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Xuelai L, Xueyan L, Wen X. Exploring the Use of the Current Perception Threshold in Pharyngeal Paresthesia Patients. Dysphagia 2022; 37:1431-1439. [PMID: 34978622 DOI: 10.1007/s00455-021-10401-5] [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: 05/17/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022]
Abstract
To explore pharyngeal sensory function by current perception threshold (CPT) measurement in paresthetic pharynx. In total, 58 healthy participants and 66 patients with pharyngeal paresthetic symptoms underwent CPT evaluation. Pharyngeal paresthesia (n = 66) was classified into three categories based on aetiologies: six cases with pain in pharynx; 34 neuropathic patients with glossopharyngeal nerve and/or vagus nerve or recurrent laryngeal nerve injury; and 26 patients with globus pharyngeus. CPT measurements were obtained from bilateral palatoglossal arch and tongue base at 2000, 250 and 5 Hz stimulation frequencies. Ranked from high to low, the CPT values for the bilateral palatoglossal arches and tongue bases were: lower cranial neuropathic patients, globus pharyngeus, healthy participants and patients with pain. The CPT values for neuropathic patients on the injured side were significantly higher than those on the healthy side (P < 0.05). The CPT values for patients with pain in pharynx were significantly lower than those of healthy participants (P < 0.05) when the bilateral tongue bases were stimulated. The CPT measurement is a reliable method for quantitatively assessing pharyngeal sensory function and able to differentiate pharyngeal paresthesia between lower cranial neuropathic and subjective discomfort. Pharyngeal sensory function is more sensitive in patients with pain in pharynx. Pharyngeal sensory function is significantly reduced in lower cranial neuropathic patients, especially on the injured side. Patients with globus pharyngeus have pharyngeal hyposensitivity.
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Affiliation(s)
- Liu Xuelai
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, 1 Dongjiaominxiang, Beijing, 100730, China
- Department of Otolaryngology Head and Neck Surgery, Chongqing General Hospital, Chongqing, China
| | - Li Xueyan
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, 1 Dongjiaominxiang, Beijing, 100730, China
| | - Xu Wen
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, 1 Dongjiaominxiang, Beijing, 100730, China.
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Bhutada AM, Davis TM, Garand KL. Electrophysiological Measures of Swallowing Functions: A Systematic Review. Dysphagia 2022; 37:1633-1650. [PMID: 35218413 DOI: 10.1007/s00455-022-10426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
The purpose of this systematic review was to examine the application of event-related potentials (ERPs) to investigate neural processes of swallowing functions in adults with and without dysphagia. Computerized literature searches were performed from three search engines. Studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2009). A total of 759 studies were initially retrieved, of which 12 studies met inclusion criteria. Electrophysiological measures assessing swallowing functions were identified in two major ERP categories: (1) sensory potentials and (2) pre-motor potentials. Approximately 80% of eligible studies demonstrated strong methodological quality, although most employed a case series or case-control study design. Pharyngeal sensory-evoked potentials (PSEPs) were used to assess pharyngeal afferent cortical processing. The temporal sequence of the PSEP waveforms varied based on the sensory stimuli. PSEPs were delayed with localized scalp maps in patients with dysphagia as compared to healthy controls. The pre-motor ERPs assessed the cortical substrates involved in motor planning for swallowing, with the following major neural substrates identified: pre-motor cortex, supplementary motor area, and primary sensorimotor cortex. The pre-motor ERPs differed in amplitude for the swallow task (saliva versus liquid swallow), and the neural networks differed for cued versus non-cued task of swallowing suggesting differences in cognitive processes. This systematic review describes the application of electrophysiological measures to assess swallowing function and the promising application for furthering understanding of the neural substrates of swallowing. Standardization of protocols for use of electrophysiological measures to examine swallowing would allow for aggregation of study data to inform clinical practice for dysphagia rehabilitation.
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Affiliation(s)
- Ankita M Bhutada
- Department of Speech Pathology and Audiology, University of South Alabama, 5721 USA Drive North, Mobile, AL, 36688, USA
| | - Tara M Davis
- Department of Speech Pathology and Audiology, University of South Alabama, 5721 USA Drive North, Mobile, AL, 36688, USA
| | - Kendrea L Garand
- Department of Speech Pathology and Audiology, University of South Alabama, 5721 USA Drive North, Mobile, AL, 36688, USA.
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Reflexive Airway Sensorimotor Responses in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia 2020; 36:574-582. [PMID: 32778945 DOI: 10.1007/s00455-020-10171-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Progressive motor denervation in amyotrophic lateral sclerosis (ALS) leads to reduced expiratory cough flow and diminished airway clearance physiologic capacity. Although ALS is thought to primarily impact motor systems, preliminary data from our laboratory suggest degradation of afferent pathways that regulate reflexive cough responses to radiographically confirmed aspiration. We, therefore, aimed to delineate both sensory and motor responses to a tussigenic airway irritant in individuals with ALS compared to healthy controls. METHODS Thirty-two individuals with ALS and 34 healthy age and gender-matched controls completed reflex cough testing. Capsaicin stimuli (0, 50, 100, 150, 200 μM) were presented in a randomized three-block design and motor (cough spirometry metrics) and sensory (patient-rated urge to cough, UtC) ratings collected. ALS patients underwent videofluoroscopy with penetration-aspiration ratings completed. Descriptives, Mann-Whitney U, and mixed models ANOVAs were performed. RESULTS Sensory: Individuals with ALS demonstrated greater UtC sensitivity slopes (i.e., increased stimulus sensitivity) vs. healthy controls (p = 0.036). Within the ALS group, however, silent aspirators (PAS = 8) demonstrated blunted UtC sensitivity slopes compared to ALS patients who did not (PAS ≤ 7, p = 0.0001). Motor: Compared to healthy controls, ALS individuals demonstrated reduced peak expiratory flow rates (p = 0.004), longer peak expiratory rise time (p = 0.017), and lower cough volume acceleration (p = 0.000). CONCLUSIONS ALS individuals demonstrated increased sensitivity to an upper airway irritant; however, they demonstrated slower and weaker expiratory cough motor output compared to healthy controls. In ALS silent aspirators, blunted sensorimotor responses were observed, suggesting that sensory degradation may occur at the final or most severe stage of bulbar disease progression.
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Nocturnal swallowing augments arousal intensity and arousal tachycardia. Proc Natl Acad Sci U S A 2020; 117:8624-8632. [PMID: 32229567 DOI: 10.1073/pnas.1907393117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cortical arousal from sleep is associated with autonomic activation and acute increases in heart rate. Arousals vary considerably in their frequency, intensity/duration, and physiological effects. Sleep and arousability impact health acutely (daytime cognitive function) and long-term (cardiovascular outcomes). Yet factors that modify the arousal intensity and autonomic activity remain enigmatic. In this study of healthy human adults, we examined whether reflex airway defense mechanisms, specifically swallowing or glottic adduction, influenced cardiac autonomic activity and cortical arousal from sleep. We found, in all subjects, that swallows trigger rapid, robust, and patterned tachycardia conserved across wake, sleep, and arousal states. Tachycardia onset was temporally matched to glottic adduction-the first phase of swallow motor program. Multiple swallows increase the magnitude of tachycardia via temporal summation, and blood pressure increases as a function of the degree of tachycardia. During sleep, swallows were overwhelmingly associated with arousal. Critically, swallows were causally linked to the intense, prolonged cortical arousals and marked tachycardia. Arousal duration and tachycardia increased in parallel as a function of swallow incidence. Our findings suggest that cortical feedback and tachycardia are integrated responses of the swallow motor program. Our work highlights the functional influence of episodic, involuntary airway defense reflexes on sleep and vigilance and cardiovascular function in healthy individuals.
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Murgia V, Manti S, Licari A, De Filippo M, Ciprandi G, Marseglia GL. Upper Respiratory Tract Infection-Associated Acute Cough and the Urge to Cough: New Insights for Clinical Practice. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2020; 33:3-11. [PMID: 33406022 PMCID: PMC7875114 DOI: 10.1089/ped.2019.1135] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/05/2020] [Indexed: 04/24/2023]
Abstract
Upper respiratory tract infection (URTI)-associated acute cough is the most common symptom both in children and adults worldwide and causes economic and social problems with significant implications for the patient, the patient's family, and the health care system. New pathogenic mechanisms in acute cough, including the urge to cough (UTC) mechanisms, have been recently identified. The brainstem neural network, pharyngeal sensory innervation, airway mechanical stimulation, inflammatory mediators, and postnasal drip actively participate in the onset and maintenance of acute cough and the urge to cough phenomenon. However, there is still no effective pharmacological treatment capable of interfering with the pathophysiologic mechanisms involved in URTI-associated acute cough. Moreover, severe adverse events frequently occur in administering such cough medications, mainly in children. New evidence has been provided concerning polysaccharides, resins, and honey as potential cough relievers with high antitussive efficiency, effect on the UTC, and minimal side effects.
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Affiliation(s)
- Vitalia Murgia
- Childhood Immunopathology Master, University of Pavia, Pavia, Italy
| | - Sara Manti
- Pediatric Clinic, Pediatrics Department, University of Messina, Messina, Italy
| | - Amelia Licari
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Maria De Filippo
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giorgio Ciprandi
- Allergist Consultant, Casa di Cura Villa Montallegro, Genoa, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
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Whitehead K, Jones L, Laudiano-Dray MP, Meek J, Fabrizi L. Event-related potentials following contraction of respiratory muscles in pre-term and full-term infants. Clin Neurophysiol 2019; 130:2216-2221. [PMID: 31677560 PMCID: PMC6907098 DOI: 10.1016/j.clinph.2019.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/17/2019] [Accepted: 09/15/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Involuntary isolated body movements are prominent in pre-term and full-term infants. Proprioceptive and tactile afferent feedback following limb muscle contractions is associated with somatotopic EEG responses. Involuntary contractions of respiratory muscles, primarily the diaphragm - hiccups - are also frequent throughout the human perinatal period during active behavioural states. Here we tested whether diaphragm contraction provides afferent input to the developing brain, as following limb muscle contraction. METHODS In 13 infants on the neonatal ward (30-42 weeks corrected gestational age), we analysed EEG activity (18-electrode recordings in six subjects; 17-electrode recordings in five subjects; 16-electrode recordings in two subjects), time-locked to diaphragm contractions (n = 1316) recorded with a movement transducer affixed to the trunk. RESULTS All bouts of hiccups occurred during wakefulness or active sleep. Each diaphragm contraction evoked two initial event-related potentials with negativity predominantly across the central region, and a third event-related potential with positivity maximal across the central region. CONCLUSIONS Involuntary contraction of the diaphragm can be encoded by the brain from as early as ten weeks prior to the average time of birth. SIGNIFICANCE Hiccups - frequently observed in neonates - can provide afferent input to developing sensory cortices in pre-term and full-term infants.
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Affiliation(s)
- Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
| | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
| | - Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
| | - Judith Meek
- Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London WC1E 6DB, United Kingdom.
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, United Kingdom.
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Pitts T, Hegland KW, Sapienza CM, Bolser DC, Davenport PW. Alterations in oropharyngeal sensory evoked potentials (PSEP) with Parkinson's disease. Respir Physiol Neurobiol 2016; 229:11-6. [PMID: 27090350 PMCID: PMC4888769 DOI: 10.1016/j.resp.2016.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 12/11/2022]
Abstract
Movement of a food bolus from the oral cavity into the oropharynx activates pharyngeal sensory mechanoreceptors. Using electroencephalography, somatosensory cortical-evoked potentials resulting from oropharyngeal mechanical stimulation (PSEP) have been studied in young healthy individuals. However, limited information is known about changes in processing of oropharyngeal afferent signals with Parkinson's disease (PD). To determine if sensory changes occurred with a mechanical stimulus (air-puff) to the oropharynx, two stimuli (S1-first; S2-s) were delivered 500ms apart. Seven healthy older adults (HOA; 3 male and 4 female; 72.2±6.9 years of age), and thirteen persons diagnosed with idiopathic Parkinson's disease (PD; 11 male and 2 female; 67.2±8.9 years of age) participated. Results demonstrated PSEP P1, N1, and P2 component peaks were identified in all participants, and the N2 peak was present in 17/20 participants. Additionally, the PD participants had a decreased N2 latency and gated the P1, P2, and N2 responses (S2/S1 under 0.6). Compared to the HOAs, the PD participants had greater evidence of gating the P1 and N2 component peaks. These results suggest that persons with PD experience changes in sensory processing of mechanical stimulation of the pharynx to a greater degree than age-matched controls. In conclusion, the altered processing of sensory feedback from the pharynx may contribute to disordered swallow in patients with PD.
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Affiliation(s)
- Teresa Pitts
- Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery University of Louisville, Louisville, KY, United States.
| | - Karen Wheeler Hegland
- Department of Speech, Language, and Hearing Sciences University of Florida, Gainesville, FL, United States
| | - Christine M Sapienza
- Brooks Rehabilitation College of Healthcare Sciences Jacksonville University, Jacksonville, FL, United States
| | - Donald C Bolser
- Department of Physiological Sciences University of Florida, Gainesville, FL, United States
| | - Paul W Davenport
- Department of Physiological Sciences University of Florida, Gainesville, FL, United States
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Troche MS, Brandimore AE, Godoy J, Hegland KW. A framework for understanding shared substrates of airway protection. J Appl Oral Sci 2014; 22:251-60. [PMID: 25141195 PMCID: PMC4126819 DOI: 10.1590/1678-775720140132] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/06/2014] [Indexed: 02/01/2023] Open
Abstract
Deficits of airway protection can have deleterious effects to health and quality of
life. Effective airway protection requires a continuum of behaviors including
swallowing and cough. Swallowing prevents material from entering the airway and
coughing ejects endogenous material from the airway. There is significant overlap
between the control mechanisms for swallowing and cough. In this review we will
present the existing literature to support a novel framework for understanding shared
substrates of airway protection. This framework was originally adapted from Eccles'
model of cough28 (2009) by Hegland,
et al.42 (2012). It will serve to
provide a basis from which to develop future studies and test specific hypotheses
that advance our field and ultimately improve outcomes for people with airway
protective deficits.
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Affiliation(s)
- Michelle Shevon Troche
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | | | - Juliana Godoy
- Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Karen Wheeler Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
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Canciani M, Murgia V, Caimmi D, Anapurapu S, Licari A, Marseglia GL. Efficacy of Grintuss® pediatric syrup in treating cough in children: a randomized, multicenter, double blind, placebo-controlled clinical trial. Ital J Pediatr 2014; 40:56. [PMID: 24917119 PMCID: PMC4066701 DOI: 10.1186/1824-7288-40-56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cough is an extremely common problem in pediatrics, mostly triggered and perpetuated by inflammatory processes or mechanical irritation leading to viscous mucous production and increased sensitivity of the cough receptors. Protecting the mucosa might be very useful in limiting the contact with micro-organisms and irritants thus decreasing the inflammation and mucus production. Natural molecular complexes can act as a mechanical barrier limiting cough stimuli with a non pharmacological approach but with an indirect anti-inflammatory action. OBJECTIVE Aim of the study was to assess the efficacy of a medical device containing natural functional components in the treatment of cough persisting more than 7 days. METHODS In this randomized, parallel groups, double-blind vs. placebo study, children with cough persisting more than 7 days were enrolled. The clinical efficacy of the study product was assessed evaluating changes in day- and night-time cough scores after 4 and 8 days (t4 and t8) of product administration. RESULTS In the inter-group analysis, in the study product group compared with the placebo group, a significant difference (t4 study treatment vs. t4 placebo, p = 0.03) was observed at t4 in night-time cough score.Considering the intra-group analysis, only the study product group registered a significant improvement from t0 to t4 in both day-time (t0 vs. t4, p = 0.04) and night-time (t0 vs. t4, p = 0.003) cough scores.A significant difference, considering the study product, was also found in the following intra-group analyses: day-time scores at t4 vs. t8 (p =0.01) and at t0 vs. t8 (p = 0.001); night-time scores at t4 vs. t8 (p = 0.05), and at t0 vs. t8 (p = 0.005). Considering a subgroup of patients with higher cough (≥ 3) scores, 92.9% of them in the study product group improved at t0 vs. t4 day-time. CONCLUSIONS Grintuss® pediatric syrup showed to possess an interesting profile of efficacy and safety in the treatment of cough persisting more than 7 days.
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Affiliation(s)
| | | | | | | | | | - Gian Luigi Marseglia
- Department of Pediatrics, Immuno-Pneumo-Allergy Unit, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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