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Raynor EM, Kern J. Assessing Dysphagia in the Child. Otolaryngol Clin North Am 2024; 57:511-521. [PMID: 38485540 DOI: 10.1016/j.otc.2024.02.011] [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] [Indexed: 07/01/2024]
Abstract
Swallowing problems in children can occur for a variety of reasons, and assessment varies based on the age of the child, underlying medical problems, and results of the clinical swallow evaluation. The need for interdisciplinary management with speech language pathologists skilled in the management of children with dysphagia is imperative to identify the components of swallowing that are impaired and provide specific recommendations for safe and adequate nutrition supporting growth, development, and oral feeding if possible. This study focuses on the types of assessment tools available and how and when they are utilized for children of different ages and abilities.
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Affiliation(s)
- Eileen M Raynor
- Duke Department of Head and Neck Surgery & Communication Sciences, DUMC Box 3805, Durham, NC 27710, USA.
| | - Jennifer Kern
- Duke Department of Speech Pathology & Audiology, DUMC Box 3887, Durham, NC 27710, USA
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2
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Mothersole KH, Ulualp SO, Johnson RF, Brown AF, Shah GB, Liu CC, Chorney SR. Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove. Int Arch Otorhinolaryngol 2024; 28:e101-e106. [PMID: 38322447 PMCID: PMC10843914 DOI: 10.1055/s-0043-1767800] [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: 08/21/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established. Objective We evaluated the subjective and objective outcomes of interarytenoid augmentation with injection in children with DIG. Methods Consecutive children under 18 years of age who underwent injection laryngoplasty for DIG were reviewed. Data pertaining to demographics, past medical history, past surgical history, and results of pre and postoperative video fluoroscopic swallow study (VFSS) were obtained. The primary outcome measure was the presence of thin liquid aspiration or penetration on postoperative VFSS. The secondary outcome measure was caregiver-reported improvement of symptoms. Results Twenty-seven patients had VFSS before and after interarytenoid augmentation with injection (IA). Twenty (70%) had thin liquid penetration and 12 (44%) had thin liquid aspiration before the IA. Thin liquid aspiration resolved in 9 children (45%) and persisted in 11 (55%). Of the 12 children who had thin liquid aspiration prior to IA, 6 (50%) had resolution of thin liquid aspiration after IA. Conclusions Injection laryngoplasty is a safe tool to improve swallowing function in children with DIG. Further studies are needed to assess the long-term outcomes of IA and identify predictors of successful IA in children with DIG.
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Affiliation(s)
- Kelsey H. Mothersole
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Seckin O. Ulualp
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Romaine F. Johnson
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Ashley F. Brown
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Gopi B. Shah
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Christopher C. Liu
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
| | - Stephen R. Chorney
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, TX, United States
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McGrattan KE, Mohr AH, Weikle E, Hernandez K, Walsh K, Park J, Ramel SE, Georgieff MK, Dietz K, Dahlstrom K, Lindsay J, Thoyre S. Establishing Normative Values for Healthy Term Infant Feeding Performance: Neonatal Eating Assessment Tool-Mixed, Oral Feeding Scale, and Early Feeding Skills Assessment. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2792-2801. [PMID: 37682537 DOI: 10.1044/2023_ajslp-22-00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE Infants with perceived feeding problems are frequently referred for assessment of their feeding abilities. However, little is known regarding how healthy nondysphagic infants perform on commonly used assessments, making determination of impairment difficult. The aim of this investigation was to elucidate the characteristics of healthy term infant feeding performance using three commonly employed clinical assessments: Neonatal Eating Assessment Tool-Mixed (NeoEat-Mixed), Oral Feeding Scale, and Early Feeding Skills (EFS). METHOD In this prospective case-control study, we recruited 30 infants without feeding impairments to undergo video-monitored bottle feeds under their normal feeding conditions. Caregiver perception of infant feeding was evaluated using the NeoEat-Mixed. Milk ingestion was monitored real time using the Oral Feeding Scale for rate of milk transfer and modified proficiency as characterized by the total volume consumed out of the total volume the caregiver provided. Videos were analyzed by two speech pathologists using the EFS assessment. Descriptive statistics were used to characterize performance. RESULTS Participants underwent feeding monitoring at an average chronological age of 4 ± 2 months. Caregivers primarily reported normal, nonconcerning feeding patterns across all of the NeoEAT-Mixed outcomes. Infants consumed milk at an average rate of transfer of 7 ± 3 ml/min, a modified proficiency of 50 ± 21%, and achieved the highest OFS score of 4 (93%, n = 28). The majority of infants scored the best EFS score (mature-3) as it related to the absence of color changes during the feed (97%, n = 29), although commonly scored in the worst EFS score (immature-1) in their presentation of one or more compelling stress cues (63%, n = 19). CONCLUSION Establishing healthy term infant normative values for commonly used feeding assessments is critical in accurately distinguishing infants with feeding impairments from those with normal developmental variants.
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Affiliation(s)
- Katlyn Elizabeth McGrattan
- Department of Speech-Language-Hearing Science, University of Minnesota, Minneapolis
- Department of Rehabilitation, Masonic Children's Hospital, Minneapolis, MN
| | | | - Ellen Weikle
- Department of Speech-Language-Hearing Science, University of Minnesota, Minneapolis
| | - Kayla Hernandez
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, MA
| | - Katie Walsh
- Department of Speech Language Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL
| | - Jinhee Park
- Connell School of Nursing, Boston College, Chestnut Hill, MA
| | - Sara E Ramel
- Department of Pediatrics, Division of Pediatric Neonatology, University of Minnesota, Minneapolis
| | - Michael K Georgieff
- Department of Pediatrics, Division of Pediatric Neonatology, University of Minnesota, Minneapolis
| | - Kelly Dietz
- Department of Radiology, University of Minnesota, Minneapolis
| | | | | | - Suzanne Thoyre
- School of Nursing, University of North Carolina at Chapel Hill
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Smith JB, Kamarunas E, O'Donoghue C. The Influence of Side-Lying Position on Oropharyngeal Swallow Function in At-Risk Infants: An Exploratory Study. Clin Pediatr (Phila) 2023; 62:1087-1100. [PMID: 36919839 DOI: 10.1177/00099228231159158] [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] [Indexed: 03/16/2023]
Abstract
This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P = .009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P = .024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P = .032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings.
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Affiliation(s)
- Julian B Smith
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
- Speech-Language Pathology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
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Miranda PP, Levy DS, Kieling RR. Aspiration in the First Year of Life and Later Tube Feeding: A Retrospective Cohort from a Low-Income Country. Dysphagia 2023; 38:192-199. [PMID: 35476230 DOI: 10.1007/s00455-022-10450-4] [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: 09/17/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
The objective of this study is to investigate in infants submitted to videofluoroscopic swallowing study (VFSS) during the first year of life, the association between aspiration and later tube feeding, and to identify potential risk factors related to feeding route outcome. Retrospective cohort study with data from electronic health records was performed. Data were collected from infants < 12 months of age who underwent VFSS during inpatient hospital stay in the period between 2013 and 2018. Patient charts after 24 months of age were reviewed to ascertain the outcome and study factors, including VFSS findings, neonatal data, clinical comorbidities, nutritional status, ICU admissions, and hospital readmissions. Relative risk (RR) for tube feeding was calculated, and a Poisson regression with robust variance was used to identify potential risk factors. VFSS data from 164 patients < 1 year old were retrieved, of whom 112 (68%) contributed with data about feeding route after 2 years of age. Most infants were preterm < 37 weeks (66%), with a median age of 9.28 weeks at the time of the exam. Aspiration occurred in 33% of the patients, with no statistically significant difference between full-term or premature infants (p = 0.173). The relative risk of tube feeding after the age of 2 among infants who aspirated in VFSS was 0.74 (CI 0.25-2.16, p = 0.573). Poisson regression analysis showed that number of hospital readmissions (RR 1.04, 95%CI 1.01-1.07, p = 0.005) and gestational age < 34 weeks (RR 0.26, 95%CI 0.07-0.089, p = 0.032) were associated with later tube feeding. Early VFSS findings have low predictive value regarding later feeding route. Aspiration events should be considered as complementary information for clinical decision.
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Affiliation(s)
- Priscilla Poliseni Miranda
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Deborah Salle Levy
- Speech and Language Pathology Service, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Room 1045, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renata Rocha Kieling
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Hasenstab KA, Jadcherla SR. Evidence-Based Approaches to Successful Oral Feeding in Infants with Feeding Difficulties. Clin Perinatol 2022; 49:503-520. [PMID: 35659100 DOI: 10.1016/j.clp.2022.02.004] [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: 11/25/2022]
Abstract
Infants in the neonatal intensive care unit (NICU) frequently have feeding difficulties with the root cause remaining elusive to identify. Evaluation of the provider/parent/infant feeding process may provide objective clues to sources of feeding difficulty. Specialized testing may be necessary to determine if the infant's swallowing skills are dysfunctional, immature, or maldeveloped, and to determine the risk of feeding failure or chronic tube feeding. Current evidence-based diagnostic and management approaches resulting in successful oral feeding in the NICU infant are discussed.
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Affiliation(s)
- Kathryn A Hasenstab
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA
| | - Sudarshan R Jadcherla
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA; Division of Neonatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Division Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA.
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7
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Smith LS, Barkmeier-Kraemer JM. Conceptual Framework Behind the Development of a Level of Confidence Tool: The Pediatric Videofluoroscopic Swallow Study Value Scale. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:689-704. [PMID: 35201847 DOI: 10.1044/2021_ajslp-20-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The videofluoroscopic swallow study (VFSS) is the most commonly used instrumental procedure for evaluating swallowing in pediatric populations suspected of having dysphagia. Assessment and interpretation of a VFSS in pediatric populations is frequently challenged by testing-specific factors that can raise concerns regarding the representativeness of swallow events observed during testing compared to daily feeding/swallowing physiology. When VFSS findings do not represent typical swallowing patterns, treatment recommendations can result in suboptimal outcomes. To address this current challenge to pediatric VFSS interpretation and associated treatment recommendations, the pediatric VFSS Value Scale (pVFSS Value Scale) was developed within a tertiary regional pediatric medical center. This clinical focus article summarizes the initial scale development phases and resulting conceptual framework for rating clinical testing factors that influence a clinician's level of confidence regarding pediatric VFSS findings. Future goals for scientific evaluation and clinical utilization of this new rating scale are also reported. CONCLUSIONS The pVFSS Value Scale was developed to assist clinicians with interpretation of pediatric VFSS assessment outcomes and to efficiently communicate factors influencing impressions and treatment recommendations with team members and caregivers. This clinical concept article summarizes potential uses of this tool to inform treatment planning as well as future clinical research to evaluate its psychometrics and clinical utility.
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Affiliation(s)
- Leann Schow Smith
- Department of Rehabilitation, Primary Children's Hospital, Salt Lake City, UT
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Frakking TT, Chang AB, Carty C, Newing J, Weir KA, Schwerin B, So S. Using an Automated Speech Recognition Approach to Differentiate Between Normal and Aspirating Swallowing Sounds Recorded from Digital Cervical Auscultation in Children. Dysphagia 2022; 37:1482-1492. [PMID: 35092488 PMCID: PMC9643257 DOI: 10.1007/s00455-022-10410-y] [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: 07/22/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Use of machine learning to accurately detect aspirating swallowing sounds in children is an evolving field. Previously reported classifiers for the detection of aspirating swallowing sounds in children have reported sensitivities between 79 and 89%. This study aimed to investigate the accuracy of using an automatic speaker recognition approach to differentiate between normal and aspirating swallowing sounds recorded from digital cervical auscultation in children. We analysed 106 normal swallows from 23 healthy children (median 13 months; 52.1% male) and 18 aspirating swallows from 18 children (median 10.5 months; 61.1% male) who underwent concurrent videofluoroscopic swallow studies with digital cervical auscultation. All swallowing sounds were on thin fluids. A support vector machine classifier with a polynomial kernel was trained on feature vectors that comprised the mean and standard deviation of spectral subband centroids extracted from each swallowing sound in the training set. The trained support vector machine was then used to classify swallowing sounds in the test set. We found high accuracy in the differentiation of aspirating and normal swallowing sounds with 98% overall accuracy. Sensitivity for the detection of aspiration and normal swallowing sounds were 89% and 100%, respectively. There were consistent differences in time, power spectral density and spectral subband centroid features between aspirating and normal swallowing sounds in children. This study provides preliminary research evidence that aspirating and normal swallowing sounds in children can be differentiated accurately using machine learning techniques.
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Affiliation(s)
- Thuy T. Frakking
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD 4510 Australia ,Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,Speech Pathology Department, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Anne B. Chang
- Department of Respiratory Medicine, Queensland Children’s Hospital, 501 Stanley St, South Brisbane, QLD 4101 Australia ,Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia ,Australian Centre for Health Services Innovation, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD 4101 Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, McKean St, Caboolture, QLD 4510 Australia ,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222 Australia
| | - Jade Newing
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD 4215 Australia
| | - Kelly A. Weir
- Menzies Health Institute QLD & School of Health Sciences & Social Work, Griffith University, Gold Coast Campus, 1 Parklands Avenue, Southport, QLD 4222 Australia ,Allied Health Research, Gold Coast University Hospital, Gold Coast Hospital & Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Belinda Schwerin
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD 4215 Australia
| | - Stephen So
- School of Engineering and Built Environment, Griffith University, Parklands Dr, Southport, QLD 4215 Australia
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Christovam CA, Manica D, Schweiger C, Sekine L, Miranda PP, Levy DS. Instrumental Swallowing Assessments in the Neonatal and Pediatric Populations: A Systematic Review. Dysphagia 2021; 37:1183-1200. [PMID: 34719729 DOI: 10.1007/s00455-021-10379-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
The scientific scope of swallowing disorders in the neonatal and pediatric populations is growing exponentially; however, the preponderance of evidence for evaluation protocols has been concentrated in non-instrumental evaluations creating a lack of research about protocols for instrumental swallowing assessment. Thus, the purpose of this study was to systematically review the literature to identify and to report protocols used in instrumental assessments through videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) in the neonatal and pediatric populations to support clinical decision making. The search strategy was applied in five online databases, no filters were applied to restrict languages or publication dates and the gray literature was reviewed. PRISMA statement was used to guide the construction of this review. The studies included validated and unvalidated protocols, the validated protocols had their risk of bias estimated using the QUADAS-2. In total, 13 studies were included in the final review, of these eleven assessed through QUADAS-2, and two classified with low risk of bias. One study is in the process of standardization and validation of an instrumental assessment protocol for swallowing in bottle-fed infants through VFSS. Information about validity and reliability of published protocols for instrumental evaluation in the neonatal and pediatric populations is limited. Therefore, further research is needs to development studies aiming to standardize and validate protocols for instrumental assessments in these populations.
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Affiliation(s)
- Caroline Aguirre Christovam
- Multiprofessional Resident in the Critical Patient Care Program at Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Denise Manica
- Otolaryngology/Head and Neck Surgery Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Claudia Schweiger
- Otolaryngology/Head and Neck Surgery Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Programa de Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Faculdade de Medicina, Universidade Federal do Rio Grando do Sul, Porto Alegre, RS, Brazil
| | - Priscilla Poliseni Miranda
- Programa de Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Deborah S Levy
- Department of Speech, Language and Audiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
- Department of Health and Communication, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
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Balest AL, Mahoney AS, Shaffer AD, White KE, Theiss R, Dohar J. Infant aspiration and associated signs on clinical feeding evaluation. Int J Pediatr Otorhinolaryngol 2021; 149:110856. [PMID: 34358815 DOI: 10.1016/j.ijporl.2021.110856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Few studies have examined clinical signs of aspiration in infants <51 weeks post-menstrual age (PMA) for whom the laryngeal cough reflex is not fully developed. This retrospective study explored 1) the association between signs of aspiration on a clinical feeding evaluation (CFE) and/or comorbid conditions with aspiration (silent or overt) on a modified barium swallow study (MBS) for infants in this age range, 2) the association between lower respiratory infection (LRI) and aspiration on MBS, and 3) the sensitivity and specificity of detecting aspiration according to signs on CFE and the evaluating speech-language pathologist's (SLP) years of experience. METHODS A retrospective review of charts of patients with MBS completed January 1, 2012-December 31, 2014 was performed. Patients were included if they were <51-weeks PMA at the time of MBS and had a CFE conducted no more than seven days prior to the MBS. Patient age, comorbidities, and MBS and CFE details were collected. The impact of CFE findings, patient age, comorbid syndromes/associations, and aerodigestive diagnoses on the odds of demonstrating silent aspiration (SA) or overt aspiration during MBS with thin liquids was determined using logistic regression, and the sensitivity and specificity of CFE for identifying SA was calculated. RESULTS Results from 114 patients indicated that 46 (40 %) of the infants had SA and nine (8 %) had overt aspiration on MBS. Notable signs on CFEs were cough (36 %), oxygen desaturations (33 %), and chest congestion (32 %). On multiple regression analysis there was increased odds of SA on MBS with at least one clinical sign on CFE (OR: 24.3, p = 0.02), chronic lung disease, (OR: 18.2, p = 0.01), and airway abnormalities (OR: 2.94, p = 0.01). Cough on CFE was associated with increased odds of overt aspiration on MBS (OR: 5.69, p = 0.04). Neither SA nor overt aspiration were significantly associated with LRI. Sensitivity and specificity of CFE for correctly identifying the presence of SA were 98 % and 15 %, respectively; experience of the SLP was not a contributing factor. CONCLUSION Further study is required to determine if specific signs on CFE are predictive of aspiration.
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Affiliation(s)
- Arcangela L Balest
- UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Neonatology, USA.
| | - Amanda S Mahoney
- University of Pittsburgh Communication Science and Disorders, 3600 Atwood Street, Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Department of Otolaryngology, USA
| | - Katherine E White
- UPMC Children's Hospital of Pittsburgh, Department of Audiology and Communication Disorders, USA
| | - Robert Theiss
- University of Pittsburgh, School of Medicine, Present Address Allegheny General Hospital, Pittsburgh, PA, USA
| | - Joseph Dohar
- University of Pittsburgh Communication Science and Disorders, 3600 Atwood Street, Forbes Tower, Pittsburgh, PA, 15260, USA; UPMC Children's Hospital of Pittsburgh, Department of Otolaryngology, USA
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11
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Edwards A, Froude E, Sharpe G, Carding P. Training for videofluoroscopic swallowing analysis: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:529-539. [PMID: 33586519 DOI: 10.1080/17549507.2020.1861327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To synthesise the available evidence relating to best practice in training videofluoroscopy and barium swallow analysts. METHOD The review was conducted according to the PRISMA statement and registered in PROSPERO (CRD42017053744). Data were extracted from nine databases. Studies were included if they described training approaches for clinicians or students of any profession learning to interpret videofluoroscopic (VFSS) or barium swallow studies and were written in English. The methods were heterogeneous and a metanalysis was not possible; a narrative review is presented. RESULT Sixteen studies were eligible, including those designed to evaluate the influence of training as well as those that described training as part of validating an assessment tool or method. The quality of the studies was assessed with the Hawker scale and assigned an NHMRC rating. While the evidence was low quality (NHMRC level IV), training consistently improved the accuracy and reliability of clinicians and students conducting VFSS. No studies reported the outcome of training for barium swallow analysis. There was significant variability in the dose, method, and setting of training. CONCLUSION To elucidate best practice in VFSS analysis to ensure training is cost effective and results in accurate diagnosticians requires further research.
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Affiliation(s)
- Ann Edwards
- School of Allied Health, Australian Catholic University (Brisbane), Virginia, Australia
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Elspeth Froude
- Faculty of Health Sciences, Australian Catholic University (Sydney), North Sydney, Australia
| | - Gabriella Sharpe
- School of Allied Health, Australian Catholic University (Brisbane), Virginia, Australia
| | - Paul Carding
- School of Allied Health, Australian Catholic University (Brisbane), Virginia, Australia
- Oxford Institute of Nursing, Midwifery, and Allied Health Research, Oxford Brookes University, Oxford, UK
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12
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Dodrill P. Evaluating Feeding and Swallowing in Infants and Children. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Stevens M, Mayerl C, Bond L, German RZ, Barkmeier-Kraemer JM. Pathophysiology of aspiration in a unilateral SLN lesion model using quantitative analysis of VFSS. Int J Pediatr Otorhinolaryngol 2021; 140:110518. [PMID: 33310447 PMCID: PMC7770015 DOI: 10.1016/j.ijporl.2020.110518] [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: 06/29/2020] [Revised: 10/23/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate the pathophysiology of aspiration in previously studied female infant piglets after a unilateral superior laryngeal nerve (uSLN) lesion. METHODS Videofluoroscopic swallow studies (VFSS) were acquired from 15 female piglets ages 2-3 weeks (9 with uSLN lesion and 6 controls). VFSS were analyzed at 30 frames/second sampling rate. Quantitative measures were conducted and compared between groups using published methodologies for VFSS assessment in adult and infant humans. Measures included the: 1) number of lingual-palatal contacts (LPC) (i.e. pre-swallow), 2) total pharyngeal transit time (TPT), 3) offset of swallow (offP), as well as onset of: 4) pharyngeal stage (onP), 5) pharyngoesophageal segment opening (oPES), 6) maximum PES opening (maxPES), 7) airway closure onset (oAC), and 8) maximum airway closure (maxAC). Measures 5-7 were determined relative to onP. Bolus residue was rated by severity (0 (none) to 3 (severe)). A gamma regression was used to compare continuous measures between lesioned and control groups. RESULTS The number of LPC (p = .006), TPT (p = .023) and timing of maxAC (p = .041) were significantly greater in the uSLN lesion than the control group. CONCLUSIONS Outcomes of this study replicated prior published findings and elucidated that piglets with right uSLN lesions exhibited delayed maxAC. Noteworthy was the use of clinically relevant quantitative videofluoroscopic measures in piglets for comparison to future studies in human pediatric populations.
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Affiliation(s)
- Maya Stevens
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
| | - Christopher Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH
| | - Laura Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, USA.
| | - Rebecca Z. German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH
| | - Julie M Barkmeier-Kraemer
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
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14
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Martin-Harris B, Canon CL, Bonilha HS, Murray J, Davidson K, Lefton-Greif MA. Best Practices in Modified Barium Swallow Studies. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1078-1093. [PMID: 32650657 PMCID: PMC7844340 DOI: 10.1044/2020_ajslp-19-00189] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 05/22/2023]
Abstract
Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cheri L. Canon
- Department of Radiology, The University of Alabama at Birmingham School of Medicine
| | - Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Joseph Murray
- Audiology and Speech-Language Pathology Service, VA Ann Arbor Healthcare System, MI
| | - Kate Davidson
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Maureen A. Lefton-Greif
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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15
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Capturing infant swallow impairment on videofluoroscopy: timing matters. Pediatr Radiol 2020; 50:199-206. [PMID: 31650190 PMCID: PMC7685400 DOI: 10.1007/s00247-019-04527-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Infant videofluoroscopic swallow studies (VFSSs) require clinicians to make determinations about swallowing deficits based on a limited number of fluoroscopically observed swallows. Although airway protection is known to decline throughout a bottle-feed, the paucity of data regarding the timing of this degradation has limited the development of procedural protocols that maximize diagnostic validity. OBJECTIVE We tested the stability of key components of swallow physiology and airway protection at four standardized timepoints throughout the VFSS. MATERIALS AND METHODS Thirty bottle-fed infants with clinical signs of swallow dysfunction underwent VFSS. Fluoroscopy was turned on to allow visualization of five swallows at 0:00, 0:30, 1:30 and 2:30 (minutes:seconds [min:s]). We evaluated swallows for components of swallow physiology (oral bolus hold, initiation of pharyngeal swallow, timing of swallow initiation) and airway protection (penetration, aspiration). We used model-based linear contrasts to test differences in the percentage of swallows with low function component attributes. RESULTS All components of swallow physiology exhibited a change throughout the VFSS (P≤0.0005). Changes were characterized by an increase in the number of sucks per swallow (P<0.0001), percentage of swallows with incomplete bolus hold (P=0.0005), delayed initiation of pharyngeal swallow (P<0.0001), delayed timing of swallow initiation (P=0.0004) and bolus airway entry (P<0.0001). These findings demonstrate that infants with dysphagia exhibit a change in swallow physiology throughout the videofluoroscopic swallow exam. CONCLUSION Fluoroscopic visualization that is confined to the initial swallows of the bottle feed limit the exam's diagnostic validity. Developing evidence-based procedural guidelines for infant VFSS execution is crucial for maximizing the exam's diagnostic and treatment yield.
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Martin-Harris B, Carson KA, Pinto JM, Lefton-Greif MA. BaByVFSSImP © A Novel Measurement Tool for Videofluoroscopic Assessment of Swallowing Impairment in Bottle-Fed Babies: Establishing a Standard. Dysphagia 2020; 35:90-98. [PMID: 30955137 PMCID: PMC6778717 DOI: 10.1007/s00455-019-10008-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
AIM This investigation tested the construct validity of the first standardized assessment tool, the BaByVFSS Impairment Profile, (BaByVFSSImP©), developed for the quantification of swallowing observations made from videofluoroscopic swallow studies (VFSS) in bottle-fed babies. METHOD Construct validity of the measures was tested using descriptive methods and confirmatory factor analysis (CFA) of swallowing scores obtained from a cohort of bottle-fed babies (median age 3 months 1 day, interquartile range 1 month 4 days-7 months 4 days) sequentially referred for VFSS based on clinical signs, symptoms, or risk factors associated with dysphagia and/or aspiration. Main outcome measures were emergence of functional domains derived from swallowing component impairment scores. RESULTS Confirmatory factor analysis resulted in 21 significant components (factor loadings ≥ 0.5) grouping into five functional domains labeled for common contribution to overall swallowing function. The tool was organized into the BaByVFSSImP. Clinical relevance was explored using correlational analyses between domain scores, maximum penetration/aspiration scores, feeding status, and caregiver burden. INTERPRETATION Quantification of physiologic swallowing impairment captured by BaByVFSSImP holds promise for identification of physiologically based targets for intervention, clinical decisions regarding enteral feeding, and tracking the trajectory of swallowing impairment throughout development in young children.
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Affiliation(s)
- Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Department of Otolaryngology Head and Neck Surgery, Department of Radiation Oncology, School of Communication, Feinberg School of Medicine, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
- Department of Otolaryngology Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, College of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
- Research Service, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, 60141, USA.
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD, 21287, USA
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jeanne M Pinto
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, David M. Rubenstein Building, Suite 3070, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Maureen A Lefton-Greif
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, David M. Rubenstein Building, Suite 3017, 200 North Wolfe Street, Baltimore, MD, 21287, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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Twenty years of quantitative instrumental measures of swallowing in children: a systematic review. Eur J Pediatr 2020; 179:203-223. [PMID: 31900589 DOI: 10.1007/s00431-019-03546-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 01/21/2023]
Abstract
Early identification and intervention has shown better health outcomes for children with dysphagia. Instrumental swallowing assessments are vital and have been a focus of dysphagia research in the last two decades. This systematic review explores published quantitative instrumental measures of swallowing in children. Five subject-related databases were searched to identify original scientific articles published in English, using instrumental quantitative measures of swallowing to study swallowing/feeding mechanism in children since 1998. Two thousand two hundred and two articles were found from the initial database search and 36 were included in the final qualitative synthesis following PRISMA guidelines. Selected studies showed great diversity in target population, phase/s of swallowing studied, instrumentation used (n = 10) and quantitative measures reported (n = 144). Videofluoroscopy and manometry have been studied most repeatedly. With less frequency, a variety of other instruments has been used to describe suck-swallow patterns and swallowing-related respiration. High-resolution manometry shows the greatest increase in publications with validated, reliable quantitative measures of pharyngeal and oesophageal pressures and timing. More recently, quantification of videofluoroscopy analysis has been a focus.Conclusion: A diverse range of quantitative measures of swallowing is available for children in the literature. However, further reliability and validity testing is needed. Opportunities for clinical application of these quantitative manometric and videofluoroscopic measures are restricted by limited normative comparisons and vast variability in published measures.What is known?• Instrumental swallowing assessments are reliable and accurate in diagnosing swallowing difficulties in children.• However, subjective interpretation of observational findings often questions the optimal use of instrumentation.What is new?• High-resolution manometry has shown promising progress with the development of quantitative objective swallow measures for children. While attempts to quantify video-fluoroscopic measures have been increased in the recent past.• A vast variety of instruments has been used to obtain quantitative and/or objective swallow measures of children, yet clinical application is still in progress.
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Batchelor G, McNaughten B, Bourke T, Dick J, Leonard C, Thompson A. How to use the videofluoroscopy swallow study in paediatric practice. Arch Dis Child Educ Pract Ed 2019; 104:313-320. [PMID: 30322859 DOI: 10.1136/archdischild-2017-313787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2018] [Indexed: 11/03/2022]
Abstract
In paediatric practice feeding, eating, drinking and swallowing difficulties are present in up to 1% of children. Dysphagia is any disruption to the swallow sequence that results in compromise to the safety, efficiency or adequacy of nutritional intake. Swallowing difficulties may lead to pharyngeal aspiration, respiratory compromise or poor nutritional intake. It causes sensory and motor dysfunction impacting on a child's ability to experience normal feeding. Incoordination can result in oral pharyngeal aspiration where fluid or food is misdirected and enters the airway, or choking where food physically blocks the airway The incidence is much higher in some clinical populations, including children with neuromuscular disease, traumatic brain injury and airway malformations. The prevalence of dysphagia and aspiration-related disease is increasing secondary to the better survival of children with highly complex medical and surgical needs. This article aims to outline the indications for performing videofluoroscopy swallow (VFS). This includes the technical aspects of the study, how to interrupt a VFS report and some of the limitations to the study.
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Affiliation(s)
| | | | - Thomas Bourke
- Royal Belfast Hospital for Sick Children, Belfast, UK.,Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Julie Dick
- Royal Belfast Hospital for Sick Children, Belfast, UK
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19
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Layly J, Marmouset F, Chassagnon G, Bertrand P, Sirinelli D, Cottier JP, Morel B. Can We Reduce Frame Rate to 15 Images per Second in Pediatric Videofluoroscopic Swallow Studies? Dysphagia 2019; 35:296-300. [DOI: 10.1007/s00455-019-10027-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/30/2019] [Accepted: 05/31/2019] [Indexed: 12/21/2022]
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Hernandez AM, Bianchini EMG. Swallowing Analyses of Neonates and Infants in Breastfeeding and Bottle-feeding: Impact on Videofluoroscopy Swallow Studies. Int Arch Otorhinolaryngol 2019; 23:e343-e353. [PMID: 31360257 PMCID: PMC6660293 DOI: 10.1055/s-0039-1677753] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/21/2018] [Indexed: 10/26/2022] Open
Abstract
Introduction Dysphagia, when left untreated, can result in an increase in morbidity and mortality rates, especially among infants with history of life-threatening neonatal diseases. The videofluoroscopy swallowing study (VFSS) is considered the gold standard for the diagnosis of dysphagia. There are few imaging studies of infant swallowing based on videofluoroscopy, none of which were performed during breast-feeding. Objective To analyze the similarities and differences in infant swallowing function -regarding the feeding method - breast or bottle - and the impact on videofluoroscopy findings. Methods A retrospective study of 25 VFSSs of breastfeeding and bottle-feeding infants was performed. The studied variables were: oral capture and control; tongue versus mandible movement coordination; sucking pattern; mandible excursion; liquid flow; bolus retention; laryngeal penetration; tracheal aspiration; clearing of material collected in the pharynx; and gastroesophageal reflux (GER). Results The study showed a statistically significant association between nipple/areole capture; oral control; sucking pattern; mandibular excursion; liquid flow and feeding method. The velar sealing deficit, the place that trigger the pharyngeal swallow, food retention in the pharyngeal recesses, laryngeal penetration and GER were also factors associated with the feeding method. Conclusion The analysis of the swallowing characteristics of both feeding methods revealed significant differences between them, with an impact on the diagnosis in the VFSSs, especially regarding velar function.
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Affiliation(s)
- Ana Maria Hernandez
- Post Graduation Program in Speech, Language and Hearing Sciences (PEPG), Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
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21
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Re GL, Vernuccio F, Di Vittorio ML, Scopelliti L, Di Piazza A, Terranova MC, Picone D, Tudisca C, Salerno S. Swallowing evaluation with videofluoroscopy in the paediatric population. ACTA ACUST UNITED AC 2019; 39:279-288. [PMID: 30933173 PMCID: PMC6843585 DOI: 10.14639/0392-100x-1942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/15/2018] [Indexed: 11/23/2022]
Affiliation(s)
- G Lo Re
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - F Vernuccio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M L Di Vittorio
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - L Scopelliti
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - A Di Piazza
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - M C Terranova
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - D Picone
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - C Tudisca
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
| | - S Salerno
- Section of Radiology Di.Bi.Med., University Hospital "Paolo Giaccone", Palermo, Italy
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Current approaches to instrumental assessment of swallowing in children. Curr Opin Otolaryngol Head Neck Surg 2019; 26:349-355. [PMID: 30325754 DOI: 10.1097/moo.0000000000000492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. RECENT FINDINGS Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. SUMMARY Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging.
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Lundine JP, Dempster R, Carpenito K, Miller‐Tate H, Burdo‐Hartman W, Halpin E, Khalid O. Incidence of aspiration in infants with single‐ventricle physiology following hybrid procedure. CONGENIT HEART DIS 2018; 13:706-712. [DOI: 10.1111/chd.12636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer P. Lundine
- Department of Speech & Hearing Science The Ohio State University Columbus Ohio
- Division of Clinical Therapies Nationwide Children s Hospital Columbus Ohio
| | - Robert Dempster
- Department of Psychology & Neuropsychology Nationwide Children s Hospital Columbus Ohio
- Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio
| | - Kirby Carpenito
- The Heart Center Nationwide Children s Hospital Columbus Ohio
| | | | - Wendelin Burdo‐Hartman
- Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio
- Division of Complex Care Nationwide Children s Hospital Columbus Ohio
| | - Elizabeth Halpin
- Division of Clinical Therapies Nationwide Children s Hospital Columbus Ohio
| | - Omar Khalid
- Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio
- The Heart Center Nationwide Children s Hospital Columbus Ohio
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