Two-dimensional perceptual videofluoroscopic swallowing analysis of the pharyngeal phase in patients older than 50 years

Quantitative Assessment of Swallowing Dysfunction in Patients with Spinal and Bulbar Muscular Atrophy

Objective This study aimed to evaluate swallowing dysfunction in patients with spinal and bulbar muscular atrophy and to identify the most appropriate method of assessing swallowing dysfunction using a videofluoroscopic swallowing study. Methods In the videofluoroscopic swallowing study, patients were instructed to swallow 3 mL of 40% weight/volume barium sulfate twice, and the pharyngeal residue was measured. We used three different methods to quantify the pharyngeal barium residue and an eight-point scale to evaluate the laryngeal penetration leading to aspiration pneumoniae. Patients We assessed 111 patients with spinal and bulbar muscular atrophy who weren't undergoing disease-specific treatment. Results Our results showed that the pharyngeal barium residue after initial swallowing correlated better with the bulbar-related functional rating scales than that after multiple deglutition. This correlation was vague when the data from patients whose barium residue was >50% were eliminated. In addition, evaluating the pharyngeal residue after initial swallowing proved to be the most sensitive method with regard to laryngeal penetration. Conclusion This study showed that the pharyngeal barium residue after initial swallowing was the most appropriate parameter for quantitatively assessing the degree of dysphagia using a videofluoroscopic swallowing study and suggests that this method may predict laryngeal penetration and aspiration in patients with spinal and bulbar muscular atrophy.

Análise acústica do tempo de deglutição através do Sonar Doppler

RESUMO Objetivo: comparar o parâmetro acústico de tempo da deglutição orofaríngea nos adultos e idosos, nas diferentes consistências e volumes, através do Sonar Doppler. Métodos: a pesquisa foi realizada em duas etapas. Na primeira foi aplicado o Protocolo de Triagem de Risco para Deglutição. Na segunda os indivíduos foram submetidos à avaliação da deglutição com o Sonar Doppler. Os indivíduos receberam as seguintes consistências alimentares durante a avaliação - deglutição seca (saliva), líquida, néctar, mel e pudim, nos volumes de 5 ml, 10 ml e deglutição livre. O parâmetro acústico analisado neste estudo foi o Tempo acústico da deglutição (T). Resultados: dados objetivos e mensuráveis foram obtidos; a diferença do tempo de deglutição entre adultos e idosos em relação à consistência e o volume foi, na maioria, significante. Conclusão: verificou-se que há modificação do tempo da deglutição, tanto em relação à consistência quanto a volume do bolo alimentar, quando comparados idosos e adultos.

Onset locations of the pharyngeal phase of swallowing: meta-analysis

Purpose

Literature review on the onset locations of the pharyngeal phase of swallowing in asymptomatic and symptomatic adults and elderly people.

Research strategies

Research was conducted in the PubMed, BIREME and SciELO databases through the descriptors fluoroscopy (fluoroscopia), deglutition (deglutição) and pharynx (faringe).

Selection criteria

Studies published between 2005 and 2015, carried out with adults and elderly people who underwent swallowing videofluoroscopy (SVF), and citing the onset location of the pharyngeal phase of swallowing.

Data analysis

Descriptive analysis and meta-analysis were performed, evaluating the heterogeneity and the measures grouped with random effects through I2 statistics. For ratio calculation in the meta-analysis, the locations described in the articles were classified according to the Modified Barium Swallowing protocol - Measurement Tool for Swallowing Impairment (MBSImp).

Results

Twelve articles were selected for descriptive analysis and seven for meta-analysis. Heterogeneity was found between studies, especially due to clinical and methodological differences. The random effect indicated predominance (58%) of the onset of the pharyngeal phase of swallowing at levels 0 and 1 of the MBSImP. In asymptomatic individuals, the onset of the pharyngeal phase was observed in the oral cavity, base of the tongue, dorsum of the tongue and vallecula. In symptomatic individuals, onset was mainly observed in the oropharynx, vallecula, hypopharynx and pyriform sinus.

Conclusion

We noted a greater frequency of the onset of the pharyngeal phase of swallowing in the vallecula. The onset of the pharyngeal phase in the hypopharynx and pyriform sinus was more often observed among elderly individuals or with comorbidities that could alter swallowing.

Association between functionality assessment scales and the severity of dysphagia post-stroke

Purpose

The aim of this study was to investigate the association between the results of functionality scales and dysphagia severity determined from videofluoroscopy swallowing study (VSS) in post-stroke patients.

Methods

A retrospective study of 109 VSS analysis of post-stroke patients. From the exams was collected information on the diagnosis of dysphagia severity and evaluated regarding the swallowing functionality in an independent way by two evaluators.

Results

A high number of discrete dysphagia was observed. In one third of dysphagic patients it was noticed the presence of tracheal aspiration. There was a significant association between the scores of Functional Oral Intake Scale and Dysphagia Outcome and Severity Scale in post-stroke patients which means when the swallowing is highly compromised, the level of intake by mouth will be smaller according to the evaluators' analysis (p < 0.001).

Conclusion

There is an association between the scales and it can be used as evaluative benchmarks and in the management of clinical Speech Pathology intervention.