as compared to puree. The current study investigated the differences between traditional and molded puree in terms of swallowing physiology and perception in healthy individuals. Thirty two participants were included. Two outcomes were used to quantify the oral preparatory and oral phase. Fibreoptic endoscopic evaluation of swallowing was used to assess the pharyngeal phase as it could retain the purees in their original form. Six outcomes were collected. Perceptual rating of the purees were provided by participants in six domains. Molded puree required significantly more masticatory cycles (p < 0.001) and longer time for ingestion (p < 0.001). Molded puree had longer swallow reaction time (p = 0.001) and more inferior site of swallow initiation (p = 0.007) compared with traditional puree. Participants' satisfaction with the appearance, texture and overall of molded puree was significantly greater. Molded puree was perceived to be more difficult to chew and swallow. This study established that the two types of puree were different in various aspects. The study also provided important clinical implications regarding the use of molded puree as a form of texture modified diet (TMD) in patients with dysphagia. The results could serve as the foundation of larger cohort studies on the effect of various TMDs on patients with dysphagia.
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Affiliation(s)
- Meko Ka Lam Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka Ming Ku
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ear, Nose & Throat, United Christian Hospital, Hong Kong, China
| | - Michael Chi Fai Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathy Yuet Sheung Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China.
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15
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Semmler M, Lasar S, Kremer F, Reinwald L, Wittig F, Peters G, Schraut T, Wendler O, Seyferth S, Schützenberger A, Dürr S. Extent and Effect of Covering Laryngeal Structures with Synthetic Laryngeal Mucus via Two Different Administration Techniques. J Voice 2023:S0892-1997(23)00228-X. [PMID: 37648625 DOI: 10.1016/j.jvoice.2023.07.019] [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: 06/06/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The first goal of this study was to investigate the coverage of laryngeal structures using two potential administration techniques for synthetic mucus: inhalation and lozenge ingestion. As a second research question, the study investigated the potential effects of these techniques on standardized voice assessment parameters. METHODS Fluorescein was added to throat lozenges and to an inhalation solution to visualize the coverage of laryngeal structures through blue light imaging. The study included 70 vocally healthy subjects. Fifty subjects underwent administration via lozenge ingestion and 20 subjects performed the inhalation process. For the first research question, the recordings from the blue light imaging system were categorized to compare the extent of coverage on individual laryngeal structures objectively. Secondly, a standardized voice evaluation protocol was performed before and after each administration to determine any measurable effects of typical voice parameters. RESULTS The administration via inhalation demonstrated complete coverage of all laryngeal structures, including the vocal folds, ventricular folds, and arytenoid cartilages, as visualized by the fluorescent dye. In contrast, the application of the lozenge predominantly covered the pharynx and laryngeal surface toward the aryepiglottic fold, but not the inferior structures. All in all, the comparison before and after administration showed no clear effect, although a minor deterioration of the acoustic signal was noted in the shimmer and cepstral peak prominence after the inhalation. CONCLUSIONS Our findings indicate that the inhalation process is a more effective technique for covering deeper laryngeal structures such as the vocal folds and ventricular folds with synthetic mucus. This knowledge enables further in vivo studies on the role of laryngeal mucus in phonation in general, and how it can be substituted or supplemented for patients with reduced glandular activity as well as for heavy voice users.
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Affiliation(s)
- Marion Semmler
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Sarina Lasar
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Franziska Kremer
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Laura Reinwald
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Fiori Wittig
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Gregor Peters
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Tobias Schraut
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Olaf Wendler
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Stefan Seyferth
- Department of Chemistry and Pharmacy, Chair of Pharmaceutics, Friedrich-Alexander-University Erlangen-Nürnberg, Cauerstr. 4, 91058 Erlangen, Germany.
| | - Anne Schützenberger
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Stephan Dürr
- University Hospital Regensburg, Department of Otorhinolaryngology, Division of Phoniatrics and Pediatric Audiology, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
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16
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Gandor F, Berger L, Gruber D, Warnecke T, Vogel A, Claus I. [Dysphagia in Parkinsonian Syndromes]. DER NERVENARZT 2023; 94:685-693. [PMID: 37115255 DOI: 10.1007/s00115-023-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/29/2023]
Abstract
Dysphagia is a clinically relevant problem in Parkinson's disease as well as in atypical Parkinsonian syndromes, such as multiple system atrophy and diseases from the spectrum of 4‑repeat tauopathies, which affect most patients to a varying degree in the course of their disease. This results in relevant restrictions in daily life due to impaired intake of food, fluids, and medication with a subsequent reduction in quality of life. This article not only gives an overview of the pathophysiological causes of dysphagia in the various Parkinson syndromes, but also presents screening, diagnostic and treatment procedures that have been investigated for the different diseases.
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Affiliation(s)
- F Gandor
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Str. nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Deutschland.
- Klinik für Neurologie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland.
| | - L Berger
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Str. nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Deutschland
- Klinik für Neurologie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - D Gruber
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Str. nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Deutschland
- Klinik für Neurologie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Deutschland
| | - T Warnecke
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - A Vogel
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Str. nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Deutschland
| | - I Claus
- Klinik für Neurologie mit Institut für translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
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17
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Niessen A, Nienstedt JC, Flügel T, Koseki JC, Müller F, Zang J, Pflug C. Narrow Band Imaging in Flexible Endoscopic Evaluation of Swallowing-How Does It Work? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-12. [PMID: 37279337 DOI: 10.1044/2023_jslhr-22-00579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The purposes of this study were to compare the visibility of various color groups in different dilutions using narrow band imaging (NBI) and white light (WL) and to determine an optimal color combination using NBI and WL for multicolor flexible endoscopic evaluation of swallowing (FEES), for example, to test different consistencies. METHOD Preliminary examinations were performed in the oral cavity of two healthy volunteers. Various dyes were tested using NBI and WL to evaluate their visibilities. In the case of a clearly discernible color change, the visibility differences in the dilution series under WL and NBI were recorded and compared. Subsequently, an abbreviated dilution series with NBI and WL was performed in a volunteer as part of a swallow endoscopy to determine whether the results from the oral cavity could be transferred to the hypopharynx. RESULTS The enhancement of visibility using NBI compared with WL can be proven. When NBI was used, yellow and red food dyes and their mixtures showed distinct color changes. The reacting dyes were still visible under NBI, even at a 10-times-higher dilution, requiring a lower dye concentration for FEES. For increased visibility, the dyes used for FEES with NBI must contain colors from a small range in the yellow and red spectra, which are close to the filter maxima of NBI. Both colors are well visible under WL when combining red and green (secondary color of yellow). CONCLUSIONS Certain food colorings are visible 10 times more diluted under NBI than under WL. In a multicolored approach, optimal visibility under NBI and WL can be achieved by combining green and red. This new high-sensitivity FEES should be highlighted to allow an instant distinction from WL-FEES; we suggest "FEES+." SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23280290.
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Affiliation(s)
- Almut Niessen
- Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Germany
| | - Julie Cläre Nienstedt
- Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Germany
| | - Till Flügel
- Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Germany
| | - Jana-Christiane Koseki
- Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Germany
| | - Frank Müller
- Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Germany
| | - Jana Zang
- Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Germany
| | - Christina Pflug
- Center for Clinical Neurosciences, Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Germany
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18
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Rudisch DM, Krasko MN, Burdick R, Broadfoot CK, Rogus-Pulia N, Ciucci MR. Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:176-187. [PMID: 37608845 PMCID: PMC10441627 DOI: 10.1007/s40141-023-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Purpose of Review Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions. Recent Findings Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hall- mark signs and diagnosis. While dysphagia often presents already in the prodrome, it is not routinely addressed in standard neurology examinations. Summary Dysphagia in PD can result in compromised efficiency and safety of swallowing, which significantly contributes to malnutrition and dehydration, decrease quality of life, and increase mortality. The heterogeneous clinical presentation of PD complicates diagnostic procedures which often leads to delayed treatment. Research has advanced our knowledge of mechanisms underlying PD, but dysphagia is still largely understudied, especially in the prodromal stage.
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Affiliation(s)
- Denis Michael Rudisch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Maryann N Krasko
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Ryan Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Courtney K Broadfoot
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
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19
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Theytaz F, Vuistiner A, Schweizer V, Crépin A, Sandu K, Chaouch A, Piquilloud L, Lecciso G, Coombes K, Diserens K. Feasibility study of the Nox-T3 device to detect swallowing and respiration pattern in neurologically impaired patients in the acute phase. Sci Rep 2023; 13:7325. [PMID: 37147335 PMCID: PMC10163003 DOI: 10.1038/s41598-023-32628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/30/2023] [Indexed: 05/07/2023] Open
Abstract
Dysphagia is a frequent complication in neurologically impaired patients, which can lead to aspiration pneumonia and thus prolonged hospitalization or even death. It is essential therefore, to detect and assess dysphagia early for best patient care. Fiberoptic endoscopic and Videofluoroscopy evaluation of swallowing are the gold standard exams in swallowing studies but neither are perfectly suitable for patients with disorders of consciousness (DOC). In this study, we aimed to find the sensitivity and specificity of the Nox-T3 sleep monitor for detection of swallowing. A combination of submental and peri-laryngeal surface electromyography, nasal cannulas and respiratory inductance plethysmography belts connected to Nox-T 3 allows recording swallowing events and their coordination with breathing, providing time-coordinated patterns of muscular and respiratory activity. We compared Nox-T3 swallowing capture to manual swallowing detection on fourteen DOC patients. The Nox-T3 method identified swallow events with a sensitivity of 95% and a specificity of 99%. In addition, Nox-T3 has qualitative contributions, such as visualization of the swallowing apnea in the respiratory cycle which provide additional information on the swallowing act that is useful to clinicians in the management and rehabilitation of the patient. These results suggest that Nox-T3 could be used for swallowing detection in DOC patients and support its continued clinical use for swallowing disorder investigation.
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Affiliation(s)
- Fanny Theytaz
- University of Lausanne, 1015, Lausanne, Switzerland.
- Hôpital Fribourgeois, 1752, Villars-sur-Glâne, Switzerland.
| | - Aline Vuistiner
- Phoniatrics and Speech Therapy Unit, Lausanne University Hospital (CHUV), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Valérie Schweizer
- Phoniatrics and Speech Therapy Unit, Lausanne University Hospital (CHUV), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Adélie Crépin
- Phoniatrics and Speech Therapy Unit, Lausanne University Hospital (CHUV), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
- Centre Hospitalier du Valais Romand, 1951, Sion, Switzerland
| | - Kishore Sandu
- Airway Unit, Department of Otorhino-Laryngology and Head and Neck Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Aziz Chaouch
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Lise Piquilloud
- Adult Intensive Care Unit, Lausanne University Hospital (CHUV), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Gianpaolo Lecciso
- Centre d'investigation et de Recherche sur le Sommeil, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Kay Coombes
- ARCOS, Malvern Centre, Hatherton Lodge, Avenue Road, Malvern Worcestershire, WR14 3AG, UK
| | - Karin Diserens
- Acute Neurorehabilitation Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
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20
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Buras M, DeSisto N, Holdgraf R. Effect of COVID-19 on the incidence of postintubation laryngeal lesions. Proc AMIA Symp 2023; 36:453-457. [PMID: 37334095 PMCID: PMC10269381 DOI: 10.1080/08998280.2023.2204544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 06/20/2023] Open
Abstract
Background Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries. This study aimed to demonstrate a suspected increase in vocal fold injury in patients who were intubated with COVID-19 as compared with patients intubated for other reasons. Methods A retrospective review of medical records was performed to identify patients examined using flexible endoscopic evaluation of swallowing exams. The study included 25 patients with COVID-19 and 27 without COVID-19 at Baylor Scott & White Medical Center in Temple, Texas. Various injuries were evaluated, ranging from granulation tissue to vocal cord paralysis. Severe lesions were those causing clinically significant airway obstruction or requiring operative intervention. The incidence of laryngeal injury in patients intubated for COVID-19 was then compared with that of patients intubated for other reasons. Results The increased presence of severe injury in COVID-positive patients appeared clinically significant but was not statistically significant (P = 0.06). Interestingly, patients who received pronation therapy had 4.6 times the odds of more severe injury compared with patients who did not (P = 0.009). Conclusion Lower thresholds for performing flexible laryngoscopy on postintubated patients who are proned may allow for earlier intervention and reduce morbidity in an already at-risk population.
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Affiliation(s)
- Madison Buras
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | - Nicole DeSisto
- School of Medicine, Texas A&M Health Sciences Center, Dallas, Texas
| | - Randall Holdgraf
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, Texas
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21
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Denk-Linnert DM, Farneti D, Nawka T, am Zehnhoff-Dinnesen A, Moerman M, Zorowka P, Farahat M, Schindler A, Geneid A. Position Statement of the Union of European Phoniatricians (UEP): Fees and Phoniatricians' Role in Multidisciplinary and Multiprofessional Dysphagia Management Team. Dysphagia 2023; 38:711-718. [PMID: 35972695 PMCID: PMC9379897 DOI: 10.1007/s00455-022-10502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/15/2022] [Indexed: 11/03/2022]
Abstract
The need for multidisciplinary and multiprofessional management of dysphagia is constantly increasing and creating a major challenge for healthcare professionals and society, especially in terms of professional expertise and human resources. The distribution of tasks among the dysphagia team members, which includes phoniatricians, otolaryngologists, and speech-language therapists, is flexible and overlapping. For assessing dysphagia, the (fibreoptic) flexible endoscopic evaluation of swallowing (FEES), with or without videofluoroscopy, is a pivotal diagnostic tool. This position paper aims to illustrate the phoniatrician's role in performing a FEES, which is an indispensable component of the diagnostic workup of patients suffering from oropharyngeal dysphagia. It is based on the current collaborative expert view of the Swallowing Committee of the Union of European Phoniatricians and a literature review. A FEES is one of the core competences of phoniatricians due to their endoscopic expertise and experience in the field of dysphagia and diseases of the upper aerodigestive tract. Therefore, the phoniatrician is an important member of the dysphagia team, for the medical diagnostics of the aerodigestive tract and dysphagia as well as for FEES. Phoniatric competence is especially important for head and neck cancer patients, infants, and complex cases.
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Affiliation(s)
- Doris-Maria Denk-Linnert
- grid.411904.90000 0004 0520 9719Division of Phoniatrics and Speech-Language Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, University Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Daniele Farneti
- Audiology and Phoniatrics Department - Romagna Health Service, Rimini Hospital, Rimini, Italy
| | - Tadeus Nawka
- grid.6363.00000 0001 2218 4662Department of Audiology and Phoniatrics, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | - Patrick Zorowka
- grid.5361.10000 0000 8853 2677Department of Hearing, Speech and Voice Disorders, Medical University, Innsbruck, Austria
| | - Mohamed Farahat
- grid.56302.320000 0004 1773 5396Department of Otolaryngology, Research Chair of Voice, Swallowing and Communication Disorders, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Antonio Schindler
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, L. Sacco, Phoniatric Unit, University of Milan, Milan, Italy
| | - Ahmed Geneid
- grid.7737.40000 0004 0410 2071Department of Otorhinolaryngology and Phoniatrics-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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22
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Brisson-McKenna M, Jefferson GD, Siddiqui SH, Adams S, Afanasieva Sonia S, Chérid A, Burns J, Di Gironimo C, Mady LJ. Swallowing Function After Treatment of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:371-388. [PMID: 37030949 DOI: 10.1016/j.otc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Dysphagia is a common functional outcome following treatment of laryngeal cancer. Despite curative advances in both nonsurgical and surgical approaches, preserving and optimizing swallowing function is critical. Understanding the nature and severity of dysphagia depending on initial tumor staging and treatment modality and intensity is crucial. This chapter explores current evidence on the acute and chronic impacts of treatments for laryngeal cancer on swallow function, as well as the medical and nonmedical management of dysphagia in this population.
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Affiliation(s)
- Maude Brisson-McKenna
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada.
| | - Gina D Jefferson
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State St.Jackson, MS 39216-4505, USA
| | - Sana H Siddiqui
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sarah Adams
- Voice and Swallowing Center, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sofia Afanasieva Sonia
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Aïda Chérid
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jesse Burns
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Carla Di Gironimo
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Leila J Mady
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA; Cancer Risk and Control Program of Excellence, Sidney Kimmel Cancer Center, 233 S 10th Street, Philadelphia, PA 19107, USA
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23
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Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E, Dhar SI, Hutcheson K, Jefferson G, Johnson F, Rameau A, Sher D, Starmer H, Strohl M, Ulmer K, Vaitaitis V, Begum S, Batjargal M, Dhepyasuwan N. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2023; 168:571-592. [PMID: 36965195 DOI: 10.1002/ohn.302] [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: 09/08/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. METHODS Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. RESULTS The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus. CONCLUSION Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
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Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey L Ishman
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA
| | - Ezra Cohen
- Moores Cancer Center at UC San Diego Health, La Jolla, California, USA
| | | | - Kate Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Gina Jefferson
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Anais Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - David Sher
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Karen Ulmer
- Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA
| | - Vilija Vaitaitis
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA
| | - Sultana Begum
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Misheelt Batjargal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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24
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Krug K, Hübl N, Freitag N, Schramm D. Safety, feasibility and diagnostic value of Clinical Swallow Examination and FEES in children between 0 and 24 months. Early Hum Dev 2023; 179:105732. [PMID: 36863223 DOI: 10.1016/j.earlhumdev.2023.105732] [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: 01/09/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Clinical Swallowing Examination (CSE) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are relevant diagnostic methods in pediatric dysphagia. Satisfactory and comprehensive healthcare is still not part of the standard diagnostic process. AIMS The purpose of this article is to evaluate the safety, feasibility, and diagnostic value of CSE and FEES in children 0-24 months of age. STUDY DESIGN A retrospective cross-sectional study which was conducted at the pediatric clinic of the University Hospital Düsseldorf, Germany, between 2013 and 2021. SUBJECTS A total of 79 infants and toddlers with suspected dysphagia were included. OUTCOME MEASURES Analyses of the cohort and FEES pathologies were performed. Dropout criterion, complications and change of diet were recorded. Chi-square identified associations between clinical symptoms and FEES results. RESULTS All FEES examinations were performed without complications and with a completion rate of 93.7 %. Anatomical abnormalities in the laryngeal region were diagnosed in 33 children. Wet voice was significantly associated with premature spillage (p = .028). CONCLUSIONS CSE and FEES are important and uncomplicated examinations for children with suspected dysphagia between 0 and 24 months. They are equally helpful for differential diagnosis of feeding disorders and anatomical abnormalities. The results underline the added value of combining both examinations and their importance for individual nutritional management. History taking and CSE are mandatory as they reflect the everyday eating situation. This study adds essential knowledge to the diagnostic work-up of dysphagic infants and toddlers. Standardizing the examinations and validating dysphagia scales are future tasks.
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Affiliation(s)
- Katrin Krug
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nicole Hübl
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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25
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Helliwell K, Hughes VJ, Bennion CM, Manning-Stanley A. The use of videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) in the investigation of oropharyngeal dysphagia in stroke patients: A narrative review. Radiography (Lond) 2023; 29:284-290. [PMID: 36640583 DOI: 10.1016/j.radi.2022.12.007] [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: 10/19/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Patients with suspected acute stroke require rapid assessment of swallowing on admission. If aspiration is suspected, this takes the form of specialist assessment, using either videofluoroscopy (VFS) or fibreoptic endoscopic evaluation of swallowing (FEES). The review aim was to evaluate and compare the effectiveness of each method in stroke patients. Literature was collected from the databases Scopus, Web of Science and Medline, and articles included in the review were published within the last 10 years, in the English language. KEY FINDINGS Sensitivity and specificity ranged from 0.29-0.33 and 0.96-1.0 for VFS, respectively, and 0.37-1.0 and 0.65-0.87 for FEES, respectively, depending on the type of bolus utilised. VFS is the current gold-standard for the investigation of oropharyngeal dysphagia (OD), however, radiation dose and patient transport implications mean FEES may be preferred. FEES has limitations including 'whiteout' and the invasive nature of the endoscope. The NICE guidelines do not recommend a definitive protocol specifically in stroke patients. This suggests further research may be required to determine the most effective method. CONCLUSION FEES is a beneficial first line examination, providing limited invasiveness, and administering a high level of patient suitability, without using ionising radiation. VFS could potentially be useful following FEES to secure full visualisation, ensuring an aspiration event is not missed during FEES. IMPLICATIONS FOR PRACTICE Use of FEES as the first line test rather than VFS, ensures radiation dose is as low as reasonably practicable (ALARP). Ongoing research to ensure protocols follow current best practice can help ensure accurate management of oropharyngeal dysphagia in stroke patients.
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Affiliation(s)
- K Helliwell
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale Royal Hospital, Salterhebble, Halifax, HX3 0PW, UK.
| | - V J Hughes
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
| | - C M Bennion
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
| | - A Manning-Stanley
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
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26
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Jijakli A, Borders JC, Gottlieb A, Ramirez E, Leonard R, Langmore SE, Murray J, Pisegna JM. Absent epiglottic inversion as seen on flexible endoscopic evaluations of swallowing (FEES) is associated with a gestalt reduction in swallowing mechanics. Am J Otolaryngol 2023; 44:103757. [PMID: 36753976 DOI: 10.1016/j.amjoto.2022.103757] [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: 10/04/2022] [Accepted: 12/18/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Epiglottic inversion, which provides one layer of the requisite protection of the airway during swallowing, is dependent on a number of biomechanical forces. The aim of this study was to examine the association between swallowing mechanics, as visualized during a Modified Barium Swallow (MBS) exam, and the rating of epiglottic inversion as seen on Flexible Endoscopic Evaluation of Swallowing (FEES). METHODS This study analyzed twenty-five adult outpatients referred for a simultaneous FEES/MBS exams. Each participant swallowed a 5 mL thin liquid bolus, which was the bolus size analyzed for this study's question. Epiglottic inversion, as seen on FEES, was rated by three independent raters. Additionally, twelve swallowing landmarks tracked the shape change of each participant's swallow on the MBS video using a MatLab-specific tracking tool. Analyses were run to determine mean differences in swallowing shape change between the swallows across 3 groups: complete, reduced, and absent epiglottic inversion, as seen on FEES. Using a Computerized Analysis of Swallowing Mechanics (CASM), canonical variate analyses and discriminant function testing were carried out. Other swallowing mechanics were also analyzed for kinematic movements to isolate the function of the hyoid and larynx. A two-sample t-test was conducted to compare mean hyolaryngeal movement between complete and incomplete epiglottic inversion groups. RESULTS Overall swallowing shape changes were statistically significantly different between the absent, reduced, and complete epiglottic inversion groups on FEES. Canonical variate analyses revealed a significant overall effect of shape change between the groups (eigenvalue = 2.46, p < 0.0001). However, no statistically significant differences were found on hyoid excursion (p = 0.37) and laryngeal elevation (p = 0.06) kinematic measurements between patients with complete and incomplete epiglottic inversion on FEES. CONCLUSION Epiglottic inversion on FEES is a valuable rating that infers reduced range of motion of structures that cannot be seen on FEES. This small sample of patients suggests that FEES ratings of absent epiglottic inversion may represent gestalt reduction in swallowing mechanics.
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Affiliation(s)
- Amr Jijakli
- Boston University School of Public Health, Boston, MA, United States of America
| | - James C Borders
- Department of Otolaryngology, Boston Medical Center, Boston, MA, United States of America
| | - Amy Gottlieb
- Department of Otolaryngology, Boston Medical Center, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Emily Ramirez
- Boston University School of Public Health, Boston, MA, United States of America
| | - Rebecca Leonard
- University of California at Davis, Davis, CA, United States of America
| | - Susan E Langmore
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Joseph Murray
- VA Ann Arbor Health Care System, Ann Arbor, MI, United States of America
| | - Jessica M Pisegna
- Department of Otolaryngology, Boston Medical Center, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America.
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27
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Rivelsrud MC, Hartelius L, Speyer R, Løvstad M. Qualifications, professional roles and service practices of nurses, occupational therapists and speech-language pathologists in the management of adults with oropharyngeal dysphagia: a Nordic survey. LOGOP PHONIATR VOCO 2023:1-13. [PMID: 36786502 DOI: 10.1080/14015439.2023.2173288] [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: 08/17/2022] [Revised: 01/10/2023] [Accepted: 01/22/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE To identify the qualifications, professional roles and service practices of nurses, occupational therapists (OTs) and speech-language pathologists (SLPs) in the management of adults with oropharyngeal dysphagia (OD) in the Nordic countries. METHODS A web-based survey was developed that consisted of 50 questions on respondent demographics, education, experience, roles and service practices provided for adults with OD. The survey was distributed to practicing nurses, OTs, and SLPs in five Nordic countries via professional associations, social media, online networks and snowballing. RESULTS Data from 396 nurses, OTs and SLPs whom provided services for adults with OD revealed that the majority of respondents worked in acute care and inpatient rehabilitation facilities. Most respondents had minimal undergraduate education and practical clinical training in OD. Notable variances in roles and service practices in OD between professions and countries were found. OTs were the primary service provider for OD management in Denmark, while SLPs had this role in the other Nordic countries. Nurses were mainly involved in screening and some compensatory treatments in most Nordic countries. Limited use of evidence-based screening, non-instrumental or instrumental clinical assessments and rehabilitative therapeutic methods was evident. CONCLUSIONS Study results highlight challenges in education and training of professionals responsible for the management of adults with OD in the Nordic countries. Increased use of evidence-based assessment and exercise-based treatments to improve swallowing are warranted. Adherence to European and international clinical practice guidelines for the management of adults with OD is recommended.
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Affiliation(s)
- Maribeth Caya Rivelsrud
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Hartelius
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Skaraborgs Hospital, Skövde, Sweden
| | - Renée Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Western, Australia
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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28
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Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia 2023; 38:76-121. [PMID: 35639156 PMCID: PMC9873728 DOI: 10.1007/s00455-022-10465-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/29/2022] [Indexed: 01/28/2023]
Abstract
Oropharyngeal dysphagia (OD) is prevalent in the elderly and persons with complex medical conditions, resulting in considerable medical and psychosocial consequences and reduced quality of life. Many prevalence studies regard OD in relation to age or diagnosis. Knowledge on the prevalence of OD in different healthcare settings is lacking. This systematic review aimed to estimate the prevalence of OD in adults admitted to hospitals, rehabilitation facilities, nursing homes, and palliative care facilities through meta-analyses. A systematic literature search was completed including all dates up to March 30, 2021. The methodology and reporting were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Forty-four out of 1,956 screened articles were deemed eligible. Considerable heterogeneity in definitions of OD and type and quality of selected outcome measures were observed. Overall within-group pooled prevalence estimates for OD determined by meta-analysis were 36.5% (95% CI 29.9 - 43.6) in the hospital setting, 42.5% (95% CI 35.8 - 49.5) in the rehabilitation setting, and 50.2% (95% CI 33.3-67.2) in nursing homes. No OD prevalence data were identified for palliative care facilities. Results for between-group analyses of OD prevalence estimates in the hospital setting were non-significant for type of assessment method, diagnostic group, and type of hospital ward, but indicated significantly higher prevalence estimates in nursing homes when using screening compared to patient-report. Future research should provide OD prevalence data for palliative care, achieve consensus in OD-related terminology when performing prevalence studies, and use screening and assessments with optimal diagnostic performance and psychometric properties.
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Affiliation(s)
| | - Lena Hartelius
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Speech Pathology, Division of Neurology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- REMEO Stockholm, Stockholm, Sweden
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Renée Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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29
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Nordio S, Maistrello L, D’Imperio D, Favaretto N, Dellai A, Montino S, Agostinelli A, Ramacciotti G, Gheller F, Berta G, Koch I, Zanoletti E, Battel I, Cazzador D. Validity and reliability of the Italian translation of the Yale Pharyngeal Residue Severity Rating Scale. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:12-19. [PMID: 36860145 PMCID: PMC9978297 DOI: 10.14639/0392-100x-n2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/18/2022] [Indexed: 03/03/2023]
Abstract
Objective In the dysphagic patient, pharyngeal residues (PR) are associated with aspiration and poor quality of life. The assessment of PR using validated scales during flexible endoscopic evaluation of swallowing (FEES) is crucial for rehabilitation. This study aims to validate and test the reliability of the Italian version of the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS). The effects of training and experience in FEES on the scale were also determined. Methods The original YPRSRS was translated into Italian according to standardised guidelines. Thirty FEES images were selected after consensus and proposed to 22 naive raters who were asked to assess the severity of PR in each image. Raters were divided into two subgroups by years of experience at FEES, and randomly by training. Construct validity, inter-rater, and intra-rater reliability were assessed by kappa statistics. Results IT-YPRSRS showed substantial to almost perfect agreement (kappa > 0.75) in validity and reliability for both the overall sample (660 ratings), and valleculae/pyriform sinus sites (330 ratings each). No significant differences emerged between groups considering years of experience, and variable differences were observed by training. Conclusions The IT-YPRSRS demonstrated excellent validity and reliability in identifying location and severity of PR.
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Affiliation(s)
| | | | | | - Niccolò Favaretto
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Angela Dellai
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 6 Euganea, Ospedale di Conselve, Padua, Italy
| | - Silvia Montino
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Anna Agostinelli
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Giulia Ramacciotti
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Flavia Gheller
- Department of Developmental Psychology and Socialisation (DPSS), University of Padua, Padua, Italy
| | | | | | - Elisabetta Zanoletti
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Irene Battel
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 3 Serenissima, Ospedale Civile di Venezia, Venice, Italy, Department of Clinical Speech & Language Studies, University of Dublin, Trinity College, College Green, Dublin 2, Ireland
| | - Diego Cazzador
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy,Correspondence Diego Cazzador Department of Neuroscience, Section of Otolaryngology, University of Padova, via Giustiniani 2, 35128 Padua, Italy Tel. +39 049 821 8778. Fax +39 049 821 1994 E-mail:
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Simon SR, Wieland MWM, Hendriks C, Pilz W, Schindler A, Winkens B, Baijens LWJ. Intra and interobserver agreement of the Dynamic Imaging Grade of Swallowing Toxicity Scale (DIGEST) in fiberoptic endoscopic evaluation of swallowing (FEES): the importance of observer-tailored training. Eur Arch Otorhinolaryngol 2023; 280:2865-2876. [PMID: 36705725 PMCID: PMC10175403 DOI: 10.1007/s00405-023-07840-1] [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: 09/21/2022] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a scale to quantify the severity of pharyngeal dysphagia in head and neck cancer (HNC) patients. This study (1) described the training process of the observers for DIGEST in fiberoptic endoscopic evaluation of swallowing (FEES), (2) determined observer agreement on the DIGEST in FEES, (3) explored the effect of bolus consistency on observer agreement, and 4) explored criterion validity of the DIGEST in FEES. METHODS Twenty-seven dysphagic HNC patients were enrolled. Two observers completed a training program for DIGEST in FEES. Observer agreement on the Penetration-Aspiration Scale (PAS), percentage of pharyngeal residue (PPR), and DIGEST grades was determined using linearly weighted Cohen's kappa coefficient (κ). RESULTS Due to insufficient observer agreement after the first measurement attempt, additional training was organized using an elaborated manual with descriptions of the visuoperceptual variables, thereby improving observer agreement. Intraobserver agreement was almost perfect on the PAS (κ = 0.86-0.88) and PPR (κ = 0.84-0.86). Interobserver agreement was substantial on the PAS (κ = 0.78), almost perfect on the PPR (κ = 0.82), substantial on the safety grade (κ = 0.64), almost perfect on the efficiency grade (κ = 0.85), and substantial on the summary grade (κ = 0.71). Bolus consistency had an effect on observer agreement. A significant correlation was found between DIGEST efficiency grade and EAT-10. CONCLUSION The DIGEST showed to be a reproducible measurement for FEES in terms of observer agreement. However, agreement between novice observers on the DIGEST was only reached after specific observer-tailored training. Observer agreement should be analyzed by taking bolus consistency into account during training, as this might affect the interpretation of the outcome. A manual with well-defined descriptions can optimize the reproducibility of DIGEST measurements.
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Affiliation(s)
- Sorina R Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Monse W M Wieland
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Charlotte Hendriks
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience-MHeNs, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
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Weng W, Imaizumi M, Murono S, Zhu X. Expert-level aspiration and penetration detection during flexible endoscopic evaluation of swallowing with artificial intelligence-assisted diagnosis. Sci Rep 2022; 12:21689. [PMID: 36522385 PMCID: PMC9753025 DOI: 10.1038/s41598-022-25618-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Flexible endoscopic evaluation of swallowing (FEES) is considered the gold standard in diagnosing oropharyngeal dysphagia. Recent advances in deep learning have led to a resurgence of artificial intelligence-assisted computer-aided diagnosis (AI-assisted CAD) for a variety of applications. AI-assisted CAD would be a remarkable benefit in providing medical services to populations with inadequate access to dysphagia experts, especially in aging societies. This paper presents an AI-assisted CAD named FEES-CAD for aspiration and penetration detection on video recording during FEES. FEES-CAD segments the input FEES video and classifies penetration, aspiration, residue in the vallecula, and residue in the hypopharynx based on the segmented FEES video. We collected and annotated FEES videos from 199 patients to train the network and tested the performance of FEES-CAD using FEES videos from other 40 patients. These patients consecutively underwent FEES between December 2016 and August 2019 at Fukushima Medical University Hospital. FEES videos were deidentified, randomized, and rated by FEES-CAD and laryngologists with over 15 years of experience in performing FEES. FEES-CAD achieved an average Dice similarity coefficient of 98.6[Formula: see text]. FEES-CAD achieved expert-level accuracy performance on penetration (92.5[Formula: see text]), aspiration (92.5[Formula: see text]), residue in the vallecula (100[Formula: see text]), and residue in the hypopharynx (87.5[Formula: see text]) classification tasks. To the best of our knowledge, FEES-CAD is the first CNN-based system that achieves expert-level performance in detecting aspiration and penetration.
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Affiliation(s)
- Weihao Weng
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan.
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Xin Zhu
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan.
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Deng J, Murphy BA, Niermann KJ, Sinard RJ, Cmelak AJ, Rohde SL, Ridner SH, Dietrich MS. Validity Testing of the Head and Neck Lymphedema and Fibrosis Symptom Inventory. Lymphat Res Biol 2022; 20:629-639. [PMID: 35483066 PMCID: PMC9810345 DOI: 10.1089/lrb.2021.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Lack of reliable and valid tools significantly impacts early identification and timely treatment of lymphedema and fibrosis (LEF) in the head and neck cancer population. To address this need, we developed and reported a patient-reported outcome measure (Head and Neck Lymphedema and Fibrosis Symptom Inventory [HN-LEF SI]). This article reports the construct validity (convergent and divergent validity) testing of the tool. Materials and Methods: A prospective, longitudinal, instrument validation study was conducted in patients with a newly diagnosed oral cavity or oropharyngeal cancer. Participants completed the HN-LEF SI and six carefully selected self-report measures at pretreatment, end-of-treatment, and every 3 months up to 12 months after treatment. Spearman correlations were used. Results: A total of 117 patients completed the study. Patterns of correlations of the HN-LEF SI scores with the established self-report measure scores were consistent with expected convergent and divergent validity. Conclusion: Evidence from this work supports the construct validity of the HN-LEF SI.
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Affiliation(s)
- Jie Deng
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Sarah L. Rohde
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Sheila H. Ridner
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Dysphagia Management in Children: Implementation and Perspectives of Flexible Endoscopic Evaluation of Swallowing (FEES). CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121857. [PMID: 36553301 PMCID: PMC9776403 DOI: 10.3390/children9121857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Dysphagia is any impairment of swallowing that compromises the safety, efficiency, or adequacy of nutritional or liquid intake. It is common in children, especially in some clinical populations, and may result in failure to thrive and respiratory problems due to pulmonary aspiration. Swallowing disorders have a severe impact on children's health, growth, and development, and on the quality of life of the child and family. Clinical evaluation cannot validly predict aspiration, which is mostly silent. A team management approach is advocated, including instrumental swallowing assessments. FEES has been proven to be safe and valid and is increasingly used in children of all ages. It allows the identification of structural abnormalities, assessment of the child's diet with real-life food and liquids while the child holds the optimal or preferred position, examination during breastfeeding, and assessment of fatigue and treatment strategies. FEES is carried out following a protocol that comprises three parts: the evaluation of the anatomical and physiological parameters of swallowing, testing of food and liquids of a range of different consistencies, and evaluation of treatment methods. Pediatric FEES involves adaptations for infants, and special considerations about readiness for nutritive trials and the infant's ability to sustain a coordinated feeding pattern. Varying consistencies and volumes of food or liquids are tried. Care of the dysphagic child involves team work. FEES, as a part of the assessment and management of dysphagia, enables the evaluation of the safety, efficiency, and adequacy of oral food and liquid intake. Future perspectives include standardized training in clinical FEES protocols to ensure clinical competency of the pediatric FESS team members and the development and validation of standardized examination and interpretation protocols for pediatric FEES.
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Coman LM, Cardell EA, Richards JA, Mahon A, Lawrie MD, Ware RS, Weir KA. Videofluoroscopic swallow study training for radiologists-in-training: a survey of practice and training needs. BMC MEDICAL EDUCATION 2022; 22:762. [PMID: 36344980 PMCID: PMC9641839 DOI: 10.1186/s12909-022-03799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a lack of formal, published videofluoroscopic swallow study (VFSS) training targeting radiologists, yet radiology senior medical officers and resident medical officers (i.e., radiologists-in-training, known in Australia as "registrars") are expected to be involved in VFSS interpretation of anatomical anomalies and reporting. This study investigated whether VFSS training is delivered to registrars during their specialist radiology training, whether it is a perceived need and, if so, to determine the desired content for inclusion in a targeted training package. METHODS A cross-sectional, mixed methods study design was used. An internet-based survey was circulated via convenience and snowball sampling to radiologists (both senior medical officers and registrars) and speech-language pathologists across Australia in October-November 2017. Surveys also were distributed to practitioners based in New Zealand and the United Kingdom, as they practised within similar health systems, and it was anticipated they may have similar VFSS training practices. The radiology survey contained 36 questions and the speech-language pathology survey contained 44 questions. Participants were asked the following: (1) Report their current VFSS radiology registrar training environment; (2) Advise whether radiology registrars need VFSS training; (3) Recommend the content, format, training intensity, and evaluation methods for an effective radiology registrar training package. Demographic data were analysed descriptively, and open-ended responses were analysed using qualitative content analysis. RESULTS 21 radiology senior medical officers and registrars and 150 speech-language pathologists predominantly based at Australian tertiary hospital settings completed the survey. Most respondents (90.6%) identified that VFSS training is needed for radiology registrars. Only one speech-language pathologist respondent reported that they deliver VFSS training for radiology registrars. Specific content and teaching modalities for a VFSS training package, including diagnosing anatomical anomalies associated with dysphagia were recommended. CONCLUSION While most of the radiologists and speech-language pathologists surveyed did not deliver VFSS training to radiology registrars, they identified that targeted training is needed to improve radiology registrars' effectiveness and engagement in VFSS clinics. The training package content, format and evaluation methods recommended by participants will inform the development of a VFSS training package targeting radiology registrars to be piloted at an Australian tertiary hospital.
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Affiliation(s)
- Leah M Coman
- Speech Pathology Service, Gold Coast Health, 1 Hospital Blvd, Southport, 4215, Queensland, Australia.
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia.
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Elizabeth A Cardell
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - John A Richards
- Medical Imaging Department, Gold Coast Health, Queensland, Australia
| | - Amanda Mahon
- Medical Imaging Department, Gold Coast Health, Queensland, Australia
| | - Melissa D Lawrie
- Speech Pathology Service, Gold Coast Health, 1 Hospital Blvd, Southport, 4215, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Kelly A Weir
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- Allied Health Research, Gold Coast Health, Queensland, Australia
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Gong S, Gao Y, Liu J, Li J, Tang X, Ran Q, Tang R, Liao C. The prevalence and associated factors of dysphagia in Parkinson's disease: A systematic review and meta-analysis. Front Neurol 2022; 13:1000527. [PMID: 36277913 PMCID: PMC9582284 DOI: 10.3389/fneur.2022.1000527] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence and associated factors of dysphagia in Parkinson's disease (PD) are different in studies conducted in different countries. The purpose of our systematic review and meta-analysis was to evaluate the prevalence of dysphagia in PD and to clarify its associated factors. Methods Two researchers systematically searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, SinoMed and VIP databases and manually searched references in the retrieved articles to identify potential research subjects. The last search was conducted on June 28, 2022. Finally, a total of 58 studies including 60 observations with 20,530 PD patients were included in our meta-analysis. Results The meta-analysis estimated that the pooled prevalence rate of dysphagia in PD was 36.9% (95% CI: 30.7–43.6%) and instrumental examination showed a higher prevalence (57.3%, 95% CI: 44.3–69.1%). Oceania showed the highest prevalence of dysphagia in PD (56.3%) compared to Africa (39.5%), Asia (38.6%), Europe (36.1%) and America (28.9%). Dysphagia in PD was associated with older age, lower body mass index, longer disease duration, higher Hoehn and Yahr stage and levodopa equivalent daily dose, PIGD subtype, severe motor symptoms, drooling and higher levels of depression, and lower quality of life. Conclusions In conclusion, our meta-analysis showed that dysphagia occurs in more than one-third of PD patients and was associated with several demographic characteristics and PD-related characteristics, motor symptoms, non-motor symptoms, as well as decreased quality of life. It deserves early screening, diagnosis, and treatment in clinical practice to prevent serious complications from dysphagia.
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Affiliation(s)
- Siyuan Gong
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Gao
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jihong Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueqin Tang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Ran
- Endocrinology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongzhu Tang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunlian Liao
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Chunlian Liao
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Zhang X, Lin F, Ma F, Cui S, OuYang G. Application Value of Flexible Endoscopic Examination of Swallowing in Acute Stoke Patients With Dysphagia. Neurologist 2022; 27:245-248. [PMID: 34873113 PMCID: PMC9439686 DOI: 10.1097/nrl.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The aim was to study the application value of flexible endoscopic examination of swallowing (FEES) for the aspiration screening, the diagnosis of dysphagia and evaluation of the therapeutic effect in acute stoke patients with dysphagia. METHODS A total of 525 patients with acute stoke who were hospitalized from October 2015 to January 2021 in the Rehabilitation Medicine Department of our hospital underwent FEES for analyzing the characteristic performance. Twenty-one cases of them were examined by video fluoroscopic swallow study and compared with the results of FEES for evaluating the reliability of the FEES, the reliability of diagnosis of dysphagia, and the consistency of the 2 methods. The effect of rehabilitation was evaluated by comparing the FEES test results before and after treatment. RESULTS In 525 patients, the FEES revealed 378 cases of aspiration (139 cases were silent aspiration), showing a higher detection rate than water swallow test. Patients with potential cricopharyngeus achalasia got the same results through both of examinations. FEES can provide more positive indicators, guide clinical rehabilitation treatment and objectively assess the effect of rehabilitation. CONCLUSIONS Acute stoke patients with dysphagia have characteristic pharyngeal and laryngeal performance. FEES is simple to operate and has high application value in the diagnosis and treatment of dysphagia.
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Affiliation(s)
| | | | - Fumei Ma
- Dalian Municipal Central Hospital
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Celtik U, Eyigor S, Divarci E, Sezgin B, Dokumcu Z, Ozcan C, Ozturk K, Erdener A. Fiberoptic endoscopic evaluation of swallowing (FEES) study: the first report in children to evaluate the oropharyngeal dysphagia after esophageal atresia repair. Pediatr Surg Int 2022; 38:1227-1233. [PMID: 35836013 DOI: 10.1007/s00383-022-05169-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the swallowing problems by fiberoptic endoscopic evaluation of swallowing (FEES) study in both short- and long-gap patients after esophageal atresia (EA) repair. METHODS Hospital records of patients who had undergone surgery for EA were reviewed retrospectively. Patients were divided into two groups as short-gap (SG) group (n:16) and long-gap (LG) group (n:10) to compare the swallowing problems. FEES study was performed, and the results were discussed in detail. RESULTS There were twenty-six (16 M/10 F) patients with a mean age at evaluation was 7.52 ∓ 3.68 years. Mean follow-up period was 75.35 ∓ 44.48 months. In FEES study, pharyngeal phase abnormalities were detected in 10 patients (38.4%). Pharyngeal phase abnormalities were detected significantly higher in LG group (p:0.015). Laryngeal penetration/aspiration was seen in four patients on FEES study (15.3%). All of them was in LG group (40%). Laryngeal penetration/aspiration was seen significantly higher in LG group (p:0.014). CONCLUSION This is the first study to conduct FEES study in children after esophageal atresia repair to evaluate their swallowing conditions. Even though our sample is small, swallowing problems are more common than expected in the cases of LG when compared to SG.
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Affiliation(s)
- Ulgen Celtik
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey.
| | - Sibel Eyigor
- Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Ege University, Bornova, 35100, Izmir, Turkey
| | - Emre Divarci
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
| | - Baha Sezgin
- Department of Otorhinolaryngology, Izmir Ekol Hospital, Cigli, Izmir, Turkey
| | - Zafer Dokumcu
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
| | - Coskun Ozcan
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
| | - Kerem Ozturk
- Faculty of Medicine, Department of Otorhinolaryngology, Ege University, Bornova, 35100, Izmir, Turkey
| | - Ata Erdener
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
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Saraniti C, Ciodaro F, Galletti C, Gallina S, Verro B. Swallowing Outcomes in Open Partial Horizontal Laryngectomy Type I and Endoscopic Supraglottic Laryngectomy: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138050. [PMID: 35805718 PMCID: PMC9265323 DOI: 10.3390/ijerph19138050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
Background: Effective swallowing represents the main challenge in supraglottic laryngectomy. This study aimed to assess swallowing outcome comparing endoscopic supraglottic laryngectomy (ESL) and open partial horizontal laryngectomy type I (OPHL I). Methods: A retrospective study was carried out on 20 patients that underwent supraglottic laryngectomy from 2015 to 2021: 10 underwent ESL (group A) and 10 underwent OPHL I (Group B). Patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) 3 months and 12 months after surgery and videofluoroscopy swallowing studies (VFSS) 12 months after surgery. A Swallowing Outcome After Laryngectomy (SOAL) questionnaire was administered to patients to assess their life quality. Results: A naso-gastric tube was placed in two patients of Group A and in all patients of Group B. Tracheostomy was performed in two patients of Group A and in all patients in Group B and it has been closed in 100% of them. According to Donzelli’s scale, FEES and VFSS showed better results in Group A at 3 months, while at 12 months they did not show statistically significant differences between ESL and OPHL I in terms of laryngeal penetration and aspiration. The SOAL questionnaire showed satisfactory life quality. Conclusion: Swallowing evaluation by FEES and VFSS did not demonstrate statistically significant differences at 12 months post-op between two surgeries, although ESL showed less cases of laryngeal penetration and aspiration at 3 months post-op. Anyway, good results of any surgery depend on careful patient selection and the surgeon’s experience.
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Affiliation(s)
- Carmelo Saraniti
- Division of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy; (C.S.); (S.G.)
| | - Francesco Ciodaro
- Division of Otorhinolaryngology, Department of Adult and Development Age Human Pathology “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.C.); (C.G.)
| | - Cosimo Galletti
- Division of Otorhinolaryngology, Department of Adult and Development Age Human Pathology “Gaetano Barresi”, University of Messina, 98125 Messina, Italy; (F.C.); (C.G.)
| | - Salvatore Gallina
- Division of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy; (C.S.); (S.G.)
| | - Barbara Verro
- Division of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy; (C.S.); (S.G.)
- Correspondence: ; Tel.: +39-327-1722-000
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Deng W, Zhao G, Li Z, Yang L, Xiao Y, Zhang S, Guo K, Xie C, Liang Y, Liao G. Recovery pattern analysis of swallowing function in patients undergoing total glossectomy and hemiglossectomy. Oral Oncol 2022; 132:105981. [PMID: 35752136 DOI: 10.1016/j.oraloncology.2022.105981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/27/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the recovery process of swallowing function and ascertain swallowing pattern in patients undergoing total glossectomy (TG). MATERIALS AND METHODS A cohort study was conducted in consecutive patients with tongue squamous cell carcinoma who received TG/hemiglossectomy (HG) from May 2017 to December 2019. Exposure factors included tongue resection range (HG and TG) and postoperative radiotherapy (PRT and non-PRT). The swallowing functions were evaluated by M.D. Anderson dysphagia inventory (MDADI), water swallow test (WST), and tongue pressure (TP) at pretreatment, 1, 4, 7, 12, 18 and 24 months postoperatively. Videofluoroscopy swallowing study (VFSS) was applied to analyze swallowing pattern of TG patients. RESULTS A total of 67 patients were enrolled, of which 17 underwent TG and 50 underwent HG. Both MDADI and TP of the TG and PRT group were lower than those of the HG and non-PRT group. TG patients had no evident improvement in MDADI and TP after surgery. There was a higher risk of swallowing unsafety with abnormal WST outcome in TG (P < 0.001, OR = 106.52) than that in HG. VFSS analysis identified prolonged oral and pharyngeal transit time, disorganized swallowing sequence, abnormal hyoid bone movement, and frequent invalid swallows in patients with TG. A shortened OTT (<5066.50 ms) and a larger pharyngeal constriction ratio (PCR > 0.31) were associated with increased risks of penetration and aspiration. CONCLUSION Postoperative swallowing pattern is a characteristic of severely impaired safety and efficacy in patients with TG. Impaired OTT and PCR are variables that should be examined when determining the need for rehabilitation treatment.
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Affiliation(s)
- Wei Deng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Guiyi Zhao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Zhengshi Li
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Le Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Yudong Xiao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Sien Zhang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Kaixin Guo
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Chunqing Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Yujie Liang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56 Lingyuanxi Road, Guangzhou 510055, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, No. 74, 2nd Zhongshan Road, Guangzhou 510080, Guangdong, China.
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Lin TH, Yang CW, Chang WK. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia. Front Immunol 2022; 12:800029. [PMID: 35185865 PMCID: PMC8847226 DOI: 10.3389/fimmu.2021.800029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization. Methods We performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization. Results Multivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11–0.63, P = 0.003). Conclusions For older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
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Affiliation(s)
- Tai-Han Lin
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation. Auris Nasus Larynx 2022; 49:986-994. [DOI: 10.1016/j.anl.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 11/17/2022]
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Fiberoptic endoscopic evaluation of swallowing and the Brazilian version of the Eating Assessment Tool-10 in resistant hypertensive patients with obstructive sleep apnea. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S90-S99. [PMID: 35241385 PMCID: PMC9801020 DOI: 10.1016/j.bjorl.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 11/04/2021] [Accepted: 01/26/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe the prevalence and characteristics of OD through Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and the Eating Assessment Tool-10 (EAT-10) in hypertensive patients with OSA, as well as to describe the sensitivity of EAT-10 for the detection of OD in this population. METHODS This study included a convenience sample in which 85 resistant hypertensive patients diagnosed with OSA in an university hospital participated. Participants were subjected to the EAT-10 (index test) and FEES (reference standard). RESULTS The median EAT-10 score was 2 (0-5.5). According to the FEES, 27 participants did not have dysphagia, 42 had mild dysphagia and 16 had mild to moderate dysphagia. The sensitivity of the EAT-10 was 70.7% (95% CI: 57.3-81.9) at a cutoff score ≥1, with a discriminatory power of 67.4% (p = 0.005). The most prevalent symptom in this population was "food stuck in the throat", while the most prevalent signs were delayed initiation of the pharyngeal phase of swallowing, premature bolus spillage and pharyngeal residue. CONCLUSION In our study, the cutoff score for the EAT-10 for screening for OD in this population was ≥ 1. In conclusion, this population presented a high prevalence of dysphagia detected in FEES and its severity is associated with higher EAT-10 scores.
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Swan K, Speyer R, Scharitzer M, Farneti D, Brown T, Cordier R. A Visuoperceptual Measure for Videofluoroscopic Swallow Studies (VMV): A Pilot Study of Validity and Reliability in Adults with Dysphagia. J Clin Med 2022; 11:724. [PMID: 35160175 PMCID: PMC8837107 DOI: 10.3390/jcm11030724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/04/2023] Open
Abstract
The visuoperceptual measure for videofluoroscopic swallow studies (VMV) is a new measure for analysing the recordings from videofluoroscopic swallow studies (VFSS). This study evaluated the reliability and validity of the pilot version of the VMV using classical test theory (CTT) analysis, informed by the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. Forty participants, diagnosed with oropharyngeal dysphagia by fibreoptic endoscopic evaluation of swallowing, were recruited. The VFSS and administration of bolus textures and volumes were conducted according to a standardised protocol. Recordings of the VFSS were rated by three blinded raters: a speech-language pathologist, a radiologist and a phoniatrician. Inter- and intra-rater reliability was assessed with a weighted kappa and resulted in 0.889 and 0.944 overall, respectively. Structural validity was determined using exploratory factor analyses, which found four and five factor solutions. Internal consistency was evaluated with Cronbach's alpha coefficients, which found all but one factor scoring within an acceptable range (>0.70 and <0.95). Hypothesis testing for construct validity found the expected correlations between the severity of dysphagia and the VMV's performance, and found no impact of gender on measure performance. These results suggest that the VMV has potential as a reliable and valid measure for VFSS. Further validation with a larger sample is required, and validation using an item response theory paradigm approach is recommended.
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Affiliation(s)
- Katina Swan
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Renée Speyer
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
- Department Special Needs Education, University of Oslo, 0315 Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Daniele Farneti
- Audiologic Phoniatric Service, Infermi Hospital Rimni, 47900 Rimini, Italy
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, Frankston, VIC 3199, Australia
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7YT, UK
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Yu-Lei X, Shan W, Ju Y, Yu-Han X, Wu Q, Yin-Xu W. Theta burst stimulation versus high-frequency repetitive transcranial magnetic stimulation for poststroke dysphagia: A randomized, double-blind, controlled trial. Medicine (Baltimore) 2022; 101:e28576. [PMID: 35029231 PMCID: PMC8758019 DOI: 10.1097/md.0000000000028576] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) of high-frequency (10 Hz) on suprahyoid motor cortex has been an evidence-based treatment for poststroke dysphagia. Intermittent theta burst stimulation (iTBS) can be performed in 3 minutes compared with 20 ± 5 minutes for 10 Hz rTMS. This study aimed to ensure the clinical efficacy, safety, and tolerability of iTBS compared with 10 Hz rTMS for patients with poststroke dysphagia. METHOD In this randomized, double-blind, single-center, controlled trial, 47 participants were randomly assigned to iTBS (n = 24) and rTMS (n = 23) group. Each participant received iTBS or rTMS daily at suprahyoid motor cortex of affected hemisphere for 10 consecutive days. The outcomes were assessed at baseline, immediately, and 2 weeks after intervention, including water-swallowing test, standardized swallowing assessment, Mann assessment of swallowing ability, Murray Secretion Scale, Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and motor evoked potential (MEP) of bilateral suprahyoid muscle. RESULTS There were no significant differences between groups. There was a significant improvement on all rating scales and MEP after rTMS and iTBS. No significant differences on water-swallowing test, Mann assessment of swallowing ability, standardized swallowing assessment, Murray Secretion Scale scores, and MEP were observed between groups. In particular, there was significant differences on Penetration-Aspiration Scale scores (viscous liquid: mean difference = 1.016; 95% CI: 0.32-1.71; effect size: 0.360; P = .005) and the residue rate of pyriform fossa (viscous liquid: mean difference = 0.732; 95% CI: 0.18-1.28; effect size: 0.248; P = .010) in between-group. Comparing the differences over the changes of all rating scales, only the residue rate of epiglottis valley between groups was found to be significantly different (dilute liquid: mean difference = -0.567; 95% CI: -0.98 to -0.15; P = .009). There was no severe adverse effect and high dropout rates in both groups. CONCLUSION The clinical efficacy, safety, and tolerability of iTBS showed non-inferior to 10 Hz rTMS for patients with poststroke dysphagia. The present study can be used to improve the clinicians' knowledge and clinical decision skills on iTBS and rTMS for poststroke dysphagia.
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Affiliation(s)
- Xie Yu-Lei
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Wang Shan
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Yang Ju
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Xie Yu-Han
- University of South China, Hengyang City, Hunan Province, China
| | - Qing Wu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
| | - Wang Yin-Xu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchang City, Sichuan Province, China
- North Sichuan Medical College, Nanchang City, Sichuan Province, China
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Zang J, Kiehn S, Flügel T, Koseki JC, Nießen A, Kim SH, Pflug C, Nienstedt JC. Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research. Dysphagia 2022; 37:1822-1838. [PMID: 35430715 PMCID: PMC9643173 DOI: 10.1007/s00455-022-10446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date. OBJECTIVE This systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome. METHODS Included were all studies reporting a pediatric FEES protocol for children aged 0-18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form. RESULTS In total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared. DISCUSSION None of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Saskia Kiehn
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susan Hyoungeun Kim
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Martins GDS, Bandeira JDF, Alves MSGL, Costa BOID, Pernambuco L. Medidas cinemáticas da deglutição obtidas por ultrassonografia: um protocolo de revisão de escopo. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222456922s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: identificar e sintetizar as evidências científicas sobre medidas cinemáticas da deglutição obtidas por ultrassonografia. Métodos: este protocolo seguiu a metodologia proposta pelo Joanna Briggs Institute (JBI) e as diretrizes para elaboração de revisões de escopo do Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). As bases de dados eletrônicas pesquisadas serão: PubMed/Medline, Scopus, Web of Science, Lilacs, ScienceDirect, Embase e Google Scholar. Uma estratégia de busca foi desenvolvida para PubMed/Medline, que será adaptada para cada base de dados. Inicialmente, os artigos serão rastreados pelo título e resumo por dois revisores independentes. Em seguida, farão a leitura do texto completo dos artigos de acordo com os critérios de elegibilidade. Os dados serão extraídos dos artigos incluídos por meio de formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo. Considerações Finais: a execução deste protocolo apresentará o estado da arte sobre o tema pesquisado e contribuirá para a melhor compreensão das possibilidades de análise quantitativa da deglutição por meio da ultrassonografia.
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Costa BOID, Machado LDS, Augusto MM, Alves TC, Pernambuco L. Treinamento para análise de parâmetros da videoendoscopia da deglutição: um protocolo de revisão de escopo. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/202224111021s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: apresentar um protocolo de revisão de escopo para identificar e mapear as evidências disponíveis sobre treinamento para a análise de parâmetros da videoendoscopia da deglutição. Métodos: o protocolo seguirá o método proposto pelo Joanna Briggs Institute e as diretrizes PRISMA-P para relato de protocolos de revisão. A busca será feita na MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL e literatura cinzenta. Uma estratégia de busca foi desenvolvida para a MEDLINE, que será adaptada para cada base de dados. Dois revisores independentes rastrearão os artigos pelo título e resumo. Em seguida, farão a leitura do texto completo dos artigos incluídos, considerando os critérios de elegibilidade. Os dados serão extraídos com um formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo, seguindo as diretrizes do PRISMA-ScR. Revisão da literatura: há escassez de pesquisas que descrevam métodos de treinamento perceptivo-visual para analisar parâmetros da VED e dados inconsistentes para orientar a tomada de decisão clínica. Esta revisão fornecerá informações abrangentes sobre o desenvolvimento de treinamento para esse tipo de análise. Conclusão: este protocolo de revisão de escopo apresentará o estado geral das pesquisas sobre o tema e identificará as lacunas existentes na base de evidências.
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Costa BOID, Machado LDS, Augusto MM, Alves TC, Pernambuco L. Training for fiberoptic endoscopic evaluation of swallowing parameter analysis: a scoping review protocol. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/202224111021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to present a scoping review protocol to identify and map available evidence on training for fiberoptic endoscopic evaluation of swallowing parameter analysis. Methods: the protocol follows the method proposed by the Joanna Briggs Institute and the PRISMA-P guidelines for review protocol reports. The survey will be made in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL, and grey literature. A search strategy has been developed for MEDLINE, which will be adapted for each database. Two independent reviewers will screen the articles by title and abstract. Then, they will read the full text of the included articles, considering the eligibility criteria. The data will be extracted with a standardized form. The results will be presented in a flowchart and narrative summary, following the PRISMA-ScR guidelines. Literature Review: there is a scarcity of research describing visual-perceptual training methods to analyze FEES parameters and inconsistent data to guide clinical decision-making. This review will provide comprehensive information on developing training for this type of analysis. Conclusion: this scoping review protocol will present the overall state of research on the topic and identify existing gaps in the base of evidence.
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Martins GDS, Bandeira JDF, Alves MSGL, Costa BOID, Pernambuco L. Kinematic measures of swallowing obtained with ultrasound: a scoping review protocol. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222456922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Purpose: to identify and synthesize scientific evidence on kinematic measures of swallowing obtained with ultrasound. Methods: a protocol following the methodology proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). The search will be made in PubMed/MEDLINE, Scopus, Web of Science, LILACS, ScienceDirect, Embase, and Google Scholar, using a search strategy developed for PubMed/MEDLINE, which will be adapted for each database. Articles will be initially screened by title and abstract by two independent reviewers who will read their full text according to the eligibility criteria. Data in included articles will be extracted by means of a standardized form and the results presented in a flowchart and narrative summary. Final Considerations: once carried out, this protocol will present the state-of-the-art on the research topic and help better understand the possibilities to quantitatively analyze swallowing through ultrasound.
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