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Le HV, Javidan Y, Khan SN, Klineberg EO. Dysphagia After Anterior Cervical Spine Surgery: Pathophysiology, Diagnosis, and Management. J Am Acad Orthop Surg 2024; 32:627-636. [PMID: 38657173 DOI: 10.5435/jaaos-d-23-00778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024] Open
Abstract
Anterior cervical spine surgery (ACSS) is a surgical intervention widely used for a myriad of indications including degenerative, oncologic, inflammatory, traumatic, and congenital spinal conditions. A primary concern for surgeons performing ACSS is the postoperative development of oropharyngeal dysphagia. Current literature reports a wide incidence of this complication ranging from 1 to 79%. Dysphagia after ACSS is multifactorial, with common risk factors being prolonged duration of operation, revision surgeries, multilevel surgeries, and use of recombinant human bone morphogenetic protein-2. Many technical strategies have been developed to reduce the risk of postoperative dysphagia, including the development of low-profile implants and retropharyngeal local steroid application. In this article, we review the most recent literature regarding the epidemiology and pathophysiology, diagnostic criteria, risk factors, and management of dysphagia after ACSS.
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Affiliation(s)
- Hai V Le
- From the Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA (Le, Javidan, Khan), and the Department of Orthopaedic Surgery, John P. and Kathrine G. McGovern Medical School at UTHealth, Houston, TX (Klineberg)
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2
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Venkat S. Improving swallowing function with thickening agents in post-stroke oropharyngeal dysphagia: a real-world experience. Curr Med Res Opin 2024; 40:1163-1170. [PMID: 38864410 DOI: 10.1080/03007995.2024.2365406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Post-stroke dysphagia (PSD) is a widely prevalent and possibly life-threatening consequence that may lead to aspiration pneumonia, malnutrition, dehydration, and higher mortality risk. Recommending thickened fluids (TF) is a longstanding practice in the management of dysphagia. Augmenting liquid viscosity with a xanthan gum-based thickener benefits patients with PSD by aiding in the enhancement of bolus control, facilitating improved coordination in the swallowing mechanism, and lowering the risk of aspiration. Despite the widespread use of TF, limited high-quality evidence supports its benefits in PSD. CASE REPORT This manuscript presents the clinical experience with four varied cases of PSD. A comprehensive approach to management with TF decreased the risk of aspiration pneumonia and facilitated effective management of dietary recommendations both during hospitalization and after discharge (all Cases). In addition, TF maintained nutrition and hydration in patients with multiple hospital admissions (Case 2), maintained hydration in those unable to engage in swallow rehabilitation due to complex medical conditions (Cases 2, 3, and 4), and those who needed slow and longer recovery due to long-term risk of silent aspiration (Cases 2, 3, and 4). In one case (Case 4), the use of TF was extended for more than two years post-stroke with no reported incidence of chest infection. CONCLUSION In routine clinical practice, a comprehensive management approach with xanthan gum-based TFs reduces the risk of aspiration and aspiration pneumonia in patients with PSD while maintaining nutritional and hydration and improving swallowing function based on formal instrumental assessments. This clinical experience highlights the pivotal role of instrumental assessment, patient education, and informed decision-making to optimize outcomes with TF.
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Georgiou R, Voniati L, Papaleontiou A, Gryparis A, Ziavra N, Tafiadis D. Exploring the diagnostic accuracy and applicability of the Gugging Swallowing Screen in children with feeding and/or swallowing disorders. Neurogastroenterol Motil 2024; 36:e14790. [PMID: 38545701 DOI: 10.1111/nmo.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The Gugging Swallowing Screen (GUSS) is a bedside dysphagia screening tool that has been designed to determine the risk of aspiration in acute stroke patients. There is no evidence in the literature for the GUSS for the pediatric population. The present study aimed to determine the diagnostic accuracy of GUSS as a screening tool in the Greek language for children with dysphagia. METHODS Eighty-Greek-Cypriot children aged 3-12 years who had dysphagia participated in this retrospective study. The translated into Greek GUSS was administered twice (pre- and post-therapy) to each patient throughout 24 sessions of dysphagia therapy. KEY RESULTS The GUSS showed a high internal consistency (Cronbach's α = 0.826), good test-retest reliability (rs = 0.767), convergent validity compared to the Greek Pediatric Eating Assessment tool-10 (PEDI-EAT-10) total score (rs = -0.365), and inter-rater reliability (κ = 0.863). A total cutoff points equal to 13.00 was also calculated. Aspiration was identified by the GUSS with low sensitivity and high specificity (PPV 100%, NPV 57%, LR+ NA, LR- 0.79); dysphagia/penetration was identified with high sensitivity and low specificity (PPV 33%, NPV 100%, LR+ 0.102, LR- NA). CONCLUSIONS & INFERENCES The pediatric version of GUSS has been found to be a valuable tool in identifying the risk of aspiration as that of adults. It proved to be used as a good screening guide for selecting and confirming the existence of dysphagia from instrumental assessments. This is the first study of the pediatric version of GUSS, and future studies on this topic are needed.
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Affiliation(s)
- Rafaella Georgiou
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Department of Health Sciences, Speech and Language Therapy, European University, Nicosia, Cyprus
| | - Louiza Voniati
- Department of Health Sciences, Speech and Language Therapy, European University, Nicosia, Cyprus
| | - Andri Papaleontiou
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandros Gryparis
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nafsika Ziavra
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dionysios Tafiadis
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Department of Health Sciences, Speech and Language Therapy, European University, Nicosia, Cyprus
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Kitila M, Borders JC, Krisciunas GP, McNally E, Pisegna JM. Confidence, Accuracy, and Reliability of Penetration-Aspiration Scale Ratings on Flexible Endoscopic Evaluations of Swallowing by Speech Pathologists. Dysphagia 2024; 39:504-513. [PMID: 37980635 DOI: 10.1007/s00455-023-10635-5] [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: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
This study investigated rater confidence when rating airway invasion with the penetration-aspiration scale (PAS) on flexible endoscopic evaluations of swallowing (FEES), raters' accuracy against a referent-standard, inter-rater reliability, and potential associations between clinician confidence, experience, and accuracy. Thirty-one clinicians who use FEES in their daily practice were asked to judge airway invasion with the PAS and to rate their confidence that their score was correct (0-100) for 40 video clips, five in each of the 8 PAS categories. We found that raters were most confident in rating PAS 1, 7, and 8. The average confidence score across all videos was 76/100. Confidence did not have a significant relationship with accuracy against the referent-standard. Accuracy was highest for PAS 1 (92%), followed by PAS 8 (80%), PAS 7 (77%), and PAS 4 (72%). Accuracy was below 60% for PAS 2, 3, 5, and 6, the lowest being for PAS 3 (49%). Mean accuracy for all ratings, compared to referent-standard ratings, was highest for the intermediate group (71%), followed by expert (68%) and novice (65%). In general, we found that certain PAS scores tend to be rated more accurately, and that participating SLPs had varied confidence in PAS ratings on FEES. Potential reasons for these findings as well as suggested next steps are discussed.
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Affiliation(s)
- Merertu Kitila
- Boston Medical Center, Boston, MA, USA
- George Washington University Hospital, Washington, DC, USA
| | - James C Borders
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Gintas P Krisciunas
- Boston Medical Center, Boston, MA, USA
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Jessica M Pisegna
- Boston Medical Center, Boston, MA, USA.
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
- Department of Speech Language Pathology, Sargent College, Boston University, Boston, MA, USA.
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Kimura S, Emoto T, Suzuki Y, Shinkai M, Shibagaki A, Shichijo F. Novel Approach Combining Shallow Learning and Ensemble Learning for the Automated Detection of Swallowing Sounds in a Clinical Database. SENSORS (BASEL, SWITZERLAND) 2024; 24:3057. [PMID: 38793908 PMCID: PMC11124773 DOI: 10.3390/s24103057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Cervical auscultation is a simple, noninvasive method for diagnosing dysphagia, although the reliability of the method largely depends on the subjectivity and experience of the evaluator. Recently developed methods for the automatic detection of swallowing sounds facilitate a rough automatic diagnosis of dysphagia, although a reliable method of detection specialized in the peculiar feature patterns of swallowing sounds in actual clinical conditions has not been established. We investigated a novel approach for automatically detecting swallowing sounds by a method wherein basic statistics and dynamic features were extracted based on acoustic features: Mel Frequency Cepstral Coefficients and Mel Frequency Magnitude Coefficients, and an ensemble learning model combining Support Vector Machine and Multi-Layer Perceptron were applied. The evaluation of the effectiveness of the proposed method, based on a swallowing-sounds database synchronized to a video fluorographic swallowing study compiled from 74 advanced-age patients with dysphagia, demonstrated an outstanding performance. It achieved an F1-micro average of approximately 0.92 and an accuracy of 95.20%. The method, proven effective in the current clinical recording database, suggests a significant advancement in the objectivity of cervical auscultation. However, validating its efficacy in other databases is crucial for confirming its broad applicability and potential impact.
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Affiliation(s)
- Satoru Kimura
- Division of Science and Technology, Graduate School of Sciences and Technology for Innovations, Tokushima University, Tokushima 770-8506, Japan;
| | - Takahiro Emoto
- Division of Science and Technology, Industrial and Social Science, Graduate School of Technology, Tokushima University, Tokushima 770-8506, Japan
| | - Yoshitaka Suzuki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Mizuki Shinkai
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Akari Shibagaki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Fumio Shichijo
- Department of Neurosurgery, Suzue Hospital, Tokushima 770-0028, Japan;
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Abdel-Hay D, Abdelhay O, Ghatasheh HA, Al-Jarrah S, Eid S, Al Tamimi MA, Al-Mayata I. The Arabic EAT-10 and FEES in dysphagia screening among cancer patients: a comparative prospective study. Sci Rep 2024; 14:9258. [PMID: 38649708 PMCID: PMC11035686 DOI: 10.1038/s41598-024-58572-z] [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: 11/05/2023] [Accepted: 04/01/2024] [Indexed: 04/25/2024] Open
Abstract
Head and neck cancer treatments, such as radiotherapy, chemotherapy, and surgery, have diverse effects on patients, leading to dysphagia as a significant post-treatment issue. This study aims to evaluate the effectiveness of the Arabic version of the EAT-10 screening instrument (A-EAT-10) using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) as an imperfect gold standard. Additionally, we seek to establish a correlation between A-EAT-10 and PEG tube insertion in head and neck cancer (HNC) patients. Our sample comprised 130 head and neck cancer patients with varying cancer types at King Hussein Cancer Center (KHCC). We followed these patients throughout their distinct treatment plans up to one month after their final treatment session. During follow-up visits, we administered the A-Eat-10 instrument to monitor dysphagia. FEES were conducted at the initial and concluding visits to compare results with A-EAT-10 scores. The results in our tests, assuming independence or dependence, demonstrated excellent agreement. A-EAT-10 exhibited outstanding predictive capabilities with an AUC ranging from 93 to 97%. A-EAT-10 tended to slightly overestimate dysphagia at later treatment stages by approximately 20% compared to FEES, with an RR of 1.2 (95% CI 0.91, 1.56, p-value = 0.21), indicating statistical insignificance. In conclusion, A-EAT-10 is an excellent option for dysphagia evaluation, offering non-invasive, straightforward, and cost-effective advantages compared to FEES. Its utility extends to predicting the need for PEG tube insertion at initial patient visits, making it a valuable tool for informed treatment decisions. Notably, A-EAT-10 demonstrates a diminishing correlation with FEES over time.
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Affiliation(s)
- Da'ad Abdel-Hay
- Department of Surgery, King Hussein Cancer Centre, Queen Rania Street, Amman, 11941, Jordan.
| | - Osama Abdelhay
- Department of Data Science and Artificial Intelligence, Princess Sumaya University of Technology, Khalil Saket Street, Amman, 1438, Jordan
| | - Hamza A Ghatasheh
- Department of Radiation Oncology, King Hussein Cancer Centre, Queen Rania Street, Amman, 11941, Jordan
| | - Sameer Al-Jarrah
- Royal Rehabilitation Center, King Hussein Medical Center, King Abdullah II St 230, Amman, Jordan
| | - Suhaib Eid
- Department of Surgery, King Hussein Cancer Centre, Queen Rania Street, Amman, 11941, Jordan
| | - Mutaz A Al Tamimi
- Department of Nursing, King Hussein Cancer Centre, Queen Rania Street, Amman, 11941, Jordan
| | - Ibrahim Al-Mayata
- Department of Surgery, King Hussein Cancer Centre, Queen Rania Street, Amman, 11941, Jordan
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Lu YT, Tseng WH, Chiu HL, Yang TL. Improvement in swallowing safety after injection laryngoplasty in patients with unilateral vocal paralysis complicated with aspiration. J Formos Med Assoc 2024; 123:179-187. [PMID: 37517935 DOI: 10.1016/j.jfma.2023.07.012] [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: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The benefit of injection laryngoplasty (IL) on voice for unilateral vocal fold paralysis (UVFP) is supported increasingly in literatures, yet less is known for swallowing. Also, prevalence of patient-reported dysphagia is substantially higher than instrumental studies. This prospective study focused on swallowing outcomes, with predetermined flexible endoscopic evaluation of swallowing (FEES) protocol that simulates daily life situation. METHODS Adult patients with UVFP and aspiration receiving IL were recruited. Voice outcome measurements, as well as swallowing outcomes including Eating Assessment Tool (EAT-10) and FEES, which challenged patients with different fluid volumes: 10 mL, 20 mL, and 90 mL cup sipping were evaluated. RESULTS Significant improvements were demonstrated in all voice outcomes. Significant changes were also presented inEAT-10 (P < 0.01). Pre-operatively, penetration-aspiration scale (PAS) was 1.5 ± 1.3, 1.9 ± 1.7 and 2.3 ± 1.8 for 10 mL, 20 mL and 90 mL serial sipping, and improved to 1.1 ± 0.3, 1.1 ± 0.4 and 1.4 ± 0.7 post-operatively (P < 0.01). Safe swallowing (PAS ≤ 2) was achieved in all, except for one patient, who presented with a post-injection PAS of 4 (material enters the airway, contacts the vocal folds, and is ejected from the airway) on 90 mL cup sipping, whose pre-injection PAS was 7 (residue in trachea). CONCLUSION Maintaining swallowing function suitable for social environment is important. Our results demonstrated the feasibility of the predetermined FEES protocol, and positive effects of IL on both voice and swallowing outcomes.
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Affiliation(s)
- Yu-Tung Lu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsiang-Ling Chiu
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
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Javorszky SM, Reiter R, Iglseder B. Validation of a Geriatric Bedside Swallowing Screen (GEBS): Protocol of a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e46252. [PMID: 37566452 PMCID: PMC10457692 DOI: 10.2196/46252] [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: 02/03/2023] [Revised: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Demographic changes will raise the need for specialized care of older patients. Oropharyngeal dysphagia has recently been declared a geriatric syndrome reflecting its multifactorial background. Alongside multimorbidity, sarcopenia, frailty, and disability, swallowing disorders increase with advancing age, with prevalence rates reported to be as high as 44% in acute geriatric hospital settings and 80% in long-term care facilities. Hence, systematic screening of older patients to diagnose dysphagia and initiate treatment is of paramount importance to prevent bolus death, aspiration pneumonia, and malnutrition and improve quality of life. Several screening tools have been evaluated in emergency and stroke units. However, no published dysphagia screening tool has been validated in the hospitalized, older adult population using a gold standard in dysphagia diagnostics as a reference test. The validation of the proposed test is a first step. OBJECTIVE The Geriatric Bedside Swallowing Screen (GEBS) study aims to validate a new screening tool developed specifically for older inpatients against an instrumental swallowing evaluation, the flexible endoscopic evaluation of swallowing (FEES), which is considered a gold standard. Primary outcomes to be evaluated are sensitivity and specificity for the GEBS in the detection of dysphagia in a mixed older adult population. The presence of dysphagia will be defined by an instrumental swallowing evaluation (FEES), analyzed by the standardized penetration-aspiration scale. METHODS To validate the GEBS, a prospective cohort study will be carried out. Two institutions, an acute geriatric department and a long-term care facility, will aim to recruit a total of 100 patients aged ≥75 years. After giving their informed consent, patients will undergo the full screening protocol described in the GEBS as well as an evaluation of swallowing function using the FEES. Investigators will be blinded to the results of the respective other testing. The analysis of pseudonymized data sets will be done by a third investigator. Outcomes to be considered are sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood quotient, and the reliability of the proposed dysphagia screening tool using the κ coefficient. RESULTS Recruitment started in October 2022 and will end in April 2024. Data publication is planned for early 2025. CONCLUSIONS If proven to be a valid screening tool for the early detection of dysphagia, further studies including different older adult populations as well as studies to determine the impact of systematic dysphagia screening on parameters, such as rates of aspiration pneumonia or nutritional status, should be planned. Effective screening of dysphagia will lead to earlier detection of patients with impaired swallowing. Those who fail the screening will be referred to speech language pathology for further diagnosis, thus optimizing care while streamlining personnel resources. TRIAL REGISTRATION ISCRTN Registry ISRCTN11581931; https://www.isrctn.com/ISRCTN11581931. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46252.
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Affiliation(s)
- Susanne Maria Javorszky
- Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Department of Health Sciences, University of Applied Sciences, Vienna, Austria
| | - Raphael Reiter
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
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Lapa S. [Flexible endoscopic evaluation of swallowing in neurology]. DER NERVENARZT 2023; 94:664-675. [PMID: 37378909 DOI: 10.1007/s00115-023-01517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Neurogenic dysphagia is a frequent symptom in a variety of neurological diseases. The establishment of the flexible endoscopic evaluation of swallowing (FEES) in the field of neurology has led to improvements in the diagnostics and treatment of patients with dysphagia. OBJECTIVE The aim of this review is to present the development of the FEES examination in the field of neurology. Furthermore, the additive value in the diagnostic classification of neurogenic dysphagia is elucidated and the impact on treatment management in patients with dysphagia is highlighted. MATERIAL AND METHODS Narrative literature review. RESULTS The FEES examination is a safe and well-tolerated method for the diagnostics of neurogenic dysphagia. It enables the valid investigation of the swallowing function within the very heterogeneous neurological patient population. It has become an important diagnostic tool, not only in the assessment of the severity of dysphagia and the risk of aspiration but also as a reliable method for the etiological classification of symptoms of deglutition disorders. As FEES can be performed at the bedside and does not require radiation exposure, it can be used not only to examine critically ill patients (point of care diagnostics) but also to monitor treatment. CONCLUSION The systematic endoscopic evaluation of swallowing is established as an important functional diagnostic tool in the field of neurology. Further developments to increase the use of FEES in clinically related disciplines such as neurosurgery, neuro-oncology or psychiatry are pending.
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Affiliation(s)
- Sriramya Lapa
- Klinik für Neurologie, Zentrum für Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt Goethe Universität, Schleusenweg 2-16, 60590, Frankfurt am Main, Deutschland.
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Sharaf OM, Hao KA, Demos DS, Plowman EK, Ahmed MM, Jeng EI. Utility of Fiberoptic Endoscopic Evaluation of Swallowing After Left Ventricular Assist Device Implantation. Cureus 2023; 15:e42291. [PMID: 37609102 PMCID: PMC10441160 DOI: 10.7759/cureus.42291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
Objective Dysphagia following cardiac surgery is common and associated with adverse outcomes. Among patients receiving left ventricular assist devices (LVAD), we evaluated the impact of fiberoptic endoscopic evaluation of swallowing (FEES) on outcomes. Methods A single-center pilot study was conducted in adults (≥18 years of age) undergoing durable LVAD (February 2019 - January 2020). Six patients were prospectively enrolled, evaluated, and underwent FEES within 72 hours of extubation-they were compared to 12 control patients. Demographic, surgical, and postoperative outcomes were collected. Unpaired two-sided t-tests and Fisher's exact tests were performed. Results Baseline characteristics were similar between groups. Intraoperative criteria including duration of transesophageal echo (314 ± 86 min) and surgery (301 ± 74 min) did not differ. The mean time of intubation was comparable (57.3 vs. 68.7 hours, p=0.77). In the entire cohort, 30-day, one-year, two-year, and three-year mortality were 0%, 5.6%, 5.6%, and 16.7%, respectively. Sixty-seven percent of the patients that underwent FEES had inefficient swallowing function. The FEES group trended to a shorter hospital length of stay (LOS) (29.1 vs. 46.6 days, p=0.098), post-implantation LOS (25.3 vs 30.7 days, p=0.46), and lower incidence of postoperative pneumonia (16.7% vs. 50%, p=0.32) and sepsis (0% vs. 33.3%, p=0.25). Conclusion FEES did not impact 30-day, one-year, two-year, or three-year mortality. Though not statistically significant, patients who underwent FEES trended toward shorter LOS and lower postoperative pneumonia and sepsis rates. Additionally, we report a higher incidence of dysphagia among patients undergoing FEES despite comparable baseline risk factors with controls.
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Affiliation(s)
- Omar M Sharaf
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Kevin A Hao
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Daniel S Demos
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Emily K Plowman
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida Health, Gainesville, USA
| | - Eric I Jeng
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
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Yang S, Park JW, Min K, Lee YS, Song YJ, Choi SH, Kim DY, Lee SH, Yang HS, Cha W, Kim JW, Oh BM, Seo HG, Kim MW, Woo HS, Park SJ, Jee S, Oh JS, Park KD, Jin YJ, Han S, Yoo D, Kim BH, Lee HH, Kim YH, Kang MG, Chung EJ, Kim BR, Kim TW, Ko EJ, Park YM, Park H, Kim MS, Seok J, Im S, Ko SH, Lim SH, Jung KW, Lee TH, Hong BY, Kim W, Shin WS, Lee YC, Park SJ, Lim J, Kim Y, Lee JH, Ahn KM, Paeng JY, Park J, Song YA, Seo KC, Ryu CH, Cho JK, Lee JH, Choi KH. Clinical Practice Guidelines for Oropharyngeal Dysphagia. Ann Rehabil Med 2023; 47:S1-S26. [PMID: 37501570 PMCID: PMC10405672 DOI: 10.5535/arm.23069] [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: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Song
- Department of Occupational Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Hee Choi
- Department Audiology and Speech-Language Pathology, Daegu Catholic University, Gyoungsan, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Kim
- Department of Otolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hee-Soon Woo
- Department of Occupational Therapy, School of Medicine, Wonkwang University, Iksan, Korea
| | - Sung-Jong Park
- Department of Speech Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Sun Oh
- Department of Rehabilitation Medicine, Seoul Medical Center, Seoul, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sungjun Han
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - DooHan Yoo
- Department of Occupational Therapy, Konyang University, Daejeon, Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Haeng Lee
- Deptartment of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gu Kang
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanaro Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Department of Gastroenterology, Konyang University College of Medicine, Daejeon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojeong Kim
- Deptartment of Nutrition & Food Control, Gangnam Severance Hospital, Seoul, Korea
| | - Weon-Sun Shin
- Deptartment of Food & Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jeonghyun Lim
- Department of Food Service & Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Young Ae Song
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Cheon Seo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Liou HH, Hsieh MHC, Tsai SH, Hung DSY, Chen YJ, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. Relationship Between Pharyngeal Residues Assessed by Bolus Residue Scale or Normalized Residue Ratio SCALE and Risk of Aspiration in Head and Neck Cancer Who Underwent Videofluoroscopy. Dysphagia 2023; 38:700-710. [PMID: 35953736 DOI: 10.1007/s00455-022-10501-w] [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: 12/28/2021] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
Abstract
Dysphagia affects 60-75% of patients treated for head and neck cancer (HNC). We aimed to evaluate the association between residue severity and airway invasion severity using a videofluoroscopic swallowing study and identify risk factors for poor penetration-aspiration outcomes in patients with dysphagia treated for HNC. Penetration-Aspiration Scale (PAS) was used to assess airway invasion severity, while residue severity was assessed using both the Bolus Residue Scale (BRS) for residue location and the Normalized Residue Ratio Scale (NRRS) for residue amount. Relevant covariates were adjusted in the logistic regression models to account for potential confounding. Significantly higher abnormal PAS was reported for increased piriform sinus NRRS (NRRSp) [odds ratio (OR), 4.81; p = 0.042] with liquid swallowing and increased BRS value (OR, 1.52; p = 0.014) for semi-liquid swallowing in multivariate analysis. Tumor location, older age, and poorer Functional Oral Intake Scale (FOIS) were significant factors for abnormal PAS in both texture swallowings. After adjusting for confounding factors (sex, age, and FOIS score), NRRS model in liquid swallowing (area under the curve [AUC], 0.83; standard error = 0.04, 95% confidence interval [CI]: 0.75, 0.91) and BRS in semi-liquid swallowing (AUC, 0.83; SE = 0.04; 95% CI: 0.76, 0.91) predicted abnormal PAS. The results indicate that while assessing residue and swallowing aspiration in patients with HNC, it is important to consider age, tumor location, and functional swallowing status. The good predictability of abnormal PAS with BRS and NRRS indicated that residue location and amount were both related to the aspiration event in patients with HNC.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Han Tsai
- Division of General Medicine, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Yi-Jen Chen
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan.
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13
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Helliwell K, Hughes VJ, Bennion CM, Manning-Stanley A. The use of videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) in the investigation of oropharyngeal dysphagia in stroke patients: A narrative review. Radiography (Lond) 2023; 29:284-290. [PMID: 36640583 DOI: 10.1016/j.radi.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Patients with suspected acute stroke require rapid assessment of swallowing on admission. If aspiration is suspected, this takes the form of specialist assessment, using either videofluoroscopy (VFS) or fibreoptic endoscopic evaluation of swallowing (FEES). The review aim was to evaluate and compare the effectiveness of each method in stroke patients. Literature was collected from the databases Scopus, Web of Science and Medline, and articles included in the review were published within the last 10 years, in the English language. KEY FINDINGS Sensitivity and specificity ranged from 0.29-0.33 and 0.96-1.0 for VFS, respectively, and 0.37-1.0 and 0.65-0.87 for FEES, respectively, depending on the type of bolus utilised. VFS is the current gold-standard for the investigation of oropharyngeal dysphagia (OD), however, radiation dose and patient transport implications mean FEES may be preferred. FEES has limitations including 'whiteout' and the invasive nature of the endoscope. The NICE guidelines do not recommend a definitive protocol specifically in stroke patients. This suggests further research may be required to determine the most effective method. CONCLUSION FEES is a beneficial first line examination, providing limited invasiveness, and administering a high level of patient suitability, without using ionising radiation. VFS could potentially be useful following FEES to secure full visualisation, ensuring an aspiration event is not missed during FEES. IMPLICATIONS FOR PRACTICE Use of FEES as the first line test rather than VFS, ensures radiation dose is as low as reasonably practicable (ALARP). Ongoing research to ensure protocols follow current best practice can help ensure accurate management of oropharyngeal dysphagia in stroke patients.
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Affiliation(s)
- K Helliwell
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale Royal Hospital, Salterhebble, Halifax, HX3 0PW, UK.
| | - V J Hughes
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
| | - C M Bennion
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
| | - A Manning-Stanley
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
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14
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Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. Instrumental swallowing assessment in adults in residential aged care homes: Practice patterns and opportunities. Australas J Ageing 2023; 42:108-117. [PMID: 35938310 PMCID: PMC10947304 DOI: 10.1111/ajag.13122] [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: 02/23/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe practice patterns in the use of instrumental swallowing assessment (ISA) for older adults in residential aged care homes (RACHs). METHODS A retrospective audit of medical records of residents living in RACHs in Melbourne, Australia to extract data on speech-language pathologist (SLP) involvement, indications for ISA and ISA practice patterns. RESULTS Medical files of 323 residents across four Melbourne facilities were reviewed. 36% (n = 115) of residents were referred to SLP for swallowing assessment. Referral to SLP was related to length of stay (U = 7393.00, p < 0.001), dementia status (χ2 [1] = 7.06, p = 0.008), texture modification (χ2 [1] = 93.34, p < 0.001) and an existing dysphagia diagnosis (χ2 [1] = 112.89, p < 0.001). There were no referrals for ISA and no instances of ISA being used. Among 115 residents who were referred to SLP for swallowing assessment, there were 33 instances where ISA might be clinically relevant according to ISA indicators. CONCLUSIONS Instrumental swallowing assessment is not being used for the management of swallowing in RACHs in Australia despite a clinical need for ISA and a potential role for ISA to improve swallowing care quality. Lack of timely ISA may fail to meet the complex health-care needs of older adults living with dysphagia in RACHs, increasing their vulnerability to complications of dysphagia and its management.
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Affiliation(s)
- Olga Birchall
- Centre for Neurosciences of SpeechThe University of MelbourneMelbourneVictoriaAustralia
- Department of Audiology and Speech PathologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Michelle Bennett
- School of Allied HealthAustralian Catholic UniversityNorth SydneyNew South WalesAustralia
| | - Nadine Lawson
- Speech Pathology DepartmentCabrini HospitalMalvernVictoriaAustralia
| | - Susan M. Cotton
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleVictoriaAustralia
- Centre for Youth Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Adam P. Vogel
- Centre for Neurosciences of SpeechThe University of MelbourneMelbourneVictoriaAustralia
- Department of Neurodegeneration, Hertie Institute for Clinical Brain ResearchUniversity of TübingenTubingenGermany
- RedenlabMelbourneVictoriaAustralia
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15
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Jenkins GW, Kennedy MP, Ellabban I, Adams JR, Sellstrom D. Functional outcomes following mandibulectomy and fibular free-flap reconstruction. Br J Oral Maxillofac Surg 2023; 61:158-164. [PMID: 36717338 DOI: 10.1016/j.bjoms.2022.11.287] [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: 08/11/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 01/04/2023]
Abstract
There remains a paucity of evidence with regards to functional outcomes following the reconstruction of segmental defects in the mandible. It is, however, well recognised that oral rehabilitation following head and neck surgery is a driver of improved quality of life outcomes. We present a prospective service review of functional outcomes of a consecutive cohort of patients following segmental mandibulectomy and virtual surgical planning (VSP) composite fibular free-flap reconstruction. Twenty-five patients, who were identified as having a complete dataset with a minimum of 12 months' follow up, ultimately met the inclusion criteria. Validated functional outcome measures were used primarily to assess speech, diet, and swallowing outcomes. The results demonstrate a decline in both speech and swallowing outcomes at three months postoperatively, with a decline of 37% in the Speech Handicap Index from the preoperative baseline, and a decline of 35% in the MD Anderson Dysphagia Inventory score over the same period. The MD Anderson Dysphagia Inventory score improved at 12 months, whereas the Speech Handicap Index did not. Fundamentally a collaborative approach is required between members of the multidisciplinary team (MDT) to enable optimal patient outcomes.
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Affiliation(s)
- Glyndwr W Jenkins
- The James Cook University Hospital, Marton Road, Middlesbrough TS4 3bW, United Kingdom.
| | - Matthew P Kennedy
- Newcastle Upon Tyne Hospitals, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom
| | - Islam Ellabban
- The York Hospital, Wigginton Road, Clifton, York YO31 8HE, United Kingdom
| | - James R Adams
- Newcastle Upon Tyne Hospitals, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom
| | - Diane Sellstrom
- Newcastle Upon Tyne Hospitals, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom
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16
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Zhang PP, Yuan Y, Lu DZ, Li TT, Zhang H, Wang HY, Wang XW. Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis. Dysphagia 2023; 38:145-158. [PMID: 35849209 PMCID: PMC9873714 DOI: 10.1007/s00455-022-10486-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023]
Abstract
The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value is still controversial. In this systematic review and meta-analysis, we estimated and compared the diagnostic accuracy of EAT-10 cutoff values of 2 and 3 for screening dysphagia. We searched the PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WANFANG, and VIP databases from May 2008 to March 2022. The meta-analysis included 7 studies involving 1064 subjects from 7 different countries. Two studies were classified as high quality and five studies as medium quality. With an EAT-10 cutoff value of 2, using flexible endoscopic evaluation of swallowing or video fluoroscopic swallowing study as the gold standard, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.89 (95% confidence interval [CI] 0.82-0.93), 0.59 (95% CI 0.39-0.77), 2.17 (95% CI 1.38-3.42), 0.19 (95% CI 0.13-0.29), and 11.49 (95% CI 5.86-22.53), respectively. When a cutoff of 3 was used, these values were 0.85 (95% CI 0.68-0.94), 0.82 (95% CI 0.65-0.92), 4.84 (95% CI 1.72-13.50), 0.18 (95% CI 0.07-0.46), and 26.24 (95% CI 5.06-135.95), respectively. Using EAT-10 cutoff values of 2 and 3, the areas under the curve were 0.873 (95% CI 0.82-0.93) and 0.903 (95% CI 0.88-0.93), respectively, showing good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, a cutoff of 3 is recommended for EAT-10 due to better diagnostic accuracy.
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Affiliation(s)
- Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Ying Yuan
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - De-Zhi Lu
- School of Medical, Shanghai University, 99 Shangda Road, Shanghai, China
| | - Ting-Ting Li
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hui Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hong-Ying Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China.
- Rehabilitation Department, Affiliated Hospital of Weifang Medical College, 518 Fuyuan Street, Weifang, Shandong, China.
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17
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The Relationship Between Lingual Strength and Functional Swallowing Outcomes in Parkinson’s Disease. Dysphagia 2022:10.1007/s00455-022-10543-0. [DOI: 10.1007/s00455-022-10543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
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18
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Synchronization between videofluoroscopic swallowing study and surface electromyography in patients with neurological involvement presenting symptoms of dysphagia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:650-664. [PMID: 36511672 PMCID: PMC9814368 DOI: 10.7705/biomedica.6446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 12/14/2022]
Abstract
Introduction: Dysphagia is defined as the difficulty in transporting food and liquids from the mouth to the stomach. The gold standard to diagnose this condition is the videofluoroscopic swallowing study. However, it exposes patients to ionizing radiation. Surface electromyography is a non-radioactive alternative for dysphagia evaluation that records muscle electrical activity during swallowing.
Objective: To evaluate the relationship between the relative activation times of the muscles involved in the oral and pharyngeal phases of swallowing and the kinematic events detected in the videofluoroscopy.
Materials and methods: Electromiographic signals from ten patients with neurological involvement who presented symptoms of dysphagia were analyzed simultaneously with
videofluoroscopy. Patients were given 5 ml of yogurt, 10 ml of water, and 3 g of crackers. Masseter, suprahyoid, and infrahyoid muscle groups were studied bilaterally. The bolus transit through the mandibular line, vallecula, and the cricopharyngeus muscle was analyzed in relation to the onset and offset times of each muscle group activation.
Results: The average time of the pharyngeal phase was 0.89 ± 0.12 s. Muscle activation was mostly observed prior to the bolus transit through the mandibular line and vallecula. The end of the muscle activity suggested that the passage of the bolus through the cricopharyngeus muscle was almost complete.
Conclusión: The muscle activity times, duration of the pharyngeal phase, and sequence of the muscle groups involved in swallowing were determined using sEMG validated with the videofluoroscopic swallowing study.
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19
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Matos KC, de Oliveira VF, de Oliveira PLC, Carvalho FA, de Mesquita MRM, da Silva Queiroz CG, Marques LM, Lima DLN, Carvalho FMM, Braga-Neto P. Combined conventional speech therapy and functional electrical stimulation in acute stroke patients with dyphagia: a randomized controlled trial. BMC Neurol 2022; 22:231. [PMID: 35733098 PMCID: PMC9215026 DOI: 10.1186/s12883-022-02753-8] [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: 01/05/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is the main cause of oropharyngeal neurogenic dysphagia. Electrostimulation has been used as a therapeutic tool in these cases. However, there are few studies that prove its effectiveness. We evaluated the effect of functional electrostimulation as a complement to conventional speech therapy in patients with dysphagia after a stroke in a stroke unit. METHODS We performed a clinical, randomized, and controlled trial divided into intervention group (IG) (n = 16) and control group (CG) (n = 17). All patients were treated with conventional speech therapy, and the IG also was submitted to the functional electrotherapy. Primary outcomes were Functional Oral Ingestion Scale (FOIS) and Swallowing videoendoscopy (FEES). The degree of dysphagia was scored in functional, mild, moderate and severe dysphagia according to FEES procedure. Dysphagia Risk Evaluation Protocol (DREP) was considered a secondary outcome. RESULTS There was a significant difference regarding FOIS scores after 5 days of intervention in groups. Both groups also showed a tendency to improve dysphagia levels measured by FEES, although not statistically significant. Improvements on oral feeding was seen in both groups. No significant differences between groups before and after the intervention were detected by DREP scores. Electrical stimulation did not show additional benefits beyond conventional therapy when comparing outcomes between groups. CONCLUSION Conventional speech therapy improved oral ingestion even regardless the use of electrostimulation in a stroke unit. TRIAL REGISTRATION This research was registered in ClinicalTrials.gov (Identifier: NCT03649295 ) in 28/08/2018 and in the Brazilian Registry of Clinical Trials (ReBEC) (Register Number: RBR-56QK5J), approval date: 18/12/2018. HGF Ethics Committee Approval Number: N. 2.388.931.
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Affiliation(s)
- Klayne Cunha Matos
- Speech Therapy Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.,Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | | | | | | | - Levi Mota Marques
- Otorhinolaryngology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | - Fernanda Martins Maia Carvalho
- Medical Sciences Post-Graduation Program, Universidade de Fortaleza, Fortaleza, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil. .,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.
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20
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Oropharyngeal Dysphagia as the Main Expression of Amyotrophic Lateral Sclerosis
. Medicina (B Aires) 2022; 58:medicina58050647. [PMID: 35630064 PMCID: PMC9146888 DOI: 10.3390/medicina58050647] [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: 04/16/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron disease. Only about 10% of ALS patients survive more than 10 years. Clinical studies show that multidisciplinary care statistically significantly improves survival compared to neurological care. ALS tends to manifest as limb weakness, but some patients present with bulbar symptoms, such as dysphagia and dysarthria. In rarer cases, the main symptom of ALS is oropharyngeal dysphagia. Respiratory muscle weakness is a relatively rare symptom at the onset of this disease and may lead to a fatal outcome due to aspiration pneumonia within about 1.4 years. These reasons led to a particularly complicated diagnosis of ALS in a 66-year-old Caucasian female patient complaining of dyspnoea and coughing while drinking water. Notably, dyspnoea is only present in one out of four treatment-seeking patients, and the course of ALS is non-specific. For these reasons, the diagnosis took an entire year while the patient underwent many tests and visited many specialists. However, the diagnosis was only made at a late stage of the disease. At present, the patient is almost unable to swallow food, water, or saliva, and is at a very high risk of aspiration, but refuses to have a percutaneous endoscopic gastrostomy performed. The objective of this case report is to highlight the fact that a symptom as simple as difficulty swallowing may be the result of severe disease, a frequent outcome of which is death.
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21
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Ku PKM, Wang K, Vlantis AC, Tang EWK, Hui TSC, Lai R, Yeung ZWC, Cho RHW, Law T, Chan SYP, Chan BYT, Wong JKT, van Hasselt A, Tong MCF. Oro-pharyngo-esophageal radionuclide scintigraphy predicts aspiration pneumonia risk and associated survival in post-irradiated nasopharyngeal carcinoma patients. Laryngoscope Investig Otolaryngol 2022; 7:170-179. [PMID: 35155795 PMCID: PMC8823181 DOI: 10.1002/lio2.704] [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: 10/13/2021] [Revised: 10/28/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To demonstrate that oro-pharyngo-esophageal radionuclide scintigraphy (OPERS) not only detects tracheobronchial aspiration after swallowing, but also quantifies the amount of aspiration and subsequent clearance. METHODS Data collected between 2014 and 2019 were reviewed for aspiration pneumonia at 12 and 24-months after OPERS. The predictive value for aspiration pneumonia on flexible endoscopic evaluation of swallowing (FEES), videofluoroscopic swallowing study (VFSS), and OPERS, and the overall survival of patients with or without aspiration were determined. RESULTS Thirty-seven patients treated with radiotherapy for nasopharyngeal carcinoma (NPC) were reviewed. The incidence of aspiration detected on FEES, VFSS, and OPERS was 78.4%, 66.7%, and 44.4%, respectively. Using VFSS as a gold standard, the sensitivity and specificity of OPERS for aspiration was 73.7% and 100%. The positive and negative predictive values for aspiration were 100% and 66.7%, respectively, with an overall accuracy of 82.8%. A history of aspiration pneumonia was one factor associated with a higher chance of subsequent aspiration pneumonia within 12 months (odds ratio: 15.5, 95% CI 1.67-145.8, p < .05) and 24 months (odds ratio: 23.8, 95% CI 3.69-152.89, p < .01) of the swallowing assessment. Aspiration detected by OPERS was a significant risk factor for future aspiration pneumonia at 12 and 24 months respectively. Significantly, better survival was associated with an absence of aspiration on OPERS only, but not on FEES or VFSS. CONCLUSION OPERS predicts the safety of swallowing, the incidence of subsequent aspiration pneumonia, and the survival prognosis in post-irradiated NPC dysphagia patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Peter K. M. Ku
- Department of Otorhinolaryngology—Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalNew TerritoriesHong Kong
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Ki Wang
- Department of Imaging and Interventional RadiologyPrince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Alexander C. Vlantis
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Evelyn W. K. Tang
- Department of Imaging and Interventional RadiologyPrince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Thomas S. C. Hui
- Department of Otorhinolaryngology—Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalNew TerritoriesHong Kong
| | - Ronald Lai
- Department of Otorhinolaryngology—Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalNew TerritoriesHong Kong
| | - Zenon W. C. Yeung
- Department of Otorhinolaryngology—Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalNew TerritoriesHong Kong
| | - Ryan H. W. Cho
- Department of Otorhinolaryngology—Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalNew TerritoriesHong Kong
| | - Thomas Law
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Simon Y. P. Chan
- Department of Speech TherapyPrince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Becky Y. T. Chan
- Department of Speech TherapyPrince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Jeffrey K. T. Wong
- Department of Imaging and Interventional RadiologyPrince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Andrew van Hasselt
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Michael C. F. Tong
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
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22
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Tamin S, Adham M, Noer A, Supriana N, Bardosono S. Upright epiglottis prevents aspiration in patients with nasopharyngeal carcinoma post-chemoradiation. PLoS One 2021; 16:e0261110. [PMID: 34882745 PMCID: PMC8659317 DOI: 10.1371/journal.pone.0261110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
NPC is the most widely found malignant tumor in the head and neck region in Indonesia. Chemoradiation therapy for NPC can induce swallowing disorders (dysphagia) that adversely affects a patients quality of life. This study aimed to assess the swallowing process by flexible endoscopic evaluation of swallowing in patients with nasopharyngeal carcinoma after chemoradiation. Thirty-nine patients with NPC who had chemoradiation therapy more than one month previously underwent flexible endoscopic evaluation of swallowing and were assessed for oral transport time, sensation, standing-secretion, pre-swallowing leakage, residue, penetration, aspiration, and silent aspiration. The most common structural abnormalities were an upright and swollen epiglottis (89.4%), poor oral hygiene, and velopharyngeal closure defects (56.4%). This examination also revealed a mild degree of standing secretion (38.5%) and aspiration (10.3%). No penetration was observed in 64.1% of the patients, and no silent aspiration was observed in any of the patients. A severe degree of residue (45.7%) was observed when administering oatmeal, while the residue was mild to moderate when administering gastric rice, crackers, and milk. The residue changed to a mild degree (32.3%-51.4%) in all food administrations after the watering maneuver. The highest penetration was noted after oatmeal administration (42.8%), and the highest aspiration was found after milk administration (8.6%). Standing secretion in almost all patients was caused by hyposensitivity of the hypopharynx. Persistent residue and hyposensitivity of the hypopharynx led to aspiration. The low percentage of aspiration and silent aspiration might have been caused by the upright and swollen epiglottis that prevented aspiration. Poor oral hygiene and a dry mouth led to prolonged oral transport. Therefore, most patients had hypopharyngeal abnormalities in the form of a swollen and upright epiglottis. Secretion and food residue were also detected. Drinking helps to expedite the swallowing process by facilitating oral phase transport and reducing residues.
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Affiliation(s)
- Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- * E-mail:
| | - Marlinda Adham
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Arfan Noer
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nana Supriana
- Department of Radio Oncology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Saptawati Bardosono
- Department of Nutrition Science, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Lee JH, Chee PS, Lim EH, Tan CH. Artificial Intelligence-Assisted Throat Sensor Using Ionic Polymer-Metal Composite (IPMC) Material. Polymers (Basel) 2021; 13:polym13183041. [PMID: 34577942 PMCID: PMC8473105 DOI: 10.3390/polym13183041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
Throat sensing has received increasing demands in recent years, especially for oropharyngeal treatment applications. The conventional videofluoroscopy (VFS) approach is limited by either exposing the patient to radiation or incurring expensive costs on sophisticated equipment as well as well-trained speech-language pathologists. Here, we propose a smart and non-invasive throat sensor that can be fabricated using an ionic polymer–metal composite (IPMC) material. Through the cation’s movement inside the IPMC material, the sensor can detect muscle movement at the throat using a self-generated signal. We have further improved the output responses of the sensor by coating it with a corrosive-resistant gold material. A support vector machine algorithm is used to train the sensor in recognizing the pattern of the throat movements, with a high accuracy of 95%. Our proposed throat sensor has revealed its potential to be used as a promising solution for smart healthcare devices, which can benefit many practical applications such as human–machine interactions, sports training, and rehabilitation.
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Roldan-Vasco S, Orozco-Duque A, Suarez-Escudero JC, Orozco-Arroyave JR. Machine learning based analysis of speech dimensions in functional oropharyngeal dysphagia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106248. [PMID: 34260973 DOI: 10.1016/j.cmpb.2021.106248] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The normal swallowing process requires a complex coordination of anatomical structures driven by sensory and cranial nerves. Alterations in such coordination cause swallowing malfunctions, namely dysphagia. The dysphagia screening methods are quite subjective and experience dependent. Bearing in mind that the swallowing process and speech production share some anatomical structures and mechanisms of neurological control, this work aims to evaluate the suitability of automatic speech processing and machine learning techniques for screening of functional dysphagia. METHODS Speech recordings were collected from 46 patients with functional oropharyngeal dysphagia produced by neurological causes, and 46 healthy controls. The dimensions of speech including phonation, articulation, and prosody were considered through different speech tasks. Specific features per dimension were extracted and analyzed using statistical tests. Machine learning models were applied per dimension via nested cross-validation. Hyperparameters were selected using the AUC - ROC as optimization criterion. RESULTS The Random Forest in the articulation related speech tasks retrieved the highest performance measures (AUC=0.86±0.10, sensitivity=0.91±0.12) for individual analysis of dimensions. In addition, the combination of speech dimensions with a voting ensemble improved the results, which suggests a contribution of information from different feature sets extracted from speech signals in dysphagia conditions. CONCLUSIONS The proposed approach based on speech related models is suitable for the automatic discrimination between dysphagic and healthy individuals. These findings seem to have potential use in the screening of functional oropharyngeal dysphagia in a non-invasive and inexpensive way.
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Affiliation(s)
- Sebastian Roldan-Vasco
- Faculty of Engineering, Instituto Tecnológico Metropolitano, Medellín, Colombia; Faculty of Engineering, Universidad de Antioquia, Medellín, Colombia.
| | - Andres Orozco-Duque
- Faculty of Pure and Applied Sciences, Instituto Tecnológico Metropolitano, Medellín, Colombia
| | - Juan Camilo Suarez-Escudero
- School of Health Sciences, Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia; Faculty of Pure and Applied Sciences, Instituto Tecnológico Metropolitano, Medellín, Colombia
| | - Juan Rafael Orozco-Arroyave
- Faculty of Engineering, Universidad de Antioquia, Medellín, Colombia; Pattern Recognition Lab, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany.
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25
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Atar Y, Atar S, Ilgin C, Anarat MEA, Uygan U, Uyar Y. Validity and Reliability of the Turkish Translation of the Yale Pharyngeal Residue Severity Rating Scale. Dysphagia 2021; 37:655-663. [PMID: 34021774 DOI: 10.1007/s00455-021-10316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the validity and reliability of the Turkish translation of the Yale pharyngeal residue severity rating scale. The scale measures the severity of residue in the vallecula and pyriform sinus. The original scale was translated into Turkish by two bilingual English-Turkish translators, and the Turkish version was translated back into English by two qualified professional translators to assess accuracy. The evaluators were divided into two groups (training and no-training) and two subgroups according to their experience. Intra-rater, inter-rater, and intra-class correlation coefficient measurements were analyzed by calculating agreement rates, kappa, and p values. In the analysis of the reliability, intra-class correlation coefficient values in the overall ratings for both the vallecula and the pyriform sinus were 0.9996 (95% CI 0.9992-0.9998) and 0.9997 (95% CI 0.9995-0.9999), respectively (p < 0.01). High agreement (> 95%) and perfect Fleiss kappa values were obtained for the vallecula and pyriform sinus ratings in the inter-rater initial assessments (κ = 0.959 and κ = 0.967, respectively). Perfect kappa values were found in the intra-rater results for both the vallecula and pyriform sinus (α = 0.9959 and κ = 0.9959, respectively). In the inter-rater secondary analysis, the vallecula and pyriform sinus kappa values were perfect (κ = 0.959 and κ = 0.967, respectively). In the intra-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9918 and κ = 1.0 for the vallecula, and κ = 1.0 and κ = 0.9902 for the pyriform sinus, respectively) In the inter-rater analysis, perfect kappa values were obtained for the vallecula and pyriform sinus in the no-training group and less-experience subgroup (κ = 0.9507 and κ = 0.9606 for the vallecula, and κ = 0.9836 and κ = 1.0 for the pyriform sinus, respectively). The Turkish translation of the Yale pharyngeal residue severity rating scale demonstrated high validity and reliability scores in determining pharyngeal residue location and value in the fiberoptic endoscopic evaluation of swallowing.
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Affiliation(s)
- Yavuz Atar
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey.
| | - Sevgi Atar
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, FTR Kliniği Kat:6 Blok:1, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Can Ilgin
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Melis Ece Arkan Anarat
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Ugur Uygan
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology, Prof. Dr. Cemil Tascioglu City Hospital, Kaptanpaşa Mah. Darülaceze Cad. No:25, Sağlık Bilimleri Üniversitesi, Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, KBB Kliniği Kat:6 Blok:5, Okmeydanı, Şişli, 34384, Istanbul, Turkey
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26
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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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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up. Dysphagia 2021; 37:217-236. [PMID: 33687558 DOI: 10.1007/s00455-021-10273-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.
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28
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J 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, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Evaluating the safety of oral methylene blue during swallowing assessment: a systematic review. Eur Arch Otorhinolaryngol 2021; 278:3155-3169. [PMID: 33389001 DOI: 10.1007/s00405-020-06509-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/17/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Methylene blue (MB) is frequently administered during fiberoptic endoscopic evaluation of swallowing (FEES) to enhance visualization of pharyngeal bolus transit. However, the safety of MB is being questioned since serious adverse events (AEs) such as hemodynamic instability, hemolysis, and serotonin syndrome were reported. The aim of this study is a systematic analysis of the literature to obtain an evidence-based overview of AEs due to oral administration of MB and to determine its safety as a food dye during swallowing assessment. METHODS A systematic literature search was carried out in PubMed, Embase, and Cochrane Library. Two reviewers independently selected articles describing oral administration of MB as a main diagnostic/therapeutic intervention, dosage, and AEs. Expert opinions, conference papers, sample size < 10, and animal studies were excluded. Level of evidence of the included studies was determined. RESULTS A total of 2264 unduplicated articles were obtained. Seventeen studies met the inclusion criteria with 100% agreement between the two reviewers. Among these, twelve studies were randomized controlled trials. In a pooled population of 1902 patients receiving oral MB, three serious AEs were reported related to MB. Non-serious AEs showed a dose-related trend and were usually mild and self-limiting. A meta-analysis could not be performed as studies were methodologically too heterogeneous. CONCLUSION Serious AEs due to oral administration of MB are rare (n = 3, 0.16%). MB-related non-serious AEs are mild, self-limiting, and show a dose-related trend. These findings indicate that it is safe to use small amounts of MB as a food dye during swallowing examinations.
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Evaluation of the pharynx and upper esophageal sphincter motility using high-resolution pharyngeal manometry for Parkinson's disease. Clin Neurol Neurosurg 2020; 201:106447. [PMID: 33421742 DOI: 10.1016/j.clineuro.2020.106447] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
Parkinson's disease (PD) is associated with a high incidence of dysphagia. Aspiration pneumonia due to dysphagia is a major cause of death in patients with PD, and therefore accurately evaluating dysphagia should help improve prognosis. It has been reported that the severity of dysphagia does not always correlate with the Hoehn and Yahr (H&Y) stage for classifying PD severity. However, no reports have quantitatively evaluated the relationship between severity of dysphagia and H&Y stage. High-resolution pharyngeal manometry (HRPM) is a quantitative method that can be used to measure swallowing pressure from the velopharynx to the entry of the upper esophageal sphincter (UES). We used HRPM to measure swallowing pressure in 51 patients with PD. As PD progresses, atrophy and degeneration of the pharyngeal muscles become more pronounced, which contributes to dysphagia. However, thus far there is no quantitative clinical evidence for this pathological change. To evaluate the relationship between severity of underlying PD and dysphagia, patients were categorized by H&Y stage, as follows: stage II in four patients, stage III in 23, stage IV in 14, and stage V in 10. In patients with H&Y stages II, III, IV, and V, the respective velopharyngeal pressures were 179.8 ± 32.5, 157.6 ± 62.2, 172.2 ± 48.9, and 107.4 ± 44.0 mmHg, the mesopharyngeal pressures were 126.8 ± 53.2, 121.6.1 ± 50.4, 142.1 ± 57.8, and 61.4 ± 19.6 mmHg, the residual UES pressure were -8.0 ± 10.8, 10.3 ± 16.1, 16.5 ± 37.9, and 11.2 ± 16.2 mmHg, and the resting UES pressure were 49.5 ± 30.0, 15.8 ± 25.7, 1.85 ± 14.1, and -1.2 ± 12.2 mmHg. Patients with severe PD demonstrated significantly decreased velopharyngeal and oropharyngeal pressures, along with incomplete UES opening and contraction. HRPM can detect subtle abnormalities by quantifying swallowing pressure in patients with PD. Evaluating swallowing pressure with HRPM provides insights into neuromuscular dysfunction that causes abnormal pressure generation during pharyngeal swallowing in patients with PD.
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Galli J, Marchese MR, Di Cesare T, Tricarico L, Almadori G, Tempesta V, Valenza V, Paludetti G. Impact of Tracheal Tube on Swallowing in Post-Operative Head and Neck Cancer Patients: Scintigraphic Analysis. Dysphagia 2020; 36:953-958. [PMID: 33278001 PMCID: PMC8578097 DOI: 10.1007/s00455-020-10222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
Dysphagia is common in tracheostomized patients who underwent head and neck surgery for cancer treatment. The objective of this study was to evaluate, by means of oropharyngoesophageal scintigraphy (OPES), the impact of an occluded tracheal tube (TT) on swallowing in patients treated for head and neck cancer before hospital discharge, to provide further information to the benefit of out-patient care management. From October 2018 to November 2019, we enrolled 19 tracheostomized patients (6 females and 13 males; mean age 61 years) who underwent primary surgical resection of head and neck tumor and swallowing rehabilitation during hospitalization. All subjects underwent a double-standard OPES, one with occluded tracheal tube and the other without TT, with their tracheal stoma being closed directly by a plaster. For each study, we assessed and compared the following quantitative parameters: oral transit time (OTTsec), pharyngeal transit time (PTTsec), esophageal transit time (ETTsec), oral retention index (ORI%), pharyngeal retention index (PRI%), esophageal retention index (ERI%), and aspiration percentage (AP%). The mean values of OTT, PTT, ORI%, PRI%, and ERI% were abnormal during OPES both with TT and without TT and did not statistically differ between the two tests (p > 0.05). Aspiration was detected in 4 cases out of 19 (21.05%) cases during OPES with TT and in 4/19 (21.05%) cases without TT who showed a mean AP% of 11.4% and 11.5% respectively (p > 0.05). Patients with abnormal AP% (> 0%) during OPES with TT showed aspiration signs without TT. Our study showed that the mere presence of a closed tracheal tube does not impact significantly the oropharyngeal transit of bolus during swallowing. This result suggests the possibility to maintain a small-diameter occluded tracheal tube in place for the postsurgical management of head and neck cancer patients.
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Affiliation(s)
- Jacopo Galli
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Maria Raffaella Marchese
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy. .,Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Policlinico "A. Gemelli" Foundation, L.Go "A. Gemelli", 8, 00168, Rome, Italy.
| | - Tiziana Di Cesare
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Laura Tricarico
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Giovanni Almadori
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
| | - Valeria Tempesta
- Department of Nuclear Medicine, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Roma, Italy
| | - Venanzio Valenza
- Department of Nuclear Medicine, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Roma, Italy
| | - Gaetano Paludetti
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC of Otorhinolaryngology, Istituto di Otorinolaringoiatria "Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore", Roma, Italy
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Kasle DA, Torabi SJ, Savoca EL, Lerner M, Manes RP. High-Volume Billing and Reimbursement Trends for Endoscopic Swallowing Studies in the Medicare Population. Dysphagia 2020; 36:919-924. [PMID: 33215264 DOI: 10.1007/s00455-020-10215-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study is to delineate the reimbursement trends in fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) and without sensory testing (FEES) in relation to that of speech-language pathology's (SLP) portion of modified barium swallow studies (MBS), as well as to document the types of providers billing for these procedures. We performed descriptive analyses of the volume of FEES/FEESST and MBS, and total reimbursements data obtained from 2013-2018 Medicare Part B National Summary files. We also utilized the 2017 Medicare Provider Utilization and Payment Data to analyze the higher volume providers (> 10 procedures annually) of either FEES and/or FEESST. From 2003 to 2018, there has been an average, annual increase of approximately 318 FEES/FEESST performed within the Medicare fee-for-service population (R = 0.9505 [95% CI 0.860-0.983]; p < 0.001) covered under Part B (which is largely outpatient coverage). Similarly, there was an increase in Medicare-specific FEES/FEESST reimbursement from $302,840 in 2003 to $1.2 million in 2018 (R = 0.9721 [95% CI 0.920-0.990; p < 0.001]). Prior to 2010, FEESST was performed more frequently than FEES (maximum annual difference of 1174), though from 2010 onward, relatively more annual FEES was performed. From 2003-2018, the reimbursement per procedure increased by $16.79 and $35.36 for FEESST and FEES, respectively, and by $32.84 for the SLP portion of the MBS. Among high-volume FEES/FEESST billers, 65.4% were otolaryngologists and 32.3% were independently billing SLPs. From 2003 to 2018, there has been a significant rise in the number of performed and reimbursed FEES/FEESST. From 2014 onward, compared to SLP-involved MBS, there has been a relative increase in performance of FEES/FEESST.
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Affiliation(s)
- David A Kasle
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, 800 Howard Avenue, Fl 4., New Haven, CT, 06519, USA
| | - Sina J Torabi
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, 800 Howard Avenue, Fl 4., New Haven, CT, 06519, USA
| | - Emily L Savoca
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, 800 Howard Avenue, Fl 4., New Haven, CT, 06519, USA
| | - Michael Lerner
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, 800 Howard Avenue, Fl 4., New Haven, CT, 06519, USA
| | - R Peter Manes
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, 800 Howard Avenue, Fl 4., New Haven, CT, 06519, USA.
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Results of pretreatment swallowing evaluation in patients with stage III/IV laryngeal and hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2020; 278:3011-3018. [PMID: 33165732 DOI: 10.1007/s00405-020-06460-3] [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: 08/12/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Laryngeal and hypopharyngeal carcinoma are among the common head and neck cancers causing considerable swallowing dysfunction. The functional status of the organ (larynx) is an important point of contention while considering the patients for organ preservation protocol. METHODOLOGY The aim of this retrospective study was to assess the swallowing status in stage III/IV laryngeal and hypopharyngeal carcinoma and its influence on treatment decision. We evaluated all treatment naïve patients who were referred to the swallowing clinic in 2017 (Jan-Dec) for assessment of swallowing prior to treatment initiation. RESULTS One hundred patients satisfied the eligibility criteria and were included in the study. The site and stage of laryngeal and hypopharyngeal cancer cases were almost equal in number. Their median age was 58 years. Fiberoptic endoscopic evaluation of swallowing (FEES) was done in all patients. 30% of the patients only had swallowing difficulties. Only advanced T-stage (p = 0.04) had an influence on the pretreatment swallowing status. Thirty-seven patients required nasogastric tube (NGT) for feeding. By 2 month post-treatment completion, most patients on NGT could resume oral feeding. CONCLUSIONS Pretreatment swallowing assessment alone did not significantly seem to influence our decisions for organ preservation treatment. However, patients with aspiration could be identified and managed appropriately. Most patients on NGT could resume oral feeds post-treatment completion.
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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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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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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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Yoshida M, Miura Y, Okada S, Yamada M, Kagaya H, Saitoh E, Kamakura Y, Okawa Y, Matsuyama Y, Sanada H. Effectiveness of Swallowing Care on Safe Oral Intake Using Ultrasound-Based Observation of Residues in the Epiglottis Valley: A Pragmatic, Quasi-Experimental Study. Healthcare (Basel) 2020; 8:E50. [PMID: 32120866 PMCID: PMC7151232 DOI: 10.3390/healthcare8010050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 11/18/2022] Open
Abstract
The demand for methods to ensure safe oral consumption of food and liquids in order to prevent aspiration pneumonia has increased over the last decade. This study investigated the safety of swallowing care selected by adding ultrasound-based observation, evaluated its efficacy, and determined effective content of selected swallowing care. The study employed a pragmatic quasi-experimental research design. Participants were 12 community-dwelling adult patients (age: 44-91 years) who had experienced choking within 1 month prior to the study. After the control phase, in which conventional swallowing care was provided, trained nurses provided ultrasound observation-based swallowing care for a minimum period of 2 weeks. Outcome measurements were compared across three points, namely T1-beginning of the control phase, T2 and T3-before and end of the intervention phase. The mean durations of intervention were 30.8 days in the control phase and 36.5 days in the intervention phase. Pneumonia and suffocation did not occur in the control phase or the intervention phase. The safe intake food level and the food intake level score significantly improved during the intervention phase (p = 0.032 and 0.017, respectively) by adding eating training based on the ultrasound observation. However, there was no significant improvement in the strength of the muscle related to swallowing by the selected basic training. Our results suggest that swallowing care selected based on the ultrasound observation, especially eating training, safely improved safe oral intake among community-dwelling adults with swallowing dysfunction.
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Affiliation(s)
- Mikako Yoshida
- Department of Women’s Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 9808575, Japan;
| | - Yuka Miura
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan;
| | - Shingo Okada
- Kitamihara Clinic, 350-18 Ishikawa-cho, Hakodate, Hokkaido 0410801, Japan;
| | - Masako Yamada
- Department of Home Care Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 1040044, Japan;
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakubo, Kutsukake-cho, Toyoake, Aichi 4701192, Japan; (H.K.); (E.S.)
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakubo, Kutsukake-cho, Toyoake, Aichi 4701192, Japan; (H.K.); (E.S.)
| | - Yayoi Kamakura
- Japanese Red Cross Toyota College of Nursing, 12-33 Nanamagari, Hakusan-cho, Toyota, Aichi 4718565, Japan;
| | - Yohei Okawa
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan;
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan;
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan;
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
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Heijnen BJ, Böhringer S, Speyer R. Prediction of aspiration in dysphagia using logistic regression: oral intake and self-evaluation. Eur Arch Otorhinolaryngol 2020; 277:197-205. [PMID: 31630245 PMCID: PMC6942603 DOI: 10.1007/s00405-019-05687-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Oropharyngeal dysphagia (OD) has a major influence on health in general and health-related quality of life (HR-QoL) in particular. The gold standard assessments for OD, especially for aspiration in OD, are fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy (VFSS), but not all patients have access to such procedures. Therefore, the current study built a prediction model to forecast aspiration in patients with OD on the basis of common self-evaluation questionnaires and oral intake status. METHODS A consecutive series of 111 patients with confirmed diagnosis of OD was measured according to a standardised protocol using the following tools: the Swallowing Quality of Life Questionnaire (SWAL-QOL), the Dysphagia Handicap Index (DHI), two self-report visual analogue scales which measure the Severity and the Impairment of the swallowing problem on everyday social life as experienced by the patient, the Eating Assessment Tool 10 (EAT-10), the Functional Oral Intake Scale (FOIS) and subsequently FEES (the gold standard). Penalised logistic regression was carried out to predict aspiration. The performance of the resulting models was evaluated by constructing receiver operating characteristics (ROC) curves and computing areas under the curve (AUC). RESULTS The final model showed an AUC of 0.92, indicating excellent performance. CONCLUSION This study shows that it may be possible to accurately predict aspiration in oropharyngeal dysphagia by a non-invasive and non-instrumental assessment protocol including oral intake status and self-report questionnaires on functional health status and HR-QoL.
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Affiliation(s)
- Bas J Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Zone H2-Q, PO Box 9600, 2300, Leiden, RC, The Netherlands.
| | - Stefan Böhringer
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Renée Speyer
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Zone H2-Q, PO Box 9600, 2300, Leiden, RC, The Netherlands
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Australia
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Lee BH, Lee JC, Lee SM, Park Y, Ryu JS. Application of Automatic Kinematic Analysis Program for the Evaluation of Dysphagia in ALS patients. Sci Rep 2019; 9:15644. [PMID: 31666678 PMCID: PMC6821821 DOI: 10.1038/s41598-019-52246-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
Dysphagia in amyotrophic lateral sclerosis (ALS) increases the risk of malnutrition, dehydration, and aspiration pneumonia. Kinematic analysis of videofluoroscopic swallowing study (VFSS) can provide detailed movement of the hyoid bone, revealing abnormalities of swallowing in ALS patients. We developed an automated kinematic analysis program (AKAP) that analyzes the trajectory of the hyoid bone via a visual tracking method. The aim of this study was to investigate the hyoid movement in ALS patients using AKAP and compare it with non-dysphagic subjects. Thirty ALS patients who underwent VFSS in Seoul National University Bundang Hospital between 2015 and 2017 were recruited. For comparison, 30 age-matched control subjects were also enrolled; the same swallowing study was conducted using thin fluid and yogurt. The hyoid bone movement was analyzed by evaluating the vertical and horizontal distances with four peak points (A, B, C, D), and the time of each point were also calculated. With respect to distance parameters, only vertical peak distance (distance between B, D points) during thin fluid swallowing was significantly decreased in ALS patients. (p = 0.038) With respect to temporal parameters, Time ABC, Time ABCD, and Duration C were significantly increased in ALS patients when swallowing both thin fluid and yogurt. (Time ABC p = 0.019, p = 0.002; Time ABCD p = 0.001, p = 0.004; Duration C p = 0.004, p = 0.025 respectively). This result revealed that dysphagia in ALS patient is caused by decreased velocity of hyoid bone movement due to the development of weakness in swallowing-related muscles. The parameters of kinematic analysis could be used to quantitatively evaluate dysphagia in motor neuron disease.
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Affiliation(s)
- Ban Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jun Chang Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun Myoung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yulhyun Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
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Lechien JR, Cavelier G, Thill MP, Huet K, Harmegnies B, Bousard L, Blecic S, Vanderwegen J, Rodriguez A, Dequanter D. Validity and reliability of the French version of Eating Assessment Tool (EAT-10). Eur Arch Otorhinolaryngol 2019; 276:1727-1736. [PMID: 31006058 DOI: 10.1007/s00405-019-05429-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/11/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a French version of the Eating Assessment Tool (Fr EAT-10) and to assess its internal consistency, reliability and clinical validity. METHODS Fifty-six patients referred in the Swallowing Clinics of CHU Saint-Pierre Hospital (Brussels) and EpiCURA hospital (Ath, Belgium) for dysphagia were enrolled and completed fiberoptic endoscopic evaluation of swallowing and videofluoroscopy. Seventy-three asymptomatic subjects were included in the study. To assess reliability, Fr-EAT-10 was completed twice within a 7-day period. Validity was assessed by comparing Fr-EAT-10 scores with the scores of dysphagia handicap index (DHI) in all individuals. Normative value of EAT-10 was calculated and the receiver operating characteristic (ROC) curve was used to determine the best Fr-EAT-10 threshold associated with aspiration. RESULTS Fifty-two patients completed the study. Cronbach's alpha was 0.95 indicating a high internal consistency. Test-retest reliability was high in the entire cohort (rs = 0.921). The correlation between Fr-EAT-10 total scores and DHI was high (rs = 0.827) indicating a high external validity. Patients had a significant higher score of Fr-EAT-10 than the controls (p < 0.001) exhibiting a high internal validity. The analysis of normative data reported that a score of Fr-EAT-10 > 3 should be considered as abnormal. The correlation between Fr-EAT-10 and the occurrence of aspiration is significant (rs = 0.327, p < 0.05). According to the ROC curve; aspirations need to be highly suspected for patients with Fr-EAT-10 ≥ 17. CONCLUSION The Fr-EAT-10 developed in this study is a reliable and valid self-administered tool in the evaluation of dysphagia in French-speaking patients.
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Affiliation(s)
- Jérôme R Lechien
- Research Committee of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.
- Laboratory of Human Anatomy and Experimental Oncology, School of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMons), Avenue du Champ de mars, 6, 7000, Mons, Belgium.
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Université Libre de Bruxelles, Brussels, Belgium.
| | - Gaëtan Cavelier
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Paule Thill
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Université Libre de Bruxelles, Brussels, Belgium
| | - Kathy Huet
- Laboratory of Phonetics, Psychology School, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Bernard Harmegnies
- Laboratory of Phonetics, Psychology School, Research Institute for Language Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Laura Bousard
- Department of Neurology, EpiCURA Hospital, Baudour, Belgium
| | - Serge Blecic
- Department of Neurology, EpiCURA Hospital, Baudour, Belgium
| | - Jan Vanderwegen
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Department of Otolaryngology-Head & Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Université Libre de Bruxelles, Brussels, Belgium
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McGinnis CM, Homan K, Solomon M, Taylor J, Staebell K, Erger D, Raut N. Dysphagia: Interprofessional Management, Impact, and Patient-Centered Care. Nutr Clin Pract 2018; 34:80-95. [DOI: 10.1002/ncp.10239] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Kimberly Homan
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Meghan Solomon
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Julia Taylor
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | | | - Denise Erger
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Namrata Raut
- Sanford USD Medical Center; Sioux Falls South Dakota USA
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Hollaar VR, van der Putten GJ, van der Maarel-Wierink CD, Bronkhorst EM, de Swart BJ, de Baat C, Creugers NH. Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study. Geriatr Nurs 2017; 38:437-441. [DOI: 10.1016/j.gerinurse.2017.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 12/27/2022]
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Sundeep M, Hirano Y, Iketani S, Konno A. Surgical management of symptomatic ossified anterior longitudinal ligament: A case report. Surg Neurol Int 2017; 8:108. [PMID: 28680727 PMCID: PMC5482169 DOI: 10.4103/sni.sni_102_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Ossified anterior longitudinal ligament (OALL) of the cervical spine can cause dysphagia, dyspnoea, and dysphonia, although these symptoms are rare. Case Description: A 71-year-old male presented with gradually progressive dysphagia secondary to OALL. He underwent fiber optic endoscopy and lateral video fluoroscopy. The OALL extended from C4 to C7 and contributed to significant compression of the pharynx as demonstrated on plain cervical radiography, magnetic resonance (MR) imaging, and computed tomography (CT). Following microsurgical resection of the OALL, his symptoms improved. Conclusions: This study focuses on the clinical and radiographic presentation of OALL; the latter utilizing plain X-rays, MR, and CT studies. Notably, surgical resection is straightforward and allows for immediate decompression of the pharynx as long as it is truly the symptomatic problem.
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Affiliation(s)
- Maddala Sundeep
- Southern Tohoku Institute for Neuroscience, Koriyama City, Fukushima Prefecture, Japan
| | - Yoshitaka Hirano
- Southern Tohoku Institute for Neuroscience, Koriyama City, Fukushima Prefecture, Japan
| | - Susumu Iketani
- Southern Tohoku Institute for Neuroscience, Koriyama City, Fukushima Prefecture, Japan
| | - Akiyoshi Konno
- Southern Tohoku Institute for Neuroscience, Koriyama City, Fukushima Prefecture, Japan
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