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McClain W, Luttrell J, Lambert E. Pediatric Dysphagia. Otolaryngol Clin North Am 2024; 57:531-540. [PMID: 38521722 DOI: 10.1016/j.otc.2024.02.010] [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: 03/25/2024]
Abstract
Pediatric dysphagia is a common condition encountered in clinical practice. We review the physiology and development of swallow, presentation, epidemiology, and etiology of dysphagia. Additionally, comorbidities, associated conditions, and medical management of dysphagia are discussed.
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Affiliation(s)
- Wade McClain
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, 101 Manning Drive Campus, Box #7070, Chapel Hill, NC 27514, USA.
| | - Jordan Luttrell
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 430, Memphis, TN 38163, USA
| | - Elton Lambert
- Department of Otolaryngology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, MC:CC640, Houston, TX 77030, USA
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Silva MA, da Silveira MMF, Pedrosa BRV, Dos Santos RTNT, de Farias ZBBM, Sobral APV. A systematic review of the perspectives of botulinum toxin use on the quality of life of neurological patients with drooling. Clin Oral Investig 2024; 28:322. [PMID: 38758415 DOI: 10.1007/s00784-024-05718-y] [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: 01/24/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To investigate the effectiveness of botulinum toxin in the salivary glands of patients with neurological impairment and drooling and its impact on the quality of life. MATERIALS AND METHODS This systematic review was registered with the International Prospective Register of Systematic Reviews (CRD 42,023,435,242) and conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic search was performed in the PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and clinical trial databases until August 2023, no language restriction. Cohort studies and randomized clinical trials of patients diagnosed with drooling and neurological impairment who used botulinum toxin on the salivary gland were included, which evaluated subjective quality of life parameters. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and Risk of Bias 2 tools. The certainty of the evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Eight studies involving 317 patients were included. All studies, through subjective parameters, suggested the effectiveness of botulinum toxin in reducing drooling, resulting in an improvement in the quality of life. Three studies demonstrated improvements in swallowing and four in cases of respiratory diseases. Two clinical trials had a high risk of bias, whereas one had low risk. The five cohort studies that were evaluated had a high risk of bias. The certainty of the evidence was considered low. CONCLUSIONS Based on the patient/caregivers' perception of improvement in drooling, dysphagia, and respiratory symptoms, it can be inferred that botulinum toxin application reduces subjective drooling in neurologically compromised patients. Its impact contributes to the general well-being and quality of life. CLINICAL RELEVANCE Injection of botulinum toxin into the salivary glands can be considered an alternative technique to surgical or medicinal approaches in reducing drooling. It is effective, less invasive and without significant side effects. It promotes a positive impact on the well-being and quality of life of neurological patients.
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Affiliation(s)
- Michelle Almeida Silva
- Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil.
- Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife (PE), Brasil.
- , Rua Coronel Barata 52, João Pessoa, 58025-300, Paraíba, Brasil.
| | - Márcia Maria Fonseca da Silveira
- Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil
- Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife (PE), Brasil
| | - Bruna Rafaele Vieira Pedrosa
- Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil
- Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife (PE), Brasil
| | - Rebeka Thiara Nascimento Thiara Dos Santos
- Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil
- Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife (PE), Brasil
| | - Zilda Betânia Barbosa Medeiros de Farias
- Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil
- Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife (PE), Brasil
| | - Ana Paula Veras Sobral
- Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil
- Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife (PE), Brasil
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Regnier A, Mélotte E, Aubinet C, Alnagger N, Fischer D, Lagier A, Thibaut A, Laureys S, Kaux JF, Gosseries O. Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management. NeuroRehabilitation 2024; 54:91-107. [PMID: 38217621 DOI: 10.3233/nre-230135] [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: 01/15/2024]
Abstract
Following severe brain injuries, a subset of patients may remain in an altered state of consciousness; most of these patients require artificial feeding. Currently, a functional oral phase and the presence of exclusive oral feeding may constitute signs of consciousness. Additionally, the presence of pharyngo-laryngeal secretions, saliva aspiration, cough reflex and tracheostomy are related to the level of consciousness. However, the link between swallowing and consciousness is yet to be fully understood. The primary aim of this review is to establish a comprehensive overview of the relationship between an individual's conscious behaviour and swallowing (reflexive and voluntary). Previous studies of brain activation during volitional and non-volitional swallowing tasks in healthy subjects are also reviewed. We demonstrate that the areas activated by voluntary swallowing tasks (primary sensorimotor, cingulate, insula, premotor, supplementary motor, cerebellum, and operculum) are not specific to deglutitive function but are shared with other motor tasks and brain networks involved in consciousness. This review also outlines suitable assessment and treatment methods for dysphagic patients with disorders of consciousness. Finally, we propose that markers of swallowing could contribute to the development of novel diagnostic guidelines for patients with disorders of consciousness.
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Affiliation(s)
- Amandine Regnier
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, Liège, Belgium
| | - Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - David Fischer
- Department of Neurology, Division of Neurocritical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Aude Lagier
- Department of Otorhinolaryngology, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, Laval University, Québec, QC, Canada
| | - Jean-François Kaux
- Department of Physical and Rehabilitation Medicine, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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Ishida N, Ono S, Suzuki R, Nojiri K, Ootsuki S, Zakoji N. Comparison of factors associated with drooling between intractable neuromuscular disease and cerebral palsy. J Clin Neurosci 2023; 115:71-76. [PMID: 37499322 DOI: 10.1016/j.jocn.2023.07.013] [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: 01/31/2023] [Revised: 03/17/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Drooling represents a common and noteworthy symptom in patients with intractable neuromuscular disease (IND) and cerebral palsy (CP) and can lead to poor quality of life (QOL) and higher incidence of death due to aspiration of saliva. Identifying the factors affecting drooling is crucial to improving QOL and improving the poor prognosis of patients with IND and CP. This study sought to assess the prevalence of drooling and to elucidate the associated factors, drugs, and differences between patients with IND and CP. We included hospitalized patients with IND and CP. Among the 269 patients, 69 of 162 patients with IND (42.6%) and 75 of 107 patients with CP (70.1%) exhibited drooling. Drooling in IND was significantly higher in patients with tube feeding and those who had a previous stroke than in patients with potential oral intake and those having no history of stroke. In individuals with CP, drooling was significantly negatively associated with age. Taltirelin in patients with IND had a significant positive association with drooling, and antipsychotics and centrally acting muscle relaxants in those with CP had a significant negative association with drooling. Our results suggest that the factors associated with frequent drooling differ between IND and CP cases, and patients who should be screened for drooling are those with decreased swallowing function, those with IND who have had a previous stroke, and young patients with CP. Moreover, clinicians should consider the impact of drugs on drooling in IND and CP cases.
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Affiliation(s)
- Natsuko Ishida
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Ishikawa, Japan.
| | - Shunsuke Ono
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Ishikawa, Japan
| | - Ryohei Suzuki
- Department of Pharmacy, National Hospital Organization Higashinagoya National Hospital, Aichi, Japan
| | - Kei Nojiri
- Department of Pharmacy, National Hospital Organization Suzuka National Hospital, Mie, Japan; Department of Pharmacy, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
| | - Shinnosuke Ootsuki
- Department of Pharmacy, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Ishikawa, Japan
| | - Nobuyuki Zakoji
- Department of Pharmacy, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
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Iizumi Y, Ihara Y, Koike J, Takahashi K. Effects of interferential current electrical stimulation (IFCS) on mastication and swallowing function in healthy young adults: A preliminary study. Clin Exp Dent Res 2023. [PMID: 37158140 DOI: 10.1002/cre2.748] [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] [Received: 12/05/2022] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the effects of interferential current electrical stimulation (IFCS) on masticatory and swallowing function. MATERIALS AND METHODS Twenty healthy young adults were enrolled. The measurement items were spontaneous swallowing frequency (SSF), voluntary swallowing frequency (VSF), saliva secretion volume (SSV), glucose elution volume (GEV), and velocity of chew (VOC). All participants underwent both IFCS and sham stimulation (without stimulation, sham). Two sets of independent IFCS electrodes were placed on the bilateral neck. The precise location of the upper electrodes was just below the angle of the mandible, while the lower electrodes were placed at the anterior border of the sternocleidomastoid muscle. The intensity of IFCS was determined to be one level below the perceptual threshold that all participants felt discomfort. Statistical analysis was performed using a two-way repeated measures analysis of variance. RESULTS For IFCS, the results of each measurement before and during stimulation were SSF: 1.16 and 1.46, VSF: 8.05 and 8.45, SSV: 5.33 and 5.56 g, GEV: 171.75 and 208.60 mg/dL, and VOC: 87.20 and 95.20, respectively. SSF, GEV, and VOC during stimulation were significantly increased by IFCS (SSF, p = .009; GEV, p = .048; and VOC, p = .007). Following sham stimulation, the results were SSF: 1.24 and 1.34, VSF: 7.75 and 7.90, SSV: 5.65 and 6.04 g, GEV: 176.45 and 187.35 mg/dL, and VOC: 91.35 and 88.25, respectively. CONCLUSION While no significant differences were observed in the sham group, our findings suggest that IFCS of the superior laryngeal nerve may impact not only the swallowing function but also the masticatory function.
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Affiliation(s)
- Yoshiki Iizumi
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
| | - Yoshiaki Ihara
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
| | - Joji Koike
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
| | - Koji Takahashi
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
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