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ISSN (Print) 1432-0460 - ISSN (Online) 0179-051X
Published by Springer-Verlag Homepage  [2351 journals]
  • Lesions Responsible for Delayed Oral Transit Time in Post-stroke Dysphagia
    • Authors: Hyun Im Moon; Seo Yeon Yoon; Tae Im Yi; Yoon Jeong Jeong; Tae Hwan Cho
      Pages: 321 - 328
      Abstract: Introduction Some stroke patients show oral phase dysphagia, characterized by a markedly prolonged oral transit time that hinders oral feeding. The aim of this study was to clarify the clinical characteristics and lesions responsible for delayed swallowing. Methods We reviewed 90 patients with stroke. The oral processing time plus the postfaucial aggregation time required to swallow semisolid food was assessed. The patients were divided into two groups according to oral transit time, and we analyzed the differences in characteristics such as demographic factors, lesion factors, and cognitive function. Logistic regression analyses were performed to examine the predictors of delayed oral transit time. Lesion location and volume were measured on brain magnetic resonance images. We generated statistic maps of lesions related to delayed oral phase in swallowing using voxel-based lesion symptom mapping (VLSM). Results The group of patients who showed delayed oral transit time had significantly low cognitive function. Also, in a regression model, delayed oral phase was predicted with low K-MMSE (Korean version of the Mini Mental Status Exam). Using VLSM, we found the lesion location to be associated with delayed oral phase after adjusting for K-MMSE score. Although these results did not reach statistical significance, they showed the lesion pattern with predominant distribution in the left frontal lobe. Conclusion Delayed oral phase in post-stroke patients was not negligible clinically. Patients’ cognitive impairments affect the oral transit time. When adjusting it, we found a trend that the lesion responsible for delayed oral phase was located in the left frontal lobe, though the association did not reach significance. The delay might be related to praxis function.
      PubDate: 2018-06-01
      DOI: 10.1007/s00455-017-9856-5
      Issue No: Vol. 33, No. 3 (2018)
  • Inter-rater Reliability of the Dysphagia Outcome and Severity Scale
           (DOSS): Effects of Clinical Experience, Audio-Recording and Training
    • Authors: Angeliki Zarkada; Julie Regan
      Pages: 329 - 336
      Abstract: The Dysphagia Outcome and Severity Scale (DOSS) is widely used to measure dysphagia severity based on videofluoroscopy (VFSS). This study investigated inter-rater reliability (IRR) of the DOSS. It also determined the effect of clinical experience, VFSS audio-recording and training on DOSS IRR. A quantitative prospective research design was used. Seventeen speech and language pathologists (SLPs) were recruited from an acute teaching hospital, Dublin (> 3 years’ VFSS experience, n = 10) and from a postgraduate dysphagia programme in a university setting (< 3 years’ VFSS experience; n = 7). During testing, participants viewed eight VFSS clips (5 with audio-recording). Each VFSS clip was independently rated using the DOSS scale. Four weeks later, the less experienced group attended a 1-h training session on DOSS rating after which DOSS IRR was re-tested. Cohen’s kappa co-efficient was used to establish IRR. IRR of the DOSS presented only fair agreement (κ = 0.36, p < 0.05). DOSS IRR was significantly higher (κ = 0.342) within the more experienced SLP group, compared to the less experienced SLP group (κ = 0.298) (p < 0.05). DOSS IRR was significantly higher in VFSS clips with audio-recording (κ = 0.287) compared to VFSS clips without audio-recording (κ = − 0.0395) (p < 0.05). IRR of the DOSS pre-training (κ = 0.328) was significantly better comparing to post-training (κ = 0.218) (p < 0.05). Findings raise concerns as the DOSS is frequently used in clinical practice to capture dysphagia severity and to monitor changes.
      PubDate: 2018-06-01
      DOI: 10.1007/s00455-017-9857-4
      Issue No: Vol. 33, No. 3 (2018)
  • Tongue-Strengthening Exercises in Healthy Older Adults: Specificity of
           Bulb Position and Detraining Effects
    • Authors: Leen Van den Steen; Charlotte Schellen; Katja Verstraelen; Anne-Sophie Beeckman; Jan Vanderwegen; Marc De Bodt; Gwen Van Nuffelen
      Pages: 337 - 344
      Abstract: Clinical tongue-strengthening therapy programs are generally based on the principles of exercise and motor learning, including the specificity paradigm. The aim of this study was to investigate the specific effect of anterior and posterior tongue-strengthening exercises (TSE) on tongue strength (TS) in healthy older adults and to measure possible detraining effects. Sixteen healthy elderly completed 8 weeks of TSE by means of the Iowa Oral Performance Instrument (IOPI). They were distributed in two different treatment arms and performed either exclusively anterior or posterior TSE (ATSE, n = 9 or PTSE, n = 7) depending on the treatment arm. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, halfway, and after completion of the training sessions. Detraining was measured by repeating MIPA and MIPP measures 4 weeks after the last session of TSE. MIPA and MIPP increased significantly in both treatment arms. MIPA was significantly higher in the ATSE group compared to the PTSE group across all measures in time. No significant differences were observed in MIPP between the ATSE and PTSE groups. Regardless of treatment arm, there was no significant detraining effect measured 4 weeks after the last TSE session. This study suggests that TSE show partial specificity concerning bulb position. We conclude that especially anterior training results in higher anterior TS in comparison with posterior exercises. Furthermore, we found no detraining effects, independent of bulb location.
      PubDate: 2018-06-01
      DOI: 10.1007/s00455-017-9858-3
      Issue No: Vol. 33, No. 3 (2018)
  • Modification of Masticatory Rhythmicity Leading to the Initiation of the
           Swallowing Reflex in Humans
    • Authors: Masaki Yoneda; Kazuya Saitoh
      Pages: 358 - 368
      Abstract: Modification of movements by proprioceptive feedback during mastication has an important role in shifting from the oral to the pharyngeal phase of swallowing. The aim of this study was to investigate the kinetics of masticatory muscles throughout a sequence of oropharyngeal swallowing and to present a hypothetical model of the involvement of the nervous system in the transition from mastication to the swallowing reflex. Surface electromyographic signals were recorded from the jaw-closing masseter muscles and the jaw-opening suprahyoid muscle group when a piece of bread (3–5 g) was ingested. Participants were not provided any additional instruction regarding how to chew and swallow. In the final stage of mastication, compared with other stages of mastication, the duration between sequential peak times of rhythmic activity of the masseter muscles was prolonged. Electromyography revealed no significant change in the suprahyoid muscle group. Accordingly, contraction of the jaw-closing muscles and the jaw-opening muscles altered from out-of-phase to in-phase. We have presented a hypothetical model based on the results of the present study, in which mastication shifts to the swallowing reflex when feed-forward inputs from rhythm generators for the jaw-closing and the jaw-opening muscles converge onto an assumed “convertor” neuron group concurrently. This model should contribute to understanding the pathophysiology of dysphagia.
      PubDate: 2018-06-01
      DOI: 10.1007/s00455-017-9860-9
      Issue No: Vol. 33, No. 3 (2018)
  • Effect of Body Position on Pharyngeal Swallowing Pressures Using
           High-Resolution Manometry
    • Authors: Sarah P. Rosen; Suzan M. Abdelhalim; Corinne A. Jones; Timothy M. McCulloch
      Pages: 389 - 398
      Abstract: The effect of body position and gravitational pull on the complex pressure-driven process of pharyngeal swallowing remains unknown. Using high-resolution manometry (HRM), this study aims to identify positional adaptations of pharyngeal physiology by evaluating swallowing pressure patterns in a series of inverted body positions. Ten healthy adults each underwent swallowing tasks with pharyngeal HRM at six body positions using an inversion table (0°[upright], 45°, 90°[supine], 110°, 135°, and 180°[fully inverted]). Repeated measures ANOVA was used to assess impact of position on pressure parameters, and pharyngeal-UES pressure gradients translate. Velopharyngeal pressures varied by position (P < 0.001), with significantly higher pressures generated with inversion ≥90°, compared with upright and 45°. Change in position did not significantly affect common mesopharyngeal pressures or swallowing pressure durations. UES valving mechanisms were preserved during inversion, with subtle variations observed in integral pressures (P = 0.011). Pharyngeal-UES pressure gradients changed with position (P < 0.01), increasing with inversion > 90° compared to upright and 45°. Mechanisms of deglutition may differ with position and relative direction of gravity, particularly when at > 45° inclination. Increased palatal pressure is generated in the upside-down position to achieve nasopharyngeal closure and prevent regurgitation. While other classically measured pressures may not consistently differ with positioning, many individuals exhibit adaptations in pressure gradients when inverted, likely due to a combination of changes in pharyngeal driving force and UES opening mechanisms. Identification of these changes, relative to position, further builds on our understanding of the adaptability of the pharyngeal swallowing system.
      PubDate: 2018-06-01
      DOI: 10.1007/s00455-017-9866-3
      Issue No: Vol. 33, No. 3 (2018)
  • Psychometric Properties of Visuoperceptual Measures of Videofluoroscopic
           and Fibre-Endoscopic Evaluations of Swallowing: A Systematic Review
    • Authors: Katina Swan; Reinie Cordier; Ted Brown; Renée Speyer
      Abstract: Fibreoptic Endoscopic Evaluation of Swallowing (FEES) and Videofluoroscopic Swallow Studies (VFSS) are instrumental assessments of dysphagia which provide videos of the internal structures of swallowing. They are commonly regarded as ‘gold-standard’ assessments; however, there is no consensus regarding a gold-standard measure to analyse the video recordings that they produce. Measures require sound psychometric properties to be suitable for clinical or research purposes. To date, no review of psychometric properties of FEES and VFSS measures has been undertaken or formally reported. This review assessed the quality of the psychometric properties of visuoperceptual measures of FEES and VFSS. Electronic databases were searched for studies reporting on psychometric qualities of visuoperceptual measures which are used to analyse recordings from FEES and VFSS. All dates until February 2017 were included. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to evaluate the methodical quality of studies. The measures’ overall quality was then assessed by combining COSMIN ratings with quality criteria. Forty-five studies, reporting on 39 measures, met the inclusion criteria for this review. Data about the measures’ psychometric properties were very limited. Twenty-one measures had information available about reliability only, while 18 had information on up to five of the possible nine psychometric properties categorised within the COSMIN framework. The majority of the FEES and VFSS measures’ psychometric properties were rated as ‘indeterminate’ overall, due to the small number of studies, issues with design, statistical analyses, and reporting practices of extant studies. There is insufficient evidence to recommend any individual measure included in this review as valid and reliable to interpret VFSS and FEES recordings. Further research, which utilises robust methodological design and reporting, is needed to examine the psychometric properties of measures for FEES and VFSS.
      PubDate: 2018-07-17
      DOI: 10.1007/s00455-018-9918-3
  • Medicine Administration in People with Parkinson’s Disease in New
           Zealand: An Interprofessional, Stakeholder-Driven Online Survey
    • Authors: Monica Amer Oad; Anna Miles; Avril Lee; Angela Lambie
      Abstract: Medicine administration errors are twice as frequent in people with dysphagia than in those without. Medicine administration is particularly critical for people with Parkinson’s disease where late, or missed doses reduce medicine effectiveness and impact on the quality of life. The aim of this study was to explore the current medicine administration practices of people with Parkinson’s disease in New Zealand. A self-administered online survey was developed by an interprofessional group including people with Parkinson’s disease (the primary stakeholders), speech-language pathologists and pharmacists. The survey was administered using a cross-sectional study design and asked respondents about self-reported swallowing difficulties [using Eating Assessment Tool (EAT-10)], medicine regimes and strategies used to swallow medicines. Seventy-one people with Parkinson’s disease responded to the survey (69% male, mean age 72 years, mean years with Parkinson’s disease 9 years). Respondents reported complex daily multi-medicine consumption (mean no. of pills 11, range 2–25). Analyses showed that 57% of respondents scored outside the normal range for EAT-10 (> 3) with 57% complaining of difficulties with pills. Many respondents admitted to missing medicines and requiring external reminders. Multiple strategies for swallowing pills were described including crushing tablets, using yoghurt or fruit juice, and swallowing strategies (such as head tilt, effortful swallow, chin down and altered pill placement in the mouth). Medicine administration is complex and challenging for people with Parkinson’s disease. The development of educational packages for people with Parkinson’s disease, their carers and health professionals is much needed.
      PubDate: 2018-07-11
      DOI: 10.1007/s00455-018-9922-7
  • Tongue Shape Dynamics in Swallowing Using Sagittal Ultrasound
    • Authors: Mai Ohkubo; James M. Scobbie
      Abstract: Ultrasound imaging is simple, repeatable, gives real-time feedback, and its dynamic soft tissue imaging may make it superior to other modalities for swallowing research. We tested this hypothesis and measured certain spatial and dynamic aspects of the swallowing to investigate its efficacy. Eleven healthy adults wearing a headset to stabilize the probe participated in the study. Both thickened and thin liquids were used, and liquid bolus volumes of 10 and 25 ml were administered to the subjects by using a cup. The tongue’s surface was traced as a spline superimposed on a fan-shaped measurement space for every image from the time at which the tongue blade started moving up toward the palate at the start of swallowing to the time when the entire tongue was in contact with the palate. To measure depression depth, the distance (in mm) was measured along each radial fan line from the location at which the tongue’s surface spline intersected the fan line to the point where the hard palate intersected the fan line at each timepoint. There were differences between individual participants in the imageability of the swallow, and so we defined quantitatively “measureable” and “unmeasurable” types. The most common type was measureable, in which we could find a clear bolus depression in the cupped tongue’s surface. Indeed, with 10 ml of thin liquids, we were able to find and measure the depression depth for all participants. The average maximum radial distance from the palate to the tongue’s surface was 20.9 mm (median) (IQR: 4.3 mm) for swallowing 10 ml of thin liquid compared to 24.6 mm (IQR: 3.3 mm) for 25 ml of thin liquid swallow (p < 0.001). We conclude that it is possible to use ultrasound imaging of the tongue to capture spatial aspects of swallowing.
      PubDate: 2018-06-28
      DOI: 10.1007/s00455-018-9921-8
  • Dysphagia Management in Iran: Knowledge, Attitude and Practice of
           Healthcare Providers
    • Authors: Sima Farpour; Hamid Reza Farpour; David Smithard; Bahareh Kardeh; Fatemeh Ghazaei; Mohsen Zafarghasempour
      Abstract: Despite the remarkable burden of dysphagia, appropriate multidisciplinary management is lacking in Iran and patients are often deprived of effective treatments. Obtaining a full understanding of knowledge, attitude and practice (KAP) of healthcare providers is necessary to determine the gaps in improvement of the quality of care for dysphagic patients. A questionnaire was designed covering demographic information and the parameters of KAP. Face and content validity were determined. Test–retest reliability confirmed that the questionnaire scores are stable over time (r = 0.77, p value < 0.01). Participants were healthcare providers employed in university-affiliated hospitals in three major cities of Iran; Tehran, Shiraz and Mashhad. In total, 312 healthcare professionals completed our survey. The majority (96.8%) were familiar with the term “dysphagia or swallowing disorders”. Most of the participants believed their profession (88.5%), as well as other disciplines (92.3%) can play an important role in the management of dysphagia; and this problem should be recognized in a multidisciplinary manner (96.2%). Also, 60.9% had encountered a patient with dysphagia. 52.2% had used at least one assessment method, while 49.9% had applied at least one treatment method. However, very few participants were familiar with a standard test for screening and assessment of dysphagia (11.9%). 74.7% were willing to participate in a workshop on dysphagia. As the main pitfalls of care lie in diagnosis and treatment expertise, the policy of hospitals should prioritize educating and updating the skills of healthcare professionals, encourage multidisciplinary teamwork, establishing clear guidelines and facilitate access to advanced tools.
      PubDate: 2018-06-21
      DOI: 10.1007/s00455-018-9919-2
  • Establishing a Multidisciplinary Head and Neck Clinical Pathway: An
           Implementation Evaluation and Audit of Dysphagia-Related Services and
    • Authors: Barbara Pisano Messing; Elizabeth C. Ward; Cathy Lazarus; Keri Ryniak; Melissa Kim; Jessica Silinonte; Dorothy Gold; Carol B. Thompson; Karen T. Pitman; Ray Blanco; Ryan Sobel; Karen Harrer; Karen Ulmer; Geoffrey Neuner; Kruti Patel; Mei Tang; Gregory Lee
      Abstract: Head and neck cancer (HNC) guidelines recommend regular multidisciplinary team (MDT) monitoring and early intervention to optimize dysphagia outcomes; however, many factors affect the ability to achieve these goals. The aims of this study were to explore the barriers/facilitators to establishing and sustaining a MDT HNC care pathway and to examine the dysphagia-related speech-language pathology (SLP) and dietetic components of the pathway. Using the Consolidated Framework for Implementation Research (CFIR), a mixed methods study design was used to evaluate an established MDT HNC pathway. Ten MDT members provided perceptions of facilitators/barriers to implementing and sustaining the pathway. Patients attending the SLP and dietetic components of the pathway who commenced treatment between 2013 and 2014 (n = 63) were audited for attendance, outcome data collected per visit, and swallowing outcomes to 24-month post-treatment. Dysphagia outcomes were compared to a published cohort who had received intensive prophylactic dysphagia management. Multiple CFIR constructs were identified as critical to implementing and sustaining the pathway. Complexity was a barrier. Patient attendance was excellent during treatment, with low rates of non-compliance (< 15%) to 24 months. Collection of clinician/patient outcome tools was good during treatment, but lower post-treatment. Dysphagia outcomes were good and comparable to prior published data. The pathway provided patients with access to regular supportive care and provided staff opportunities to provide early and ongoing dysphagia monitoring and management. However, implementing and sustaining a HNC pathway is complex, requiring significant staff resources, financial investment, and perseverance. Regular audits are necessary to monitor the quality of the pathway.
      PubDate: 2018-06-19
      DOI: 10.1007/s00455-018-9917-4
  • Changes in Swallowing and Cough Functions Among Stroke Patients Before and
           After Tracheostomy Decannulation
    • Authors: Min Kyu Park; Sook Joung Lee
      Abstract: We investigated the functional changes in swallowing and voluntary coughing before and after tracheostomy decannulation among stroke patients who had undergone a tracheostomy. We also compared these functions between stroke patients who underwent tracheostomy tube removal and those who did not within 6 months of their stroke. Seventy-seven stroke patients who had undergone a tracheostomy were enrolled. All patients were evaluated by videofluoroscopic swallowing studies and a peak flow meter through the oral cavity serially until 6 months after their stroke. During the intensive rehabilitation period, if a patient satisfied the criteria for tracheostomy tube removal, the tube was removed. The patients were divided into the ‘decannulated’ group and the ‘non-decannulated’ group according to their tracheostomy tube removal status. In the decannulated group, swallowing function did not change before and after tracheostomy decannulation; however, cough function was significantly improved after decannulation. Although both groups exhibited functional improvement in swallowing and coughing over time, the improvement in the decannulated group was more significant than the improvement in the non-decannulated group. Our results revealed that stroke patients who had better functional improvement in swallowing and coughing were more likely to be potential candidates for tracheostomy decannulation. Stroke patients who recovered from neurogenic dysphagia, they were no longer affected by the mechanical effect of the tracheostomy tube on swallowing function. This study suggests that if patients show improvement in swallowing and coughing after their stroke, a multidisciplinary approach to tracheostomy decannulation would be needed to achieve better rehabilitation outcomes.
      PubDate: 2018-06-18
      DOI: 10.1007/s00455-018-9920-9
  • Characterizing the Flow of Thickened Barium and Non-barium Liquid Recipes
           Using the IDDSI Flow Test
    • Authors: Carly E. A. Barbon; Catriona M. Steele
      Abstract: The use of thickened liquids for dysphagia management has become wide-spread. Videofluoroscopy is commonly used to determine dysphagia severity and to evaluate the effectiveness of interventions, including texture modification, but this requires the use of radio-opaque contrast media. In order for the results of a videofluoroscopy to have validity with respect to confirming swallowing safety and efficiency on different liquid consistencies, it is important to understand the flow characteristics of the contrast media used and how the flow of these stimuli compares to the flow of liquids that are provided outside the assessment context. In this study, we explored the flow characteristics of 20% w/v barium and non-barium stimuli prepared using starch and gum thickeners to reach the slightly, mildly and moderately thick liquid categories defined by the International Dysphagia Diet Standardisation Initiative (IDDSI). Our goal was to identify recipes that would produce stimuli with stable flow properties over a 3 h time frame post mixing. Thickener concentration was titrated to achieve matching flow (i.e., IDDSI Flow Test results within a 1 ml range) across the four stimulus types (non-barium starch, non-barium gum, barium starch, barium gum) within each IDDSI level. The combination of barium and thickeners resulted in further thickening, particularly with starch-based thickening agents. A probe of the influence of refrigeration showed no difference in flow measures between chilled and room temperature stimuli over a 3-h time frame. Overall, recipes with stable flow over three hours were identified for all barium and non-barium liquids tested.
      PubDate: 2018-06-11
      DOI: 10.1007/s00455-018-9915-6
  • Tongue Pressure Measurement and Videofluoroscopic Study of Swallowing in
           Patients with Parkinson’s Disease
    • Authors: Tatsuyuki Fukuoka; Takahiro Ono; Kazuhiro Hori; Yosuke Wada; Yuki Uchiyama; Shuhei Kasama; Hiroo Yoshikawa; Kazuhisa Domen
      Abstract: This study investigated the relationship between tongue pressure during swallowing and dysphagia in patients with Parkinson’s disease (PD). A total of 24 patients with PD (12 men and 12 women, mean age 70.4 years) were studied. Their mean Hoehn and Yahr scale was 3.0 ± 1.3 (range 1–5). All participants underwent tongue pressure measurement and videofluorography during swallowing. Tongue pressure when swallowing 5 mL of barium on videofluorography was measured using a sensor sheet with five sensors. Based on the findings of videofluorography, the patients were divided into two groups: dysphagic PD group (n = 9) and non-dysphagic PD group (n = 15). The maximal magnitude (kPa), duration (s), time to peak pressure (s), and pressure gradient (kPa/s) of tongue pressure were analyzed for each part. For duration, time to peak pressure, and pressure gradient, similar values were calculated from the total waveform. There was no significant difference in maximal tongue pressure between the groups. The dysphagic PD group had prolonged duration of tongue pressure and time to peak pressure and a reduced pressure gradient compared with the non-dysphagic PD group. These results indicate that there is a clear difference in the temporal aspects of tongue pressure between the non-dysphagic and dysphagic PD patients. These differences provide the characteristics of tongue movement during swallowing in PD patients with dysphagia, which may be useful for the diagnosis and treatment of dysphagia.
      PubDate: 2018-06-08
      DOI: 10.1007/s00455-018-9916-5
  • Swallowing Changes in Community-Dwelling Older Adults
    • Authors: Rachel W. Mulheren; Alba M. Azola; Stephanie Kwiatkowski; Eleni Karagiorgos; Ianessa Humbert; Jeffrey B. Palmer; Marlís González-Fernández
      Abstract: Older adults may evidence changes in swallowing physiology. Our goals were to identify dysphagia risk in community-dwelling older adults with no history of dysphagia, and to compare swallowing physiology and safety between older and younger adults. Thirty-two older adults with no history of dysphagia were prospectively recruited and completed the Dysphagia Handicap Index (DHI), two trials of a 3 oz. swallow screen, and videofluoroscopy (VFSS). Self-ratings of swallowing function were compared to published norms by paired t tests, and multivariate logistic regression models were generated to determine whether these ratings and VFSS analysis of swallowing function were associated with failure of one or both swallow screen trials. Archived VFSS of 33 younger adults were compared to older adults with Wilcoxon rank-sum tests. The DHI scores of older adults were higher than published non-dysphagic adults but lower than dysphagic adults. Older participants with greater Oral Residue scores were more likely to fail both swallow screen trials. Older adults received higher median MBSImP™© scores for select pharyngeal components than younger adults. The two age groups did not differ on Penetration-Aspiration Scale scores, and no aspiration was observed. Measures of swallowing in older individuals may reflect age-related sensory and motor changes in the context of functional swallowing and adequate airway protection.
      PubDate: 2018-06-08
      DOI: 10.1007/s00455-018-9911-x
  • Predictors of Patient-Reported Dysphagia Following IMRT Plus Chemotherapy
           in Oropharyngeal Cancer
    • Authors: Ester Orlandi; Rosalba Miceli; Gabriele Infante; Aurora Mirabile; Daniela Alterio; Maria Cossu Rocca; Nerina Denaro; Riccardo Vigna-Taglianti; Annamaria Merlotti; Antonio Schindler; Nicole Pizzorni; Carlo Fallai; Lisa Licitra; Paolo Bossi
      Abstract: The aim of this cross-sectional study is to evaluate the factors associated with patient-reported dysphagia in patients affected by locally advanced oropharyngeal cancer (OPC) treated with definitive intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy (CHT), with or without induction CHT. We evaluated 148 OPC patients treated with IMRT and concurrent CHT, without evidence of disease and who had completed their treatment since at least 6 months. At their planned follow-up visit, patients underwent clinical evaluation and completed the M.D. Anderson dysphagia inventory (MDADI) questionnaire. The association between questionnaire composite score (MDADI-CS) and different patients’ and tumor’s characteristics and treatments (covariates) was investigated by univariable and multivariable analyses, the latter including only covariates significant at univariable analysis. With a median time from treatment end of 30 months [range 6–74 months, interquartile range (IQR) 16–50 months], the median (IQR) MDADI-CS was 72 (63–84). The majority of patients (82.4%) had a MDADI-CS ≥ 60. At multivariable analysis, female gender, human papilloma virus (HPV)-negative status, and moderate and severe clinician-rated xerostomia were significantly associated with lower MDADI-CS. Patient-perceived dysphagia was satisfactory or acceptable in the majority of patients. HPV status and xerostomia were confirmed as important predictive factors for swallowing dysfunction after radiochemotherapy. Data regarding female gender are new and deserve further investigation.
      PubDate: 2018-06-08
      DOI: 10.1007/s00455-018-9913-8
  • Inter-rater Agreement of Clinicians’ Treatment Recommendations Based on
           Modified Barium Swallow Study Reports
    • Authors: Laurie Slovarp; Jennifer Danielson; Julie Liss
      Abstract: The modified barium swallow study (MBSS) is a commonly used radiographic procedure for diagnosis and treatment of swallowing disorders. Despite attempts by dysphagia specialists to standardize the MBSS, most institutions have not adopted such standardized procedures. High variability of assessment patterns arguably contribute to variability of treatment recommendations made from diagnostic information derived from the MBSS report. An online survey was distributed to speech-language pathologists (SLPs) participating in American Speech Language Hearing Association (ASHA) listservs. Sixty-three SLPs who treat swallowing disorders participated. Participating SLPs reviewed two MBSS reports and chose physiologic treatment targets (e.g., tongue base retraction) based on each report. One report primarily contained symptomatology (e.g., aspiration, pharyngeal residue) with minimal information on impaired physiology (e.g., laryngeal incompetence, reduced hyolaryngeal elevation/excursion). In contrast, the second report contained a clear description of impaired physiology to explain the dysphagia symptoms. Fleiss kappa coefficients were used to analyze inter-rater agreement across the high and low physiology report types. Results revealed significantly higher inter-rater agreement across clinicians when reviewing reports with clear explanation(s) of physiologic impairment relative to reports that primarily focused on symptomatology. Clinicians also reported significantly greater satisfaction and treatment confidence following review of reports with clear description(s) of impaired physiology.
      PubDate: 2018-06-07
      DOI: 10.1007/s00455-018-9907-6
  • Translation and Validation of the Dysphagia Handicap Index in
           Hebrew-Speaking Patients
    • Authors: Yael Shapira-Galitz; Michael Drendel; Ruth Yousovich-Ulriech; Liat Shtreiffler-Moskovich; Michael Wolf; Yonatan Lahav
      Abstract: The Dysphagia Handicap Index (DHI) is a 25-item questionnaire assessing the physical, functional, and emotional aspects of dysphagia patients’ quality of life (QoL). The study goal was to translate and validate the Hebrew-DHI. 148 patients undergoing fiberoptic endoscopic examination of swallowing (FEES) in two specialized dysphagia clinics between February and August 2017 filled the Hebrew-DHI and self-reported their dysphagia severity on a scale of 1–7. 21 patients refilled the DHI during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency), penetration and aspiration (1 point for penetration, 2 points for aspiration, per consistency). 51 healthy volunteers also filled the DHI. Internal consistency and test–retest reproducibility were used for reliability testing. Validity was established by comparing DHI scores of dysphagia patients and healthy controls. Concurrent validity was established by correlating the DHI score with the FEES score. Internal consistency of the Hebrew-DHI was high (Cronbach’s alpha = 0.96), as was the test–retest reproducibility (Spearman’s correlation coefficient = 0.82, p < 0.001). The Hebrew-DHI’s total score, and its three subscales (physical/functional/emotional) were significantly higher in dysphagia patients compared to those in healthy controls (median 38 pts, IQR 18–56 for dysphagia patients compared to 0, IQR 0–2 for healthy controls, p < 0.0001). A strong correlation was observed between the DHI score and the self-reported dysphagia severity measure (Spearman’s correlation coefficient = 0.88, p < 0.0001). A moderate correlation was found between the DHI score and the FEES score (Pearson’s correlation coefficient = 0.245, p = 0.003). The Hebrew-DHI is a reliable and valid questionnaire assessing dysphagia patients’ QoL.
      PubDate: 2018-06-07
      DOI: 10.1007/s00455-018-9914-7
  • Medically Unexplained Oropharyngeal Dysphagia at the University Hospital
           ENT Outpatient Clinic for Dysphagia: A Cross-Sectional Cohort Study
    • Abstract: Medically unexplained oropharyngeal dysphagia (MUNOD) is a rare condition. It presents without demonstrable abnormalities in the anatomy of the upper aero-digestive tract and/or swallowing physiology. This study investigates whether MUNOD is related to affective or other psychiatric conditions. The study included patients with dysphagic complaints who had no detectible structural or physiological abnormalities upon swallowing examination. Patients with any underlying disease or disorder that could explain the oropharyngeal dysphagia were excluded. All patients underwent a standardized examination protocol, with FEES examination, the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Severity Scale (DSS). Two blinded judges scored five different FEES variables. None of the 14 patients included in this study showed any structural or physiological abnormalities during FEES examination. However, the majority did show abnormal piecemeal deglutition, which could be a symptom of MUNOD. Six patients (42.8%) had clinically relevant symptoms of anxiety and/or depression. The DSS scores did not differ significantly between patients with and without affective symptoms. Affective symptoms are common in patients with MUNOD, and their psychiatric conditions could possibly be related to their swallowing problems.
      PubDate: 2018-06-05
      DOI: 10.1007/s00455-018-9912-9
  • 7th ESSD Congress and World Dysphagia Summit, Barcelona 2017
    • PubDate: 2018-06-05
      DOI: 10.1007/s00455-018-9900-0
  • A Smooth Esophageal Stricture Causing Dysphagia
    • Authors: Edoardo Forti; Giulia Bonato; Lorenzo Dioscoridi; Marcello Cintolo; Francesco Pugliese; Laura Cristoferi; Alberto Tringali; Valentina Caputo; Valentina Motta; Massimo Domenico Torre; Serena Conforti; Massimiliano Mutignani
      Abstract: Dysphagia in patients with lung cancer is usually due to direct invasion from bronchogenic carcinomas or nodal localizations, while metastases from distant lung neoplasms are considered rare. We report a case of a smooth esophageal narrowing secondary to intramural metastasis from pulmonary adenocarcinoma in a patient with no previous history of neoplasia. Since standard linear echoendoscope could not overpass the malignant stricture, we obtained a histological diagnosis by fine-needle aspiration biopsy using an echobronchoscope (EBUS), due to its lower diameter. The EBUS scope represents a valuable tool to obtain cytological specimens in patients with esophageal strictures.
      PubDate: 2018-04-10
      DOI: 10.1007/s00455-018-9891-x
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Heriot-Watt University
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Fax: +00 44 (0)131 4513327
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