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Bonilha HS, Reedy EL, Wilmskoetter J, Nietert PJ, Martin-Harris B. Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies. Dysphagia 2024; 39:632-641. [PMID: 38265506 PMCID: PMC11239744 DOI: 10.1007/s00455-023-10643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 01/25/2024]
Abstract
Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.
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Affiliation(s)
- Heather Shaw Bonilha
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA.
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Room 202B, Columbia, SC, 29208, USA.
| | - Erin L Reedy
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
| | - Janina Wilmskoetter
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- College of Medicine, Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 606, Charleston, SC, 29425-2503, USA
| | - Paul J Nietert
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon Street, MSC 835, Charleston, SC, 29425-2503, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Feinberg School of Medicine, Otolaryngology - Head & Neck Surgery, Radiation Oncology, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
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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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Sugg JN, Lee JW. Neurologic Dysphagia. Otolaryngol Clin North Am 2024; 57:599-608. [PMID: 38664090 DOI: 10.1016/j.otc.2024.03.005] [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
Dysphagia is commonly associated with neurologic/neuromuscular disorders including prematurity, cerebral palsy, traumatic brain injury, brain tumors, genetic disorders, and neuromuscular diseases. This article aims to review the major categories of neurologic dysphagia, to outline specific findings and special considerations for each population, and to acknowledge the importance of integrating each patient's medical prognosis, goals of care, and developmental stage into a multidisciplinary treatment plan.
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Affiliation(s)
- Jillian Nyswonger Sugg
- Department of Head and Neck Surgery & Communication Sciences, Division of Speech Pathology and Audiology, Duke University, DUMC 3887, Durham, NC 27710, USA
| | - Janet Waimin Lee
- Department of Head and Neck Surgery & Communication Sciences, Division of Pediatric Otolaryngology, Duke University, DUMC 3805, Durham, NC 27710, USA.
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Ocrospoma S, Restrepo MI. Severe aspiration pneumonia in the elderly. JOURNAL OF INTENSIVE MEDICINE 2024; 4:307-317. [PMID: 39035624 PMCID: PMC11258512 DOI: 10.1016/j.jointm.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 07/23/2024]
Abstract
The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.
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Affiliation(s)
- Sebastian Ocrospoma
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Marcos I. Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
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Hutcheson KA, Aldridge EF, Warneke CL, Buoy SN, Tang X, Macdonald C, Alvarez CP, Barringer DA, Barbon CEA, Ebersole BM, McMillan H, Montealegre JR. Clinical Implementation of DIGEST as an Evidence-Based Practice Tool for Videofluoroscopy in Oncology: A Six-Year Single Institution Implementation Evaluation. Dysphagia 2024:10.1007/s00455-024-10721-2. [PMID: 38935170 DOI: 10.1007/s00455-024-10721-2] [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: 12/12/2023] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
Clinical implementation of evidence-based practice (EBP) tools is a healthcare priority. The Dynamic Grade of Swallowing Toxicity (DIGEST) is an EBP tool developed in 2016 for videofluoroscopy in head and neck (H&N) oncology with clinical implementation as a goal. We sought to examine: (1) feasibility of clinical implementation of DIGEST in a national comprehensive cancer center, and (2) fidelity of DIGEST adoption in real-world practice. A retrospective implementation evaluation was conducted in accordance with the STARI framework. Electronic health record (EHR) databases were queried for all consecutive modified barium swallow (MBS) studies conducted at MD Anderson Cancer Center from 2016 to 2021. Implementation outcomes included: feasibility as measured by DIGEST reporting in EHR (as a marker of clinical use) and fidelity as measured by accuracy of DIGEST reporting relative to the decision-tree logic (penetration-aspiration scale [PAS], residue, and Safety [S] and Efficiency [E] grades). Contextual factors examined included year, setting, cancer type, MBS indication, and provider. 13,055 MBS were conducted by 29 providers in 7,842 unique patients across the lifespan in diverse oncology populations (69% M; age 1-96 years; 58% H&N cancer; 10% inpatient, 90% outpatient). DIGEST was reported in 12,137/13,088 exams over the 6-year implementation period representing 93% (95% CI: 93-94%) adoption in all exams and 99% (95% CI: 98-99%) of exams excluding the total laryngectomy population (n = 730). DIGEST reporting varied modestly by year, cancer type, and setting/provider (> 91% in all subgroups, p < 0.001). Accuracy of DIGEST reporting was high for overall DIGEST (incorrect SE profile 1.6%, 200/12,137), DIGEST-safety (incorrect PAS 0.4% 51/12,137) and DIGEST-efficiency (incorrect residue 1.2%, 148/12,137). Clinical implementation of DIGEST was feasible with high fidelity in a busy oncology practice across a large number of providers. Adoption of the tool across the lifespan in diverse cancer diagnoses may motivate validation beyond H&N oncology.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1445, Houston, Texas, 77030-4009, US.
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Ella F Aldridge
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1445, Houston, Texas, 77030-4009, US
| | - Carla L Warneke
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1689, Houston, Texas, 77030, US
| | - Sheila N Buoy
- Department of Head & Neck Surgery - Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1445, Houston, Texas, 77030, US
| | - Xiaohui Tang
- Department of Head & Neck Surgery - Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1445, Houston, Texas, 77030, US
| | - Cameron Macdonald
- Qualitative Health Research Center, 111 King St., Suite 23, Madison, WI, 53703, US
| | - Clare P Alvarez
- Department of Head & Neck Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0340, Houston, Texas, 77030, US
| | - Denise A Barringer
- Department of Endoscopy Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0385, Houston, Texas, 77030, US
| | - Carly E A Barbon
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1445, Houston, Texas, 77030-4009, US
| | - Barbara M Ebersole
- Department of Head & Neck Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. (R10.1810), Houston, Texas, 77030, US
| | - Holly McMillan
- Department of Head & Neck Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. (R10.1824), Houston, Texas, 77030, US
| | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler (CPB3.3253), Houston, Texas, 77030, US
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Marangu-Boore D, Mwaniki P, Isaaka L, Njoroge T, Mumelo L, Kimego D, Adem A, Jowi E, Ithondeka A, Wanyama C, Agweyu A. Characteristics of children readmitted with severe pneumonia in Kenyan hospitals. BMC Public Health 2024; 24:1324. [PMID: 38755590 PMCID: PMC11097591 DOI: 10.1186/s12889-024-18651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities. METHODS We conducted a retrospective cohort study including children aged ≥ 2 months-14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 20 primary referral hospitals in Kenya. Severe pneumonia was defined using the 2013 World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality. RESULTS Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% CI 10.6-11.5) were readmitted. Re-admission was independently associated with age (12-59 months vs. 2-11 months: adjusted odds ratio (aOR) 1.70, 1.54-1.87; >5 years vs. 2-11 months: aOR 1.85, 1.55-2.22), malnutrition (weight-for-age-z-score (WAZ) <-3SD vs. WAZ> -2SD: aOR 2.05, 1.84-2.29); WAZ - 2 to -3 SD vs. WAZ> -2SD: aOR 1.37, 1.20-1.57), wheeze (aOR 1.17, 1.03-1.33) and presence of a concurrent neurological disorder (aOR 4.42, 1.70-11.48). Chest radiography was ordered more frequently among those readmitted (540/2,274 [23.7%] vs. 3,102/18,329 [16.9%], p < 0.001). Readmitted patients more frequently received second-line antibiotics (808/2,256 [35.8%] vs. 5,538/18,173 [30.5%], p < 0.001), TB medication (69/2,256 [3.1%] vs. 298/18,173 [1.6%], p < 0.001), salbutamol (530/2,256 [23.5%] vs. 3,707/18,173 [20.4%], p = 0.003), and prednisolone (157/2,256 [7.0%] vs. 764/18,173 [4.2%], p < 0.001). Inpatient mortality was 2,354/18,329 (12.8%) among children admitted with a first episode of severe pneumonia and 269/2,274 (11.8%) among those who were readmitted (adjusted hazard ratio (aHR) 0.93, 95% CI 0.82-1.07). Age (12-59 months vs. 2-11 months: aHR 0.62, 0.57-0.67), male sex (aHR 0.81, 0.75-0.88), malnutrition (WAZ <-3SD vs. WAZ >-2SD: aHR 1.87, 1.71-2.05); WAZ - 2 to -3 SD vs. WAZ >-2SD: aHR 1.46, 1.31-1.63), complete vaccination (aHR 0.74, 0.60-0.91), wheeze (aHR 0.87, 0.78-0.98) and anaemia (aHR 2.14, 1.89-2.43) were independently associated with mortality. CONCLUSIONS Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality.
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Affiliation(s)
- Diana Marangu-Boore
- Paediatric Pulmonology Division, Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Paul Mwaniki
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lynda Isaaka
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Teresiah Njoroge
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Livingstone Mumelo
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dennis Kimego
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | | | - Conrad Wanyama
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, Great Britain
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Palmer PM, Padilla AH, Murray SC, Rashidi M, Martinez-Fisher A, Winter T. The Impact of Videofluoroscopic Pulse Rate on Duration and Kinematic Measures in Infants and Adults with Feeding and Swallowing Disorders. Dysphagia 2024:10.1007/s00455-024-10709-y. [PMID: 38683399 DOI: 10.1007/s00455-024-10709-y] [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: 09/03/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
This investigation assessed the impact of temporal resolution during a videofluoroscopic evaluation of swallowing (VFSS) on measures of duration and kinematics. Thirty adult and ten infant swallow studies, all acquired at 30 frames and 30 pulses per second, were obtained from a New Mexico hospital. All swallow studies were altered to simulate 15 and 5 pulses per second. Duration measures included pharyngeal response time, duration of upper esophageal sphincter (UES) opening, velopharyngeal closure duration and total swallow duration. Kinematic measures were assessed in adults only and included peak hyoid position and extent of UES opening during the swallow. Analysis of outcome measures was performed and compared across the three temporal resolutions (30, 15, and 5 pulses per second). For data points where normative values are available, we evaluated the impact of temporal resolution on clinical determination (i.e., did a change in pulse rate alter the clinical classification). Kinematic and duration measures were altered with changes in pulse rate and these changes increased as temporal resolution decreased. For outcome measures where normative values are available, accuracy of clinical determination decreased with decreased pulse rate. Temporal resolution impacts duration and kinematic measures. However, the direction of these changes is unpredictable, indicating sensitivity and specificity are both affected. Without a predictable impact, the use of lower pulse rates may alter clinical impressions and treatment recommendations yielding inappropriate treatment goals and treatment duration.
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Affiliation(s)
| | | | - Shauna C Murray
- University of New Mexico Hospital, Albuquerque, NM, MSC01 1195, 87131-0001, USA
| | | | | | - Taite Winter
- University of New Mexico Hospital, Albuquerque, NM, MSC01 1195, 87131-0001, USA
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D'Angelo EC. Clinical Feeding and Swallowing Evaluation for the School-Based Speech-Language Pathologist. Lang Speech Hear Serv Sch 2024; 55:409-422. [PMID: 38029415 DOI: 10.1044/2023_lshss-23-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
PURPOSE From preschool through high school, eating is part of the school day. Children with feeding and/or swallowing issues are now in our neighborhood schools, our responsibility in our care, and require adequate nutrition and hydration to participate in school and access the curriculum. The whole child is in school, including all of their medical, behavioral, social, and educational needs. This clinical focus article describes a holistic process of evaluating swallowing and feeding in the school setting for the school speech-language pathologist (SLP) leading the team supporting the child. METHOD This clinical focus article explores the evaluation process in the educational setting for the school SLP in identification of pediatric feeding disorders (PFDs), which can involve dysphagia. Detailed descriptions of the related U.S. educational law, PFD, assessment processes for the multiple systems relating to eating, and collaboration with an interdisciplinary team are highlighted. Using the four overlapping domains of PFD (medical, psychosocial, feeding skill-based systems and associated nutritional aspects), medical and background history gathering; integration with instrumental results; and the need to consider the complex interaction of developmental, physical, cognitive, social, behavioral, family, and cultural aspects in the evaluation are detailed. CONCLUSIONS School-age children require safe and adequate nutrition and hydration for learning and social participation. The SLP has a lead role in the school team in evaluating swallowing and feeding, and developing a plan for team implementation. A holistic school-based SLP clinical evaluation process is described.
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Affiliation(s)
- Elisabeth C D'Angelo
- Department of Communication Sciences & Disorders, California State University, Sacramento
- Davis Joint Unified School District, CA
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Stanley C, Rotman A, McKenzie D, Malcolm L, Paddle P. South of the UES: Improving the ability of speech-language pathologists to detect oesophageal abnormalities during videofluoroscopy swallowing studies. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:225-232. [PMID: 37403440 DOI: 10.1080/17549507.2023.2225801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE With two-thirds of adults presenting for a videofluoroscopy swallow study (VFSS) with oesophageal abnormalities, it seems prudent to include visualisation of the oesophagus, in the context of the entire swallow process, to provide further information to the diagnostic team. This study aims to evaluate the ability of speech-language pathologists (SLPs) to interpret oesophageal sweep on VFSS and the relative improvement in that ability with additional training. METHOD One hundred SLPs attended training in oesophageal visualisation during VFSS, based on a previous study. Ten oesophageal sweep videos (five normal, five abnormal) with one 20 ml thin fluid barium bolus (19% w/v) were presented at baseline and following training. Raters were blinded to patient information other than age. Binary ratings were collected for oesophageal transit time (OTT), presence of stasis, redirection, and referral to other specialists. RESULT Inter-rater reliability as measured by Fleiss' kappa improved for all parameters, reaching statistical significance for OTT (pre-test kappa = 0.34, post-test kappa = 0.73; p < 0.01) and redirection (pre-test kappa = 0.38, post-test kappa = 0.49; p < 0.05). Overall agreement improved significantly (p < 0.001) for all parameters except stasis, where improvement was only slight. Interaction between pre-post and type of video (normal/abnormal) was statistically significant (p < 0.001) for redirection, with a large pre-post increase in positive accuracy compared with a slight pre-post decrease in negative accuracy. CONCLUSION Findings indicate that SLPs require training to accurately interpret an oesophageal sweep on VFSS. This supports the inclusion of education and training on both normal and abnormal oesophageal sweep patterns, and the use of standardised protocols for clinicians using oesophageal visualisation as part of the VFSS protocol.
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Affiliation(s)
- Claire Stanley
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Australia
- Department of Surgery, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Swallow Analysis Centre, Melbourne, Australia
| | - Anthony Rotman
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Australia
- Department of Surgery, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Swallow Analysis Centre, Melbourne, Australia
| | - Dean McKenzie
- Epworth HealthCare, Melbourne, Australia, and
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Paul Paddle
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Australia
- Department of Surgery, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Melbourne Swallow Analysis Centre, Melbourne, Australia
- Epworth HealthCare, Melbourne, Australia, and
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Weppner J, Senol S, Larick R, Jackson S. Diagnostic Accuracy of the Yale Swallow Protocol in Moderate-to-Severe Traumatic Brain Injury: A Prospective Blinded Videofluoroscopic Investigation. J Head Trauma Rehabil 2024:00001199-990000000-00130. [PMID: 38453631 DOI: 10.1097/htr.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The study aimed to assess the accuracy of the Yale Swallow Protocol (YSP) in screening aspiration in adults with acute moderate-to-severe traumatic brain injury (TBI) by comparing the YSP with a videofluoroscopic swallow study (VFSS). SETTING Level 1 academic trauma center. PARTICIPANTS The study involved a cohort of 50 consecutive adults with a history of acute moderate-to-severe TBI. DESIGN The prospective cohort study was conducted between July 2020 and June 2021. Participants underwent the YSP to assess aspiration risk, followed by a VFSS within 5 to 10 minutes after the YSP, to assess the accuracy of the YSP compared with the VFSS. MAIN MEASURE The accuracy of the YSP in identifying aspiration in adults with acute moderate-to-severe TBI. RESULTS The interrater agreement for identifying aspiration on the VFSS and the YSP was excellent, as well as 100% agreement between the speech-language pathologists and the radiologist and between the 2 speech-language pathologists, respectively. Of the 50 participants, 16 passed the YSP, while 34 failed. Among those who failed, 30 were confirmed to have aspirated on the VFSS (true-positives) and 4 did not show aspiration on the VFSS (false-positives). The YSP demonstrated a high sensitivity of 96.8%, a specificity of 78.9%, a positive predictive value of 88.2%, and a negative predictive value of 93.8% in identification of aspiration in this cohort. CONCLUSIONS To date, no dedicated prospective studies have been conducted to assess the utility of the YSP as a screening tool for identifying aspiration risk in persons with moderate-to-severe TBI. The results of this study conclude that the YSP is an effective screening tool for prediction of aspiration in acute care patients with moderate-to-severe TBI due to its high sensitivity and negative predictive value. These factors aid in identification of individuals at risk for aspiration and facilitate timely interventions to prevent complications.
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Affiliation(s)
- Justin Weppner
- Author Affiliations: Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke (Dr Weppner); Department of Internal Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia (Dr Weppner); Department of Internal Medicine, Carilion Clinic, Roanoke, Virginia (Dr Weppner and Ms Jackson); and Department of Physical Medicine and Rehabilitation (Dr Senol), Eastern Virginia Medical School (Mr Larick), Norfolk, Virginia
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11
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Ji YB, Choi HW, Song CM, Yun BR, Park HJ, Oh S, Tae K. Long-term functional swallowing and speech outcomes after transoral robotic surgery for oropharyngeal cancer. Front Surg 2024; 11:1362654. [PMID: 38357192 PMCID: PMC10864447 DOI: 10.3389/fsurg.2024.1362654] [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: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives Transoral robotic surgery (TORS) has emerged as a minimally invasive approach for oropharyngeal cancer, aiming to improve functional preservation and reduce morbidity. However, the long-term effects on speech and swallowing, crucial aspects of quality of life, remain unclear. This study investigates the long-term functional swallowing and speech outcomes of TORS for oropharyngeal cancer. Methods We retrospectively reviewed 41 patients diagnosed with oropharyngeal squamous cell carcinoma who underwent TORS from 2010 to 2018. Tongue mobility, articulation, verbal diadochokinesis, reading speed, and modified barium swallowing tests were performed 2-3 years post-operatively to assess long-term speech and swallowing function. Results The mean age was 57.7 ± 9.9 years, and the male to female ratio was 34:7. The palatine tonsil was the most common tumor site (73.2%), followed by the base of tongue (22.0%). Concurrent neck dissection was performed in 97.6% of patients, and adjuvant radiation or chemoradiation was administered to 36 patients (87.8%). Tongue mobility, articulation, verbal diadochokinesis, and reading speed were comparable to normal population. Modified barium swallowing tests revealed acceptable outcomes in most patients; only one patient (2.4%) required a percutaneous endoscopic gastrostomy tube. Notably, no permanent tracheostomies were necessary. Conclusions Long-term speech and swallowing functions were preserved in most patients treated with TORS for oropharyngeal cancer. TORS is an excellent treatment modality for oropharyngeal cancer in terms of functional outcomes.
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Affiliation(s)
- Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hae Won Choi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Bo Ram Yun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Sukjoong Oh
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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12
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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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13
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Farrell A, Raol N. Current opinion in otolaryngology and head and neck surgery: the role of the otolaryngologist in the management of pediatric dysphagia. Curr Opin Otolaryngol Head Neck Surg 2023; 31:412-418. [PMID: 37820272 DOI: 10.1097/moo.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Dysphagia affects at least 1% of the pediatric population. This prevalence further increases in patients who are born prematurely or who have underlying neuromuscular or cardiopulmonary disorders. A multidisciplinary team approach, including an Otolaryngologist, can help promote an expedited diagnosis and therapeutic regimen, ensuring that the patient receives adequate nutrition needed for growth and development. RECENT FINDINGS The development and growth of multidisciplinary aerodigestive clinics have improved outcomes in pediatric patients with dysphagia. If a structural concern is noted on examination, there remain a multitude of medical and surgical options to help improve patient outcomes and swallow. These treatment options are usually multimodality and specific interventions may be employed to target a specific and notable abnormality. SUMMARY Pediatric dysphagia is a complex concern. For the otolaryngologist, etiologies with surgical targets may include ankyloglossia, tonsillar hypertrophy, laryngomalacia, laryngo-esophageal cleft, vocal fold movement impairment, and cricopharyngeal achalasia. The development and formalization of a multidisciplinary approach has streamlined and broadened treatment options for these patients. An otolaryngologist is integral as part of the treatment team of these patients.
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Affiliation(s)
- Annie Farrell
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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14
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Griffin L, Kamarunas E, Smith JB, Kuo C, O'Donoghue C. Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2676-2690. [PMID: 37669615 DOI: 10.1044/2023_ajslp-23-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. METHOD In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. RESULTS Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. CONCLUSION These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.
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Affiliation(s)
- Lindsay Griffin
- Department of Communication Sciences & Disorders, School of Communication, Emerson College, Boston, MA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Julian Bergen Smith
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven
| | - Christina Kuo
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
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15
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Lawlor CM, Choi SS. Videofluoroscopic swallow study and fiberoptic endoscopic evaluation of swallow, which is superior? Laryngoscope 2023; 133:2445-2446. [PMID: 37725318 DOI: 10.1002/lary.30755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 09/21/2023]
Affiliation(s)
- C M Lawlor
- Division of Otolaryngology, Children's National Medical Center, Washington, DC, USA
| | - Sukgi S Choi
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital. Harvard Medical School, Boston, Massachusetts, USA
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16
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McCarthy K, Finch E, Miles A. Oesophageal screening in videofluoroscopic swallow studies: Perceptions and practices of Australian speech-language pathologists. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:500-508. [PMID: 35506612 DOI: 10.1080/17549507.2022.2061049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE There is building evidence that oesophageal screening (OS) should be considered a critical component of videofluoroscopic swallow studies (VFSS). This study surveyed Australian speech-language pathologists (SLPs) regarding current practices and perceptions of OS in VFSS. METHOD A 16-24 item online survey was distributed to Australian SLPs via relevant email forums. One response per site was requested. Survey questions explored experience and training in VFSS, skill and confidence with OS, OS protocol use, and pathways following OS. RESULT One hundred and one SLPs across all Australian states and territories responded, with 70% (n = 69/99) from metropolitan hospitals and 74% (n = 75/101) having more than five years' VFSS experience. While 69% (n = 70/101) of SLPs conducted OS, only half (n = 35/70) conducted OS routinely, and only 4% (n = 3/70) always used published OS protocols. Barriers to OS, for some participants, were concerns about scope of practice and confidence. CONCLUSION This study confirms higher levels of OS in Australia compared to similar international surveys and provides rich data on the Australian context. Prescriptive clinical guidelines for OS, consensus regarding a preferred OS protocol, and specific OS training may clarify SLP scope of practice and improve SLP confidence and standardisation in OS.
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Affiliation(s)
- Kellie McCarthy
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Emma Finch
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
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17
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Watts S, Gaziano J, Kumar A, Richter J. The Modified Barium Swallow Study and Esophageal Screening: A Survey of Clinical Practice Patterns. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1065-1082. [PMID: 36917803 DOI: 10.1044/2022_ajslp-22-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Modified barium swallow study (MBSS) is a videofluoroscopic evaluation of oropharyngeal swallowing. Views of esophageal bolus flow during MBSS are permitted under speech-language pathology practice guidelines. However, controversy exists over its implementation. Poor consensus and limited practice guidance may lead to clinical practice variations. Aims of the investigation were to (a) describe current practice patterns of speech-language pathologist visualizing bolus flow through the esophagus during the MBSS, (b) understand areas of variation when incorporating esophageal visualization during the MBSS, and (c) determine clinicians' willingness to modify MBSS procedures to include esophageal imaging. METHOD A web-based survey (Qualtrics XM) consisting of 26 questions was distributed via web posting and e-mail to members of the American Speech-Language-Hearing Association Special Interest Group 13 and Dysphagia Café. The survey was open for 3 months. Descriptive and associative statistics were completed. Field-testing was performed prior to dissemination of the survey to address content validity. RESULTS A total of 321 individuals participated; 265 responses were used for analysis. Ninety-three percent of respondents viewed the esophagus during the MBSS. Twelve percent followed to the proximal esophagus, 15% to the mid esophagus, 66% to the lower esophagus, and 6% to varied levels. Variability was also reported in contrast type, volume administered, and nomenclature used. Interestingly, few people (3.61%) disagreed that esophageal visualization should be performed during MBSS. CONCLUSIONS Speech-language pathology respondents in this study visualize contrast flow through the esophagus and are enthusiastic about expanding the standard MBSS. However, results of the survey demonstrate a lack of uniformity in assessment practices. Unfortunately, this may impact the diagnostic accuracy and clinical utility when adding esophageal visualization to the MBSS. This study highlights the need for a standardized protocol and identifies current barriers and controversies that may prevent expanding the MBSS to more comprehensively evaluate individuals with dysphagia.
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Affiliation(s)
- Stephanie Watts
- Department of Internal Medicine, University of South Florida, Tampa
| | - Joy Gaziano
- Department of Internal Medicine, University of South Florida, Tampa
| | - Ambuj Kumar
- Department of Internal Medicine, University of South Florida, Tampa
| | - Joel Richter
- Department of Internal Medicine, University of South Florida, Tampa
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18
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Brisson-McKenna M, Jefferson GD, Siddiqui SH, Adams S, Afanasieva Sonia S, Chérid A, Burns J, Di Gironimo C, Mady LJ. Swallowing Function After Treatment of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:371-388. [PMID: 37030949 DOI: 10.1016/j.otc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Dysphagia is a common functional outcome following treatment of laryngeal cancer. Despite curative advances in both nonsurgical and surgical approaches, preserving and optimizing swallowing function is critical. Understanding the nature and severity of dysphagia depending on initial tumor staging and treatment modality and intensity is crucial. This chapter explores current evidence on the acute and chronic impacts of treatments for laryngeal cancer on swallow function, as well as the medical and nonmedical management of dysphagia in this population.
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Affiliation(s)
- Maude Brisson-McKenna
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada.
| | - Gina D Jefferson
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State St.Jackson, MS 39216-4505, USA
| | - Sana H Siddiqui
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sarah Adams
- Voice and Swallowing Center, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sofia Afanasieva Sonia
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Aïda Chérid
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jesse Burns
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Carla Di Gironimo
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Leila J Mady
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA; Cancer Risk and Control Program of Excellence, Sidney Kimmel Cancer Center, 233 S 10th Street, Philadelphia, PA 19107, USA
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19
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Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E, Dhar SI, Hutcheson K, Jefferson G, Johnson F, Rameau A, Sher D, Starmer H, Strohl M, Ulmer K, Vaitaitis V, Begum S, Batjargal M, Dhepyasuwan N. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2023; 168:571-592. [PMID: 36965195 DOI: 10.1002/ohn.302] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. METHODS Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. RESULTS The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus. CONCLUSION Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
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Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey L Ishman
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA
| | - Ezra Cohen
- Moores Cancer Center at UC San Diego Health, La Jolla, California, USA
| | | | - Kate Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Gina Jefferson
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Anais Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - David Sher
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Karen Ulmer
- Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA
| | - Vilija Vaitaitis
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA
| | - Sultana Begum
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Misheelt Batjargal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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20
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Ingleby HR, Bonilha HS, Steele CM. A Tutorial on Diagnostic Benefit and Radiation Risk in Videofluoroscopic Swallowing Studies. Dysphagia 2023; 38:517-542. [PMID: 34254167 DOI: 10.1007/s00455-021-10335-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
The videofluoroscopic swallowing study (VFSS) is a key tool in assessing swallowing function. As with any diagnostic procedure, the probable benefits of the study must be weighed against possible risks. The probable benefit of VFSS is an accurate assessment of swallowing function, enabling patient management decisions potentially leading to improved patient health status and quality of life. A possible (though highly unlikely) risk in VFSS is carcinogenesis, arising from the use of ionizing radiation. Clinicians performing videofluoroscopic swallowing studies should be familiar with both sides of the risk benefit equation in order to determine whether the study is medically justified. The intent of this article is to provide the necessary background for conversations about benefit and risk in videofluoroscopic swallowing studies.
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Affiliation(s)
- Harry R Ingleby
- Division of Medical Physics, CancerCare Manitoba; Departments of Radiology and Physics & Astronomy, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada.
| | - Heather S Bonilha
- Departments of Rehabilitation Sciences; Health Science and Research; and Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Catriona M Steele
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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21
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Kabalan S, Papadopoulos-Nydam G, Jeffery CC, Rieger J, Constantinescu G. Temporal Trends in Clinician-Assessed and Patient-Reported Swallowing Outcomes in Oropharyngeal Cancer Patients. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:492-505. [PMID: 36630888 DOI: 10.1044/2022_ajslp-22-00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Dysphagia is a consequence of oropharyngeal squamous cell carcinoma (OPSCC) treatments and often results in a devastating reduction in quality of life (QoL; Nguyen et al., 2005; Pauloski, 2008). OBJECTIVES This study aimed to report temporal trends in swallowing outcomes using the Modified Barium Swallow Impairment Profile (MBSImP) and the M.D. Anderson Dysphagia Inventory (MDADI) and to study the relationship between these two measures. METHOD This was a retrospective review of clinical data collected in January 2013 to December 2017 from a tertiary care center. MBSImP PI scores and MDADI composite scores were collected pretreatment and 1, 6, and 12 months posttreatment. Data were analyzed in aggregate and stratified by treatment modality. To address the primary objective, descriptive statistics were used. To address the secondary objective, four Spearman tests were run between MBSImP PI and MDADI composite scores. RESULTS A total of 123 OPSCC participants were included. With respect to trends, MBSImP PI scores worsened 1 month posttreatment and remained impaired at 6 and 12 months. For MDADI composite scores, patient reports worsened 1 month posttreatment and subsequently improved at 6 and 12 months. MBSImP PI and MDADI composite scores were weakly negatively correlated (i.e., in agreement) at the pre- and 12-month posttreatment appointments. CONCLUSIONS Swallowing outcomes in OPSCC patients have distinct yet predictable trends for both clinician-assessed and patient-reported swallowing outcomes during the first year following cancer treatment. However, unlike previous findings, these two types of measures were in agreement at the pretreatment and 12 months posttreatment appointments.
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Affiliation(s)
- Sarah Kabalan
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Georgina Papadopoulos-Nydam
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Caroline C Jeffery
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Jana Rieger
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Gabriela Constantinescu
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
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22
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Valenzano TJ, Smaoui S, Peladeau-Pigeon M, Barbon CEA, Craven BC, Steele CM. Using Reference Values to Identify Profiles of Swallowing Impairment in a Case Series of Individuals With Traumatic Spinal Cord Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:688-700. [PMID: 36812476 PMCID: PMC10171848 DOI: 10.1044/2022_ajslp-22-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE In this article, we illustrate use of a systematic approach to rating videofluoroscopic swallowing studies (VFSS), the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) method. The method is applied to a clinical case series of individuals with a history of traumatic spinal cord injury (tSCI) requiring surgical intervention using a posterior approach. Previous studies suggest that swallowing is highly variable in this population given heterogeneity in mechanisms, location and extent of injury, and in surgical management approaches. METHOD The case series involved 6 individuals who were at least 1 month postsurgery for management of tSCI. Participants completed a VFSS using a standardized bolus protocol. Each VFSS was blindly rated in duplicate using the ASPEKT method and compared with published reference values. RESULTS The analysis revealed considerable heterogeneity across this clinical sample. Penetration-aspiration scale scores of 3 or higher were not observed in this cohort. Of note, patterns of impairment did emerge, suggesting there are some commonalities across profiles in this population, including the presence of residue associated with poor pharyngeal constriction, reduced upper esophageal opening diameter, and short upper esophageal sphincter opening duration. CONCLUSIONS Although the participants in this clinical sample shared a history of tSCI requiring surgical intervention using a posterior approach, there was great heterogeneity in swallowing profile. Using a systematic method to identify atypical swallowing parameters can guide clinical decision making for determining rehabilitative targets and measuring swallowing outcomes.
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Affiliation(s)
- Teresa J. Valenzano
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sana Smaoui
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Carly E. A. Barbon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - B. Cathy Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of Physiatry, Department of Medicine, University of Toronto, Ontario, Canada
| | - Catriona M. Steele
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Canada Research Chair (Tier 1) in Swallowing and Food Oral Processing
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Doddi S, Bera K, Myers A, Ramaiya N, Tirumani SH. Development and Implementation of Integrated Radiologist-Speech Pathologist Report for Modified Barium Swallow Study: Experience at a Multi-hospital Single Health Care System. Curr Probl Diagn Radiol 2023; 52:89-92. [PMID: 36494234 DOI: 10.1067/j.cpradiol.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Dysphagia, or a disorder of swallowing, is very common and is reported in 1 out of 25 adults with approximately 1 million new cases per year in the United States alone. This also disproportionately impacts elderly patients, with a prevalence of 17%. Patients with dysphagia may have severe clinical complications such as starvation, dehydration, and airway obstruction- which may further increase mortality. Hence, timely and accurate diagnosis of dysphagia is hence crucial in management considerations. The gold standard for evaluating and diagnosing dysphagia is a modified barium swallow study (MBSS). The study is typically performed as a collaborative effort between a speech language pathologist (SLP) and a radiologist, who bring their individual skill sets to the table. Current MBSS reporting involves separately dictated and interpreted reports from the SLP and radiologist. In this paper, we elucidate our experience in a multi-institutional healthcare system wherein we have devised a single, integrated report for MBSS, which involves collaborative effort between SLP and the radiologist. We weight the advantages and disadvantages of unified reporting, the challenges of implementing it in a large healthcare system, and note how it can help improve efficiency and deliver unified patient care. We hope that this would be a template for other institutions as well as improve standardization of reporting techniques.
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Affiliation(s)
- Sishir Doddi
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH
| | - Kaustav Bera
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Andrew Myers
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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24
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Bonilha HS, Canon CL, O'Rourke A, Tipnis S, Martin-Harris B. Stakeholder Perspectives on Radiation Use and Interdisciplinary Collaboration in Adult Modified Barium Swallow Studies. Dysphagia 2023; 38:23-32. [PMID: 35461361 DOI: 10.1007/s00455-022-10447-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/28/2022] [Indexed: 01/27/2023]
Abstract
The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations, the MBSS uses ionizing radiation with related radiation risks. Thus, the procedures and protocols related to MBSSs must balance the benefit of the diagnostic information gained with the risk of radiation exposure. This requires complex decision-making for any given clinician but becomes complicated due to the interprofessional nature of conducting MBSSs, namely the direct involvement of both the speech-language pathologist and radiologist with indirect involvement of the medical physicist and the referring physician. This editorial provides the perspectives of the various stakeholder groups related to radiation use in adult MBSSs, identifies barriers to conducting MBSSs in an evidence-based manner, and suggests areas for improvement.
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Affiliation(s)
- Heather Shaw Bonilha
- Departments of Rehabilitation Sciences, Health Science and Research, and Otolaryngology - Head and Neck Surgery, College of Health Professions, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Ashli O'Rourke
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29451, USA
| | - Sameer Tipnis
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Departments of Otolaryngology - Head and Neck Surgery and Radiation Oncology, Feinberg School of Medicine, Northwestern University, Evanston, IL, 60208, USA
- Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA
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25
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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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Eslinger L, Ahmed T, Lodhi SH, Ahmed T. Chronic dysphagia as a presenting complaint for primary mediastinal diffuse large B-cell lymphoma. BMJ Case Rep 2023; 16:e253357. [PMID: 36634994 PMCID: PMC9843212 DOI: 10.1136/bcr-2022-253357] [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: 01/14/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy in adults. It manifests a variable presentation, depending on the tissue in which it arises. Rarely, it can present as dysphagia to solid and liquid foods in primary oesophageal lymphoma with or without B symptoms. We present a case of a 66-year-old man who presented with 3 months of progressive dysphagia with only a mild associated weight loss. This was later found to be caused by DLBCL of the mediastinum causing external compression of the patient's distal oesophagus and gastric cardia. He was treated with one cycle of standard-of-care chemotherapy and subsequently discharged with outpatient follow-up. We emphasise the importance of ruling out life-threatening conditions such as lymphoma in patients who present with dysphagia, as well as the high variability in presentation of DLBCL.
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Affiliation(s)
- Logan Eslinger
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Taimoor Ahmed
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Samra Haroon Lodhi
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Taha Ahmed
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
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Olinger K, Young C, Hermann L, Huffman J, Mervak BM. Radiologic evaluation of dysphagia. Dysphagia 2023. [DOI: 10.1016/b978-0-323-99865-9.00012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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28
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Caudell CW, Covil EP, Gilpin JW, Hodgens B, Ewing A, Kothari SN. Can the marshmallow esophagram replace high-resolution manometry as an appropriate screening for esophageal motility prior to anti-reflux surgery? Am J Surg 2022; 224:1366-1369. [PMID: 36372582 DOI: 10.1016/j.amjsurg.2022.10.036] [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: 03/25/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGOUND The purpose of our study was to evaluate the use of minimally invasive Marshmallow Swallow Study (MSS) as a preoperative screening technique for patients and correlate marshmallow results with High Resolution Manometry (HRM) results and post-operative dysphagia following antireflux surgery. METHODS A retrospective electronic chart review of data on 61 adult patients undergoing MSS was completed. Patients were included if they completed the MSS as well as: HRM and/or antireflux surgery. RESULTS Sixty-one patients completed MSS. Of the 37 patients that completed HRM, 27 had abnormal results. 23 of these 27 patients who had abnormal results also failed MSS. The NPV for a failure on the MSS and abnormal HRM results is 0.767(p-value = 0.360). The PPV for a pass on the MSS and no post-operative dysphagia is 0.833 (p-value = 0.656). CONCLUSIONS MSS is an effective screening tool for ruling out major esophageal motility disorders and can prevent need for invasive HRM.
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Affiliation(s)
- Chloe W Caudell
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate, USA.
| | - Ethan P Covil
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate, USA
| | - John W Gilpin
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate, USA
| | - Brian Hodgens
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate, USA
| | - Alex Ewing
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate, USA
| | - Shanu N Kothari
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate, USA
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29
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Coman LM, Cardell EA, Richards JA, Mahon A, Lawrie MD, Ware RS, Weir KA. Videofluoroscopic swallow study training for radiologists-in-training: a survey of practice and training needs. BMC MEDICAL EDUCATION 2022; 22:762. [PMID: 36344980 PMCID: PMC9641839 DOI: 10.1186/s12909-022-03799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a lack of formal, published videofluoroscopic swallow study (VFSS) training targeting radiologists, yet radiology senior medical officers and resident medical officers (i.e., radiologists-in-training, known in Australia as "registrars") are expected to be involved in VFSS interpretation of anatomical anomalies and reporting. This study investigated whether VFSS training is delivered to registrars during their specialist radiology training, whether it is a perceived need and, if so, to determine the desired content for inclusion in a targeted training package. METHODS A cross-sectional, mixed methods study design was used. An internet-based survey was circulated via convenience and snowball sampling to radiologists (both senior medical officers and registrars) and speech-language pathologists across Australia in October-November 2017. Surveys also were distributed to practitioners based in New Zealand and the United Kingdom, as they practised within similar health systems, and it was anticipated they may have similar VFSS training practices. The radiology survey contained 36 questions and the speech-language pathology survey contained 44 questions. Participants were asked the following: (1) Report their current VFSS radiology registrar training environment; (2) Advise whether radiology registrars need VFSS training; (3) Recommend the content, format, training intensity, and evaluation methods for an effective radiology registrar training package. Demographic data were analysed descriptively, and open-ended responses were analysed using qualitative content analysis. RESULTS 21 radiology senior medical officers and registrars and 150 speech-language pathologists predominantly based at Australian tertiary hospital settings completed the survey. Most respondents (90.6%) identified that VFSS training is needed for radiology registrars. Only one speech-language pathologist respondent reported that they deliver VFSS training for radiology registrars. Specific content and teaching modalities for a VFSS training package, including diagnosing anatomical anomalies associated with dysphagia were recommended. CONCLUSION While most of the radiologists and speech-language pathologists surveyed did not deliver VFSS training to radiology registrars, they identified that targeted training is needed to improve radiology registrars' effectiveness and engagement in VFSS clinics. The training package content, format and evaluation methods recommended by participants will inform the development of a VFSS training package targeting radiology registrars to be piloted at an Australian tertiary hospital.
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Affiliation(s)
- Leah M Coman
- Speech Pathology Service, Gold Coast Health, 1 Hospital Blvd, Southport, 4215, Queensland, Australia.
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia.
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Elizabeth A Cardell
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - John A Richards
- Medical Imaging Department, Gold Coast Health, Queensland, Australia
| | - Amanda Mahon
- Medical Imaging Department, Gold Coast Health, Queensland, Australia
| | - Melissa D Lawrie
- Speech Pathology Service, Gold Coast Health, 1 Hospital Blvd, Southport, 4215, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Kelly A Weir
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- Allied Health Research, Gold Coast Health, Queensland, Australia
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30
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Hayes M, Gillman A, Wright B, Dorgan S, Brennan I, Walshe M, Donohoe C, Reynolds JV, Regan J. Prevalence, nature and trajectory of dysphagia postoesophageal cancer surgery: a prospective longitudinal study protocol. BMJ Open 2022; 12:e058815. [PMID: 36137623 PMCID: PMC9511601 DOI: 10.1136/bmjopen-2021-058815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Dysphagia is a common problem following oesophagectomy, and is associated with aspiration pneumonia, malnutrition, weight loss, prolonged enteral feeding tube dependence, in addition to an extended in-hospital stay and compromised quality of life (QOL). To date, the prevalence, nature and trajectory of post-oesophagectomy dysphagia has not been systematically studied in a prospective longitudinal design. The study aims (1) to evaluate the prevalence, nature and trajectory of dysphagia for participants undergoing an oesophagectomy as part of curative treatment, (2) to determine the risk factors for, and post-operative complications of dysphagia in this population and (3) to examine the impact of oropharyngeal dysphagia on health-related QOL across time points. METHODS AND ANALYSIS A videofluoroscopy will be completed and analysed on both post-operative day (POD) 4 or 5 and at 6-months post-surgery. Other swallow evaluations will be completed preoperatively, POD 4 or 5, 1-month and 6-month time points will include a swallowing screening test, tongue pressure measurement, cough reflex testing and an oral hygiene evaluation. Nutritional measurements will include the Functional Oral Intake Scale to measure feeding tube reliance, Malnutrition Screening Tool and the Strength, Assistance With Walking, Rise From a Chair, Climb Stairs and Falls questionnaire. The Reflux Symptom Index will be administered to investigate aerodigestive symptoms commonly experienced by adults post-oesophagectomy. Swallowing-related QOL outcome measures will be determined using the European Organisation for Research and Treatment of Cancer QLQ-18, MD Anderson Dysphagia Inventory and the Swallowing Quality of Life Questionnaire. ETHICS AND DISSEMINATION Ethical approval has been granted by the Tallaght University Hospital/St. James' Hospital Research Ethics Committee (JREC), Dublin, Ireland (Ref. No. 2021-Jul-310). The study results will be published in peer-reviewed journals and presented at national and international scientific conferences.
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Affiliation(s)
- Michelle Hayes
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
- Senior Upper GI and ICU Speech and Language Therapist, St. James's Hospital, Dublin, Ireland
| | - Anna Gillman
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Brona Wright
- Patient and Public Representative Group, Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sean Dorgan
- Patient and Public Representative Group, Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Ian Brennan
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Claire Donohoe
- Consultant Gastrointestinal Surgeon, Department of Surgery, St. James's Hospital, Dublin, Ireland
| | - John V Reynolds
- Consultant Gastrointestinal Surgeon, Department of Surgery, St. James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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31
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Kang YJ, Arafa HM, Yoo JY, Kantarcigil C, Kim JT, Jeong H, Yoo S, Oh S, Kim J, Wu C, Tzavelis A, Wu Y, Kwon K, Winograd J, Xu S, Martin-Harris B, Rogers JA. Soft skin-interfaced mechano-acoustic sensors for real-time monitoring and patient feedback on respiratory and swallowing biomechanics. NPJ Digit Med 2022; 5:147. [PMID: 36123384 PMCID: PMC9485153 DOI: 10.1038/s41746-022-00691-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
Swallowing is a complex neuromuscular activity regulated by the autonomic nervous system. Millions of adults suffer from dysphagia (impaired or difficulty swallowing), including patients with neurological disorders, head and neck cancer, gastrointestinal diseases, and respiratory disorders. Therapeutic treatments for dysphagia include interventions by speech-language pathologists designed to improve the physiology of the swallowing mechanism by training patients to initiate swallows with sufficient frequency and during the expiratory phase of the breathing cycle. These therapeutic treatments require bulky, expensive equipment to synchronously record swallows and respirations, confined to use in clinical settings. This paper introduces a wireless, wearable technology that enables continuous, mechanoacoustic tracking of respiratory activities and swallows through movements and vibratory processes monitored at the skin surface. Validation studies in healthy adults (n = 67) and patients with dysphagia (n = 4) establish measurement equivalency to existing clinical standard equipment. Additional studies using a differential mode of operation reveal similar performance even during routine daily activities and vigorous exercise. A graphical user interface with real-time data analytics and a separate, optional wireless module support both visual and haptic forms of feedback to facilitate the treatment of patients with dysphagia.
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Affiliation(s)
- Youn J Kang
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Ocean System Engineering, Jeju National University, Jeju, Republic of Korea
| | - Hany M Arafa
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Jae-Young Yoo
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Cagla Kantarcigil
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Jin-Tae Kim
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Hyoyoung Jeong
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Seonggwang Yoo
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Seyong Oh
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Joohee Kim
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Changsheng Wu
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, National University of Singapore, Singapore, 117575, Singapore
- Institute for Health Innovation and Technology, National University of Singapore, Singapore, 117599, Singapore
| | - Andreas Tzavelis
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Yunyun Wu
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Kyeongha Kwon
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Joshua Winograd
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Shuai Xu
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.
- Department of Otolaryngology-Head and Neck Surgery and Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - John A Rogers
- Querrey-Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.
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32
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Kidane J, Laus J, Gulati A, Gochman GE, Schneider SL, Chan JW, Yom SS, Ha P, Boscardin WJ, Ryan WR, Ma Y. Longitudinal Analysis of Swallowing Displacement Kinematics After Oropharyngeal Cancer Treatment. Laryngoscope 2022; 133:1339-1348. [PMID: 36054296 DOI: 10.1002/lary.30355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND/OBJECTIVE Quantitative swallowing displacement kinematics evolve in patients treated for oropharyngeal squamous cell carcinoma (OPSCC). We aimed to longitudinally assess these measurements and correlate them with functional swallowing outcomes. METHOD A retrospective review was conducted on patients with OPSCC treated with definitive (chemo)radiation ([C]RT) or surgery with adjuvant (chemo)radiation (S-[C]RT) who completed at least two videofluoroscopic swallow studies (VFSS). Longitudinal analysis was accomplished via mixed-effects logistic regression for the Functional Oral Intake Scale (FOIS), and Penetration Aspiration Scale (PAS), and mixed-effects linear regression for kinematic measures. Spearman's correlation was conducted between changes in FOIS/PAS and kinematic measures. RESULTS Ninety-seven patients (76 males; mean age 61) completed 245 VFSS studies. A total of 94% had human papillomavirus (HPV)/p16 positive OPSCC and 74% were T0-T2. Sixty-four patients underwent [C]RT while 33 patients underwent S-[C]RT. After treatment, posterior pharyngeal wall at hold (PPWhold) increased 3.2 standard deviation (SD) between 0 and 6 months (p < 0.001), then decreased 2.2 SD between 6 and 12 months (p < 0.001) and did not return to baseline. Hyoid-to-larynx (HL) (p = 0.046) and maximal hyoid displacement (Hmax) + HL (p = 0.042) increased between 6 and 12 months. Hmax (p = 0.020) and Hmax + HL (p < 0.001) decreased between 12-24 months beyond baseline values. The decrease in HL and increase in PPWhold (p < 0.05) correlated with an increase in PAS. From baseline, increased pharyngeal constriction ratio correlated with decreased FOIS and PPWhold (p < 0.05). CONCLUSIONS Quantitative swallowing kinematic measures can effectively track changes in swallowing physiology. Increased PPWhold and restricted hyolaryngeal movement were seen in patients with OPSCC after treatment and correlated with a change in swallowing outcome, emphasizing the need for serial VFSS monitoring and targeted intervention. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Joseph Kidane
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Joey Laus
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Arushi Gulati
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Grant E Gochman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jason W Chan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, U.S.A
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, U.S.A
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, U.S.A
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Yue Ma
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
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Ullal TV, Marks SL, Belafsky PC, Conklin JL, Pandolfino JE. A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans. Front Vet Sci 2022; 9:889331. [PMID: 35754550 PMCID: PMC9228035 DOI: 10.3389/fvets.2022.889331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology, Center for Voice and Swallowing, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jeffrey L Conklin
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UCLA Robert G. Kardashian Center for Esophageal Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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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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Understanding differences in practices and preferences during videofluoroscopic swallow studies: A survey of radiologists and speech language pathologists in the United States. Clin Imaging 2022; 83:144-151. [DOI: 10.1016/j.clinimag.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/13/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
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Webler K, Carpenter J, Hamilton V, Rafferty M, Cherney LR. Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation. Arch Phys Med Rehabil 2022; 103:336-341. [PMID: 34757074 PMCID: PMC8555115 DOI: 10.1016/j.apmr.2021.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DESIGN Retrospective cohort study. SETTING Urban inpatient rehabilitation hospital. PARTICIPANTS The first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. RESULTS Twenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. CONCLUSIONS Instrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.
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Affiliation(s)
| | - Julia Carpenter
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Valerie Hamilton
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leora R Cherney
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
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Allen JE, Clunie G, Ma JKY, Coffey M, Winiker K, Richmond S, Lowell SY, Volkmer A. Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study. Dysphagia 2022; 37:1586-1598. [PMID: 35201387 PMCID: PMC8867131 DOI: 10.1007/s00455-022-10413-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1-13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.
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Affiliation(s)
- Jodi E. Allen
- The National Hospital for Neurology and Neurosurgery, Therapy & Rehabilitation Services, 2nd Floor 8-11 Queen Square, London, WC1N 3BG UK
| | - Gemma Clunie
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Joan K.-Y. Ma
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Margaret Coffey
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Katharina Winiker
- Swiss University of Speech and Language Sciences SHLR, Seminarstrasse 27, 9400 Rorschach, Switzerland
| | - Sally Richmond
- Imaging Department, University College London Hospitals, London, UK
| | - Soren Y. Lowell
- Communication Sciences & Disorders Department, Syracuse University, Syracuse, NY USA
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
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Abstract
Background: Among patients seen by palliative care, dysphagia is prevalent and can lead to disturbing symptoms and challenges in medical decisions for patients and families. Case: Our patient, AP, an 88-year-old woman with a history of thyroid cancer and esophageal dysmotility, was nearing end of life. She wanted nothing more than to eat her chocolate cake in peace. This shocked her family and also presented multiple ethical and logistical issues for the medical team caring for her during an acute admission for hypoxia. Discussion: This case presents an opportunity to: review strategies for evaluating and diagnosing dysphagia; appraise evidenced based approach to the palliative management of dysphagia; and promote the education of families and staff regarding palliative options for care. Conclusion: Palliative care professionals can be instrumental in educating patients, families, other clinicians, including swallowing therapists, on how to enhance comfort and quality of life among patients with dysphagia.
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Affiliation(s)
- Amanda Warren
- Department of Communication Sciences and Disorders, Emerson College, Boston, Massachusetts, USA
| | - Mary K Buss
- Department of Ambulatory Palliative Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Jadcherla SR, Hasenstab KA, Osborn EK, Levy DS, Ipek H, Helmick R, Sultana Z, Logue N, Yildiz VO, Blosser H, Shah SH, Wei L. Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study. Sci Rep 2021; 11:19934. [PMID: 34620898 PMCID: PMC8497609 DOI: 10.1038/s41598-021-99070-w] [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: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76-94%] in study (N = 60) vs. 63% [50-77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.
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Affiliation(s)
- Sudarshan R. Jadcherla
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA ,grid.412332.50000 0001 1545 0811Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Kathryn A. Hasenstab
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Erika K. Osborn
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Deborah S. Levy
- grid.8532.c0000 0001 2200 7498Department of Speech and Language Pathology, Hospital de Clínicas de Porto Alegre, Department of Health and Communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Haluk Ipek
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Roseanna Helmick
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Zakia Sultana
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Nicole Logue
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Vedat O. Yildiz
- grid.240344.50000 0004 0392 3476Biostatistics Resource at Nationwide Children’s Hospital (BRANCH), Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Hailey Blosser
- grid.240344.50000 0004 0392 3476Division of Clinical Therapies, Nationwide Children’s Hospital, Columbus, OH USA
| | - Summit H. Shah
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Lai Wei
- grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
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Kornum DS, Terkelsen AJ, Bertoli D, Klinge MW, Høyer KL, Kufaishi HHA, Borghammer P, Drewes AM, Brock C, Krogh K. Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives. J Clin Med 2021; 10:jcm10071392. [PMID: 33807256 PMCID: PMC8037288 DOI: 10.3390/jcm10071392] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
The autonomic nervous system delicately regulates the function of several target organs, including the gastrointestinal tract. Thus, nerve lesions or other nerve pathologies may cause autonomic dysfunction (AD). Some of the most common causes of AD are diabetes mellitus and α-synucleinopathies such as Parkinson’s disease. Widespread dysmotility throughout the gastrointestinal tract is a common finding in AD, but no commercially available method exists for direct verification of enteric dysfunction. Thus, assessing segmental enteric physiological function is recommended to aid diagnostics and guide treatment. Several established assessment methods exist, but disadvantages such as lack of standardization, exposure to radiation, advanced data interpretation, or high cost, limit their utility. Emerging methods, including high-resolution colonic manometry, 3D-transit, advanced imaging methods, analysis of gut biopsies, and microbiota, may all assist in the evaluation of gastroenteropathy related to AD. This review provides an overview of established and emerging assessment methods of physiological function within the gut and assessment methods of autonomic neuropathy outside the gut, especially in regards to clinical performance, strengths, and limitations for each method.
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Affiliation(s)
- Ditte S. Kornum
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark; (M.W.K.); (K.L.H.); (K.K.)
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, DK8200 Aarhus, Denmark
- Correspondence:
| | - Astrid J. Terkelsen
- Department of Neurology, Aarhus University Hospital, DK8200 Aarhus, Denmark;
| | - Davide Bertoli
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, DK9100 Aalborg, Denmark; (D.B.); (A.M.D.); (C.B.)
| | - Mette W. Klinge
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark; (M.W.K.); (K.L.H.); (K.K.)
| | - Katrine L. Høyer
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark; (M.W.K.); (K.L.H.); (K.K.)
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, DK8200 Aarhus, Denmark
| | - Huda H. A. Kufaishi
- Steno Diabetes Centre Copenhagen, Gentofte Hospital, DK2820 Gentofte, Denmark;
| | - Per Borghammer
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, DK8200 Aarhus, Denmark;
| | - Asbjørn M. Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, DK9100 Aalborg, Denmark; (D.B.); (A.M.D.); (C.B.)
- Steno Diabetes Centre North Jutland, Aalborg University Hospital, DK9100 Aalborg, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, DK9100 Aalborg, Denmark; (D.B.); (A.M.D.); (C.B.)
- Steno Diabetes Centre North Jutland, Aalborg University Hospital, DK9100 Aalborg, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark; (M.W.K.); (K.L.H.); (K.K.)
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, DK8200 Aarhus, Denmark
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GERD DFP report. Abdom Radiol (NY) 2021; 46:406-407. [PMID: 33544164 DOI: 10.1007/s00261-020-02931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
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