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Giraldo-Cadavid LF, Insignares D, Velasco V, Londoño N, Galvis AM, Rengifo ML, Bastidas-Goyes AR. Fiberoptic Endoscopy Evaluation of Swallowing (FEES) Findings Associated with High Pneumonia Risk in a Cohort of Patients at Risk of Dysphagia. Dysphagia 2024:10.1007/s00455-024-10727-w. [PMID: 38958706 DOI: 10.1007/s00455-024-10727-w] [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: 08/07/2023] [Accepted: 05/23/2024] [Indexed: 07/04/2024]
Abstract
Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.
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Affiliation(s)
- Luis F Giraldo-Cadavid
- Department of Epidemiology and Biostatistics, Facultad de Medicina de la Universidad de La Sabana, Chia, Cundinamarca, Colombia.
- Interventional Pulmonology Division, Fundación Neumológica Colombiana, Bogotá DC, Colombia.
- Departments of Internal Medicine and Pulmonary Medicine, Facultad de Medicina de la Universidad de La Sabana, Campus Puente del Común, Autopista norte de Bogotá Km 7, Chía, Cundinamarca, Colombia.
| | - Diego Insignares
- Interventional Pulmonology Division, Fundación Neumológica Colombiana, Bogotá DC, Colombia
- Departments of Internal Medicine and Pulmonary Medicine, Facultad de Medicina de la Universidad de La Sabana, Campus Puente del Común, Autopista norte de Bogotá Km 7, Chía, Cundinamarca, Colombia
| | - Valentina Velasco
- Department of Rehabilitation Medicine, Facultad de Medicina de la Universidad de La Sabana and Clínica Universidad de La Sabana, Chía, Colombia
| | - Natalia Londoño
- Department of Epidemiology and Biostatistics, Facultad de Medicina de la Universidad de La Sabana, Chia, Cundinamarca, Colombia
| | - Ana María Galvis
- Department of Rehabilitation Medicine, Clínica Universidad de La Sabana, Chía, Colombia
| | - María Leonor Rengifo
- Department of Rehabilitation Medicine, Facultad de Medicina de la Universidad de La Sabana and Clínica Universidad de La Sabana, Chía, Colombia
| | - Alirio R Bastidas-Goyes
- Department of Epidemiology and Biostatistics, Facultad de Medicina de la Universidad de La Sabana, Chia, Cundinamarca, Colombia
- Departments of Internal Medicine and Pulmonary Medicine, Facultad de Medicina de la Universidad de La Sabana, Campus Puente del Común, Autopista norte de Bogotá Km 7, Chía, Cundinamarca, Colombia
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Imaizumi M, Weng W, Zhu X, Murono S. Effectiveness of FEES with artificial intelligence-assisted computer-aided diagnosis. Auris Nasus Larynx 2024; 51:251-258. [PMID: 37980257 DOI: 10.1016/j.anl.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES FEES is a standard procedure for diagnosing dysphagia. However, appropriate evaluation of FEES findings is difficult for inexperienced evaluators. Recent progress in deep learning has highlighted the use of artificial intelligence-assisted computer-aided diagnosis (AI-assisted CAD) in medical applications. We investigated the detection accuracy of FEES findings evaluated by inexperienced evaluators with and without the use of CAD. METHODS The algorithm for FEES-CAD was developed using 25,630 expert-annotated images. A total of 45 inexperienced evaluators from three groups of people (resident doctors, nurses, and medical students), evaluated 32 FEES videos from 32 patients. To confirm the effectiveness of FEES-CAD, first, 32 FEES videos were evaluated without the use of CAD. Second, one half was evaluated with, and one half without, the use of CAD. The detection accuracy of the FEES findings was investigated, and the evaluation results obtained with CAD were statistically compared with those obtained without CAD. RESULTS In the first FEES evaluation, the total detection accuracy was 82.2 %. In the second evaluation, the total detection accuracy with CAD was 84.3 %, and that without CAD was 81.7 %. The detection accuracies by the resident doctors, nurses, and medical students with CAD were 90.1 %, 82.6 %, and 79.4 %, respectively, and those without CAD were 83.7 %, 80.9 % and 80.1 %, respectively. In the resident doctors, the detection accuracy was significantly better when CAD was used for evaluation, compared with the non-CAD evaluations. CONCLUSION The present study demonstrated the effectiveness of FEES-CAD in improving the detection accuracy of resident doctors, however, the differences were small.
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Affiliation(s)
- Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Weihao Weng
- Graduate School of Computer Science and Engineering, The University of Aizu
| | - Xin Zhu
- Graduate School of Computer Science and Engineering, The University of Aizu
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
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Okada T, Yamaguchi H, Tanaka S, Koyama K, Hishida A, Konno S, Nakamura M, Sugiura H, Nishida Y. Hand Grip Strength Assessment Based on Sarcopenia Diagnostic Criteria Predicts Swallowing Function. Dysphagia 2024; 39:223-230. [PMID: 37507638 DOI: 10.1007/s00455-023-10604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
The purpose of this study is to clarify whether swallowing function can be inferred from grip strength. Based on the diagnostic criteria of sarcopenia, patients were divided into two groups according to grip strength, and it was analyzed whether there was a difference in the evaluation index for swallowing function between the two groups. Among the cases requesting evaluation of swallowing function from June 10, 2020 to October 28, 2020, 83 cases (mean age: 71.7 years, 59 males and 24 females) who received assessment tests and swallowing endoscopy were included. According to the diagnostic criteria for grip strength in the Asian working group in Sarcopenia, less than 28 kgf and 18 kgf were defined as the weak group for men and women, respectively. Hyodo scores, repeated salivary swallowing tests (RSST), maximum vocalization time (MPT), and dysphagia severity classification (DSS) were compared between the two groups. Of the 83 patients, 29 and 54 were in the normal group and weak group, respectively. In all indicators, the normal group showed significantly better results than the weak group: Hyodo score (2.4 vs. 4.0, p < 0.01), RSST (4.1 times vs. 2.4 times, p < 0.01), MPT (12.1 s vs. 5.9 s, p < 0.001), DSS (4.5 vs. 5.9, p < 0.001), respectively. In multiple regression analysis with DSS as the dependent variable, grip strength was a significant independent variable of DSS even after adjusting for age, gender, and body mass index. Grip strength assessment based on sarcopenia criteria can be a useful tool for estimating swallowing function.
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Affiliation(s)
- Takashi Okada
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Hidetoshi Yamaguchi
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Kyohei Koyama
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Aika Hishida
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Suzuna Konno
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Masataka Nakamura
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan.
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Chang J, Okland T, Johnson A, Speiser N, Seetharaman A, Sidell D. Risk of Aspiration Increased by Post-swallow Residue in Infant Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Laryngoscope 2024; 134:1431-1436. [PMID: 37610281 DOI: 10.1002/lary.30954] [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: 03/30/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE To assess the risk of aspiration associated with post-swallow residue subsites in Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in bottle-fed infants <1 year of age. METHODS This is a retrospective matched-pairs cohort study at an academic tertiary children's hospital. FEES and Videofluoroscopic Swallowing Study (VFSS) trials performed within the same infant <5 days apart were paired by matching bolus consistency and bottle flow rate. Positive aspiration was defined by the "or rule" in which aspiration is positive when either FEES or VFSS within a matched pair is positive. RESULTS Eighty-seven FEES-VFSS matched pairs from 29 patients (16 males; mean [SD] age, 2.9 [2.8] months) were included. The rate of positive aspiration, as defined by the "or rule", was 59% (51/87). In FEES, post-swallow pyriform sinus residue was present in 16% (14/87) and anterior commissure residue 27% (31/87). Risk of positive aspiration was increased by pyriform sinus residue (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.9-19.3, p < 0.01) and anterior commissure residue in FEES (OR 2.5, 95% CI 1.1-6.1, p = 0.03). In the neonate subgroup, <1 month of age, multivariate-adjusted analysis showed that anterior commissure residue had better diagnostic accuracy for aspiration than in older infants (overall 70% vs. 42%, p < 0.01; sensitivity 60% vs. 10%, p < 0.01), whereas pyriform sinus residue had worse accuracy (overall 41% vs. 70%, p = 0.02; sensitivity 13% vs. 43%, p = 0.02). CONCLUSION This study demonstrates that pyriform sinus and anterior commissure residue during infant FEES were associated with fivefold and twofold increased risk of aspiration, respectively. LEVEL OF EVIDENCE: 3 Using a retrospective matched-pairs cohort, this study assesses the diagnostic accuracy of post-swallow residue in FEES for predicting aspiration. Laryngoscope, 134:1431-1436, 2024.
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Affiliation(s)
- Julia Chang
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, California, USA
| | - Tyler Okland
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - April Johnson
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, Stanford, California, USA
| | - Noah Speiser
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Aditya Seetharaman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Douglas Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Pediatric Aerodigestive and Airway Reconstruction Center and the Center for Pediatric Voice and Swallowing Disorders, Lucile Packard Children's Hospital Stanford, California, Stanford, USA
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Heise KM, Miller S, Ptok M, Jungheim M. [Prevalence of mucosal injuries during flexible endoscopic evaluation of swallowing in the presence of a nasogastric tube]. HNO 2024; 72:25-31. [PMID: 37796338 PMCID: PMC10781840 DOI: 10.1007/s00106-023-01361-3] [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] [Accepted: 08/05/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The flexible endoscopic evaluation of swallowing (FEES) is an established low-risk examination method to assess the risk of penetration or aspiration in patients with dysphagia. FEES might be more difficult or of higher-risk when a nasogastric tube is in place. OBJECTIVE This study aims to identify whether the prevalence of mucosal lesions is higher when the endoscopy is carried out with a nasogastric tube in place. Pre-existing mucosal lesions were also documented. METHODS In a retrospective, monocentric study, a total of 918 FEES procedures routinely performed in hospitalized patients of a university hospital from January 2014 to March 2019 were evaluated. Mucosal lesions were identified and characterized for descriptive statistics. RESULTS In the video material analysed here, no endoscopy-related injuries were identified. However, pre-existing mucosal lesions, which often occurred as multiple lesions, were detected in 48.6% of the endoscopies. Further analysis showed that these pre-existing lesions were not worsened by the endoscopy performed. CONCLUSION The results demonstrate that transnasal flexible endoscopy is a safe, low-risk examination method, even in patients with a nasogastric tube. A very high number of pre-existing mucosal lesions were found, which is probably related to the previous insertion of the nasogastric tube. Due to the high number of pre-existing lesions, strategies should be developed to minimize injuries when placing nasogastric tubes.
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Affiliation(s)
- Kira-Milena Heise
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Simone Miller
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Martin Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Michael Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Chen WC, Lin CW, Wu MN, Fong YO, Chen CH, Hsieh SW, Chen CYE, Huang P. Consistencies among miscellaneous scales for evaluation of post-stroke dysphagia. Eur Arch Otorhinolaryngol 2023; 280:4561-4567. [PMID: 37428229 DOI: 10.1007/s00405-023-08101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Post-stroke dysphagia (PSD) is the most common type of dysphagia. Stroke patients with sustained dysphagia have poorer outcomes. The severity of PSD is assessed using miscellaneous scales with unknown consistencies. We aim to investigate the consistencies among miscellaneous scales, which could aid in the assessment of PSD. METHODS A total of 49 PSD patients were enrolled. Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), Ohkuma Questionnaire, Eating Assessment Tool-10, and Repetitive Saliva Swallowing Test were performed. FOIS was performed by physicians, and DSS was conducted by both the physicians and nurses; the physicians used either videofluoroscopy (VF) or videoendoscopy (VE) for evaluation; while, the nurses assessed PSD by observation and subjective judgment. RESULTS When using VF (VF-DSS and VF-FOIS) as the gold standard for the evaluation, VE-FOIS (κ = 0.625, 95% CI 0.300-0.950, p < 0.001) has a substantial agreement with VF-FOIS, and VE-DSS (κ = 0.381, 95% CI 0.127-0.636, p = 0.007) has a fair agreement with VF-DSS. The weighted kappa of FOIS to DSS in VE (weighted κ = 0.577, 95% CI 0.414-0.740, p < 0.001) is not lower than that in VF (weighted kappa = 0.249, 95% CI 0.136-0.362, p < 0.001). CONCLUSION For both DSS and FOIS, only VE has a statistically significant agreement with VF. Though VF has been viewed as the traditional gold standard of dysphagia screening, it has the limitations of being invasive and equipment dependent. For PSD, VE could be considered as a substitution when VF is not available or suitable.
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Affiliation(s)
- Wen-Ching Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Yi-On Fong
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yin Elizabeth Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Poyin Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan.
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Imaoka M, Okuno K, Kobuchi R, Inoue T, Takahashi K. Evaluation of masticatory performance by motion capture analysis of jaw movement. J Oral Rehabil 2023; 50:1020-1029. [PMID: 37323094 DOI: 10.1111/joor.13538] [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: 09/16/2022] [Revised: 01/18/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The assessment of masticatory performance (MP) is conducted in hospitals, but is difficult to perform in nursing facilities that lack specialists in dysphagia. To select the appropriate food textures in nursing practice, a simple method of evaluating the MP should be developed. OBJECTIVE The purpose of this study was to investigate motion parameters that influence MP by motion capture analysis of maxillofacial movement on chewing gummy jelly in healthy adults. METHODS The subjects were 50 healthy adults. The state of chewing gummy jelly was photographed using a high-speed camera. Simultaneously, we evaluated the amount of glucose extracted (AGE) obtained with gummy jelly as a reference value for MP. The subjects were divided into two groups: normal and low masticatory groups (NG and LG, respectively) based on the AGE. The cycle of mastication was classified into three phases: closing phase (CP), transition phase (TP) and opening phase (OP) through motion capture analysis of the video photographed. Parameters of jaw movement and their associations with the AGE were examined. RESULTS The transition phase rate (TR) and opening phase rate (OR) were correlated with the AGE. Furthermore, the TR in the NG was significantly higher than in the LG, whereas the OR was significantly lower than in the LG. The age, TR and opening velocity were significant independent variables. CONCLUSION Motion capture technology facilitated the analysis of jaw movement. The results suggested that MP can be evaluated by analysing the TP and OP rates.
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Affiliation(s)
- Masaaki Imaoka
- Departmet of Geriatric Dentistry, Osaka Dental University Graduate School of Dentistry, Osaka, Japan
| | - Kentaro Okuno
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
| | - Ryuichiro Kobuchi
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
| | - Taro Inoue
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
| | - Kazuya Takahashi
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
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Kraus F, Wech T, Köstler H, Hagen R, Scherzad A. Do Disinfectant Solutions during Gargling Reach the Pharynx? Folia Phoniatr Logop 2023; 76:102-108. [PMID: 37544306 DOI: 10.1159/000533135] [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: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION In times of COVID-19, gargling disinfectant is commonly used. Disinfectant solutions seem to decrease the infection's symptoms. For disinfection, several techniques are reported. So far, there are no data about the regions in the upper airways achieved by gargled fluid. METHODS Ten healthy volunteers without any dysphagia were investigated with a high-sensitivity flexible endoscopic evaluation of swallowing (hsFEES®) during and after gargling colored water. One volunteer repeated the gargling process in fast and real-time MRI. RESULTS In all cases, no color accumulation was detected on the posterior pharyngeal wall, epi- or hypopharynx during gargling. The MRI scans confirmed the results. CONCLUSIONS hsFEES® and fast MRI provide an insight into the gargling pattern. Data show that during gargling, the fluid covers the soft tissue in the oral cavity and the anterior part of the soft palate, but not the posterior pharyngeal wall nor the epi- and hypopharynx.
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Affiliation(s)
- Fabian Kraus
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
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Kono T, Tomisato S, Ozawa H. Effectiveness of vocal fold medialization surgery on the swallowing function of patients with unilateral vocal fold paralysis. Laryngoscope Investig Otolaryngol 2023; 8:1007-1013. [PMID: 37621299 PMCID: PMC10446277 DOI: 10.1002/lio2.1125] [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: 05/30/2023] [Accepted: 07/16/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives Vocal fold medialization surgery is generally considered a phonosurgical procedure for improvement of vocal function in patients with glottic insufficiency. However, the literature describing this procedure for the management of dysphagia is limited. This study aims to assess the effects of medialization surgery on swallowing function in patients with unilateral vocal fold paralysis (UVFP). Methods We enrolled 32 patients with UVFP undergoing vocal fold medialization surgery (medialization laryngoplasty combined with arytenoid adduction [ML + AA], 12 cases; injection laryngoplasty [IL], 20 cases). We assessed the aerodynamic vocal function including maximum phonation time and mean flow rate to evaluate glottal closure status. The Hyodo score determined by flexible endoscopic evaluation and Functional Oral Intake Scale (FOIS) were evaluated pre- and postoperatively. Results Almost 60% of patients with UVFP had dysphagia, and one-third were at high risk for aspiration. Aerodynamic parameters effectively improved after IL and ML + AA. With regard to swallowing, both the FOIS and total Hyodo score were significantly improved postoperatively. We found a particularly significant improvement in pharyngeal clearance. However, patients with high vagal nerve paralysis and postoperative insufficient glottal closure showed poor swallowing benefits after the interventions. In patients with recurrent laryngeal nerve palsy, there were no significant differences in postoperative swallowing function between the ML + AA and IL groups. Conclusion Vocal fold medialization surgery was effective in improving swallowing function in most cases with UVFP, except for those with high vagal paralysis and insufficient postoperative glottal closure. Both IL and ML + AA showed an equivalent effect on swallowing improvement. Level of evidence 3b.
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Affiliation(s)
- Takeyuki Kono
- Department of Otolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Shuta Tomisato
- Department of Otolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Hiroyuki Ozawa
- Department of Otolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
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Tamai T, Yoshimi K, Nakagawa K, Yanagida R, Okumura T, Yamaguchi K, Ishii M, Nagasawa Y, Tohara H. Usefulness of a newly developed endoscope for the observation of the posterior tracheal wall. Laryngoscope Investig Otolaryngol 2023; 8:963-969. [PMID: 37621293 PMCID: PMC10446257 DOI: 10.1002/lio2.1105] [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: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Videoendoscopic evaluation of swallowing is an objective swallowing function evaluation method used in dysphagia rehabilitation. However, it is anatomically difficult to detect the entry of foreign substances through the posterior tracheal wall using a conventional endoscope (CE). In this study, we developed an endoscope that can observe the posterior tracheal wall and investigated its reliability and validity in healthy adults. Methods Twenty healthy adults were included. The trachea was observed from inside the larynx using a CE and a portable, flexible two-step angulation endoscope (two-AE) with a two-step curved shaft tip. The visibility of the anterior and posterior walls was recorded. The time from the endoscope tip entering the larynx to the posterior tracheal wall was measured. Additionally, discomfort events were assessed after the examination. McNemar's test and a paired t-test were used for statistical analysis. Kappa coefficients and concordance rates were calculated. Results The anterior tracheal wall was observed using both endoscopes. The posterior tracheal wall was significantly observed in 18 participants with the two-AE (p < .001), compared to only three of 20 participants with the CE. The time to observation of the posterior tracheal wall for examiners 1 and 2 was 13.3 ± 6.5 and 12.0 ± 6.7 s, respectively, with no difference between groups (p = .400). The kappa coefficients of examiners 1 and 2 and between the examiners were 0.444, 0.643, and 0.643, respectively, with concordance rates of 90%, 95%, and 95%, respectively. Conclusion Regardless of the examiner's years of experience, we observed that the two-AE could observe the posterior tracheal wall. Level of Evidence Step 5.
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Affiliation(s)
- Tomoe Tamai
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Ryosuke Yanagida
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Takuma Okumura
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
- Department of Dentistry and Oral SurgeryHokuto HospitalObihiro‐shiJapan
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Miki Ishii
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Yuki Nagasawa
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
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11
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Jotz GP. Dysphagia: An Overview. Int Arch Otorhinolaryngol 2023; 27:e377-e379. [PMID: 37564484 PMCID: PMC10411117 DOI: 10.1055/s-0043-1771014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Affiliation(s)
- Geraldo Pereira Jotz
- Dean of Innovation and Institutional Affairs, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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12
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Nordio S, Maistrello L, D’Imperio D, Favaretto N, Dellai A, Montino S, Agostinelli A, Ramacciotti G, Gheller F, Berta G, Koch I, Zanoletti E, Battel I, Cazzador D. Validity and reliability of the Italian translation of the Yale Pharyngeal Residue Severity Rating Scale. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:12-19. [PMID: 36860145 PMCID: PMC9978297 DOI: 10.14639/0392-100x-n2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/18/2022] [Indexed: 03/03/2023]
Abstract
Objective In the dysphagic patient, pharyngeal residues (PR) are associated with aspiration and poor quality of life. The assessment of PR using validated scales during flexible endoscopic evaluation of swallowing (FEES) is crucial for rehabilitation. This study aims to validate and test the reliability of the Italian version of the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS). The effects of training and experience in FEES on the scale were also determined. Methods The original YPRSRS was translated into Italian according to standardised guidelines. Thirty FEES images were selected after consensus and proposed to 22 naive raters who were asked to assess the severity of PR in each image. Raters were divided into two subgroups by years of experience at FEES, and randomly by training. Construct validity, inter-rater, and intra-rater reliability were assessed by kappa statistics. Results IT-YPRSRS showed substantial to almost perfect agreement (kappa > 0.75) in validity and reliability for both the overall sample (660 ratings), and valleculae/pyriform sinus sites (330 ratings each). No significant differences emerged between groups considering years of experience, and variable differences were observed by training. Conclusions The IT-YPRSRS demonstrated excellent validity and reliability in identifying location and severity of PR.
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Affiliation(s)
| | | | | | - Niccolò Favaretto
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Angela Dellai
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 6 Euganea, Ospedale di Conselve, Padua, Italy
| | - Silvia Montino
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Anna Agostinelli
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Giulia Ramacciotti
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Flavia Gheller
- Department of Developmental Psychology and Socialisation (DPSS), University of Padua, Padua, Italy
| | | | | | - Elisabetta Zanoletti
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Irene Battel
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 3 Serenissima, Ospedale Civile di Venezia, Venice, Italy, Department of Clinical Speech & Language Studies, University of Dublin, Trinity College, College Green, Dublin 2, Ireland
| | - Diego Cazzador
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy,Correspondence Diego Cazzador Department of Neuroscience, Section of Otolaryngology, University of Padova, via Giustiniani 2, 35128 Padua, Italy Tel. +39 049 821 8778. Fax +39 049 821 1994 E-mail:
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13
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Yamano T, Nishi K, Omori F, Wada K, Naito T. Association Between Oral Health and Swallowing Function in the Elderly. Clin Interv Aging 2023; 18:343-351. [PMID: 36911810 PMCID: PMC9999723 DOI: 10.2147/cia.s400032] [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: 12/02/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Objective Although the oral environment significantly affects the risk of pneumonia, there have been few studies regarding its relation with swallowing. There is no doubt that there is a significant link between the oral environment and the development of pneumonia; however, there have been few comparative studies of swallowing using video endoscopy (VE) and video fluorography (VF) as indicators to determine the actual availability of oral intake and the choice of food form. This study was performed to examine whether the oral environment or swallowing function contributes more to the development of pneumonia in the elderly. Methods The study population consisted of 24 patients (7 men and 17 women; age range: 64-97 years; average age: 86 years) assessed using the Oral Health Assessment Tool (OHAT), VE and VF at Fukuoka Dental College Hospital. The most common disease was pneumonia (17 patients), followed by cerebral infarction (5 patients), pyelonephritis (4 patients), bronchitis (2 patients), Parkinson's disease (2 patients), scleroderma (1 patient), diabetes (1 patient), eosophageal cancer (1 patient) and Parkinson's syndrome> (1 patient). Some patients had multiple diseases. Oral intake was possible in 20 patients (80%), whereas tube feeding and gastric banding were required in 4 patients. Results The OHAT score was not correlated with either the VE or VF score. Furthermore, the OHAT score was not significantly different between the multiple- and no/single-pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than those with no or only a single episode of pneumonia. Conclusion Oral assessment, VE and VF are necessary to evaluate swallowing in patients with suspected dysphagia. Swallowing function, especially as assessed by VE and VF, is more important than examination of the oral environment for evaluating risk of recurrent aspiration pneumonia in the elderly. In addition, multiple factors contribute to recurrent pneumonia in patients with a good oral environment, including subclinical aspiration, pharyngeal clearance and delayed activation of the gag reflex.
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Affiliation(s)
- Takafumi Yamano
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, 814-0193, Japan
| | - Kensuke Nishi
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, 814-0193, Japan
| | - Fumitaka Omori
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, 814-0193, Japan
| | - Kaori Wada
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, 814-0193, Japan
| | - Toru Naito
- Section of Gerodontology, Department of General Dentistry Fukuoka Dental College, Fukuoka, 814-0193, Japan
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Pneumonia, Mortality, and Other Outcomes Associated with Unsafe Swallowing Detected via Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Functional Oropharyngeal Dysphagia: A Systematic Review and Meta-analysis. Dysphagia 2022; 37:1662-1672. [PMID: 35226186 DOI: 10.1007/s00455-022-10427-3] [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: 08/02/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
The association between impairments in swallowing safety detected via fiberoptic endoscopic evaluation of swallowing (FEES) and dysphagia complications has been evaluated in small studies that have not allowed obtaining precise estimates of the presence of such an association. The objective of this study was to evaluate the risk of dysphagia complications associated with the detection of premature spillage, residue, penetration, and aspiration via FEES. A systematic review and meta-analysis of the literature were carried out. A search strategy was established using terms of controlled and free vocabulary (free text) in the PubMed, Lilacs, Embase, Medline, and Cochrane databases. The initial search in the databases identified 3545 articles, of which 321 were excluded due to duplication, 3224 were selected for review of titles and abstracts, 45 were selected for full-text review, 37 were excluded for not meeting the selection criteria, and 8 were included for the final analysis, with a total population of 1168 patients. Aspiration increased the risk of pneumonia (OR 2.97, 95% CI 1.52-5.80, P = 0.001). The number of studies that have evaluated the relationship of other FEES findings with dysphagia complications was limited (≤ 3). One study found a higher risk of mortality in patients with aspiration (OR 4.08, 95% CI 1.60-10.27, P = 0.003). Another study that evaluated the risk of mortality in a combined group of penetration and aspiration found no higher risk of mortality. Penetration, residue, and premature spillage were not found to be associated with an increased risk of pneumonia, mortality, or other outcomes. Aspiration demonstrated via FEES was associated with an increased risk of pneumonia and mortality. There is insufficient evidence for the capacity of premature spillage, penetration, and residue to predict dysphagia complications.
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15
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Quantitative Measurement of Swallowing Performance Using Iowa Oral Performance Instrument: A Systematic Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10092319. [PMID: 36140420 PMCID: PMC9496474 DOI: 10.3390/biomedicines10092319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/12/2022] Open
Abstract
Swallowing is a complex but stereotyped motor activity aimed at serving two vital purposes: alimentary function and the protection of upper airways. Therefore, any impairment of the swallowing act can represent a significant clinical and personal problem that needs an accurate diagnosis by means of reliable and non-invasive techniques. Thus, a systematic review and meta-analysis was performed to investigate the reliability of the Iowa Oral Pressure Instrument (IOPI) in distinguishing healthy controls (HC) from patients affected by swallowing disorders or pathologies and conditions that imply dysphagia. A comprehensive search was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and using PubMed, Scopus, Web of Science, Cochrane, and Lilacs databases. Overall, 271 articles were identified and, after a three-step screening, 33 case-control and interventional studies reporting IOPI measurements were included. The methodological quality of the retrieved studies resulted in being at a low risk of bias. The meta-analysis on case-control studies showed that maximum tongue pressure (MIP) values were always higher in HC than in patients, with an overall effect of the MIP difference of 18.2 KPa (17.7–18.7 KPa CI). This result was also confirmed when the sample was split into adults and children, although the MIP difference between HC and patients was greater in children than in adults (21.0 vs. 15.4 KPa in the MIP mean difference overall effect, respectively). Tongue endurance (TE) showed conflicting results among studies, with an overall effect among studies near zero (0.7 s, 0.2–1.1 s CI) and a slight tendency toward higher TE values in HC than in patients. Among the intervention studies, MIP values were higher after treatment than before, with a better outcome after the experimental tongue training exercise than traditional treatments (the MIP mean difference overall effect was 10.8 and 2.3 KPa, respectively). In conclusion, MIP values can be considered as a reliable measure of swallowing function in adults and in children, with a more marked MIP difference between HC and patients for the children population. MIP measures in patients are also able to detect the best outcome on the tongue function after the training exercise compared to traditional training.
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16
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Celtik U, Eyigor S, Divarci E, Sezgin B, Dokumcu Z, Ozcan C, Ozturk K, Erdener A. Fiberoptic endoscopic evaluation of swallowing (FEES) study: the first report in children to evaluate the oropharyngeal dysphagia after esophageal atresia repair. Pediatr Surg Int 2022; 38:1227-1233. [PMID: 35836013 DOI: 10.1007/s00383-022-05169-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the swallowing problems by fiberoptic endoscopic evaluation of swallowing (FEES) study in both short- and long-gap patients after esophageal atresia (EA) repair. METHODS Hospital records of patients who had undergone surgery for EA were reviewed retrospectively. Patients were divided into two groups as short-gap (SG) group (n:16) and long-gap (LG) group (n:10) to compare the swallowing problems. FEES study was performed, and the results were discussed in detail. RESULTS There were twenty-six (16 M/10 F) patients with a mean age at evaluation was 7.52 ∓ 3.68 years. Mean follow-up period was 75.35 ∓ 44.48 months. In FEES study, pharyngeal phase abnormalities were detected in 10 patients (38.4%). Pharyngeal phase abnormalities were detected significantly higher in LG group (p:0.015). Laryngeal penetration/aspiration was seen in four patients on FEES study (15.3%). All of them was in LG group (40%). Laryngeal penetration/aspiration was seen significantly higher in LG group (p:0.014). CONCLUSION This is the first study to conduct FEES study in children after esophageal atresia repair to evaluate their swallowing conditions. Even though our sample is small, swallowing problems are more common than expected in the cases of LG when compared to SG.
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Affiliation(s)
- Ulgen Celtik
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey.
| | - Sibel Eyigor
- Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Ege University, Bornova, 35100, Izmir, Turkey
| | - Emre Divarci
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
| | - Baha Sezgin
- Department of Otorhinolaryngology, Izmir Ekol Hospital, Cigli, Izmir, Turkey
| | - Zafer Dokumcu
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
| | - Coskun Ozcan
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
| | - Kerem Ozturk
- Faculty of Medicine, Department of Otorhinolaryngology, Ege University, Bornova, 35100, Izmir, Turkey
| | - Ata Erdener
- Faculty of Medicine, Department of Pediatric Surgery, Ege University, Bornova, 35100, Izmir, Turkey
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17
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Colizza A, Ralli M, Di Stadio A, Cambria F, Zoccali F, Cialente F, Angeletti D, Greco A, de Vincentiis M. Outcomes of Laryngeal Cancer Surgery after Open Partial Horizontal Laryngectomies with Lateral Cervical Approach. J Clin Med 2022; 11:jcm11164741. [PMID: 36012980 PMCID: PMC9410219 DOI: 10.3390/jcm11164741] [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: 07/05/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Open partial horizontal laryngectomies (OPHL) are one of the surgical techniques used for the conservative management of laryngeal cancers. The aims of this study are to analyze the oncological and functional results of a group of patients affected by laryngeal squamous cell carcinoma (LSCC) treated with OPHL, performed using a minimally invasive technique. Methods: This is a prospective case−control study. We enrolled 17 consecutive patients with LSCC treated with OPHL through a lateral cervical approach (LCA). Patients were evaluated using their Penetration Aspiration Scale score (liquid, semiliquid and solid) and Voice Handicap Index (VHI) at three different endpoints: 15 days (T1), 3 months (T2), and 6 months (T2) after surgery. Results: The functional outcomes of the LCA are stackable with that of the classical anterior cervical approach in terms of respiration, swallowing, and speech. One-way ANOVA was performed to evaluate the variances of PAS and VHI scores at the three different observation points. No statistically significant differences were observed between OPHL- PAS scores for liquid (p = 0.1) at the three different observation points. A statistically significant improvement was observed in the OPHL- PAS score for semisolids and solids (p < 0.00001) between T1 and T3 (p = 0.0001) and for solids between T2 and T3 (p < 0.00001). The improvement of VHI-10 was statistically significative (p < 0.00001) at the three different observation points (T1−T2 and T2−T3). Conclusion: The LCA is a potential approach for laryngeal surgery in selected cases. The preoperative staging and planning are of the utmost importance to ensure oncological radicality. The main advantage of this approach is the preservation of the healthy tissues surrounding the larynx and the functional and oncological outcomes are stackable with the classic anterior cervical approach.
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Affiliation(s)
- Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
- Correspondence: ; Tel.: +39-340-380-7820
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Arianna Di Stadio
- Department GF Ingrassia, University of Catania, 95125 Catania, Italy
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Federica Zoccali
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Diletta Angeletti
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, 00161 Roma, Italy
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Nacci A, Simoni F, Pagani R, Santoro A, Capobianco S, D'Anna C, Berrettini S, Fattori B, Bastiani L. Complications during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in 5680 examinations. Folia Phoniatr Logop 2022; 74:352-363. [PMID: 35038706 DOI: 10.1159/000521145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate retrospectively the incidence of complications during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in 5680 examinations. PATIENTS AND METHODS 5680 patients were evaluated at the Department of Otorhinolaryngology, Audiology and Phoniatrics of Pisa University Hospital between January 2014 and December 2018, involving both inpatients and outpatients. Most common comorbidities included neurological pathologies such as stroke (11.8%), neurodegenerative diseases (28.9%) and a history of previous head and neck surgery (24.6%). The evaluation was conducted by clinicians with experience in swallowing for a minimum of 10 years with the assistance of one or more speech language pathologists. RESULTS In all patients studied the endoscope insertion was tolerated and it was possible to visualize the pharyngo-laryngeal structures. Most patients reported discomfort In a minority of patients, complications were recorded, such as anterior epistaxis, posterior epistaxis, vasovagal crises and laryngospasm. Laryngospasm was recorded in patients affected by Amyotrophic Lateral Sclerosis (ALS). Multivariate binary logistic regression showed that discomfort, chronic gastrointestinal diseases, neurodegenerative diseases and brain tumors were risk factors associated with minor complications. CONCLUSIONS FEES proved to be easy to perform, well tolerated by the patients and cost-effective. It can be performed at the patient's bedside and it is characterized by low rate of complications. As a matter of fact, normally only discomfort, gagging and/or vomit are reported. Only rarely complications occur, such as anterior or posterior epistaxis episodes or vasovagal crises, but these are still easily managed. Exceptionally, more severe complications are reported: adverse drug reactions to substances such as blue dye (methylene blue) and local anesthetics (not used in our protocol), and laryngospasm.
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Affiliation(s)
- Andrea Nacci
- ENT Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Federica Simoni
- ENT Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Rebecca Pagani
- ENT Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Amelia Santoro
- ENT Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | | | - Clelia D'Anna
- ENT Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | | | - Bruno Fattori
- ENT Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Luca Bastiani
- Epidemiology Section, CNR Institute of Clinical Physiology, Pisa, Italy
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Evaluating dysphagia in infants with congenital heart disease using Fiberoptic Endoscopic Evaluation of Swallowing. Int J Pediatr Otorhinolaryngol 2022; 152:111004. [PMID: 34902666 DOI: 10.1016/j.ijporl.2021.111004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 12/05/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Dysphagia is common in infants with congenital heart disease (CHD). However, there is minimal published data regarding its management outside of the perioperative period. The objective of this study is to describe the role of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in the diagnosis and management of dysphagia in infants with CHD. METHODS Infants with CHD who underwent FEES exam for evaluation of swallowing dysfunction between February 2015 and February 2021 at a university-based, tertiary care urban pediatric hospital were studied. Demographic data, presenting symptoms, medical history, and dysphagia history were examined. The validated Dysphagia Outcome and Severity Scale (DOSS) was used to standardize and compare dysphagia severity. RESULTS 62 FEES exams were performed on 48 patients. All 48 patients were diagnosed with dysphagia and had a mean dysphagia severity score (DOSS) of 2.68. Patients with wet laryngeal congestion on presentation had worse mean DOSS score and were more likely to demonstrate aspiration on FEES exam (p < 0.01). There was no significant difference in mean DOSS or presence of aspiration when comparing infants who had cardiothoracic surgery, vocal cord paralysis, or lower respiratory tract illness with those who had not (p > 0.05). CONCLUSION A FEES exam is an effective and well-tolerated procedure for evaluating swallowing dysfunction in pediatric patients with CHD and its use reduces radiation exposure for this vulnerable population. Wet laryngeal congestion was found to be predictive of more severe dysphagia and aspiration. There is no significant association between severity of dysphagia or aspiration on FEES exam and history of cardiac surgery, vocal cord paralysis, or lower respiratory tract illness.
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Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management. CHILDREN 2021; 8:children8121158. [PMID: 34943354 PMCID: PMC8700416 DOI: 10.3390/children8121158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.
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Black RJ, Novakovic D, Plit M, Miles A, MacDonald P, Madill C. Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis. J Heart Lung Transplant 2021; 40:1483-1494. [PMID: 34836605 DOI: 10.1016/j.healun.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Despite continued surgical advancements in the field of cardiothoracic transplantation, post-operative complications remain a burden for the patient and the multidisciplinary team. Lesser-known complications including swallowing disorders (dysphagia), and voice disorders (dysphonia), are now being reported. Such disorders are known to be associated with increased morbidity and mortality in other medical populations, however their etiology amongst the heart and lung transplant populations has received little attention in the literature. This paper explores the potential mechanisms of oropharyngeal dysphagia and dysphonia following transplantation and discusses optimal modalities of diagnostic evaluation and management. A greater understanding of the implications of swallowing and laryngeal dysfunction in the heart and lung transplant populations is important to expedite early diagnosis and management in order to optimize patient outcomes, minimize allograft injury and improve quality of life.
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Affiliation(s)
- Rebecca J Black
- Speech Pathology Department, St Vincent's Hospital, Darlinghurst, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Daniel Novakovic
- Faculty of Medicine and Health, The University of Sydney, Australia
| | | | | | - Peter MacDonald
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Catherine Madill
- Faculty of Medicine and Health, The University of Sydney, Australia
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22
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Accuracy of Acoustic Evaluation of Swallowing as a Diagnostic Method of Dysphagia in Individuals Affected by Stroke: Preliminary Analysis. Dysphagia 2021; 37:724-735. [PMID: 34586494 DOI: 10.1007/s00455-021-10358-5] [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: 06/18/2020] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
After a stroke, more than half of the patients have some kind of disability, and dysphagia is frequently found. Cervical auscultation by Doppler sonar is an innovative technique with gain of credibility in the clinical evaluation of swallowing. To verify the diagnostic accuracy of Doppler sonar along with the DeglutiSom® software as an auxiliary method in the evaluation of oropharyngeal dysphagia in patients after stroke. The research is a cross-sectional, uncontrolled, blind, quantitative study with systematic random sampling. Patients from inpatient and outpatient units of a reference hospital with a stroke care unit were concomitantly submitted to both Doppler sonar and Fiberoptic Endoscopic Evaluation of Swallowing (FEES®). Seventy-three audio files collected from 26 patients through Doppler sonar were analyzed using DeglutiSom® software and confronted with the FEES® report, regarding three food consistencies offered to them during the exam. The study showed that the Doppler sonar correctly identified, among all the analyzed files, those that actually presented tracheal aspiration as well as it effectively identified patients who did not aspirate. The Youden index of 0.91 corroborates this information, showing a promising accuracy in detecting tracheal aspiration in the studied sample. The study evaluates the diagnostic accuracy of Doppler sonar, showing that it can be used as a valuable tool in the diagnosis of tracheal aspiration in patients after stroke. It is important to emphasize that the identification of residue by this method requires further studies. Also, larger sample size and more than one blind evaluator should be considered in future researches to increase the reliability of the proposed method.
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23
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High-sensitivity FEES ® with the professional image enhancement technology "PIET". Eur Arch Otorhinolaryngol 2021; 279:293-298. [PMID: 34487219 PMCID: PMC8739291 DOI: 10.1007/s00405-021-07067-y] [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: 03/14/2021] [Accepted: 08/30/2021] [Indexed: 11/05/2022]
Abstract
Purpose Flexible endoscopic evaluation of swallowing (FEES®) is a standard diagnostic tool in dysphagia. The combination of FEES® and narrow band light (narrow band imaging; NBI) provides a more precise and detailed investigation method. So far, this technique could only be performed with the NBI illumination. The new version of the “professional image enhancement technique” (PIET) provides another image enhancing system. This study investigates the eligibility of PIET in the FEES® procedure. Methods Both techniques, NBI and PIET, were compared using a target system. Furthermore, the image enhancement during FEES® was performed and recorded with the two systems during daily routine. Results Performing an image enhancement during FEES® is possible with both systems PIET and NBI. On the target system, the contrast of the PIET showed a brighter and a more detailed picture. In dysphagia patients, no difference between PIET and NBI was detected. Conclusions PIET proved to be non-inferior to NBI during image enhancement FEES®. So far, image enhancement FEES® was exclusively connected to NBI. With the PIET system, an alternative endoscopy technology is available for certain indications.
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Curtis JA, Borders JC, Perry SE, Dakin AE, Seikaly ZN, Troche MS. Visual Analysis of Swallowing Efficiency and Safety (VASES): A Standardized Approach to Rating Pharyngeal Residue, Penetration, and Aspiration During FEES. Dysphagia 2021; 37:417-435. [PMID: 33837841 DOI: 10.1007/s00455-021-10293-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
The primary aim of this study was to describe the development of the Visual Analysis of Swallowing Efficiency and Safety (VASES)-a standardized method to rate pharyngeal residue, penetration, and aspiration during FEES. As a secondary aim, we explored the feasibility of training novices to interpret FEES using VASES. Literature review and consensus panel discussions were used to develop standardized rules for VASES. A training protocol was developed and criterion ratings were established. Twenty-five novice raters completed VASES training and pre-/post-training assessments. Statistical analyses were used to examine pre- to post-training differences in the accuracy, reliability, and time to rate each video clip using VASES. Four sets of VASES rules were developed, including 'what', 'where', 'when', and 'how' to rate FEES. Large, significant post-training improvements in rating accuracy were observed across all seven VASES outcome measures (Cohen's d range 0.74-1.59). Additionally, inter-rater reliability increased for four of the seven outcome measures, and the amount of time to rate each video clip decreased from 2.6 min pre-training to 1.5 min post-training. VASES is a standardized FEES rating method used to enhance the subjective analysis of pharyngeal residue, penetration, and aspiration. It can be feasibly taught to novice raters with a high level of success and may be an effective method to analyze swallowing safety and efficiency in clinical and research practices. Future research is needed to test the validity of VASES by examining its relationship with other validated FEES rating scales.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA.
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Sarah E Perry
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA.,New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Zeina N Seikaly
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, New York City, NY, USA
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25
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Seo ZW, Min JH, Huh S, Shin YI, Ko HY, Ko SH. Prevalence and Severity of Dysphagia Using Videofluoroscopic Swallowing Study in Patients with Aspiration Pneumonia. Lung 2021; 199:55-61. [PMID: 33458798 DOI: 10.1007/s00408-020-00413-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of this study was to identify the prevalence and severity of dysphagia in patients diagnosed with aspiration pneumonia, with and without neurologic disorders. METHODS We retrospectively reviewed the medical records of inpatients with aspiration pneumonia who underwent a videofluoroscopic swallowing study (VFSS) for evaluation of dysphagia. Patients were divided into two groups based on the presence or absence of neurologic disorders. The prevalence and severity of aspiration and pharyngeal residue due to dysphagia were assessed using the penetration-aspiration scale (PAS) and pharyngeal residue grade (PRG). RESULTS A total of 784 patients were enrolled; of these, 58.7% were males and the mean age was 76.12 ± 6.69. Penetration-aspiration-related dysphagia (PAS scores 3-8) was seen in 56.5% of all subjects, and 32.5% showed silent aspiration (PAS 8). Pharyngeal residue-related dysphagia (PRG scores 2-3) was seen in 65.2% of all patients, and the PAS and PRG were positively correlated. On dividing the subjects into two groups based on the presence of neurologic disorders, there was no significant difference in prevalence of the dysphagia between groups (PAS: p = 0.641; PRG: p = 0.872) with the proportion of silent aspiration (p = 0.720). CONCLUSION In patients hospitalized for aspiration pneumonia, there was a high prevalence of dysphagia. There were no differences in the prevalence and severity of dysphagia in patients with aspiration pneumonia based on the presence or absence of a neurologic disorder. Therefore, diagnostic evaluation of dysphagia is necessary regardless of the presence of neurologic disorders.
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Affiliation(s)
- Zee Won Seo
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Sungchul Huh
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Hyun-Yoon Ko
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea. .,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.
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26
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Rayneau P, Bouteloup R, Rouf C, Makris P, Moriniere S. Automatic Detection and Analysis of Swallowing Sounds in Healthy Subjects and in Patients with Pharyngolaryngeal Cancer. Dysphagia 2021; 36:984-992. [PMID: 33389178 DOI: 10.1007/s00455-020-10225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Assessment of swallowing function is often invasive or involves irradiation. Analysis of swallowing sounds is a noninvasive method for assessment of swallowing but is not used in daily medical practice. Dysphagia could be the first symptom that occurs in head and neck cancer. This study evaluated a method for the automatic detection and analysis of swallowing sounds in healthy subjects and in patients with pharyngolaryngeal cancer. A smartphone application, developed for automatic detection and analysis of swallowing sounds was developed and tested in 12 healthy volunteers and in 26 patients with pharyngolaryngeal cancer. Swallowing sounds were recorded with a laryngophone during a standardized meal (100 mL mashed potatoes, 100 mL water, and 100 mL yogurt). Swallowing number and duration were noted; the results were compared to a standard swallowing sound analysis using the software AUDACITY®. There were no statistically significant differences in swallowing number or duration between the two analysis methods for the three types of foods in healthy volunteers and only for water in patients. In healthy volunteers, the results of our automatic analysis were comparable with those obtained with the standard analysis. However, a better discrimination of swallowing sounds is necessary for the algorithm to obtain reliable results with thicker food in patients with head and neck cancer.
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Affiliation(s)
- P Rayneau
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France. .,Service ORL Et Chirurgie Cervico-Faciale, CHU de Tours, 2 Boulevard Tonnelé, 37044, Tours, France.
| | - R Bouteloup
- Polytech School, University of Tours, 64 Avenue Jean Portalis, 37200, Tours, France
| | - C Rouf
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France
| | - P Makris
- Tours Fundamental and Applied Computer Laboratory, University of Tours, CNRS 7002, 64 Avenue Jean Portalis, 37200, Tours, France
| | - S Moriniere
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France.,Francois-Rabelais University of Tours, University Hospital of Tours, 10 Boulevard Tonnelé, 37032, Tours, France
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27
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Matsuzaki T, Suzuki Y, Tanimoto M, Masuyama K, Osano M, Sakata O, Morisawa M. Bolus Inflow Detection Method by Ultrasound Video Processing for Evaluation of Swallowing. ADVANCED BIOMEDICAL ENGINEERING 2021. [DOI: 10.14326/abe.10.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | | | | | | | - Osamu Sakata
- Department of Engineering, Tokyo University of Science
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28
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Prevalence, Pathophysiology, Diagnostic Modalities, and Treatment Options for Dysphagia in Critically Ill Patients. Am J Phys Med Rehabil 2020; 99:1164-1170. [PMID: 32304381 DOI: 10.1097/phm.0000000000001440] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postextubation dysphagia may impose a substantial burden on intensive care unit patients and healthcare systems. Approximately 517,000 patients survive mechanical ventilation during critical care annually. Reports of postextubation dysphagia prevalence are highly variable ranging between 3% and 93%. Of great concern is aspiration leading to the development of aspiration pneumonia when patients resume oral feeding. Screening for aspiration with a water swallow test has been reported to be positive for 12% of patients in the intensive care unit after extubation. This review aims to increase awareness of postextubation dysphagia and provide an updated overview of the current knowledge regarding prevalence, pathophysiology, diagnostic modalities, and treatment options.
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29
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Mattioli F, Fernandez IJ, Bassano E, Luppi MP, Bonali M, Ghidini A, Trebbi M, Bergamini G, Presutti L, Botti C. Surgical rehabilitation of swallowing with polydimethylsiloxane injections after open partial horizontal laryngectomy: Long-term functional results and quality of life. Head Neck 2020; 43:1161-1173. [PMID: 33355954 DOI: 10.1002/hed.26584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/17/2020] [Accepted: 12/08/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Swallowing disorders are common problems after partial laryngectomy. The aim of this study is to illustrate the long-term functional results of rehabilitation of swallowing by polydimethylsiloxane (PDMS) injection. METHODS Twenty-eight patients with dysphagia after partial laryngectomy who underwent injection of PDMS for rehabilitation of swallowing were included in the study. Impairment of swallowing and quality of life (QoL) were investigated with questionnaires: M. D. Anderson Dysphagia Inventory (MDADI) and Performance Status Scale for Head and Neck Cancer (PSS-HNC). Functional results at fiberoptic endoscopic evaluation of swallowing (FEES) were analyzed using a modified penetration-aspiration scale. RESULTS Mean follow-up was 8.5 years. Twenty-six patients showed an improvement at questionnaires (p < 0.001). Median improvement was 6 (p < 0.001) in the modified penetration-aspiration scale. Total laryngectomy was required in one patient. CONCLUSIONS PDMS injection is a good option for rehabilitation of swallowing in case of dysphagia after partial laryngectomy. It improves QoL and the results persist after a long follow-up period.
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Affiliation(s)
- Francesco Mattioli
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Bassano
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Maria Pia Luppi
- Department of Head and Neck, University Hospital of Modena, Modena, Italy
| | - Marco Bonali
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Trebbi
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giuseppe Bergamini
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
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30
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Pavithran J, Puthiyottil IV, Kumar M, Nikitha AV, Vidyadharan S, Bhaskaran R, Chandrababu Jaya A, Thankappan K, Subramania I, Sundaram KR. Exploring the utility of fibreoptic endoscopic evaluation of swallowing in young children- A comparison with videofluoroscopy. Int J Pediatr Otorhinolaryngol 2020; 138:110339. [PMID: 32911239 DOI: 10.1016/j.ijporl.2020.110339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS In adults, fibreoptic endoscopic evaluation of swallowing (FEES) has established its place in the assessment of dysphagia and aspiration vis-à-vis the current gold standard, videofluoroscopic swallow study (VFSS), almost at parity. However, in children with quite a different set of factors in play, its role is not certain. The primary objective was to measure the accuracy of FEES in young children with dysphagia, compared to VFSS. The secondary objective was to correlate other endoscopic findings with aspiration in videofluoroscopy. STUDY DESIGN Prospective, observational. METHODOLOGY Sixty-five children, aged 0.4-36 months with suspected oropharyngeal dysphagia and aspiration underwent FEES and VFSS. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic agreement of FEES were calculated using VFSS as the gold standard. To test the statistical significance of the difference in two measurements, Mc Nemar's Chi-square test was used and to test the agreement between FEES and VFSS, Kappa value was calculated. To test the statistical significance of the association of endoscopic findings with VFSS findings, Chi-square test was used. RESULTS FEES performed in young children was found to be less sensitive (50%) but more specific of aspiration (82%) with an accuracy of 77% in comparison with VFSS. The reverse was true of penetration (81%, 44% and 59% respectively). The agreement between FEES and VFSS in young children, on all parameters were low (k = 0.061-0.302). Endoscopic findings such as glottic secretions (P = 0.02), weak or diminished laryngeal adductor reflex (LAR) (P = 0.001) and penetration (P = 0.01) were significantly associated with aspiration in VFSS. Excessive secretions in the hypopharynx had a stronger correlation with oesophageal dysmotility (P = 0.02) than pharyngeal dysphagia (P = 0.05). CONCLUSION FEES in young children appears to have a low agreement with VFSS unlike in adults. Aspiration observed in FEES is likely to be significant since specificity is high. FEES negative for aspiration may be interpreted taking into account, the aspiration risk of the subject and/or other endoscopic risk factors (penetration, weak/absent LAR & glottic secretions), if VFSS is not a viable alternative.
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Affiliation(s)
- Jayanthy Pavithran
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Indu Vadakke Puthiyottil
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Madhumita Kumar
- Department of ENT, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Anju Viswambharan Nikitha
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Sivakumar Vidyadharan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Renjitha Bhaskaran
- Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India.
| | - Arya Chandrababu Jaya
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Iyer Subramania
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - K R Sundaram
- Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala, India.
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31
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Velasco LC, Imamura R, Rêgo APV, Alves PR, da Silva Peixoto LP, de Oliveira Siqueira J. Sensitivity and Specificity of Bedside Screening Tests for Detection of Aspiration in Patients Admitted to a Public Rehabilitation Hospital. Dysphagia 2020; 36:821-830. [PMID: 33052481 DOI: 10.1007/s00455-020-10198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
Early detection of dysphagia and specifically aspiration is essential to prevent and reduce complications of hospitalized patients in rehabilitation centers. Bedside screening test are often used to evaluate swallowing disorders, but their results may be questionable due to insufficient and inconsistent sensitivity and specificity. To compare the sensitivity and specificity of various bedside screening tests for detecting aspiration in hospitalized rehabilitation patients. A prospective observational study was performed in 150 consecutive patients of a tertiary rehabilitation hospital. Patients were evaluated regarding clinical predictors for aspiration, maximum phonation time (MPT), Eating Assessment Tool 10 (EAT-10) questionnaire, tongue strength and endurance (Iowa Oral Performance Instrument [IOPI]) and a swallowing test (Volume-Viscosity Swallow Test [V-VST]). Flexible Endoscopic Evaluation of Swallowing (FEES) was the reference test. Of the 144 patients included, 22% aspirated on FEES. Previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex were significantly associated with aspiration. The sensitivity, specificity and accuracy for V-VST (83.3%, 72.6%, 74.8%, respectively) and EAT-10 (82.8%, 57.7%, 62.8%, respectively) to detect aspiration were superior than those of other methods. Maximum tongue strength on IOPI and MPT presented high sensitivity but low specificity to detect aspiration. Clinical predictors of aspiration (previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex) associated with either V-VST or EAT-10 may be good screening methods to detect aspiration in patients hospitalized in a rehabilitation center.
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Affiliation(s)
- Leandro Castro Velasco
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua T-14, número 1529, apartamento 2301, bloco Monet, Goiânia, GO, CEP 74230-130, Brasil.
| | - Rui Imamura
- Department of Otorhinolaryngology, School of Medicine, University of São Paulo, Avenida Padre Pereira de Andrade, 545, apto 153-F, Boacava, São Paulo, 05469-000, Brazil
| | - Ana Paula Valeriano Rêgo
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Avenida T-4, número 550, Condomínio Ilhas Do Caribe, apartamento 1303, Bloco A, Setor Bueno, Goiânia, Goiás, 74230030, Brazil
| | - Priscilla Rabelo Alves
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua 230, número 978, Condomínio Quinta Vila Boa, apartamento 303, Bloco C, Setor Vila Jaraguá, Goiânia, Goiás, 74655130, Brazil
| | - Lorena Pacheco da Silva Peixoto
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua Vitória, número 265, Residencial Veneza, apartamento 601, Setor Alto da Glória, Goiânia, Goiás, 74815745, Brazil
| | - José de Oliveira Siqueira
- Department of Pathology, School of Medicine, University of São Paulo, Rua Catuaba, número 595, Vila Alpina, São Paulo, 03208000, Brazil
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32
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A potential for seamless designs in diagnostic research could be identified. J Clin Epidemiol 2020; 129:51-59. [PMID: 32991994 DOI: 10.1016/j.jclinepi.2020.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/26/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE New diagnostic tests to identify a well-established disease state must undergo a series of scientific studies from test construction to finally demonstrating a societal impact. Traditionally, these studies are performed with substantial time gaps in between, resulting in a long time period from the initial idea to roll out in clinical practice including reimbursement. Seamless designs allowing us to combine a sequence of studies in one protocol may hence accelerate this process. Currently, a systematic investigation of the potential of seamless designs in diagnostic research is lacking. METHODS We identify major study types in diagnostic research and their basic characteristics with respect to the application of seamless designs. This information is used to identify major hurdles and opportunities for seamless designs. RESULTS The following major study types were identified: Variable construction studies, cut point finding studies, variable value studies, single-arm accuracy studies, comparative accuracy studies, change-in-management studies, observational discordant pair studies, randomized discordant pair studies, and randomized diagnostic studies. The following characteristics were identified: Type of recruitment (case-control vs. population-based), application of a reference standard, inclusion of a comparator, paired or unpaired application of a comparator, assessment of patient-relevant outcomes, and possibility for blinding of test results. Two basic hurdles could be identified: 1) Accuracy studies are hard to combine with postaccuracy studies in a seamless design for the following reasons. First, because the former are required to justify the latter and application of a reference test in outcome studies may be a threat to the integrity of the study. 2) Randomized diagnostic studies are probably best placed as singular studies at the end of the process, as all other questions should be clarified before performing such a study. However, otherwise there is a substantial potential for seamless designs. All steps from the construction to the comparison with the comparator can be combined in one protocol. This may include a switch from case-control to population-based recruitment as well as a switch from a single-arm study to a comparative accuracy study. In addition, change-in-management studies can be combined with an outcome study in discordant pairs. CONCLUSION There is a potential for seamless designs in diagnostic research. It is wise to have the whole sequence of necessary studies in mind and to plan a full programme than rather individual studies one by one.
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Schlickewei O, Nienstedt JC, Frank U, Fründt O, Pötter-Nerger M, Gerloff C, Buhmann C, Müller F, Lezius S, Koseki JC, Pflug C. The ability of the eating assessment tool-10 to detect penetration and aspiration in Parkinson's disease. Eur Arch Otorhinolaryngol 2020; 278:1661-1668. [PMID: 32978686 DOI: 10.1007/s00405-020-06377-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Dysphagia is common in patients with Parkinson's disease (PD) and often leads to pneumonia, malnutrition, and reduced quality of life. This study investigates the ability of the Eating Assessment Tool-10 (EAT-10), an established, easy self-administered screening tool, to detect aspiration in PD patients. This study aims to validate the ability of the EAT-10 to detect FEES-proven aspiration in patients with PD. METHODS In a controlled prospective cross-sectional study, a total of 50 PD patients completed the EAT-10 and, subsequently, were examined by Flexible Endoscopic Evaluation of Swallowing (FEES) to determine the swallowing status. The results were rated through the Penetration-Aspiration Scale (PAS) and data were analyzed retrospectively. RESULTS PAS and EAT-10 did not correlate significantly. Selected items of the EAT-10 could not predict aspiration or residues. 19 (38%) out of 50 patients with either penetration or aspiration were not detected by the EAT-10. The diagnostic accuracy was established at only a sufficient level (AUC 0.65). An optimal cut-off value of ≥ 6 presented a sensitivity of 58% and specificity of 82%. CONCLUSIONS The EAT-10 is not suited for the detection of penetration and aspiration in PD patients. Therefore, it cannot be used as a screening method in this patient population. There is still a need for a valid, simple, and efficient screening tool to assist physicians in their daily diagnostics and to avoid clinical complications.
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Affiliation(s)
- Ole Schlickewei
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Ulrike Frank
- Department of Linguistics, Swallowing Research Lab, University of Potsdam, Potsdam, Germany
| | - Odette Fründt
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Frank Müller
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Implementing a flexible endoscopic evaluation of swallowing at elderly care facilities to reveal characteristics of elderly subjects who screened positive for a swallowing disorder. Auris Nasus Larynx 2020; 47:602-608. [DOI: 10.1016/j.anl.2020.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/14/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
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Đanić Hadžibegović A, Hergešić F, Babić E, Slipac J, Prstačić R. Thyroidectomy-related Swallowing Difficulties: Review of the Literature. Acta Clin Croat 2020; 59:38-49. [PMID: 34219883 PMCID: PMC8212616 DOI: 10.20471/acc.2020.59.s1.05] [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] [Indexed: 11/24/2022] Open
Abstract
This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.
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Affiliation(s)
| | - Filip Hergešić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ema Babić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Juraj Slipac
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ratko Prstačić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
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Cristalli G, Ferri E, Di Maio P, Spriano G, Mercante G, Ferreli F, Pellini R, Boscolo Nata F. Lateral conservative approach for recurrent/persistent hypopharyngeal carcinoma: a case series. Eur Arch Otorhinolaryngol 2020; 277:2375-2380. [PMID: 32367150 DOI: 10.1007/s00405-020-06009-4] [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: 03/14/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Early persistent/recurrent hypopharyngeal tumours represent a challenge for surgeons who have to balance the need for oncological radicality and the desire to maintain a functioning larynx with preservation of the patient's quality of life. The aim of this study was primarily to understand the technical feasibility, functional outcomes, and the possibility of obtaining oncological radicality using lateral hypopharyngectomy with laryngeal preservation in early recurrent post-radio/(chemo)therapy hypopharyngeal tumours. METHODS Patients with recurrent T1 hypopharyngeal squamous cell carcinoma were retrospectively selected from our institutional database. The external lateral approach according to Spriano and a modified lateral hypopharyngectomy with laryngeal preservation were used to resect tumours of the lateral pyriform sinus wall. Reconstruction was obtained by direct approximation of the posterior border of the sectioned thyroid cartilage to the posterior hypopharyngeal wall, and this was reinforced with a second layer of vascularised and non-irradiated tissue that was provided by a microvascular fascial anterobrachial flap. Swallowing was assessed 3 weeks after surgery using videoendoscopic evaluation. RESULTS The surgical procedure was technically feasible, and complete resection was obtained in all patients. None of the patients experienced major post-operative complications (salivary fistula, bleeding, aspiration pneumonia). Mild dysphagia was observed in one patient who underwent swallowing rehabilitation. Tracheostomy was closed in all patients. No recurrence was recorded after a median follow-up of 20 months. CONCLUSION The reported experience shows that, in selected cases, it is possible to radically remove lateral hypopharyngeal cancer with acceptable functional results.
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Affiliation(s)
- G Cristalli
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy.
| | - E Ferri
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy
| | - P Di Maio
- Department of Otolaryngology, Head and Neck Surgery (P.D., M.G.), Civil Hospital, Via Giovanni Borea, 56, Sanremo, 18038, Imperia, Italy
| | - G Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - G Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - F Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - R Pellini
- Department of Otolaryngology Head and Neck Surgery, National Cancer Institute "Regina Elena", Via Elio Chianesi 53, 00144, Roma, Italy
| | - F Boscolo Nata
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy
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Florie M, Pilz W, Kremer B, Verhees F, Waltman G, Winkens B, Winter N, Baijens L. EAT-10 Scores and Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients. Laryngoscope 2020; 131:E45-E51. [PMID: 32246779 PMCID: PMC7754346 DOI: 10.1002/lary.28626] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/08/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
Abstract
Objective The purpose of this study was to determine the relationship between patient‐reported symptoms of oropharyngeal dysphagia (OD) using the Eating Assessment Tool (EAT)‐10 and the swallowing function using a standardized fiberoptic endoscopic evaluation of swallowing (FEES) protocol in head and neck cancer (HNC) patients with confirmed OD. Methods Fifty‐seven dysphagic HNC patients completed the EAT‐10 and a FEES. Two blinded clinicians scored the randomized FEES examinations. Exclusion criteria consisted of presenting with a concurrent neurological disease, scoring below 23 on a Mini‐Mental State Examination, being older than 85 years, having undergone a total laryngectomy, and being illiterate or blind. Descriptive statistics, linear regression, sensitivity, specificity, and predictive values were calculated. Results The majority of the dysphagic patients (N = 38; 66.7%) aspirated after swallowing thin liquid consistency. A large number of patients showed postswallow pharyngeal residue while swallowing thick liquid consistency. More specifically, 42 (73.0%) patients presented postswallow vallecular residue, and 39 (67.9%) patients presented postswallow pyriform sinus residue. All dysphagic patients had an EAT‐10 score ≥ 3. Linear regression analyses showed significant differences in mean EAT‐10 scores between the dichotomized categories (abnormal vs. normal) of postswallow vallecular (P = .037) and pyriform sinus residue (P = .013). No statistically significant difference in mean EAT‐10 scores between the dichotomized categories of penetration or aspiration was found (P = .966). Conclusion The EAT‐10 questionnaire seems to have an indicative value for the presence of postswallow pharyngeal residue in dysphagic HNC patients, and a value of 19 points turned out to be useful as a cutoff point for the presence of pharyngeal residue in this study population. Level of Evidence: 2b
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Affiliation(s)
- Michelle Florie
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands
| | - Femke Verhees
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ghislaine Waltman
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bjorn Winkens
- CAPHRI - Care and Public Health Research Institute, Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Naomi Winter
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands
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Ansari NN, Tarameshlu M, Ghelichi L. Dysphagia In Multiple Sclerosis Patients: Diagnostic And Evaluation Strategies. Degener Neurol Neuromuscul Dis 2020; 10:15-28. [PMID: 32273788 PMCID: PMC7114936 DOI: 10.2147/dnnd.s198659] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/18/2019] [Indexed: 12/18/2022] Open
Abstract
Dysphagia after multiple sclerosis (MS) is a common disabling symptom which can lead to serious complications. Regular screening and assessment of dysphagia in patients with MS are important. Using valid and reliable instruments to measure dysphagia in MS patients is a crucial component in clinical practice and of research quality. There are various strategies to diagnose and assess the dysphagia in patients with MS. Screening strategies are for early diagnosis of the dysphagia. Clinical, non-instrumental strategies are used to verify the presence and to determine the severity and cause of dysphagia. Instrumental strategies are complementary to clinical examination to provide objective data on the various aspects of swallowing dysfunctions. This review revealed a few validated tools for dysphagia assessment in MS. The Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) and the Mann Assessment of Swallowing Ability (MASA) are the only validated MS-specific dysphagia tools. Further development of valid and reliable MS-specific screening and assessment tools that can be administered rapidly and scored easily to detect dysphagia and evaluate clinical outcomes in adults with MS is imperative. Until then, validation and metric evaluation of the screening and assessment tools currently available are required.
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Affiliation(s)
- Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Tarameshlu
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Ghelichi
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Farneti D, Fattori B, Bastiani L. Time as a factor during endoscopic assessment of swallowing: relevance in defining the score and severity of swallowing disorders. ACTA ACUST UNITED AC 2020; 39:244-249. [PMID: 31501616 PMCID: PMC6734198 DOI: 10.14639/0392-100x-n0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/26/2019] [Indexed: 11/23/2022]
Abstract
Time is a parameter of great interest in swallowing and can be considered in different ways to express severity during endoscopic evaluation. The objectives of this study are to evaluate how the severity of this score changes at different times of scoring and the interaction between residue persistence and airway invasion. Two experienced raters blindly evaluated 35 short clips of bolus transit that were recorded during endoscopic evaluations of 16 patients with dysphagia of differing aetiologies. The pooling score (p-score) and the Penetration Aspiration Scale (PAS) were detected after the first swallowing (T1) and after the fifth dry swallow (T5). For each task, the time needed to complete the clearing of the bolus (total time: TT) was blindly determined by the two raters and compared with the Functional Oral Intake Scale (FOIS) and Dysphagia Outcome and Severity Scale (DOSS) scales, previously detected.The inter-rater agreement between the 2 raters in scoring the p-score and PAS was good (ICC > 0.800) for T1 vs T1 and T1 vs T5, and in determining TT for each consistency (ICC > 0.9), with a Spearman’s Rho > 0.70 and > 0.90 respectively. A statistical correlation of the p-score total, TT and consistency with FOIS and DOSS was found. The p-score showed a good trade-off between sensitivity and specificity compared with the PAS aspiration and penetration scores. The time of scoring (T1 vs T5) is relevant in detecting severity of dysphagia during endoscopic evaluation. The time spent to clear residue is a useful parameter and is correlated with severity of dysphagia expressed by the p-score and with functional swallowing status in dysphagic patients. The p-score is correlated with the PAS score in detecting airway invasion.
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Affiliation(s)
- D Farneti
- Audiology and Phoniatrics Department, Romagna Health Service, Rimini Hospital, Italy
| | - B Fattori
- ENT Department, Audiology and Phoniatrics, Pisa University, Italy
| | - L Bastiani
- Institute of Clinical Physiology, National Council of Research (CNR), Pisa, Italy
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Kamity R, Ferrara L, Dumpa V, Reynolds J, Islam S, Hanna N. Simultaneous Videofluoroscopy and Endoscopy for Dysphagia Evaluation in Preterm Infants-A Pilot Study. Front Pediatr 2020; 8:537. [PMID: 33042904 PMCID: PMC7522365 DOI: 10.3389/fped.2020.00537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/27/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction: The assessment of dysphagia in preterm infants has been limited to clinical bedside evaluation followed by videofluoroscopic swallow study (VFSS) in selected patients. Recently, fiberoptic endoscopic evaluation of swallowing (FEES) is being described more in literature for preterm infants. However, it is unclear if one test has a better diagnostic utility than the other in this population. Furthermore, it is also unclear if performing FEES and VFSS simultaneously will increase the sensitivity and specificity of detecting dysphagia compared to either test performed independently. Objectives: The primary objective of this study is to evaluate the feasibility of performing VFSS and FEES simultaneously in preterm infants. Our secondary objective is to determine whether simultaneously performed VFSS-FEES improves the diagnostic ability in detecting dysphagia in preterm infants compared to either test done separately. Methods: In this pilot study, we describe the process involved in performing simultaneous VFSS-FEES in five preterm infants (postmenstrual age ≥36 weeks) with dysphagia. A total of 26 linked VFSS-FEES swallows were analyzed, where the same bolus during the same swallow was compared using simultaneous fluoroscopy and endoscopy. The sensitivity and specificity of detecting penetration and aspiration were evaluated in simultaneous VFSS-FEES compared with each test done independently. Results: Our results demonstrated that performing simultaneous VFSS-FEES is feasible in preterm infants with dysphagia. All patients tolerated the procedures well without any complications. Our pilot study in these five symptomatic preterm infants demonstrated a low incidence of aspiration but a high incidence of penetration. Simultaneous VFSS-FEES (26 linked swallows) improved the ability to detect penetration compared to each test done separately. Conclusion: To our knowledge, this study is the first to demonstrate the feasibility of performing VFSS and FEES simultaneously in symptomatic preterm infants with dysphagia resulting in potentially higher diagnostic yield than either procedure done separately.
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Affiliation(s)
- Ranjith Kamity
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Louisa Ferrara
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Communication Sciences and Disorders, Molloy College, Rockville Centre, NY, United States
| | - Vikramaditya Dumpa
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Jenny Reynolds
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, United States
| | - Shahidul Islam
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Nazeeh Hanna
- Department of Pediatrics, New York University Winthrop Hospital, Mineola, NY, United States.,Department of Pediatrics, New York University Long Island School of Medicine, Mineola, NY, United States
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Katagiri S, Shiba T, Tohara H, Yamaguchi K, Hara K, Nakagawa K, Komatsu K, Watanabe K, Ohsugi Y, Maekawa S, Iwata T. Re-initiation of Oral Food Intake Following Enteral Nutrition Alters Oral and Gut Microbiota Communities. Front Cell Infect Microbiol 2019; 9:434. [PMID: 31956606 PMCID: PMC6951430 DOI: 10.3389/fcimb.2019.00434] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
Stroke is associated with multiple forms of disability, including dysphagia. Post-stroke dysphagia increases the risks of pneumonia and mortality and often results in cessation of oral feeding. However, appropriate rehabilitation methods can eventually lead to resumption of oral food intake. This study tried to clarify that re-initiating oral food intake could modify the composition of oral/gut microbial communities in patients with dysphagia. From 78 patients with sub-acute stage of stroke, 11 complete tube feeding subjects without taking antibiotics were enrolled and received rehabilitation for re-initiation of oral food intake, and 8 subjects were brought back to complete oral feeding. Oral and gut microbiota community profiles were evaluated using 16S rRNA sequencing of the saliva and feces samples before and after re-initiation of oral food intake in patients recovering from enteral nutrition under the same nutrient condition. Standard nutrition in the hospital was 1,840 kcal, including protein = 75 g, fat = 45 g, and carbohydrates = 280 g both for tube and oral feeding subjects. Oral food intake increased oral and gut microbiome diversity and altered the composition of the microbiome. Oral and gut microbiome compositions were drastically different; however, the abundance of family Carnobacteriaceae and genus Granulicatella was increased in both the oral and gut microbiome after re-initiation of oral food intake. Although oral microbiota showed more significant changes than the gut microbiota, metagenome prediction revealed the presence of more differentially enriched pathways in the gut. In addition, simpler co-occurrence networks of oral and gut microbiomes, indicating improved dysbiosis of the microbiome, were observed during oral feeding as compared to that during tube feeding. Oral food intake affects oral and gut microbiomes in patients recovering from enteral nutrition. Rehabilitation for dysphagia can modify systemic health by increasing the diversity and altering the composition and co-occurrence network structure of oral and gut microbial communities.
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Affiliation(s)
- Sayaka Katagiri
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiko Shiba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruka Tohara
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Yamaguchi
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Hara
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuharu Nakagawa
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Komatsu
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuki Watanabe
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yujin Ohsugi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shogo Maekawa
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Jakobsen D, Poulsen I, Schultheiss C, Riberholt C, Curtis D, Petersen T, Seidl R. The effect of intensified nonverbal facilitation of swallowing on dysphagia after severe acquired brain injury: A randomised controlled pilot study. NeuroRehabilitation 2019; 45:525-536. [PMID: 31868691 PMCID: PMC7029366 DOI: 10.3233/nre-192901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is little high-level evidence for the effect of the nonverbal facilitation of swallowing on swallowing ability in the subacute stage of rehabilitation following severe acquired brain injury (ABI). OBJECTIVE To pilot test a randomised controlled trial to determine the effect of an intensification of the nonverbal facilitation of swallowing on dysphagia. METHODS Ten patients with severe ABI and dysphagia were randomised into two groups at a highly specialised neurorehabilitation clinic.The intervention group received an intensification of the nonverbal facilitation of swallowing and the control group received basic care of the face and mouth in addition to treatment as usual for two sessions of 20 minutes per day for three weeks.Outcomes were Functional Oral Intake Scale (FOIS), Penetration Aspiration Scale (PAS), and electrophysiological swallowing specific parameters (EMBI). RESULTS The intensified intervention was feasible. PAS and FOIS scores improved in both groups, with no differences between groups. The swallowing specific parameters reflected clinically observed changes in swallowing. CONCLUSIONS PAS and FOIS are feasible instruments to measure dysphagia. It is possible and valid to measure swallowing frequency and kinematics using electromyography and bioimpedance. The definitive study should have widened inclusion criteria and optimise intervention timing to maintain patient arousal.
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Affiliation(s)
- D. Jakobsen
- Department of Neurorehabilitation, Rigshospitalet, TBI Unit, Copenhagen, Denmark
| | - I. Poulsen
- Department of Neurorehabilitation, Rigshospitalet, TBI Unit, Copenhagen, Denmark
- Department of Science in Nursing Health, Aarhus University, Aarhus, Denmark
| | | | - C.G. Riberholt
- Department of Neurorehabilitation, Rigshospitalet, TBI Unit, Copenhagen, Denmark
| | - D.J. Curtis
- Department of Neurorehabilitation, Rigshospitalet, TBI Unit, Copenhagen, Denmark
| | - T.H. Petersen
- Department of Neurorehabilitation, Rigshospitalet, TBI Unit, Copenhagen, Denmark
| | - R.O. Seidl
- Department of Otolaryngology at UKB, Hospital of the University of Berlin, Charite Medical School, Berlin, Germany
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Nordio S, Burgio F, D'Imperio D, De Biagi F, Cosentino E, Meneghello F. Communicative and swallowing disorders in anoxic patients: A retrospective study on clinical outcomes and performance measures. NeuroRehabilitation 2019; 45:453-461. [PMID: 31868687 DOI: 10.3233/nre-192884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anoxic brain injury (ABI) is a neurological condition associated to a severe deterioration of brain functioning, whose symptomatology and clinical outcomes may be heterogeneous: cognitive deficits, language disorders like dysarthria and swallowing impairments. Nevertheless, there is still a lack of information on the rehabilitation outcomes. OBJECTIVE To confirm the occurrence of communication and swallowing deficits in 37 ABI patients and to examine whether intensive rehabilitation may contribute to any improvements and its relation to ABI severity and functional autonomy. METHODS 37 patients, hospitalized at IRCCS San Camillo Hospital from 2011 to 2018 were analyzed retrospectively. All patients completed a functional evaluation and a language and swallowing assessment, within one week from hospital admission (T0). The assessment was repeated after an intensive rehabilitation treatment (T1). RESULTS Results show that dysphagia is a frequent and severe outcome in anoxic patients, whereas communication disorders (aphasia and dysarthria) are less severe. Moreover, ABI patients seem to be positively sensitive to an intensive rehabilitation program. CONCLUSIONS An early multidisciplinary management of communicative-linguistic and swallowing functions is crucial in order to prevent adverse events and to plan a tailored rehabilitation pathway.
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Miller CK, Willging JP. Fiberoptic Endoscopic Evaluation of Swallowing in Infants and Children: Protocol, Safety, and Clinical Efficacy: 25 Years of Experience. Ann Otol Rhinol Laryngol 2019; 129:469-481. [PMID: 31845586 DOI: 10.1177/0003489419893720] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The application of fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric dysphagia protocol requires specialized knowledge of pediatric conditions that result in dysphagia, recognition of normal and abnormal laryngopharyngeal anatomy and function across ages, and the ability to identify maturational changes in anatomy and function of the aerodigestive tract that pertain to airway protection and swallowing function. METHODS Over the past 25 years, we have performed over 7,000 collaborative Otolaryngology and Speech-Language Pathology FEES examinations in patients ranging from 2 days of age to young adults. During this time period, we have monitored the safety of the procedure, explored the feasibility and utility of FEES across conditions, compared and contrasted FEES to the videofluoroscopic evaluation of swallowing (VFSS), and developed specific pediatric FEES protocols with operational definitions for identification and interpretation of swallowing parameters. RESULTS FEES has proved to be a safe procedure in patients across ages. There have been no significant adverse events. FEES is comparable to the VFSS in the assessment of events before and after the swallow. It provides unique information regarding laryngopharyngeal anatomy and function, airway protection integrity, sensory threshold, and secretion management ability, as well as pharyngeal swallowing dynamics and the efficacy of compensatory swallowing strategies. CONCLUSIONS There are specific indications and contraindications for pediatric FEES, and unique components that characterize the pediatric FEES protocols across ages and conditions. FEES procedures performed jointly by an Otolaryngologist and Speech-Language pathologist offer a team approach to interpretation and management recommendations.
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Affiliation(s)
- Claire Kane Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jay Paul Willging
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Yoon JA, Kim SH, Jang MH, Kim SD, Shin YB. Correlations between Aspiration and Pharyngeal Residue Scale Scores for Fiberoptic Endoscopic Evaluation and Videofluoroscopy. Yonsei Med J 2019; 60:1181-1186. [PMID: 31769249 PMCID: PMC6881705 DOI: 10.3349/ymj.2019.60.12.1181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/11/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. MATERIALS AND METHODS We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. RESULTS A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05). CONCLUSION Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.
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Affiliation(s)
- Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Myung Hun Jang
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung Dong Kim
- Department of Otorhinolaryngology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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Cuellar ME, Harvey J. Predictive value of laryngeal adductor reflex testing in patients with dysphagia due to a cerebral vascular accident. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:593-601. [PMID: 30301381 DOI: 10.1080/17549507.2018.1512652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 06/27/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
Purpose: To determine the relationship between air pulse vs. touch laryngeal adductor reflex (LAR) tests and the clinical sensory findings of fiberoptic endoscopic evaluations of swallowing.Method: A retrospective review was conducted for 43 patients with dysphagia due to stroke that underwent fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). Each patient received LAR testing using air pulse or touch methodologies. Clinically, responsiveness to pharyngeal residue and responsiveness to penetration or aspiration were analysed.Result: The sensitivity, specificity, positive and negative predictive values for both LAR test groups indicate that LAR testing did not effectively predict sensory function during the clinical swallow evaluation. Across both LAR groups, specificity values were higher than sensitivity values. In fact, the specificity values for the light touch LAR test group were extremely high, but the negative predictive values did not support those findings. Sensitivity and positive predictive values were low for both groups.Conclusion: Although LAR testing provides valuable information regarding laryngeal sensory discrimination, the results of the current study suggest that a clinical evaluation of swallowing is critical for effectively assessing the way in which patients utilise sensory information during swallowing.
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Affiliation(s)
- Megan E Cuellar
- Speech-Language Pathology Program, Midwestern University, Downers Grove, IL, USA
| | - Jennine Harvey
- Communication Sciences and Disorders, Illinois State University, Normal, IL, USA
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Armstrong ES, Reynolds J, Carroll S, Sturdivant C, Suterwala MS. Comparing videofluoroscopy and endoscopy to assess swallowing in bottle-fed young infants in the neonatal intensive care unit. J Perinatol 2019; 39:1249-1256. [PMID: 31332272 DOI: 10.1038/s41372-019-0438-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of videofluoroscopy (VFSS) and endoscopy (FEES) in detecting laryngeal penetration and tracheal aspiration in bottle-fed young infants in the NICU. STUDY DESIGN VFSS and FEES findings of 22 infants were compared to each other and to a composite reference standard in this prospective study. Sensitivity, specificity, positive and negative predictive values were calculated for each assessment. RESULT Agreement between VFSS and FEES was high (92%) for aspiration and moderate (56%) for penetration, with FEES detecting more instances of penetration. Compared to the composite reference standard, FEES had greater sensitivity and a higher negative predictive value for penetration than VFSS. Because of the low prevalence of aspiration, diagnostic accuracy could not be determined for aspiration for either assessment. CONCLUSION FEES appears to be more accurate in detecting penetration in this population, and both assessments are valuable tools in a comprehensive feeding and swallowing evaluation.
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Affiliation(s)
- Erika S Armstrong
- Department of Communication Sciences and Oral Health, Texas Woman's University, Denton, TX, USA
| | - Jenny Reynolds
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Sandra Carroll
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Chrysty Sturdivant
- Department of Physical Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Mustafa S Suterwala
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA.
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Effect of aspiration on the lungs in children: a comparison using chest computed tomography findings. BMC Pediatr 2019; 19:162. [PMID: 31117982 PMCID: PMC6529997 DOI: 10.1186/s12887-019-1531-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 05/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Detecting and addressing aspiration early in children with dysphagia, such as those with cerebral palsy, is important for preventing aspiration pneumonia. The current gold standards for assessing aspiration are swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing (FEES) and videofluorographic swallowing study; however, the relationship between aspiration of secretion vs aspiration of foodstuff and pulmonary injury is unclear. To clarify this relationship, we examined the correlations between pneumonia findings from chest computed tomography (CT) and the presence or absence of aspiration detected by FEES. Methods Eighty-five children (11 years 2 months ±7 years 2 months) underwent FEES and chest CT. Based on the FEES findings, the participants were divided into groups: with and without food aspiration, and with and without saliva aspiration. Correlations between chest CT findings of pneumonia and the presence or absence of each type of aspiration were then examined. Results No significant correlations were observed between food aspiration and chest CT findings of pneumonia, whereas saliva aspiration and chest CT findings of pneumonia were significantly correlated. In addition, saliva aspiration was significantly associated with bronchial wall thickening (p < 0.01) and atelectasis (p < 0.05). Conclusions Our findings in children suggest that: (1) the presence or absence of food aspiration detected by FEES evaluation has little correlation with pneumonia, and (2) the presence or absence of saliva aspiration may be an indicator of aspiration pneumonia risk.
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Imaizumi M, Suzuki T, Matsuzuka T, Murono S, Omori K. Low‐risk assessment of swallowing impairment using flexible endoscopy without food or liquid. Laryngoscope 2019; 129:2249-2252. [DOI: 10.1002/lary.28073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mitsuyoshi Imaizumi
- Department of OtolaryngologySchool of Medicine, Fukushima Medical University Fukushima Japan
| | - Toshihiko Suzuki
- Department of OtolaryngologySchool of Medicine, Fukushima Medical University Fukushima Japan
| | - Takashi Matsuzuka
- Department of OtolaryngologySchool of Medicine, Fukushima Medical University Fukushima Japan
| | - Shigeyuki Murono
- Department of OtolaryngologySchool of Medicine, Fukushima Medical University Fukushima Japan
| | - Koichi Omori
- Department of OtolaryngologySchool of Medicine, Fukushima Medical University Fukushima Japan
- Department of Otolaryngology–Head and Neck SurgeryGraduate School of Medicine, Kyoto University Kyoto Japan
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The accuracy of the modified Evan's blue dye test in detecting aspiration in tracheostomised patients. The Journal of Laryngology & Otology 2019; 133:329-332. [PMID: 30929652 DOI: 10.1017/s0022215119000471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the sensitivity and specificity of the modified Evans blue dye test compared to the fibre-optic endoscopic evaluation of swallowing to detect aspiration in tracheostomised patients. METHODS This observational accuracy study included 17 patients hospitalised for respiratory complications, subjected to prolonged intubation, and for this reason, tracheostomised. RESULTS Mean patient age was 60.2 ± 21.0 years. Aspiration was identified in 10 patients when assessed by fibre-optic endoscopic evaluation of swallowing; of these, 1 had aspiration when evaluated by modified Evans blue dye test. The dye test had a sensitivity of 10.0 per cent and specificity of 100.0 per cent for detecting aspiration. Fibre-optic endoscopic evaluation of swallowing revealed no statistically significant associations between aspiration presence and: speech and language therapy duration, intubation time, or tracheostomy plus mechanical ventilation duration. CONCLUSION The modified Evans blue dye test is simple and inexpensive, and does not require prior knowledge in endoscopy; it may be used as an initial screening test in all tracheostomised patients for evaluating aspiration. However, fibre-optic endoscopic evaluation of swallowing should be used for a more comprehensive diagnosis of tracheostomy patients, especially for those at high risk for aspiration.
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