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Galli J, Marchese MR, Di Cesare T, Tricarico L, Almadori G, Tempesta V, Valenza V, Paludetti G. Impact of Tracheal Tube on Swallowing in Post-Operative Head and Neck Cancer Patients: Scintigraphic Analysis. Dysphagia 2020; 36:953-958. [PMID: 33278001 PMCID: PMC8578097 DOI: 10.1007/s00455-020-10222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
Dysphagia is common in tracheostomized patients who underwent head and neck surgery for cancer treatment. The objective of this study was to evaluate, by means of oropharyngoesophageal scintigraphy (OPES), the impact of an occluded tracheal tube (TT) on swallowing in patients treated for head and neck cancer before hospital discharge, to provide further information to the benefit of out-patient care management. From October 2018 to November 2019, we enrolled 19 tracheostomized patients (6 females and 13 males; mean age 61 years) who underwent primary surgical resection of head and neck tumor and swallowing rehabilitation during hospitalization. All subjects underwent a double-standard OPES, one with occluded tracheal tube and the other without TT, with their tracheal stoma being closed directly by a plaster. For each study, we assessed and compared the following quantitative parameters: oral transit time (OTTsec), pharyngeal transit time (PTTsec), esophageal transit time (ETTsec), oral retention index (ORI%), pharyngeal retention index (PRI%), esophageal retention index (ERI%), and aspiration percentage (AP%). The mean values of OTT, PTT, ORI%, PRI%, and ERI% were abnormal during OPES both with TT and without TT and did not statistically differ between the two tests (p > 0.05). Aspiration was detected in 4 cases out of 19 (21.05%) cases during OPES with TT and in 4/19 (21.05%) cases without TT who showed a mean AP% of 11.4% and 11.5% respectively (p > 0.05). Patients with abnormal AP% (> 0%) during OPES with TT showed aspiration signs without TT. Our study showed that the mere presence of a closed tracheal tube does not impact significantly the oropharyngeal transit of bolus during swallowing. This result suggests the possibility to maintain a small-diameter occluded tracheal tube in place for the postsurgical management of head and neck cancer patients.
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Affiliation(s)
- Jacopo Galli
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Maria Raffaella Marchese
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy. .,Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Policlinico "A. Gemelli" Foundation, L.Go "A. Gemelli", 8, 00168, Rome, Italy.
| | - Tiziana Di Cesare
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Laura Tricarico
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Giovanni Almadori
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Valeria Tempesta
- Department of Nuclear Medicine, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Roma, Italy
| | - Venanzio Valenza
- Department of Nuclear Medicine, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Roma, Italy
| | - Gaetano Paludetti
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
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Fattori B, Giusti P, Mancini V, Grosso M, Barillari MR, Bastiani L, Molinaro S, Nacci A. Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:395-402. [PMID: 27958600 PMCID: PMC5225795 DOI: 10.14639/0392-100x-829] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 06/09/2016] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to compare videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngo- oesophageal scintigraphy (OPES) with regards to premature spillage, post-swallowing residue and aspiration to assess the reliability of these tests for detection of oro-pharyngeal dysphagia. Sixty patients affected with dysphagia of various origin were enrolled in the study and submitted to VFS, FEES and OPES using a liquid and semi-solid bolus. As a reference, we used VFS. Both the FEES and the OPES showed good sensitivity with high overall values (≥ 80% and ≥ 90% respectively). The comparison between FEES vs VFS concerning drop before swallowing showed good specificity (84.4% for semi-solids and 86.7% for liquids). In the case of post-swallowing residue, FEES vs VFS revealed good overall validity (75% for semi-solids) with specificity and sensitivity well balanced for the semi-solids. OPES vs. VFS demonstrated good sensitivity (88.6%) and overall validity (76.7%) for liquids. The analysis of FEES vs. VFS for aspiration showed that the overall validity was low (≤ 65%). On the other hand, OPES demonstrated appreciable overall validity (71.7%). VFS, FEES and OPES are capable of detecting oro-pharyngeal dysphagia. FEES gave significant results in the evaluation of post-swallowing residues.
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Affiliation(s)
- B Fattori
- ENT, Audiology and Phoniatric Unit, Department of Neurosciences, University of Pisa, Italy
| | - P Giusti
- Department of Diagnostic and Interventional Radiology, University of Pisa, Italy
| | - V Mancini
- ENT, Audiology and Phoniatric Unit, Department of Neurosciences, University of Pisa, Italy
| | - M Grosso
- Regional Centre of Nuclear Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - M R Barillari
- Audiology and Phoniatric Unit, University of Napoli 2, Italy
| | - L Bastiani
- Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Pisa, Italy
| | - S Molinaro
- Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Pisa, Italy
| | - A Nacci
- ENT, Audiology and Phoniatric Unit, Department of Neurosciences, University of Pisa, Italy
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Abstract
Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.
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Affiliation(s)
- Nathalie Rommel
- KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, B-3000 Leuven, Belgium
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital, Eccles Old Road, Salford M6 8HD, UK
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Grosso M, Fattori B, Volterrani D, Chondrogiannis S, Boni G, Nacci A, Marzola M, Rubello D. The value of oropharyngoesophageal scintigraphy in the management of aspiration into the tracheobronchial tree in neurological patients. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Grosso M, Fattori B, Volterrani D, Chondrogiannis S, Boni G, Nacci A, Marzola MC, Rubello D. The value of oropharyngoesophageal scintigraphy in the management of aspiration into the tracheobronchial tree in neurological patients. Rev Esp Med Nucl Imagen Mol 2015; 34:282-6. [PMID: 26095943 DOI: 10.1016/j.remn.2015.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/17/2022]
Abstract
AIM Dysphagia and bolus aspiration are two of the most frequent and invalidating symptoms of various neurological diseases. Swallowing disorders often lead to tracheobronchial aspiration with consequent pneumonia episodes. Aspiration pneumonia per se constitutes the most frequent cause of death in these patients, with mortality rate ranging from 20% to 62%. Oropharyngoesophageal scintigraphy (OPES) permits functional quantitative assessment of the different stages of swallowing, together with the detection and quantitative measurement of bolus aspiration. In this work, we analyzed the role of OPES in patients with different neurological conditions to evaluate swallowing and to detect and quantify bolus aspiration. MATERIAL AND METHODS We enrolled 43 neurological patients (25 women and 18 men, mean age 67.3±12.4 yr) complaining of dysphagia with suspected inhalation. All patients underwent OPES with (99m)Tc-nanocolloid using a liquid bolus first, followed by a semi-solid bolus. We evaluated the following parameters: Oral, Pharyngeal and Esophageal Transit Time, Oro-Pharyngeal Retention Index, Esophageal Emptying Rate, and Aspiration Rate (% AR). RESULTS OPES detected some airway aspiration in 26/43 patients. 19 patients had tracheal aspiration (with a mean 18.1% AR) and the remaining 7 patients had bilateral broncho-pulmonary aspiration (mean 44.9% AR). CONCLUSIONS OPES is a feasible, repeatable and noninvasive method that allows quantitative assessment of bolus aspiration into the tracheobronchial tract, thus representing a useful and accurate tool to guide the most appropriate treatment and to monitor response to therapy in neurological patients with dysphagia.
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Affiliation(s)
- M Grosso
- Regional Centre of Nuclear Medicine, Santa Chiara Hospital, University Hospital of Pisa, Pisa, Italy
| | - B Fattori
- Ear, Nose and Throat Audiology Phoniatrics Unit, University Hospital of Pisa, Pisa, Italy
| | - D Volterrani
- Regional Centre of Nuclear Medicine, Santa Chiara Hospital, University Hospital of Pisa, Pisa, Italy
| | - S Chondrogiannis
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - G Boni
- Regional Centre of Nuclear Medicine, Santa Chiara Hospital, University Hospital of Pisa, Pisa, Italy
| | - A Nacci
- Ear, Nose and Throat Audiology Phoniatrics Unit, University Hospital of Pisa, Pisa, Italy
| | - M C Marzola
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - D Rubello
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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