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Muhle P, Claus I, Labeit B, Roderigo M, Warnecke T, Dziewas R, Suntrup-Krueger S. Pharyngeal Electrical Stimulation prior to extubation - Reduction of extubation failure rate in acute stroke patients? J Crit Care 2024; 82:154808. [PMID: 38581884 DOI: 10.1016/j.jcrc.2024.154808] [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: 05/05/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The aim of our study was to assess if PES before extubation can minimize the extubation failure risk in orally intubated, mechanically ventilated stroke patients at high risk of severe dysphagia. MATERIALS AND METHODS Thirty-two ICU patients were prospectively enrolled in this study presenting with a high risk for dysphagia as defined by a DEFISS (Determine Extubation Failure In Severe Stroke) risk score and compared 1:1 to a retrospective matched patient control group. The prospective patient group received PES prior to extubation. Endpoints were need for reintubation, swallowing function as assessed with FEES, pneumonia incidence and length of stay after extubation. RESULTS Post-extubation, the Fiberoptic Endoscopic Dysphagia Severity Score (FEDSS, 4.31 ± 1.53vs.5.03 ± 1.28;p = 0.047) and reintubation rate within 72 h (9.4vs.34.4%;p = 0.032) were significantly lower in the PES group than in the historical control group. Pulmonary infections after extubation were less common in PES-treated patients although this difference was not significant (37.5vs.59.4%;p = 0.133). Time from extubation to discharge was significantly shorter after PES compared with the control group (14.09 ± 11.58vs.26.59 ± 20.49 days;p = 0.003). CONCLUSIONS In orally intubated and mechanically ventilated stroke patients at high risk of severe dysphagia, PES may improve swallowing function, reduce extubation failure risk and decrease time from extubation to discharge. Further research is required.
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Affiliation(s)
- Paul Muhle
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany.
| | - Inga Claus
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
| | - Bendix Labeit
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
| | - Malte Roderigo
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
| | - Tobias Warnecke
- Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076 Osnabrück, Germany
| | - Rainer Dziewas
- Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076 Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1A, 48149 Muenster, Germany
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Sasegbon A, Cheng I, Labeit B, Lapa S, Rommel N, Hamdy S. New and Evolving Treatments for Neurologic Dysphagia. Drugs 2024:10.1007/s40265-024-02064-x. [PMID: 38954267 DOI: 10.1007/s40265-024-02064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
Despite swallowing being a frequently performed daily function, it is highly complex. For a safe swallow to occur, muscles within the head, neck, and thorax need to contract in a concerted pattern, controlled by several swallowing centers at multiple levels of the central nervous system, including the midbrain, cerebral cortex, and cerebellum in addition to five cranial nerves. Dysphagia, or difficulty swallowing, is caused by a long list of pathologic processes and diseases, which can interfere with various stages along the swallowing sensorimotor pathway. When present, dysphagia leads to increased mortality, morbidity, hospital length of stay, and reduced quality of life. Current dysphagia management approaches, such as altering the texture and consistency of foods and fluids and teaching patients rehabilitative exercises, have been broadly unchanged for many years and, in the case of texture modification, are of uncertain effectiveness. However, evidence is emerging in support of new medication-based and neuromodulatory treatment approaches. Regarding medication-based therapies, most research has focused on capsaicinoids, which studies have shown are able to improve swallowing in patients with post-stroke dysphagia. Separately, albeit convergently, in the field of neuromodulation, there is a growing and positive evidential base behind three non-invasive brain stimulation techniques: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (TDCS), and pharyngeal electrical stimulation (PES). Should some or all of these emerging therapies fulfill their promise, dysphagia-related patient outcomes may be improved. This paper describes the current state of our understanding regarding new medication and neuromodulation-based neurogenic oropharyngeal dysphagia treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignal Analysis, University of Münster, Münster, Germany
- Universitätsklinikum Münster, Münster, Germany
| | - Bendix Labeit
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sriramya Lapa
- Department of Neurology, Goethe University and University Hospital, Frankfurt, Germany
| | - Nathalie Rommel
- Deglutology, Experimental Otorhinolaryngology, Department of Neurosciences, University of Leuven, Leuven, Belgium
- Department of Gastroenterology, Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK.
- Centre for Gastrointestinal Sciences, Salford Royal Foundation Trust, University of Manchester, Clinical Sciences Building, Manchester, Eccles Old Road, Salford, M6 8HD, UK.
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3
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Hu J, Wang Q, Dai Y, Tian Y, Xu N, Wen H, Dou Z, Ye Q. Screening for optimal parameters for modified pharyngeal electrical stimulation for the treatment of dysphagia after stroke in rats. Exp Neurol 2024; 379:114878. [PMID: 38944330 DOI: 10.1016/j.expneurol.2024.114878] [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: 02/12/2024] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
Pharyngeal electrical stimulation (PES), a novel noninvasive peripheral nerve stimulation technique, can effectively improve neurogenic dysphagia and increase the safety and effectiveness of swallowing in the clinic. However, the lack of animal models for dysphagia has limited the mechanistic research on PES, which affects its wide application. Therefore, determining optimal parameters for PES in rats is needed to enable mechanistic studies. Modified PES (mPES), which has different waves and pulse widths from PES, was used; in previous studies mPES was found to have a neurological mechanism like that of PES. A poststroke dysphagia (PSD) model was established, and rats with dysphagia were grouped into three different intensities (0.1 mA, 0.5 mA, and 1 mA) for the selection of optimal intensity and three different frequencies (1 Hz, 2 Hz, and 5 Hz) for the selection of optimal frequency based on a stimulation duration of 10 min in the clinic. A Videofluroscopic Swallow Screen (VFSS) was used to assess swallowing function in rats before and after mPES treatment. The results showed that the 1 mA group had better swallowing function (p < 0.05) than the model group. Compared with the model group, the 1 Hz and 5 Hz groups had the same improvement in swallowing function (p < 0.05). However, the increase in excitatory signals in the sensorimotor cortex was more pronounced in the 5 Hz group than in the other frequency stimulation groups (p < 0.05). Combining the clinical findings with the above results, we concluded that the optimal stimulation parameter for mPES in rats is "frequency: 5 Hz, current intensity: 1 mA for 10 min/day", which provides a basis for future basic experimental studies of mPES in animals.
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Affiliation(s)
- Jiahui Hu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qianqian Wang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Dai
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yueqin Tian
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Nenggui Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zulin Dou
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Qiuping Ye
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Eskildsen SJ, Wessel I, Poulsen I, Hansen CA, Curtis DJ. Rehabilitative intervention for successful decannulation in adult patients with acquired brain injury and tracheostomy: a systematic review. Disabil Rehabil 2024; 46:2464-2476. [PMID: 37449332 DOI: 10.1080/09638288.2023.2233437] [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: 02/14/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Tracheostomy and dysphagia are independently associated with increased complications and poorer functional outcome after acquired brain injury (ABI). The aim of this study was to identify and evaluate rehabilitation to restore functional swallowing ability and respiratory capacity during tracheal tube weaning. MATERIALS AND METHODS The review was conducted according to PRISMA guidelines. Any study design with adult patients with ABI and tracheostomy was eligible. The primary outcome was decannulation. RESULTS A total of 2647 records were identified and eight papers included. Four studies investigated pharyngeal electrical stimulation (PES), two explored Facial Oral Tract Therapy (F.O.T.T.), one respiratory physiotherapy (RPT), and one study investigated external subglottic air flow (ESAF). Two RCTs found a significant difference between intervention and control on successful decannulation and readiness for decannulation in favour of PES. Time from rehabilitation admission and tracheostomy to decannulation was significantly reduced after implementing an F.O.T.T.-based protocol. CONCLUSION Four interventions were identified, PES, F.O.T.T., RPT, and ESAF, all aimed at increasing oropharyngeal sensory input through stimulation. Due to heterogeneity of interventions, designs and outcome measures, effect could not be estimated. This review highlights the limited research on rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.
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Affiliation(s)
- Signe Janum Eskildsen
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Health, Aarhus, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Aarhus University, Health, Aarhus, Denmark
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Carrinna Aviaja Hansen
- Department of Orthopaedic Surgery, Zealand University Hospital, University of Copenhagen, Koege, Denmark
- Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Derek John Curtis
- Department of Pediatric Rehabilitation, Children's Therapy Center, The Child and Youth Administration, Copenhagen, Denmark
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [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: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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6
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Mishra B, Sudheer P, Agarwal A, Nilima N, Srivastava MVP, Vishnu VY. Minimal Clinically Important Difference of Scales Reported in Stroke Trials: A Review. Brain Sci 2024; 14:80. [PMID: 38248295 PMCID: PMC10813687 DOI: 10.3390/brainsci14010080] [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: 12/15/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
There is a growing awareness of the significance of using minimum clinically important differences (MCIDs) in stroke research. An MCID is the smallest change in an outcome measure that is considered clinically meaningful. This review is the first to provide a comprehensive summary of various scales and patient-reported outcome measures (PROMs) used in stroke research and their MCID values reported in the literature, including a concise overview of the concept of and methods for determining MCIDs in stroke research. Despite the controversies and limitations surrounding the estimation of MCIDs, their importance in modern clinical trials cannot be overstated. Anchor-based and distribution-based methods are recommended for estimating MCIDs, with patient self-evaluation being a crucial component in capturing the patient's perspective on their health. A combination of methods can provide a more comprehensive understanding of the clinical relevance of treatment effects, and incorporating the patient's perspective can enhance the care of stroke patients.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Nilima Nilima
- Department of Biostatics, All India Institute of Medical Sciences, New Delhi 110029, India;
| | | | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
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7
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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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8
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Wu FM, Gorelik D, Brenner MJ, Takashima M, Goyal A, Kita AE, Rose AS, Hong RS, Abuzeid WM, Maria PS, Al-Sayed AA, Dunham ME, Kadkade P, Schaffer SR, Johnson AW, Eshraghi AA, Samargandy S, Morrison RJ, Weissbrod PA, Mitchell MB, Rabbani CC, Futran N, Ahmed OG. New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2022. OTO Open 2024; 8:e105. [PMID: 38259521 PMCID: PMC10802084 DOI: 10.1002/oto2.105] [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: 10/01/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024] Open
Abstract
Objective To review new drugs and devices relevant to otolaryngology approved by the Food and Drug Administration (FDA) in 2022. Data Sources Publicly available FDA data on drugs and devices approved in 2022. Review Methods A preliminary screen was conducted to identify drugs and devices relevant to otolaryngology. A secondary screen by members of the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) Medical Devices and Drugs Committee differentiated between minor updates and new approvals. The final list of drugs and devices was sent to members of each subspecialty for review and analysis. Conclusion A total of 1251 devices and 37 drugs were identified on preliminary screening. Of these, 329 devices and 5 drugs were sent to subspecialists for further review, from which 37 devices and 2 novel drugs were selected for further analysis. The newly approved devices spanned all subspecialties within otolaryngology. Many of the newly approved devices aimed to enhance patient experience, including over-the-counter hearing aids, sleep monitoring devices, and refined CPAP devices. Other advances aimed to improve surgical access, convenience, or comfort in the operating room and clinic. Implications for Practice Many new devices and drugs are approved each year to improve patient care and care delivery. By staying up to date with these advances, otolaryngologists can leverage new innovations to improve the safety and quality of care. Given the recent approval of these devices, further studies are needed to assess long-term impact within the field of otolaryngology.
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Affiliation(s)
- Franklin M Wu
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
| | - Daniel Gorelik
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery University of Michigan Medical School Ann Arbor USA
| | - Masayoshi Takashima
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
| | - Amit Goyal
- Department of Otorhinolaryngology All India Institute of Medical Sciences Jodhpur Jodhpur USA
| | - Ashley E Kita
- Department of Head and Neck Surgery David Geffen School of Medicine at UCLA Los Angeles USA
| | - Austin S Rose
- University of North Carolina School of Medicine Department of Otolaryngology-Head and Neck Surgery
| | - Robert S Hong
- Michigan Ear Institute Farmington Hills USA
- Department of Otolaryngology-Head and Neck Surgery Wayne State University Detroit USA
| | - Waleed M Abuzeid
- University of Washington Department of Otolaryngology-Head and Neck Surgery
| | - Peter S Maria
- Stanford University Department of Otolaryngology-Head and Neck Surgery
| | - Ahmed A Al-Sayed
- King Saud University Department of Otolaryngology-Head & Neck Surgery
| | - Michael E Dunham
- Louisiana State University Health Sciences Center School of Medicine Department of Otolaryngology-Head and Neck Surgery
| | - Prajoy Kadkade
- Columbia University-Harlem Hospital Department of Surgery
- Department of Surgery NYU Long Island School of Medicine New York City USA
| | - Scott R Schaffer
- Department of Otorhinolaryngology-Head and Neck Surgery Hospital University of Pennsylvania Philadelphia USA
| | - Alan W Johnson
- Department of Otolaryngology-Head & Neck Surgery Park Nicollet Specialty Care Bloomington USA
| | - Adrien A Eshraghi
- Department of Otolaryngology and Neurosurgery University of Miami Miller School of Medicine Miami USA
| | - Shireen Samargandy
- Department of Otolaryngology-Head and Neck Surgery University of Arizona Tucson USA
- Department of Otolaryngology-Head and Neck Surgery King Abdulaziz University Jeddah Saudi Arabia
| | - Robert J Morrison
- Department of Otolaryngology-Head & Neck Surgery University of Michigan Medical School Ann Arbor USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery University of California San Diego La Jolla USA
| | - Margaret B Mitchell
- Department of Otolaryngology-Head & Neck Surgery Harvard Medical School/Mass Eye and Ear Boston USA
| | - Cyrus C Rabbani
- Department of Otolaryngology-Head and Neck Surgery Case Western Reserve University and University Hospitals Cleveland USA
| | - Neil Futran
- University of Washington Department of Otolaryngology-Head and Neck Surgery
| | - Omar G Ahmed
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
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9
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Zhang X, Wang X, Dou Z, Wen H. A Novel Approach to Severe Chronic Neurogenic Dysphagia Using Pharyngeal Sensory Electrical Stimulation. Am J Phys Med Rehabil 2023; 102:e32-e35. [PMID: 36194834 PMCID: PMC9940831 DOI: 10.1097/phm.0000000000002116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The treatment options for severe chronic neurogenic dysphagia are limited. A patient, after resection of medulla oblongata hemangioblastoma, who failed to respond to 7 mos of traditional dysphagia rehabilitation therapy, was treated with prolonged pharyngeal sensory electrical stimulation for 39 sessions over 57 days. For the first time, this case report showed improvement in hypopharyngeal peak pressure (9.1 vs. 90.8 mm Hg) using high-resolution manometry. Reductions in the penetration and aspiration scale, secretion, and residue of the vallecular and pyriform sinus were verified by videofluoroscopic swallowing study and flexible endoscopic evaluation of swallowing. The Functional Oral Intake Scale score increased from 1 to 6. No adverse event was observed. This case report presented a potential therapeutic protocol for severe chronic neurogenic dysphagia, which might be instructive for clinical practice.
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10
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Neuroplasticity Elicited by Modified Pharyngeal Electrical Stimulation: A Pilot Study. Brain Sci 2023; 13:brainsci13010119. [PMID: 36672100 PMCID: PMC9856550 DOI: 10.3390/brainsci13010119] [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: 11/13/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Modified pharyngeal electrical stimulation (mPES) is a novel therapeutic method for patients with neurogenic dysphagia and tracheostomy. However, the underlying neural mechanisms are still unclear. This study aims to investigate the impact of mPES on swallowing-related neural networks and involuntary swallowing frequency using functional near-infrared spectroscopy (fNIRS). 20 healthy volunteers participated in this study, including two separate experimental paradigms. Experiment 1: Immediate effect observation, 20 participants (10 female; mean age 47.65 ± 10.48) were delivered with real and sham mPES in random order for 8 repetitions. fNIRS signals were collected during the whole period of Experiments 1. Swallowing frequency was assessed during sham/real mPES. Experiment 2: Prolonged effect observation, 7 out of the 20 participants (4 female; mean age 49.71 ± 6.26) completed real mPES for 5 sessions (1 session/day). 13 of the 20 participants withdrew for personal reasons. Hemodynamic changes were recorded by fNIRS on day 1 and 5. Results show that mPES evoked cortical activation over a distributed network in bilateral primary somatosensory, primary motor, somatosensory association cortex, pre-motor and supplementary motor area, dorsolateral prefrontal cortex, Broca's area, and supramarginal gyrus part of Wernicke's area. Meanwhile, the increased frequency of involuntary swallowing was associated with decreased frontopolar activation (frontopolar cortex: Channel 6, p = 0.024, r = -0.529; Channel 23, p = 0.019, r = -0.545). Furthermore, after five days of mPES, decreased cortical activations were observed in the right dorsolateral prefrontal and supramarginal gyrus part of Wernicke's area, and left frontopolar and M1 areas. Overall, these results might suggest that mPES could elicit changes in neuroplasticity that could reorganize the swallowing-related neural network and increase involuntary swallow frequency.
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Borders JC, Grande AA, Troche MS. Statistical Power and Swallowing Rehabilitation Research: Current Landscape and Next Steps. Dysphagia 2022; 37:1673-1688. [PMID: 35226185 DOI: 10.1007/s00455-022-10428-2] [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: 11/02/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes. Given that power analyses are infrequently reported in dysphagia research, it remains unclear whether studies are adequately powered to detect a range of treatment effects. Therefore, this review sought to examine the current landscape of statistical power in swallowing rehabilitation research. Databases were searched for swallowing treatments using instrumental evaluations of swallowing and the penetration-aspiration scale as an outcome. Sensitivity power analyses based on each study's statistical test and sample size were performed to determine the minimum effect size detectable with 80% power. Eighty-nine studies with 94 treatment comparisons were included. Sixty-seven percent of treatment comparisons were unable to detect effects smaller than d = 0.80. The smallest detectable effect size was d = 0.29 for electrical stimulation, d = 0.49 for postural maneuvers, d = 0.52 for non-invasive brain stimulation, d = 0.61 for combined treatments, d = 0.63 for respiratory-based interventions, d = 0.70 for lingual strengthening, and d = 0.79 for oral sensory stimulation. Dysphagia treatments examining changes in penetration-aspiration scale scores were generally powered to reliably detect larger effect sizes and not smaller (but potentially clinically meaningful) effects. These findings suggest that non-significant results may be related to low statistical power, highlighting the need for collaborative, well-powered intervention studies that can detect smaller, clinically meaningful changes in swallowing function. To facilitate implementation, a tutorial on simulation-based power analyses for ordinal outcomes is provided ( https://osf.io/e6usd/ ).
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | | | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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Zhang X, Liang Y, Wang X, Shan Y, Xie M, Li C, Hong J, Chen J, Wan G, Zhang Y, Lin Y, Zhao F, He Z, Dou Z, Wen H. Effect of Modified Pharyngeal Electrical Stimulation on Patients with Severe Chronic Neurogenic Dysphagia: A Single-Arm Prospective Study. Dysphagia 2022:10.1007/s00455-022-10536-z. [DOI: 10.1007/s00455-022-10536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022]
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13
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Raciti L, Raciti G, Pulejo G, Conti-Nibali V, Calabrò RS. Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem. MEDICINES 2022; 9:medicines9020016. [PMID: 35200759 PMCID: PMC8874700 DOI: 10.3390/medicines9020016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Neurogenic dysphagia is a difficulty in swallowing food caused by disease or impairment of the nervous system, including stroke and traumatic brain injury. The most clinically apparent complication of neurogenic dysphagia is pulmonary aspiration, which may manifest itself acutely as choking or coughing, respiratory distress, wheezing, gasping or gurgling, and tachycardia. However, chronic symptoms, including weight loss, production of excessive oral secretions and aspiration pneumonia, may be also present, especially in patients with a disorder of consciousness (DOC). Usually, patients with dysphagia after the acute phase need to be treated with enteral nutrition using a feeding tube. This avoids patient malnutrition and supports the rehabilitation program. This narrative review aims to investigate dysphagia and its complications and management in patients with DOC. Clinical indications and practical advice on how to assess and treat this complex problem are also provided.
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Affiliation(s)
- Loredana Raciti
- GCA-Centro Spoke AO Cannizzaro, Catania, IRCCS Centro Neurolesi Bonino-Pulejo, 95122 Messina, Italy; (L.R.); (G.R.)
| | - Gianfranco Raciti
- GCA-Centro Spoke AO Cannizzaro, Catania, IRCCS Centro Neurolesi Bonino-Pulejo, 95122 Messina, Italy; (L.R.); (G.R.)
| | - Grazia Pulejo
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98123 Messina, Italy; (G.P.); (V.C.-N.)
| | - Valeria Conti-Nibali
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98123 Messina, Italy; (G.P.); (V.C.-N.)
| | - Rocco Salvatore Calabrò
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98123 Messina, Italy; (G.P.); (V.C.-N.)
- Correspondence: ; Fax: +39-9060128950
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Prosiegel M. Neuroanatomie des Schluckens. SCHLUCKSTÖRUNGEN 2022:53-66. [DOI: 10.1016/b978-3-437-44418-0.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Eskildsen SJ, Poulsen I, Jakobsen D, Riberholt CG, Curtis DJ. Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury. BMJ Open 2021; 11:e053244. [PMID: 34857571 PMCID: PMC8640633 DOI: 10.1136/bmjopen-2021-053244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/03/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Dysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI. OBJECTIVE To systematically map the accessible research literature to answer the research question: Which non-surgical, non-pharmacological interventions are used in the treatment of dysphagia in patients with moderate and severe ABI in the acute and subacute phase? DESIGN: Scoping review based on the methodology of Arksey and O'Malley and methodological advancement by Levac et al. DATA SOURCES: MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021. ELIGIBILITY CRITERIA All studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included. DATA EXTRACTION AND SYNTHESIS Data was extracted by two independent reviewers and studies were categorised based on treatment modality. RESULTS A total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into cortical or non-cortical stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training. CONCLUSION This scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.
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Affiliation(s)
- Signe Janum Eskildsen
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Nursing and Health Care, Health, Aarhus University, Aarhus, Denmark
| | - Ingrid Poulsen
- Research Unit of Nursing and Health Care, Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Copenhagen University Hospital, Rigshospitalet, Amager and Hvidovre, Denmark
| | - Daniela Jakobsen
- Department of Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Derek John Curtis
- Department of Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Child Centre Copenhagen, The Child and Youth Administration, Copenhagen, Denmark
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Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation. Neurol Sci 2021; 43:199-209. [PMID: 34654983 PMCID: PMC8724108 DOI: 10.1007/s10072-021-05654-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Dysphagia is a common and devastating complication following brain damage. Over the last 2 decades, dysphagia treatments have shifted from compensatory to rehabilitative strategies that facilitate neuroplasticity, which is the reorganization of neural networks that is essential for functional recovery. Moreover, there is growing interest in the application of cortical and peripheral neurostimulation to promote such neuroplasticity. Despite some preliminary positive findings, the variability in responsiveness toward these treatments remains substantial. The purpose of this review is to summarize findings on the effects of neurostimulation in promoting neuroplasticity for dysphagia rehabilitation and highlight the need to develop more effective treatment strategies. We then discuss the role of metaplasticity, a homeostatic mechanism of the brain to regulate plasticity changes, in helping to drive neurorehabilitation. Finally, a hypothesis on how metaplasticity could be applied in dysphagia rehabilitation to enhance treatment outcomes is proposed.
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Traugott M, Hoepler W, Kitzberger R, Pavlata S, Seitz T, Baumgartner S, Placher-Sorko G, Pirker-Krassnig D, Ehehalt U, Grasnek A, Beham-Kacerovsky M, Friese E, Wenisch C, Neuhold S. Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using pharyngeal electrical stimulation in a COVID-19 survivor: a case report. J Med Case Rep 2021; 15:148. [PMID: 33752743 PMCID: PMC7983095 DOI: 10.1186/s13256-021-02763-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background A significant portion of critically ill patients with coronavirus disease 2019 (COVID-19) are at high risk of developing intensive care unit (ICU)-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. It has been shown that PES can restore safe swallowing in orally intubated or tracheotomized ICU patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES. Case presentation A 71-year-old Caucasian female patient with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol-generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the PED, as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS) and Dysphagia Severity Rating Scale (DSRS), and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department 5 days after completing PES treatment. Conclusions PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimize their full recovery. PES may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.
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Affiliation(s)
- Marianna Traugott
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Wolfgang Hoepler
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Reinhard Kitzberger
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sophie Pavlata
- Otorhinolaryngeology Department, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Tamara Seitz
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sebastian Baumgartner
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Gudrun Placher-Sorko
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Daniela Pirker-Krassnig
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Urs Ehehalt
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Andreas Grasnek
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Michaela Beham-Kacerovsky
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Emanuela Friese
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Christoph Wenisch
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Stephanie Neuhold
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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