1
|
Yang HC, Umugire A, Song MK, Man SC, Kim HC, Kim J, Vena D, Huyett P, Choi I, Wellman AD. Sleep apnea patients with epiglottic collapse elevate their larynx more with swallowing; videofluoroscopic swallowing study of 80 patients. Sleep Breath 2024:10.1007/s11325-024-03065-6. [PMID: 38795279 DOI: 10.1007/s11325-024-03065-6] [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: 01/22/2024] [Revised: 03/26/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE The epiglottis plays an integral role in the swallowing mechanism and is also implicated as an obstruction site in obstructive sleep apnea (OSA). The underlying causes of epiglottic collapse during sleep remain unclear. This study aimed to investigate the cognitive functions using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the neurophysiological and anatomical factors using videofluoroscopic swallowing studies (VFSS). We compared patients with OSA exhibiting epiglottic collapse to those without, assessing differences in anatomical or neurophysiological characteristics. METHODS The study included 12 patients with epiglottic collapse (Epi-group) and 68 without (non-Epi group), all undergoing overnight polysomnography (PSG), drug-induced sleep endoscopy (DISE), LOTCA, and VFSS. Oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were considered as neurophysiological traits, and laryngeal elevation length (LE) as anatomical trait, and were measured across various test diets (10 ml of liquid, soft, or solid). RESULTS The study comprised 80 individuals, 57 men and 23 women, with no significant age, sex, body mass index or PSG parameters between groups, or DISE findings, with the exception of epiglottic collapse. Swallowing metrics from VFSS were normal, with no differences in OTT, PDT, PTT, or LOTCA scores. Notably, patients with epiglottic collapse showed a greater laryngeal elevation when swallowing soft and solid foods (p = 0.025 and p = 0.048, respectively). CONCLUSIONS Patients with epiglottic collapse do not exhibit neurophysiological or cognitive impairments when compared to non-Epi group. However, the Epi-group displayed a significantly increased laryngeal elevation length. This suggests that anatomical factors may have a more substantial role in the development of epiglottic collapse than neurophysiological factors.
Collapse
Affiliation(s)
- Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Alphonse Umugire
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea.
| | - Sung Chung Man
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Jisun Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Phillip Huyett
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Insung Choi
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea.
| | - Andrew D Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Gu H, Ren D. Prevalence and Risk Factors of Poststroke Dysphagia: A Meta-Analysis. Cerebrovasc Dis 2024:1-24. [PMID: 38643757 DOI: 10.1159/000538218] [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: 01/04/2024] [Accepted: 02/29/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION In patients with stroke, poststroke dysphagia (PSD) is a common complication that plays an important role in morbidity and mortality. The aim of this paper was to assess the prevalence and risk factors of PSD using a systemic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for potentially eligible studies published until September 2023. Further, the pooled incidence and risk factors for PSD were determined using a random-effects model. Overall, 58 studies involving 37,404 patients with acute stroke were selected for the meta-analysis. RESULTS The pooled incidence of PSD in patients with acute stroke was 42% (95% confidence interval [CI]: 36-48%), which is the highest in South America (47%) and lowest in Asia (37%). Notably, older age (odds ratio [OR]: 2.13; 95% CI: 1.53-2.97; p < 0.001), hypertension (OR: 1.23; 95% CI: 1.06-1.44; p = 0.007), diabetes mellitus (OR: 1.22; 95% CI: 1.04-1.44; p = 0.014), stroke history (OR: 1.26; 95% CI: 1.04-1.53; p = 0.019), and atrial fibrillation (OR: 1.58; 95% CI: 1.02-2.44; p = 0.039) were found to be associated with an increased risk of PSD. Conversely, sex differences, smoking, alcoholism, obesity, hyperlipidemia, ischemic heart disease, stroke type, and the hemisphere affected were not associated with the risk of PSD. CONCLUSION The abstract reports the prevalence of PSD in patients with acute stroke and identified potential risk factors for PSD, including older age, hypertension, diabetes mellitus, stroke history, and atrial fibrillation.
Collapse
Affiliation(s)
- Haiyan Gu
- Intensive Care Rehabilitation Department, Ningbo Rehabilitation Hospital, Ningbo, China
| | - Dan Ren
- Intensive Care Rehabilitation Department, Ningbo Rehabilitation Hospital, Ningbo, China
| |
Collapse
|
3
|
Bayona HHG, Inamoto Y, Saitoh E, Aihara K, Kobayashi M, Otaka Y. Prediction of Pharyngeal 3D Volume Using 2D Lateral Area Measurements During Swallowing. Dysphagia 2024:10.1007/s00455-023-10659-x. [PMID: 38245902 DOI: 10.1007/s00455-023-10659-x] [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: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3 years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10 mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior-posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT.
Collapse
Affiliation(s)
- Howell Henrian G Bayona
- Graduate School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Eichii Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masanao Kobayashi
- Faculty of Radiology, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| |
Collapse
|
4
|
Liu C, Li Y, Tan Z, Liu H, Zhou M, Li J, Liang J, Xiao L. Endoscopic botulinum toxin injection combined with balloon dilatation for treatment of cricopharyngeal achalasia in patient with brainstem stroke. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1203-1209. [PMID: 37875360 PMCID: PMC10930855 DOI: 10.11817/j.issn.1672-7347.2023.230254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES At present, there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A (BTX-A) into cricopharyngeal muscle guided by ultrasound, electromyography or CT in China, but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope. This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke, and to provide a better method for the treatment of dysphagia after brainstem stroke. METHODS From June to December 2022, 30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine, the First Hospital of Changsha. They were randomly assigned into a control group and a combined group, 15 patients in each group. Patients in both groups were treated with routine rehabilitation therapy, while patients in the control group were treated with balloon dilatation, and patients in the combined group were treated with balloon dilatation and BTX-A injection. Before treatment and after 2 weeks of treatment, the patients were examined by video fluoroscopic swallowing study, Penetration-aspiration Scale (PAS), Dysphagia Outcome Severity Scale (DOSS), and Functional Oral Intake Scale (FOIS) were used to assess the swallowing function. RESULTS In the combined group, 1 patient withdrew from the treatment because of personal reasons. Two weeks after treatment, the scores of DOSS, PAS, and FOIS in both groups were better than those before treatment (all P<0.01), and the combined group was better than the control group (all P<0.001). The effective rate was 85.7% in the combined group and 66.7% in the control group, with no significant difference between the 2 groups (P>0.05). CONCLUSIONS BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.
Collapse
Affiliation(s)
- Chao Liu
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005.
| | - Yuan Li
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Zhi Tan
- Department of Gastroenterology, First Hospital of Changsha, Changsha 410005, China
| | - Hua Liu
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Meiyun Zhou
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Jie Li
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Junjun Liang
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Le Xiao
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005.
| |
Collapse
|
5
|
Kussik de Almeida Leite K, Chiarion Sassi F, Navas Perissinotti I, Comerlatti LR, Furquim de Andrade CR. Risk factors independently associated with the maintenance of severe restriction of oral intake and alternative feeding method indication at hospital outcome in patients after acute ischemic stroke. Clinics (Sao Paulo) 2023; 78:100275. [PMID: 37572389 PMCID: PMC10428027 DOI: 10.1016/j.clinsp.2023.100275] [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: 03/30/2023] [Revised: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND AND AIMS From a clinical point of view, post-stroke patients present difficulties in swallowing management. The purpose of this research was to identify risk factors that were independently related to the maintenance of a severe restriction of oral intake in patients affected by acute ischemic stroke. METHODS The authors conducted a prospective observational cohort study of patients with dysphagia post-acute ischemic stroke who were admitted to an Emergency Room (ER). Demographic and clinical data were collected at ER admission. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at the patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment (at hospital outcome): G1 with severe restriction of oral intake and indication of feeding tube - patients with FOIS levels 1 to 4; G2 without restriction of food consistencies in oral intake - patients with FOIS levels 5 to 7. RESULTS One hundred and six patients were included in our study. Results of the multivariate logistic regression model for the prediction of maintenance of a severe restriction of oral intake at hospital outcome in patients post-acute ischemic stroke indicated that increasing age (p = 0.006), and dysarthria (p = 0.003) were associated with higher chances of presenting severe restriction of oral intake at hospital outcome. CONCLUSIONS Patients with acute ischemic stroke in an Emergency Room may experience non-resolved severe dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.
Collapse
Affiliation(s)
| | - Fernanda Chiarion Sassi
- Department of Physiotherapy, Speech-Language and Hearing Science and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Iago Navas Perissinotti
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Roberto Comerlatti
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Claudia Regina Furquim de Andrade
- Department of Physiotherapy, Speech-Language and Hearing Science and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
6
|
Luo J, Huang B, Zheng H, Yang Z, Xu M, Xu Z, Ma W, Lin R, Feng Z, Wu M, Cui S. Acupuncture combined with balloon dilation for post-stroke cricopharyngeal achalasia: A meta-analysis of randomized controlled trials. Front Neurosci 2023; 16:1092443. [PMID: 36711135 PMCID: PMC9879211 DOI: 10.3389/fnins.2022.1092443] [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] [Received: 11/08/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this study was to systematically evaluate the effectiveness of acupuncture combined with balloon dilatation in patients with post-stroke cricopharyngeal achalasia (CPA) according to the effective rate, videofluoroscopy swallowing study (VFSS) score and standardized swallowing function assessment scale (SSA) score through Meta-analysis. Methods English and Chinese language literature published before July 24,2022 were searched in ten electronic databases. The identified articles were screened, data were extracted, and the methodological quality of the included trials was assessed. Using RevMan 5.4.1 software to perform Meta-analysis. Results 10 studies with 517 patients with post-stroke CPA were included. Meta-analysis showed that the effective rate of the experience group was higher than that of the control group [OR = 0.62; 95% CI (2.32, 13.05); I 2 = 0%; p = 0.0001]. Compared to the control group, the SSA score was lower in the experience group [MD = -4.22; 95% CI (-4.57, -3.87); I 2 = 42%; p < 0.00001]. In terms of VFSS scores, the experience group showed greater efficacy differences than control group [MD = 1.53; 95% CI (1.32, 1.75); I 2 = 0%; p < 0.00001]. The subgroup analysis of VFSS score based on the average course of disease (<1 month vs. ≥1 month) showed no significant difference. The subgroup analysis based on average age (>60 years vs. ≤60 years) showed the VFSS score of the experience group was significantly higher than that of the control group, and the effect may be better in the subgroup older than 60 years. The subgroup analysis based on the treatment course (>30 days vs. ≤30 days) showed the VFSS score of the experience group was significantly higher than that of the control group, and the effect may be better in the subgroup the treatment course>30 days. Conclusion Acupuncture combined with balloon dilatation may be an effective method for treating post-stroke CPA. Compared with balloon dilatation, acupuncture combined with balloon can significantly improve the swallowing function of patients, and it is also effective for patients of different courses, ages, and treatment course, while patients over 60 years old and the treatment course over 30 days may have better clinical outcomes.
Collapse
Affiliation(s)
- Jing Luo
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bingjing Huang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Huiyan Zheng
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zeyu Yang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mingzhu Xu
- Department of Rehabilitation, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Zhenhua Xu
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenjun Ma
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Run Lin
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zitong Feng
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Meng Wu
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Shaoyang Cui
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
7
|
Xie M, Wen H, Dou Z. Case report: A case of novel treatment for retrograde cricopharyngeal dysfunction. Front Neurol 2022; 13:1005655. [PMID: 36619911 PMCID: PMC9811257 DOI: 10.3389/fneur.2022.1005655] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Retrograde cricopharyngeal dysfunction (R-CPD) is a recently described disorder characterized by an inability to belch, excessive flatulence, unpleasant gurgling noises, and discomfort in the lower neck, chest, and abdomen. Herein, we describe a case of R-CPD in a 19-year-old man. The patient suffered from flatulence and was unable to belch since birth; auxiliary examination of his digestive system was normal. He was diagnosed with R-CPD based on clinical manifestations and laboratory results. He received an injection of botulinum toxin to the cricopharyngeal muscle under ultrasound, catheter balloon, and electromyographic guidance. His symptoms completely resolved 1 week after the injection.
Collapse
|
8
|
Li X, Jin L, Gu C, Zhang W, Zhou X, You X. Effect of Cold Fluid Compensatory Swallowing Combined with Balloon Dilation on the Treatment of Poststroke Cricopharyngeal Achalasia: A Pilot Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4171561. [PMID: 36254140 PMCID: PMC9569196 DOI: 10.1155/2022/4171561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
Objective This study is aimed at comparing the treatment efficacy between catheter balloon dilation combined with cold fluid compensatory swallowing training and catheter balloon dilation alone on poststroke cricopharyngeal achalasia (CPA). Methods We conducted a single-blind, randomized controlled trial (RCT). Poststroke patients with CPA were divided into two groups: the control group (treated with catheter balloon dilation) and the trial group (catheter balloon dilation combined with cold fluid compensatory swallowing). Videofluoroscopic swallowing study (VFSS) was performed, and functional oral intake scale (FOIS) was used to evaluate and compare the swallowing function of patients in the 2 groups before and after intervention. Posttreatment VAS pain scores and recovery time were also measured. Results VFSS and FOIS scores in the two groups were improved after treatment (P < 0.05). In the trial group, VFSS scores in the pharyngeal phase and aspiration degree were significantly higher compared with the control group (P < 0.05) but not in the oral phase (P > 0.05). The difference in FOIS scores and patients' recovery time from intervention to eating mushy food between the trial and control groups was significant (P < 0.05), but not the VAS scores (P > 0.05). Conclusion The catheter balloon dilation combined with cold fluid compensatory swallowing was superior to catheter balloon dilation alone in terms of relieving dysphagia and reducing aspiration in patients with CPA following stroke. Long-term efficacy should be followed up with more objective and quantitative indicators in future studies.
Collapse
Affiliation(s)
- Xiangwei Li
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Linna Jin
- Department of Rehabilitation, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, China
| | - Chengxiao Gu
- Department of Nursing, Hangzhou Anatorium of People's Liberation Army, Hangzhou 310013, China
| | - Wangyuan Zhang
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Xiao Zhou
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Xiaoting You
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| |
Collapse
|
9
|
Zhu L, Chen J, Shao X, Pu X, Zheng J, Zhang J, Wu X, Wu D. Botulinum toxin A injection using ultrasound combined with balloon guidance for the treatment of cricopharyngeal dysphagia: analysis of 21 cases. Scand J Gastroenterol 2022; 57:884-890. [PMID: 35213271 DOI: 10.1080/00365521.2022.2041716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND As an upper oesophageal sphincter (UES) dysfunction disorder, cricopharyngeal achalasia (CPA) is a common cause of dysphagia and is associated with an increased risk of pulmonary complications. The aim of this study was to investigate the effectiveness and safety of BTX-A injection using ultrasound combined with balloon guidance for the treatment of CPA caused by stroke. METHODS A total of 21 patients diagnosed with CPA were treated with BTX-A injection into the cricopharyngeal muscle using ultrasound combined with balloon guidance. Primary outcome measures, including the functional oral intake scale (FOIS), videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS), which are quantitative measures for a video fluoroscopic swallowing study (VFSS), and scores of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were assessed from baseline to 12 weeks after treatment. Repeated measures analysis of variance was used to compare the scores between time points. RESULTS BTX-A injection led to improved dysphagia symptoms and scores in 19 patients (90.48%). Among them, 5 cases were cured (23.81%), 11 cases showed significant improvement (52.38%), and 3 cases showed improvement (14.29%). Two cases were absolutely ineffective (9.52%). Compared with the scores prior to treatment, the scores on the FOIS, VDS, PAS, SAS and SDS significantly improved beginning at 3 days (p < .05) and lasting for at least 12 weeks after injection. CONCLUSIONS Ultrasound with balloon-guided BTX-A injection is probably a relatively safe, easy, and effective technique for the treatment of CPA caused by stroke, with better visualization of the injection procedure. A well-designed controlled trial with a larger sample size is needed for more convincing conclusions.
Collapse
Affiliation(s)
- Lielie Zhu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Jiajun Chen
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Xiangzhi Shao
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Xinyu Pu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Jinyihui Zheng
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Jiacheng Zhang
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Xinming Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Dengchong Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| |
Collapse
|
10
|
Yang C, Pan Y. Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review. PLoS One 2022; 17:e0270096. [PMID: 35709228 PMCID: PMC9202855 DOI: 10.1371/journal.pone.0270096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Dysphagia is a common yet serious complication in stroke patients. We aimed to conduct a meta-analysis and systematic review to evaluate the risk factors of dysphagia in patients with ischemic stroke, to provide insights to the clinical treatment and nursing care of dysphagia. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Database, China Biomedical Literature Database (CBM) for studies on dysphagia in patients with ischemic stroke up to January 31, 2022. The quality of the literature was evaluated using the Newcastle-Ottawa scale. Meta-analysis was performed using RevMan 5.3 software. Results A total of 10 studies involving 4637 ischemic stroke patients were included, 1183(25.51%) patients had dysphagia after stroke. The synthesized outcomes showed that elder age (SMD = 0.42, 95%CI:0.34–0.50), hypertension (OR = 1.96, 95%CI:1.48–2.61), diabetes (OR = 1.83, 95%CI:1.47–2.28), brainstem stroke (OR = 2.12, 95%CI:1.45–3.09) were associated with dysphagia in patients with ischemic stroke (all P<0.05). There was no significant difference in the gender between dysphagia and no dysphagia patients (OR = 1.07, 95%CI:0.91–1.27, P = 0.40). Egger regression tests indicated there were no significant publication biases in the synthesized outcomes (all P>0.05). Conclusions Elder age, hypertension, diabetes and brainstem stroke are associated with the development of dysphagia in patients with ischemic stroke. Attention should be paid to the assessment and early intervention of those risk factors for dysphagia to improve the prognosis of stroke patients.
Collapse
Affiliation(s)
- Cui Yang
- Department of Neurology, The First People's Hospital of Lianyungang, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Yun Pan
- Division of Rheumatology, The First People's Hospital of Lianyungang, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, China
| |
Collapse
|
11
|
Dai M, Qiao J, Wei X, Chen H, Shi Z, Dou Z. Increased cortical-medulla functional connectivity is correlated with swallowing in dysphagia patients with subacute infratentorial stroke. NEUROIMAGE: CLINICAL 2022; 35:103104. [PMID: 35792418 PMCID: PMC9421453 DOI: 10.1016/j.nicl.2022.103104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with infratentorial stroke showed increased cortex-medulla connectivity. The cortex-medulla functional connectivities were related to swallowing function. The identified regions may be candidates for non-invasive strategies for dysphagia. FC mapping using the medulla as a seed is useful in swallowing network research.
Patients with infratentorial stroke (IS) exhibit more severe dysphagia and a higher risk of aspiration than patients with supratentorial stroke. Nevertheless, a large proportion of patients with IS regain swallowing function within 6 months; however, the neural mechanism for this recovery remains unclear. We aimed to investigate possible neuroplastic changes involved using functional magnetic resonance imaging (fMRI) and their relation to swallowing function. We assessed 21 patients with IS (mean age: 59.9 ± 11.1 years) exhibiting dysphagia in the subacute phase and 21 healthy controls (mean age: 57.1 ± 7.8 years). Patient evaluations were based on the functional oral intake scale (FOIS), videofluoroscopic swallow study (VFSS), and fMRI. Temporal swallowing measures and the penetration-aspiration scale (PAS) were obtained using VFSS. Whole-brain–medulla resting-state functional connectivity (rsFC) was calculated and compared between patients and healthy controls. The rsFCs were also correlated with functional measures within the patient group. In patients with IS, whole-brain–medulla rsFCs were significantly higher in the precuneus, the left and right precentral gyrus, and the right supplementary motor area compared to those in healthy controls (P < 0.001, family-wise error-corrected cluster-level P < 0.05). The rsFCs to the medulla for the left (r = −0.507, P = 0.027) and right side (r = −0.503, P = 0.028) precentral gyrus were negatively correlated with the PAS. The rsFC between the left (r = 0.470, P = 0.042) and right (r = 0.459, P = 0.048) precentral gyrus to the medulla was positively correlated with upper esophageal sphincter opening durations (UOD). In addition, PAS was also correlated with UOD (r = −0.638, P = 0.003) whereas the laryngeal closure duration was correlated with the hyoid bone movement duration (r = 0.550, P = 0.015). Patients with IS exhibited overall modulation of cortical-medulla connectivity during the subacute phase. Patients with higher connectivities showed better swallowing performance. These findings support that there is cortical involvement in swallowing regulation after IS and can aid in determining potential treatment targets for dysphagia.
Collapse
Affiliation(s)
- Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Jia Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Xiaomei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Huayu Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Zhonghui Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, People's Republic of China.
| |
Collapse
|
12
|
Luan S, Wu SL, Xiao LJ, Yang HY, Liao MX, Wang SL, Fan SN, Ma C. Comparison studies of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in the treatment of neurogenic cricopharyngeal muscle dysfunction. NeuroRehabilitation 2021; 49:629-639. [PMID: 34806624 DOI: 10.3233/nre-210113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cricopharyngeal muscle dysfunction (CPD) management has been challenging in clinical practice. OBJECTIVE To compare the efficacy and safety of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in treating CPD. METHODS Forty patients with CPD were randomly divided into two groups, namely the botulinum toxin injection group (BTX group) and balloon dilatation group (BD group). Patients in the BTX group received a single ultrasound-guided injection of 50 units of botulinum toxin type A, while the BD group received dilatation therapy five times per week, consecutively for two weeks. Relative opening percentage of the upper esophageal sphincter (UES), the penetration-aspiration scale (PAS), and the Dysphagia Outcome Severity Scale (DOSS) were evaluated by a videofluoroscopic swallowing study (VFSS) at baseline, 1-month, and 3-months posttreatment. The Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA) were also used to evaluate participants' swallowing function at baseline and the 1-week, 2-week, 1-month, and 3-month follow-ups. RESULTS A generalized estimating equation (GEE) model revealed the significant main effect for time in UES, PAS, DOSS, FOIS, and SSA compared to baseline (P <0.05), while no group-by-time interactions (except for the PAS assessment) or main effect for treatment was detected among the above multiple variances. No systematic complications or severe adverse effects were noted. CONCLUSION Both ultrasound-guided botulinum toxin type A injections and balloon dilatation therapy have been proven as safe and effective treatments for CPD patients. Future clinical trials with longer follow-up periods and more participants are warranted.
Collapse
Affiliation(s)
- Shuo Luan
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Shao-Ling Wu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Ling-Jun Xiao
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Hai-Yun Yang
- Department of Ultrasonic, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Mei-Xin Liao
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Shao-Ling Wang
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Sheng-Nuo Fan
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Chao Ma
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| |
Collapse
|
13
|
Xie M, Zeng P, Wan G, An D, Tang Z, Li C, Wei X, Shi J, Zhang Y, Dou Z, Wen H. The Effect of Combined Guidance of Botulinum Toxin Injection with Ultrasound, Catheter Balloon, and Electromyography on Neurogenic Cricopharyngeal Dysfunction: A Prospective Study. Dysphagia 2021; 37:601-611. [PMID: 33928464 DOI: 10.1007/s00455-021-10310-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/20/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cricopharyngeal botulinum toxin (BTX) injection is one of the treatments for neurogenic cricopharyngeal dysfunction (CPD). We conducted this prospective study to investigate the effect and safety of BTX injection for neurogenic CPD with a novel guidance. METHODS Twenty-one patients with neurogenic CPD whose symptoms did not reduce after conventional swallowing therapy were included in this study. The impact of BTX injection on the swallowing function of the patients was evaluated. KEY RESULTS After the injection, the Functional Oral Intake Scale (FOIS) score increased in 17 of 21 patients (80.9%), which ranged from 1 to 3 (P < 0.001). Moreover, there was a significant reduction in the UES opening impairment (P < 0.01), UES residual pressure (P < 0.05), duration of UES relaxation, penetration-aspiration scale score (P < 0.05), secretion (P < 0.05), vallecular residue (P < 0.01), and left (P < 0.05) and right (P < 0.05) pyriform sinus residue. With at least 6 months of follow-up, we found that FOIS continued to increase in patients who showed improvement after the injection (i.e., FOIS 5-7 points), while it remained unchanged in patients without improvement after the injection. There were no side effects reported in this study. CONCLUSION & INFERENCES BTX injection into the cricopharyngeal muscle guided by ultrasound, catheter balloon, and electromyography possibly has a long-lasting effect that can effectively and safely improve the swallowing function of patients with neurogenic CPD.
Collapse
Affiliation(s)
- Mengshu Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Peishan Zeng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Guifang Wan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Delian An
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Zhiming Tang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Xiaomei Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Jing Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Yaowen Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
| |
Collapse
|
14
|
Kim JY, Yoon SY, Kim J, Wook Kim Y. Neural correlates of cricopharyngeal dysfunction after supratentorial stroke: A voxel-based lesion-symptom mapping with propensity score matched case-control. Int J Stroke 2021; 17:207-217. [PMID: 33724099 DOI: 10.1177/17474930211006300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poststroke cricopharyngeal dysfunction has been reported to occur in 50% of brainstem strokes; however, cricopharyngeal dysfunction also occurs commonly in patients with supratentorial stroke. The hemispheric neuroanatomical location of this dysfunction has not been clearly identified. AIM We aimed to analyze the relationship between cricopharyngeal dysfunction and supratentorial lesion location in poststroke patients through this retrospective case-control voxel-based lesion-symptom mapping study. METHODS Cricopharyngeal dysfunction was diagnosed when the residue after swallowing (pyriform sinus) accounted for more than 25% of volume of pyriform sinus. Medical records and the video fluoroscopic swallowing studies of first-ever stroke patients who were admitted to our hospital during acute to subacute phase from 2009 to 2019 were reviewed. After propensity score matching to reduce the likelihood of selection bias, 50 patients per group were included in the cricopharyngeal dysfunction and control groups. We used a P threshold of 0.01 corrected for multiple comparisons with permutation thresholding (5000 permutations). Dichotomized diagnosis of cricopharyngeal dysfunction and the magnitude of pyriform sinus were used as dependent variables. RESULTS Analysis using the Liebermeister statistics indicated that lesions of the right lentiform nucleus were associated with the development of cricopharyngeal dysfunction. After adjustment for age and total lesion volume, which are known effectors for the development of dysphagia, statistically significant correlations were found between pyriform sinus and lesions of the right lentiform nucleus and anterior corona radiata beneath the right middle frontal gyrus. CONCLUSION Thus, our study demonstrated for the first time that damages to the right lentiform nucleus, especially globus pallidus externa, and anterior corona radiata beneath the right middle frontal gyrus are associated with the development and severity of cricopharyngeal dysfunction.
Collapse
Affiliation(s)
- Jun Yup Kim
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea.,Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Republic of Korea
| | - Jinna Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
15
|
Xie M, Dou Z, Wan G, Zeng P, Wen H. Design and implementation of botulinum toxin on cricopharyngeal dysfunction guided by a combination of catheter balloon, ultrasound, and electromyography (BECURE) in patients with stroke: study protocol for a randomized, double-blinded, placebo-controlled trial. Trials 2021; 22:238. [PMID: 33789722 PMCID: PMC8010959 DOI: 10.1186/s13063-021-05195-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Cricopharyngeal dysfunction (CPD) occurs in various neurological disorders, especially stroke. The treatment approaches of CPD include swallowing training, cricopharyngeal dilation, botulinum toxin (BTX) injection, and cricopharyngeal myotomy. BTX injection into the cricopharyngeal muscle is effective and safe for some patients with dysphagia, with a success rate between 43 and 100% (mean = 76%). However, well-designed randomized controlled clinical trials are needed to verify its efficacy and safety for the treatment of CPD. The objective of this study is to explore the efficacy and safety of BTX for neurogenic cricopharyngeal achalasia, when administering an injection into the cricopharyngeal muscle guided by a novel precise positioning method, that combines ultrasound, catheter balloon, and electromyography (BECURE). Methods BECURE is a single-center randomized, placebo controlled, double-blinded, superiority clinical trial. To detect a significant difference between the 2 groups, a sample size of 44 patients is estimated. The intervention is BTX versus placebo, with 1:1 randomization. The randomization sequence from 1 to 44 was generated using the Statistical Package for Social Sciences. The study is divided into two phases. In the first phase, patients will be injected with BTX or the placebo. In the second phase, patients who received a placebo injection and those who did not respond to the first BTX injection will receive an injection of BTX. The primary outcome is the score of the Functional Oral Intake Scale (FOIS). The secondary outcomes are as follows: upper esophageal sphincter (UES) residual pressure, UES resting pressure, duration of UES relaxation, velopharyngeal and laryngopharyngeal peak pressure, UES opening, pharyngeal construction ratio, residue of bolus in the epiglottis valley or piriform sinus, and penetration and aspiration. Discussion Dysphagia is a common complication of stroke. There is lack of high-quality evidence for the efficacy of BTX in treating neurogenic CPD. This study will clarify whether BTX injection into the cricopharyngeal muscle can be effective and safe for patients with stroke and CPD. Trial registration Chinese Clinical Trial Register (ChiCTR1900025562). Registered on September 1, 2019.
Collapse
Affiliation(s)
- Mengshu Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Guifang Wan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Peishan Zeng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong Province, China.
| |
Collapse
|
16
|
Chen JM, Chen YJ, Ni J, Wang ZY. Ultrasound, electromyography, and balloon guidance for injecting botulinum toxin for cricopharyngeal achalasia: A case report. Medicine (Baltimore) 2021; 100:e24909. [PMID: 33725963 PMCID: PMC7982191 DOI: 10.1097/md.0000000000024909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/04/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Botulinum toxin (BTX) injection is a widely used treatment option for dysphagia associated with cricopharyngeal (CP) muscle achalasia, but uniform standards and protocols for administration techniques and injection sites are still lacking. This case study suggests that a unique administration technique involving a combination of ultrasound, electromyography, and balloon guidance for injecting the CP muscle can reduce inadvertent migration of BTX to non-injected tissues and increase the effectiveness and safety of BTX treatment. PATIENT CONCERNS We describe the case of a 74-year-old man who could not swallow food or saliva for 8 months. DIAGNOSIS The patient showed signs of true bulbar paralysis, including dizziness, hoarseness, and dysphagia. The fiberoptic endoscopic evaluation of swallowing showed massive mucilage secretion and residual materials in the postcricoid region and aspiration when swallowing 1 ml of yogurt. The video fluoroscopic swallowing study showed profoundly limited epiglottic folding and CP muscle non-relaxation, despite several unsuccessful swallow attempts. INTERVENTIONS To manage insufficient relaxation opening of the CP muscle, BTX injection was performed using ultrasound, electromyography, and balloon catheter guidance. The narrow CP muscle situated above the balloon was identified as the target of injection by ultrasound. OUTCOMES The patient was able to eat a soft diet. The follow-up fibrotic endoscopic swallowing study demonstrated a reduction in the amount of pharyngeal residue. The video fluoroscopic swallowing study showed that CP muscle relaxation was significantly enhanced and no penetration was shown. CONCLUSION The unique administration technique with triple guidance holds several advantages, suggesting that it may be a promising treatment for CP muscle achalasia.
Collapse
|
17
|
Kim JW, Choi H, Jung J, Kim HJ. Risk factors for aspiration pneumonia in patients with dysphagia undergoing videofluoroscopic swallowing studies: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23177. [PMID: 33181693 PMCID: PMC7668488 DOI: 10.1097/md.0000000000023177] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Prediction of aspiration pneumonia development in at-risk patients is vital for implementation of appropriate interventions to reduce morbidity and mortality. Unfortunately, studies utilizing a comprehensive approach to risk assessment are still lacking. The objective of this study was to analyze the clinical features and videofluoroscopic swallowing study (VFSS) findings that predict aspiration pneumonia in patients with suspected dysphagia.Medical records of 916 patients who underwent VFSS between September 2014 and June 2018 were retrospectively analyzed. Patients were divided into either a pneumonia group or a non-pneumonia group based on diagnosis of aspiration pneumonia. Clinical information and VFSS findings were evaluated.One hundred seven patients (11.7%) were classified as having pneumonia. Multivariate analysis indicated that aspiration during the 2- cubic centimeter thick-liquid trial of VFSS (odds ratio [OR] = 3.23, 95% confidence interval [CI]: 1.93-5.41), smoking history (OR = 2.63, 95% CI: 1.53-4.53), underweight status (OR = 2.27, 95% CI: 1.31-3.94), abnormal pharyngeal delay time (OR = 1.60, 95% CI: 1.01-2.53), and a Penetration-Aspiration Scale level of 8 (OR = 3.73, 95% CI: 2.11-6.59) were significantly associated with aspiration pneumonia development. Integrated together, these factors were used to develop a predictive model for development of aspiration pneumonia (DAP), with a sensitivity of 82%, specificity of 56%, and an area under the receiver operating characteristic curve of 0.73.The best predictors for DAP included videofluoroscopic findings of aspiration during a 2-cubic centimeter thick-liquid trial, prolonged pharyngeal delay time, a Penetration-Aspiration Scale level of 8, history of smoking, and underweight status. These 5 proposed determinants and the associated DAP score are relatively simple to assess and may constitute a clinical screening tool that can readily identify and improve the management of patients at risk for aspiration pneumonia.
Collapse
|
18
|
Taira K, Yamamoto T, Mori-Yoshimura M, Sajima K, Takizawa H, Shinmi J, Oya Y, Nishino I, Takahashi Y. Cricopharyngeal bar on videofluoroscopy: high specificity for inclusion body myositis. J Neurol 2020; 268:1016-1024. [PMID: 32980980 DOI: 10.1007/s00415-020-10241-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the prevalence and characteristics of the cricopharyngeal bar (CPB), defined as marked protrusion with lacking relaxation and stricture of the upper esophageal sphincter on videofluoroscopy, in patients with inclusion body myositis (IBM). METHODS We conducted a case-control study of comprehensive series of adult healthy individuals and consecutive patients with neuropsychiatric disorders aged over 45 (52 versus 2486). A standard videofluoroscopy was performed. RESULTS Overall, 47 individuals with CPB were identified. Of the individuals with CPB, 36% were IBM followed by neurodegenerative disorders, muscular disorders, neuromuscular disorders, and others (32%, 21%, 2.1%, and 8.5%, respectively), indicating the heterogeneity of the etiologies. Against muscular disorders, the sensitivity and specificity of the CPB for IBM were 33% (= 17/52; 95% confidence interval [CI], 20-45%) and 96% (= 264/274; 95% CI, 94-99%), respectively. IBM with CPB showed a higher frequency of obstruction-related dysphagia (88% versus 22%, p < 0.001) and severe CPB (76% versus 23%, p < 0.001) than the control with one. The ratio of the upper esophageal distance at the maximum distension at the level of C6 to that of C4 was lower in IBM with CPB than in the controls with one (0.50 versus 0.77, p < 0.001), which suggests the insufficient opening of the upper esophageal sphincter. CONCLUSION A CPB could be indicative of IBM. The upper esophagus in IBM with CPB became narrow, like a bottleneck. We provide new perspectives of dysphagia diagnosis by videofluoroscopy, especially for IBM-associated dysphagia, to expand the knowledge on the CPB.
Collapse
Affiliation(s)
- Kenichiro Taira
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Toshiyuki Yamamoto
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan.
- Department of Neurology, Dysphagia Research Center, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
- Department of Neurology, Dysphagia Research Center, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Kazuaki Sajima
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Hotake Takizawa
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Jun Shinmi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
- Medical Genome Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, Japan
| |
Collapse
|
19
|
Tran EK, Juarez KO, Long JL. Stem cell treatments for oropharyngeal dysphagia: Rationale, benefits, and challenges. World J Stem Cells 2020; 12:1001-1012. [PMID: 33033560 PMCID: PMC7524699 DOI: 10.4252/wjsc.v12.i9.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/28/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Dysphagia, defined as difficulty swallowing, is a common symptom negatively impacting millions of adults annually. Estimated prevalence ranges from 14 to 33 percent in those over age 65 to over 70 percent in a nursing home setting. The elderly, those with neurodegenerative diseases, head and neck cancer patients, and those with autoimmune conditions such as Sjögren's syndrome are disproportionately affected. Oropharyngeal dysphagia refers specifically to difficulty in initiating a swallow due to dysfunction at or above the upper esophageal sphincter, and represents a large proportion of dysphagia cases. Current treatments are limited and are often ineffective. Stem cell therapy is a new and novel advancement that may fill a much-needed role in our treatment regimen. Here, we review the current literature regarding stem cell treatments for oropharyngeal dysphagia. Topics discussed include tissue regeneration advancements as a whole and translation of these principles into research surrounding tongue dysfunction, xerostomia, cricopharyngeal dysfunction, and finally an overview of the challenges and future directions for investigation. Although this field of study remains in its early stages, initial promising results show potential for the use of stem cell-based therapies to treat oropharyngeal dysphagia and warrant further research.
Collapse
Affiliation(s)
- Eric K Tran
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, United States
| | - Kevin O Juarez
- Department of Otolaryngology, Yale School of Medicine, New Haven, CT 06511, United States
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, United States
- Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, United States
| |
Collapse
|
20
|
Ghazaleh S, Nehme C, Khader Y, Hasan S, Nawras A. Combined achalasia and cricopharyngeal achalasia in a patient with type 1 myotonic dystrophy: a case report. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2020; 13:181-183. [PMID: 32308942 PMCID: PMC7149813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Type 1 myotonic dystrophy (MD) is a rare inherited disease which presents with skeletal muscle weakness and myotonia. Involvement of smooth muscles is also common and mainly manifests in the gastrointestinal tract. We report a case of type 1 MD who presented with dysphagia and was found to have unique esophageal manometry findings. A 57-year-old male patient presented with dysphagia for the last few months. Past medical history was significant for type 1 myotonic muscular dystrophy, gastroesophageal reflux disease, diaphragmatic paralysis, and obstructive sleep apnea. Both his father and brother died in their 50s because of unclear respiratory problems. He was a former smoker and did not drink alcohol. Review of systems was unremarkable. His neurological examination was significant for bilateral facial muscle weakness and mild ptosis. He had atrophy and weakness of the distal upper and lower extremities. Deep tendon reflexes were absent. Upper endoscopy and 24-hour esophageal pH testing were non-diagnostic. Finally, esophageal manometry revealed elevated lower esophageal sphincter (LES) pressure, elevated upper esophageal sphincter (UES) pressure, and very week peristalsis of the esophageal body. Esophageal involvement is common in type 1 MD manifesting with dysfunction of UES, esophageal body, and LES. Manometry usually describes a reduced resting tone of the UES and LES. The patient had elevated LES pressure and week peristalsis of the esophageal body consistent with achalasia. He also had an elevated UES pressure consistent with cricopharyngeal achalasia. This is the opposite of what is expected in type 1 MD.
Collapse
Affiliation(s)
- Sami Ghazaleh
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Christian Nehme
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Yasmin Khader
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Syed Hasan
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
| |
Collapse
|
21
|
Botulinum Toxin A Injection Using Esophageal Balloon Radiography Combined with CT Guidance for the Treatment of Cricopharyngeal Dysphagia. Dysphagia 2019; 35:630-635. [DOI: 10.1007/s00455-019-10070-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
|
22
|
Pearson WG, Griffeth JV, Ennis AM. Functional Anatomy Underlying Pharyngeal Swallowing Mechanics and Swallowing Performance Goals. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig13-2018-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
Rehabilitation of pharyngeal swallowing dysfunction requires a thorough understanding of the functional anatomy underlying the performance goals of pharyngeal swallowing. These goals include the safe and efficient transfer of a bolus through the hypopharynx into the esophagus. Penetration or aspiration of a bolus threatens swallowing safety. Bolus residue indicates swallowing inefficiency. Several primary mechanics, or elements of the swallowing mechanism, underlie these performance goals, with some elements contributing to both goals. These primary mechanics include velopharyngeal port closure, hyoid movement, laryngeal elevation, pharyngeal shortening, tongue base retraction, and pharyngeal constriction. Each element of the swallowing mechanism is under neuromuscular control and is therefore, in principle, a potential target for rehabilitation. Secondary mechanics of pharyngeal swallowing, those movements dependent on primary mechanics, include opening the upper esophageal sphincter and epiglottic inversion.
Conclusion
Understanding the functional anatomy of pharyngeal swallowing underlying swallowing performance goals will facilitate anatomically informed critical thinking in the rehabilitation of pharyngeal swallowing dysfunction.
Collapse
Affiliation(s)
- William G. Pearson
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University
- Department of Otolaryngology, Medical College of Georgia,Augusta University
| | | | - Alexis M. Ennis
- Department of Academic Affairs, Medical College of Georgia, Augusta University
| |
Collapse
|
23
|
He F, Zhang N, Lv Y, Sun W, Chen H. Low‑dose lipopolysaccharide inhibits neuronal apoptosis induced by cerebral ischemia/reperfusion injury via the PI3K/Akt/FoxO1 signaling pathway in rats. Mol Med Rep 2019; 19:1443-1452. [PMID: 30628689 PMCID: PMC6390019 DOI: 10.3892/mmr.2019.9827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/03/2018] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to investigate the effects of low‑dose lipopolysaccharide (LPS) on ischemia/reperfusion (I/R)‑induced brain injury, and to explore the mechanism of phosphoinositide 3‑kinase (PI3K)/Akt/forkhead box protein (Fox)O1 signaling pathway. Male Sprague‑Dawley rats were divided into control group (control), ischemia/reperfusion surgery group (I/R) and low‑dose LPS treatment group (LPS). An I/R model was established and the hemodynamic parameters were recorded at the end of I/R injury. The brain tissues were observed by hematoxylin and eosin staining, immunohistochemistry and terminal deoxynucleotidyl‑transferase‑mediated dUTP nick end labeling staining. Microglia were treated with LPS following hypoxia/reoxygenation. The cellular viability was detected by 3‑(4,5‑dimethylthiazol‑2‑yl)‑2,5‑diphenyltetrazolium bromide assay. The apoptotic rate of microglia was detected using AnnexinV/propidium iodide staining. The expression of B‑cell lymphoma (Bcl)‑2, Bcl‑2‑associated X (Bax), and caspase‑3 were detected by western blot analysis and reverse transcription‑quantitative polymerase chain reaction. Akt, phosphorylated (p)‑Akt, FoxO1 and p‑FoxO1 expression were detected by western blotting. It was previously reported that, following I/R injury, neuronal cells were disorderly and brain injury markers (neuron‑specific enolase and S100 β), inflammatory cytokines [interleukin (IL)‑1β, IL‑6 and tumor necrosis factor‑α] levels were significantly upregulated. In the present study, the expression levels of Bax, caspase‑3 Akt and p‑Akt were significantly higher, while that of Bcl‑2, FoxO1 and p‑FoxO1 were significantly lower in the I/R group. LPS treatment significantly increased the viability of neuronal cells and decreased the rate of neuronal cell apoptosis. Following the addition of PI3K signaling pathway inhibitor LY294002 to microglia, LPS reduced the levels of activated Akt, increased the downstream regulatory gene phosphorylation of FoxO1 and reduced microglia apoptosis. It was concluded that LPS can alleviate I/R‑induced brain injury, inhibit neuronal cells apoptosis and protect neuronal cells via the PI3K/Akt/FoxO1 signaling pathway.
Collapse
Affiliation(s)
- Fan He
- Department of Neurology, General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110016, P.R. China
| | - Nannan Zhang
- Department of Neurology, General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110016, P.R. China
| | - Yan Lv
- Department of Neurology, General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110016, P.R. China
| | - Wenhao Sun
- Department of Neurology, The General Hospital of Tianjin Medical University, Tianjin 300020, P.R. China
| | - Huisheng Chen
- Department of Neurology, General Hospital of Shenyang Military Area Command, Shenyang, Liaoning 110016, P.R. China
| |
Collapse
|