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Journal Cover Dysphagia
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1432-0460 - ISSN (Online) 0179-051X
   Published by Springer-Verlag Homepage  [2352 journals]
  • The Prevalence of Oropharyngeal Dysphagia in Adults Presenting with
           Temporomandibular Disorders Associated with Rheumatoid Arthritis: A
           Systematic Review and Meta-analysis
    • Authors: Órla Gilheaney; Lina Zgaga; Isolde Harpur; Greg Sheaf; Liss Kiefer; Sibylle Béchet; Margaret Walshe
      Pages: 587 - 600
      Abstract: Abstract Temporomandibular disorders (TMDs) are the most frequent non-dental orofacial pain disorders and may be associated with rheumatoid arthritis (RA), resulting in oropharyngeal dysphagia (OD). However, clinicians’ understanding of involvement with OD caused by RA-related TMDs is limited and the methodological quality of research in this field has been criticised. Therefore, the aim of this study was to systematically review the prevalence of oral preparatory and oral stage signs and symptoms of OD in adults presenting with TMDs associated with RA. A systematic review of the literature was completed. The following electronic databases were searched from inception to February 2016, with no date/language restriction: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Grey literature and reference lists of the included studies were also searched. Studies reporting the frequency of OD in adults presenting with TMD and RA were included. Study eligibility and quality were assessed by three independent reviewers. Methodological quality was assessed using the Down’s and Black tool. The search yielded 19 eligible studies. Typical difficulties experienced by RA patients included impaired swallowing (24.63%), impaired masticatory ability (30.69%), masticatory pain (35.58%), and masticatory fatigue (21.26%). No eligible studies reported figures relating to the prevalence of weight loss. Eligible studies were deemed on average to be of moderate quality. Study limitations included the small number of studies which met the inclusion criteria and the limited amount of studies utilising objective assessments. Valid and reliable prospective research is urgently required to address the assessment and treatment of swallowing difficulties in RA as TMJ involvement may produce signs and symptoms of OD.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9808-0
      Issue No: Vol. 32, No. 5 (2017)
  • Reflections on Clinical and Statistical Use of the Penetration-Aspiration
    • Authors: Catriona M. Steele; Karen Grace-Martin
      Pages: 601 - 616
      Abstract: Abstract The 8-point Penetration-Aspiration Scale (PAS) was introduced to the field of dysphagia in 1996 and has become the standard method used by both clinicians and researchers to describe and measure the severity of airway invasion during swallowing. In this article, we review the properties of the scale and explore what has been learned over 20 years of use regarding the construct validity, ordinality, intervality, score distribution, and sensitivity of the PAS to change. We propose that a categorical revision of the PAS into four levels of increasing physiological severity would be appropriate. The article concludes with a discussion of common errors made in the statistical analysis of the PAS, proposing that frequency distributions and ordinal logistic regression approaches are most appropriate given the properties of the scale. A hypothetical dataset is included to illustrate both the problems and strengths of different statistical approaches.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9809-z
      Issue No: Vol. 32, No. 5 (2017)
  • A Comparison of Visual Recognition of the Laryngopharyngeal Structures
           Between High and Standard Frame Rate Videos of the Fiberoptic Endoscopic
           Evaluation of Swallowing
    • Authors: Mehran Alizadeh Aghdam; Makoto Ogawa; Toshihiko Iwahashi; Kiyohito Hosokawa; Chieri Kato; Hidenori Inohara
      Pages: 617 - 625
      Abstract: Abstract The purpose of this study was to assess whether or not high frame rate (HFR) videos recorded using high-speed digital imaging (HSDI) improve the visual recognition of the motions of the laryngopharyngeal structures during pharyngeal swallow in fiberoptic endoscopic evaluation of swallowing (FEES). Five healthy subjects were asked to swallow 0.5 ml water under fiberoptic nasolaryngoscopy. The endoscope was connected to a high-speed camera, which recorded the laryngopharyngeal view throughout the swallowing process at 4000 frames/s (fps). Each HFR video was then copied and downsampled into a standard frame rate (SFR) video version (30 fps). Fifteen otorhinolaryngologists observed all of the HFR/SFR videos in random order and rated the four-point ordinal scale reflecting the degree of visual recognition of the rapid laryngopharyngeal structure motions just before the ‘white-out’ phenomenon. Significantly higher scores, reflecting better visibility, were seen for the HFR videos compared with the SFR videos for the following laryngopharyngeal structures: the posterior pharyngeal wall (p = 0.001), left pharyngeal wall (p = 0.015), right lateral pharyngeal wall (p = 0.035), tongue base (p = 0.005), and epiglottis tilting (p = 0.005). However, when visualized with HFR and SFR, ‘certainly clear observation’ of the laryngeal structures was achieved in <50% of cases, because all the motions were not necessarily captured in each video. These results demonstrate the use of HSDI in FEES makes the motion perception of the laryngopharyngeal structures during pharyngeal swallow easier in comparison to SFR videos with equivalent image quality due to the ability of HSDI to depict the laryngopharyngeal motions in a continuous manner.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9803-5
      Issue No: Vol. 32, No. 5 (2017)
  • Dysphagia in Friedreich Ataxia
    • Authors: Megan J. Keage; Martin B. Delatycki; Isabelle Gupta; Louise A. Corben; Adam P. Vogel
      Pages: 626 - 635
      Abstract: Abstract The objective of the study was to comprehensively characterise dysphagia in Friedreich ataxia (FRDA) and identify predictors of penetration/aspiration during swallowing. We also investigated the psychosocial impact of dysphagia on individuals with FRDA. Sixty participants with FRDA were screened for dysphagia using a swallowing quality of life questionnaire (Swal-QOL) and case history. Individuals reporting dysphagia underwent a standardised oromotor assessment (Frenchay Dysarthria Assessment, 2, FDA-2) and videofluoroscopic study of swallowing (VFSS). Data were correlated with disease parameters (age at symptom onset, age at assessment, disease duration, FXN intron 1 GAA repeat sizes, and Friedreich Ataxia Rating Scale (FARS) score). Predictors of airway penetration/aspiration were explored using logistic regression analysis. Ninety-eight percent (59/60) of participants reported dysphagia, of whom 35 (58.3%) underwent FDA-2 assessment, and 38 (63.3%) underwent VFSS. Laryngeal, respiratory, and tongue dysfunction was observed on the FDA-2. A Penetration–Aspiration Scale score above 3 (deemed significant airway compromise based on non-clinical groups) was observed on at least one consistency in 13/38 (34.2%) participants. All of those who aspirated (10/38, 26.3%) did so silently, with no overt signs of airway entry such as reflexive cough. Significant correlations were observed between dysphagic symptoms and disease duration and severity. No reliable predictors of penetration or aspiration were identified. Oropharyngeal dysphagia is commonly present in individuals with FRDA and worsens with disease duration and severity. Individuals with FRDA are at risk of aspiration at any stage of the disease and should be reviewed regularly. Instrumental analysis remains the only reliable method to detect aspiration in this population. Dysphagia significantly affects the quality of life of individuals with FRDA.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9804-4
      Issue No: Vol. 32, No. 5 (2017)
  • What Type of Food Can Older Adults Masticate': Evaluation of
           Mastication Performance Using Color-Changeable Chewing Gum
    • Authors: Shinichi Wada; Nobuyuki Kawate; Masazumi Mizuma
      Pages: 636 - 643
      Abstract: Abstract This study determines if older adults can masticate regular foods via a simple test conducted using a color-changeable chewing gum. Seventy-nine consecutive inpatients of our clinic receiving rehabilitation and general medicine were assessed for eligibility. The inclusion criterion was >65 years. Thirty patients consented to participate. The main outcome variable was the food bolus texture at the swallowing threshold for five regular foods. The main explanatory variable was the a* value of the color-changeable chewing gum after 120 s of chewing (a* represents the degree of color between red and green, and a positive a* value indicates red). The mean age ± standard deviation of the participants was 81.6 ± 8.6 years, and 40% were men. Participants being able to prepare the food with suitable texture for swallowing was positively associated with the a* values in boiled rice, ginger-fried pork loin, boiled fish-paste, and rice cracker (Crude OR 1.18, 1.15, 1.17, and 1.50; P < 0.001, = 0.026, <0.001, and <0.001, respectively). The cut-off a* values had markedly high specificities (1.0) for boiled rice and boiled fish-paste and high sensitivities (0.86–0.94) for three foods, except boiled rice. We believe that mastication evaluation using the color-changeable chewing gum is not only useful but also extremely practical, even for older adults in a wide range of settings, including an individual’s home. This approach would lead to a reduction in unnecessary mechanically altered or pureed food for older adults who can eat pureed food and safely provide palatable food.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9807-1
      Issue No: Vol. 32, No. 5 (2017)
  • Erratum to: What Type of Food Can Older Adults Masticate': Evaluation
           of Mastication Performance Using Color-Changeable Chewing Gum
    • Authors: Shinichi Wada; Nobuyuki Kawate; Masazumi Mizuma
      Pages: 644 - 644
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9823-1
      Issue No: Vol. 32, No. 5 (2017)
  • Change in Excitability of Cortical Projection After Modified Catheter
           Balloon Dilatation Therapy in Brainstem Stroke Patients with Dysphagia: A
           Prospective Controlled Study
    • Authors: Xiaomei Wei; Fan Yu; Meng Dai; Chunqing Xie; Guifang Wan; Yujue Wang; Zulin Dou
      Pages: 645 - 656
      Abstract: Abstract Although the modified balloon dilatation therapy has been demonstrated to improve pharyngeal swallowing function post stroke, the underlying neural mechanisms of improvement are unknown. Our aims are (1) to investigate the effect of modified balloon dilatation on the excitability of corticobulbar projections to the submental muscle in dysphagic patients with brainstem stroke and (2) the relation between changes in excitability and pharyngeal kinematic modifications. Thirty patients with upper esophageal sphincter (UES) dysfunction due to unilateral brainstem stroke were recruited into two groups. The patients in dilatation group received modified balloon dilatation and conventional therapies, and those in control were only treated by conventional therapies (twice per day). The amplitudes of bilateral submental motor evoked potentials (MEPs) induced by transcranial magnetic stimulations over bilateral motor cortex, diameters of UES opening (UOD) and maximal displacement of hyoid (HD) were all assessed at baseline and the endpoint of treatments. Repeated ANOVA analysis revealed significant main effect of group, time and MEP laterality on MEP amplitudes (p = 0.02). There were no differences in the pretreatment measures between groups (all p > 0.05). After treatment, the amplitudes of affected submental MEP evoked by ipsilateral cortical pulse as well as UOD and HD were significantly different in dilatation group compared to control (amplitude: p = 0.02, UOD: p < 0.001, HD: p = 0.03). The differences of pre- and post-treatment amplitudes of the affected MEP evoked by ipsilateral stimulation showed a positive correlation with the improvement of HD (dilatation: R 2 = 0.51, p = 0.03; control: R 2 = 0.39, p = 0.01), rather than UOD in both groups (all p > 0.05). In conclusion, modified balloon dilatation therapy can increase the excitability of affected projection in patients with unilateral brainstem stroke.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9810-6
      Issue No: Vol. 32, No. 5 (2017)
  • High-Resolution Manometry Evaluation of Pressures at the Pharyngo-upper
           Esophageal Area in Patients with Oropharyngeal Dysphagia Due to Vagal
    • Authors: Bruno Rezende Pinna; Fernando A. M. Herbella; Noemi de Biase; Thays C. G. Vaiano; Marco G. Patti
      Pages: 657 - 662
      Abstract: Abstract The motility of the pharynx, upper esophageal sphincter (UES), and proximal esophagus in patients with oropharyngeal dysphagia is still not entirely understood. High-resolution manometry (HRM) was recently added to the armamentarium for the study of this area. This study aims to describe HRM findings in patients with vagal paralysis. Sixteen patients (mean age 54 years, 69% females) with oropharyngeal dysphagia due to unilateral vagal paralysis were prospectively studied. All patients underwent HRM. Motility of the UES and at the topography of the velopharynx and epiglottis were recorded. (1) UES relaxation is compromised in a minority of patients, (2) epiglottis pressure does not follow a specific pattern, (3) vellum is hypotonic in half of the patients, (4) dysphagia is related to a low pharyngeal pressure, not to a flow obstruction at the level of the UES, and (5) aspiration is related to low pressures at the level of the UES and epiglottis and higher pressures at the level of the vellum. Pharyngeal motility is significantly impaired in patients with oropharyngeal dysphagia and unilateral vagal paralysis. In half of the cases, UES resting pressure is preserved due to unilateral innervation and relaxation is normal in most patients. Dysphagia therapy in these patients must be directed toward improvement in the oropharyngeal motility not at the UES.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9811-5
      Issue No: Vol. 32, No. 5 (2017)
  • Sagittal Plane Kinematics of the Jaw and Hyolingual Apparatus During
           Swallowing in Macaca mulatta
    • Authors: Yuki Nakamura; Jose Iriarte-Diaz; Fritzie Arce-McShane; Courtney P. Orsbon; Kevin A. Brown; McKenna Eastment; Limor Avivi-Arber; Barry J. Sessle; Makoto Inoue; Nicholas G. Hatsopoulos; Callum F. Ross; Kazutaka Takahashi
      Pages: 663 - 677
      Abstract: Abstract Studies of mechanisms of feeding behavior are important in a society where aging- and disease-related feeding disorders are increasingly prevalent. It is important to evaluate the clinical relevance of animal models of the disease and the control. Our present study quantifies macaque hyolingual and jaw kinematics around swallowing cycles to determine the extent to which macaque swallowing resembles that of humans. One female and one male adult Macaca mulatta were trained to feed in a primate chair. Videofluoroscopy was used to record kinematics in a sagittal view during natural feeding on solid food, and the kinematics of the hyoid bone, thyroid cartilage, mandibular jaw, and anterior-, middle-, and posterior-tongue. Jaw gape cycles were defined by consecutive maximum gapes, and the kinematics of the swallow cycles were compared with those of the two consecutive non-swallow cycles preceding and succeeding the swallow cycles. Although there are size differences between macaques and humans, and macaques have shorter durations of jaw gape cycles and hyoid and thyroid upward movements, there are several important similarities between our macaque data and human data reported in the literature: (1) The durations of jaw gape cycles during swallow cycles are longer than those of non-swallow cycles as a result of an increased duration of the jaw-opening phase; (2) Hyoid and thyroid upward movement is linked with a posterior tongue movement and is faster during swallow than non-swallow cycles; (3) Tongue elevation propagates from anterior to posterior during swallow and non-swallow cycles. These findings suggest that macaques can be a useful experimental model for human swallowing studies.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9812-4
      Issue No: Vol. 32, No. 5 (2017)
  • Voice Outcomes in Surgical Repair of Zenker’s Diverticulum
    • Authors: Stephen Schoeff; Michael Freeman; James Daniero
      Pages: 678 - 682
      Abstract: Abstract The purpose of the study was to define the impact of Zenker’s diverticula on voice and potential benefit from repair. Retrospective chart review of prospectively collected data from eleven patients with a Zenker’s diverticulum treated surgically in a tertiary care center from November 2014 through January 2016. The voice handicap index-10 (VHI-10) and eating assessment tool-10 (EAT-10) questionnaires were collected as part of pre- and post-operative evaluation, with an average post-operative follow-up of 69 days. Surgical techniques included: trans-oral endoscopic diverticulotomy with laser assistance, or trans-cervical approach with diverticulopexy or diverticulectomy. The primary outcome was subjective voice improvement. Secondary outcome was swallowing function improvement. Statistical analysis was performed using Wilcoxon Signed-Ranks and Mann–Whitney U tests. In patients undergoing surgical treatment of Zenker’s diverticula, there is a statistically significant improvement (p = 0.001) in patient-reported dysphagia symptoms measured by the EAT-10. There is also a clinically relevant improvement in subjective voice quality (average pre-operative total 6.55, post-operative 2.09, p = 0.022) as measured by the VHI-10. Many patients suffering from Zenker’s diverticula experience subjective voice handicap. Most note improvement in voice quality post-operatively, which we were able to quantify using the voice handicap index. We consider this a relevant consideration in pre-operative evaluation.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9813-3
      Issue No: Vol. 32, No. 5 (2017)
  • Within-Bolus Variability of the Penetration-Aspiration Scale Across Two
           Subsequent Swallows in Patients with Head and Neck Cancer
    • Authors: Johanna Hedström; Lisa Tuomi; Mats Andersson; Hans Dotevall; Hanna Osbeck; Caterina Finizia
      Pages: 683 - 690
      Abstract: Abstract To compare two consecutive swallowing attempts to study if there is a difference in Rosenbek’s penetration-aspiration scale (PAS) scores between the first and second swallowing attempt of the same bolus type in videofluoroscopic examination of swallowing (VFS). Additional aims include reflecting on which bolus sizes and consistencies are the most relevant to include in further studies for head and neck cancer (HNC) patients. The VFS for 38 patients curatively treated for HNC was studied. All included patients showed swallowing difficulties (PAS ≥ 2). The examination protocol included two swallows each of six different boluses: 3, 5, 10, 20 ml thin, 5 ml mildly thick, and 3 ml of extremely thick liquid. All boluses were compared between the first and second swallowing attempt with regard to PAS scores. No statistically significant differences in PAS were found between the first and second swallow for any of the boluses in this study on group level. For 20 ml thin and 3 ml extremely thick liquid, there were low Intra-Class Correlations, indicating a low within-bolus agreement. The greatest within-bolus differences were found for 20 ml thin, 5 ml mildly thick and 3 ml extremely thick liquid, which demonstrated high intra-individual coefficient of variation (0.458–0.759). The data of this study show a high within-bolus variability of the PAS score between two subsequent swallows for all different consistencies. In order to assess swallowing safety, the highest PAS score for each bolus type is suggested for use in studies of HNC patients.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9814-2
      Issue No: Vol. 32, No. 5 (2017)
  • Measurement of the Maximum Frequency of Electroglottographic Fluctuations
           in the Expiration Phase of Volitional Cough as a Functional Test for Cough
    • Authors: Toshihiko Iwahashi; Makoto Ogawa; Kiyohito Hosokawa; Chieri Kato; Hidenori Inohara
      Pages: 691 - 702
      Abstract: Abstract The hypotheses of the present study were that the maximum frequency of fluctuation of electroglottographic (EGG) signals in the expiration phase of volitional cough (VC) reflects the cough efficiency and that this EGG parameter is affected by impaired laryngeal closure, expiratory effort strength, and gender. For 20 normal healthy adults and 20 patients diagnosed with unilateral vocal fold paralysis (UVFP), each participant was fitted with EGG electrodes on the neck, had a transnasal laryngo-fiberscope inserted, and was asked to perform weak/strong VC tasks while EGG signals and a high-speed digital image of the larynx were recorded. The maximum frequency was calculated in the EGG fluctuation region coinciding with vigorous vocal fold vibration in the laryngeal HSDIs. In addition, each participant underwent spirometry for measurement of three aerodynamic parameters, including peak expiratory air flow (PEAF), during weak/strong VC tasks. Significant differences were found for both maximum EGG frequency and PEAF between the healthy and UVFP groups and between the weak and strong VC tasks. Among the three cough aerodynamic parameters, PEAF showed the highest positive correlation with the maximum EGG frequency. The correlation coefficients between the maximum EGG frequency and PEAF recorded simultaneously were 0.574 for the whole group, and 0.782/0.717/0.823/0.688 for the male/female/male-healthy/male-UVFP subgroups, respectively. Consequently, the maximum EGG frequency measured in the expiration phase of VC was shown to reflect the velocity of expiratory airflow to some extent and was suggested to be affected by vocal fold physical properties, glottal closure condition, and the expiratory function.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9815-1
      Issue No: Vol. 32, No. 5 (2017)
  • The Role of the Corpus Callosum in Pediatric Dysphagia: Preliminary
           Findings from a Diffusion Tensor Imaging Study in Children with Unilateral
           Spastic Cerebral Palsy
    • Authors: Lucia Figueiredo Mourão; Kathleen M. Friel; Justine Joan Sheppard; Hsing-Ching Kuo; Karen Fontes Luchesi; Andrew M. Gordon; Georgia A. Malandraki
      Pages: 703 - 713
      Abstract: Abstract The purpose of this study is to determine the relationship between the structural integrity of the corpus callosum (CC) and clinical feeding/swallowing performance in children with unilateral spastic cerebral palsy (USCP). Twenty children with USCP, (11 males, 5.11–17.6 yoa) were assessed via the Dysphagia Disorder Survey (DDS) and diffusion tensor imaging. Children were grouped into left hemisphere lesion (LHL; n = 13) and right hemisphere lesion (RHL; n = 7) groups. DTI variables analyzed for three CC regions (anterior, middle, posterior) were: fractional anisotropy (FA), radial diffusivity (RD), mean diffusivity (MD), and fibers count. Children with RHL presented with higher clinical dysphagia severity (p = 0.03). Six of seven children with RHL had lesions affecting periventricular/subcortical areas, and 8/13 children with LHL had lesions affecting the sensorimotor cortex. In the LHL group, as FA and fiber count of the anterior CC decreased and RD increased (all indicating reduced CC structural integrity), signs of dysphagia increased (r = −0.667, p = 0.013; r = −0.829, p ≤ 0.001; r = 0.594, p = 0.032, respectively). Reduced fiber count in the middle and posterior CC was also significantly associated with increased DDS scores (r = −0.762, p = 0.002; r = −0.739, p = 0.004, respectively). For the RHL group no significant correlations were observed. We provide preliminary evidence that corpus callosum integrity correlates with feeding/swallowing performance in children with USCP, especially when cortical sensorimotor areas of the left hemisphere are impacted. In this sample, CC integrity appeared to enable interhemispheric cortical plasticity for swallowing, but was not as critical when intrahemispheric connections were disrupted, as seen in the RHL group.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9816-0
      Issue No: Vol. 32, No. 5 (2017)
  • The Eating Assessment Tool-10 Predicts Aspiration in Adults with Stable
           Chronic Obstructive Pulmonary Disease
    • Authors: Julie Regan; Susan Lawson; Vânia De Aguiar
      Pages: 714 - 720
      Abstract: Abstract Adults with COPD frequently present with dysphagia, which often leads to clinical complications and hospital admissions. This study investigates the ability of the Eating Assessment Tool (EAT-10) to predict aspiration during objective dysphagia evaluation in adults with stable COPD. Thirty adults (20 male, 10 female; mean age = 69.07 ± 16.82) with stable COPD attended an outpatient dysphagia clinic for a fiberoptic endoscopic evaluation of swallowing (FEES) in an acute teaching hospital (January 2015–November 2016). During evaluations, individuals completed an EAT-10 rating scale followed immediately by a standardised FEES exam. Aspiration status during FEES was rated using the penetration–aspiration scale by clinicians blinded to EAT-10 scores. Data were retrospectively analysed. Significant differences in mean EAT-10 scores were found between aspirators (16.3; SEM = 2.165) and non-aspirators (7.3; SEM = 1.009) (p = 0.000). The EAT-10 predicted aspiration with a high level of accuracy (AUC = 0.88). An EAT-10 cut-off value of >9 presented a sensitivity of 91.67, specificity of 77.78 with positive and negative likelihood ratios of 4.12 and 0.11, respectively. Positive and negative predictive values were 73.30 and 93.30, respectively. Diagnostic odds ratio was 38.50 (p < 0.01, CI 3.75–395.42). EAT-10 is a quick, easy to administer tool, which can accurately predict the presence of aspiration in adults with COPD. The scale can also very accurately exclude the absence of aspiration, helping clinicians to determine the need for onward referral for a comprehensive dysphagia evaluation. This may ultimately reduce clinical complications and hospital admissions resulting from dysphagia in this clinical population.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9822-2
      Issue No: Vol. 32, No. 5 (2017)
  • Unusual Cause of Dysphagia in a Post-Stroke Patient
    • Authors: So-Hyun Kwon; Han Gil Seo
      Pages: 721 - 723
      Abstract: Abstract Vallecular cysts are formed when the duct of a mucous gland or lingual tonsillar crypt is dilated owing to obstruction from inflammation, irritation, or trauma. Small cysts are usually asymptomatic; however, cyst growth results in dysphagia, odynophagia, and acute airway complications. As complete transoral laser excision of a vallecular cyst often results in cyst resolution and improved symptoms, proper diagnosis and management of vallecular lesions are important. We describe the evaluation and treatment of a 53-year-old man with a history of intracerebral hemorrhage in the left basal ganglia who presented with dysphagia caused by a vallecular cyst.
      PubDate: 2017-10-01
      DOI: 10.1007/s00455-017-9796-0
      Issue No: Vol. 32, No. 5 (2017)
  • 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
      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: 2017-10-11
      DOI: 10.1007/s00455-017-9856-5
  • A Significant Association of Malnutrition with Dysphagia in Acute Patients
    • Authors: Tsukasa Saito; Keisuke Hayashi; Hajime Nakazawa; Fumika Yagihashi; Leo O. Oikawa; Tetsuo Ota
      Abstract: Abstract Dysphagia and malnutrition seem to be associated, but little research in detail has been reported. We aimed to clarify the association between dysphagia and malnutrition by adopting accurate diagnosis and mathematical evaluation of dysphagia using videofluorography and nutritional assessment calculated by a well-established nutritional risk index. We conducted a retrospective analysis of 165 enrolled patients who were admitted to our hospital for acute diseases and underwent videofluorography on suspicion of dysphagia in the year 2016. We diagnosed high-risk dysphagia in patients with 8-point penetration–aspiration scale (PAS) score over 4. We used the geriatric nutritional risk index (GNRI) as a nutritional assessment tool. A GNRI score less than 91.2 corresponds to malnutrition. The median age of 165 enrolled patients was 76.0, and the number of female patients was 53. The mean GNRI was 81.2, and 134 patients (81.2%) had malnutrition. The number of the patients with a diagnosis of high-risk dysphagia was 54 (32.7%). The GNRI of patients with high-risk dysphagia was significantly less than that of patients without (mean value 77.7 ± 10.5 vs. 83.0 ± 10.5, P = 0.003). GNRI < 91.2 was independently and significantly associated with high-risk dysphagia (OR 3.094; CI 1.057–9.058; P = 0.039). Based on the current study, the authors propose evaluating nutritional status to predict dysphagia risk of patients in the acute phase.
      PubDate: 2017-10-11
      DOI: 10.1007/s00455-017-9855-6
  • Effects of Mechanical Complications on Radiation Exposure During
           Fluoroscopically Guided Gastrojejunostomy Exchange in the Pediatric
    • Authors: Kevin S. H. Koo; Joseph Reis; Jodi Manchester; Gulraiz Chaudry; Brian Dillon
      Abstract: Abstract The purpose of the article is to evaluate the effects of mechanical complications, such as clogging or coiling, of gastrojejunostomy tubes on radiation exposure during exchange in the pediatric population. In this HIPAA-compliant and IRB-approved study, we retrospectively reviewed procedural records for patients undergoing gastrojejunostomy (GJ) tube exchange during a 4-month period in 2014. Success of the procedure, specifications of the tube, age, and sex of the patient as well as radiation exposure during the procedure were included. Radiation exposure was measured in fluoroscopy time and cumulative air kerma. Complications encountered during exchange were also recorded, if available. Patients presenting for gastrostomy to GJ conversions or combined procedures were excluded from the study. Ordinary and mixed effect linear regression models were used to test associations between GJ tube parameters, presence of mechanical complications, and fluoroscopy time and radiation dose. 146 patients undergoing 285 GJ exchanges met inclusion criteria over the 4-month study period (M:F 82:64). All exchanges were successful with 85 demonstrating a form of mechanical complication (44 coiled, 41 clogged). Of the reported GJ tube specifications, only tube length was significantly associated with mechanical complications (p < 0.001). The presence of mechanical complication was significantly associated with increased radiation exposure and fluoroscopy time (p < 0.0001). Mechanical complications of gastrojejunostomy tubes, such as clogging or coiling, are associated with increased radiation exposure during exchange. Strategies to decrease these complications, including re-siting the gastrostomy tract or placement of a surgical jejunostomy in the event of repeated coiling of a tube should be strongly considered.
      PubDate: 2017-10-07
      DOI: 10.1007/s00455-017-9854-7
  • Feasibility of a Mobile Application to Enhance Swallowing Therapy for
           Patients Undergoing Radiation-Based Treatment for Head and Neck Cancer
    • Authors: Heather M. Starmer; Rina Abrams; Kimberly Webster; Jennifer Kizner; Beth Beadle; F. Christopher Holsinger; Harry Quon; Jeremy Richmon
      Abstract: Abstract Dysphagia following treatment for head and neck cancer is one of the most significant morbidities impacting quality of life. Despite the value of prophylactic exercises to mitigate the impact of radiation on long-term swallowing function, adherence to treatment is limited. The purpose of this investigation was to explore the feasibility of a mobile health application to support patient adherence to swallowing therapy during radiation-based treatment. 36 patients undergoing radiation therapy were provided with the Vibrent™ mobile application as an adjunct to standard swallowing therapy. The application included exercise videos, written instructions, reminders, exercise logging, and educational content. 80% of participants used the app during treatment and logged an average of 102 exercise sessions over the course of treatment. 25% of participants logged at least two exercise sessions per day over the 7-week treatment period, and 53% recorded at least one session per day. Exit interviews regarding the patient experience with the Vibrent™ mobile application were largely positive, but also provided actionable strategies to improve future versions of the application. The Vibrent™ mobile application appears to be a tool that can be feasibly integrated into existing patient care practices and may assist patients in adhering to treatment recommendations and facilitate communication between patients and providers between encounters.
      PubDate: 2017-09-30
      DOI: 10.1007/s00455-017-9850-y
  • Patient Adherence to Dysphagia Recommendations: A Systematic Review
    • Authors: Brittany N. Krekeler; Courtney K. Broadfoot; Stephen Johnson; Nadine P. Connor; Nicole Rogus-Pulia
      Abstract: Abstract Patient adherence to treatment recommendations is an important issue for healthcare providers, in a multitude of specialties, and is critical when assessing the efficacy and effectiveness of a particular treatment approach. Patients who have swallowing impairment often require complex and specific interventions requiring altered daily patterns of behavior. Patients with dysphagia who do not follow recommendations or prescribed exercises may not receive maximum benefit of an intervention. Poor adherence also makes it more difficult to evaluate efficacy of a treatment both clinically and in experimental settings. Further, swallow safety can be compromised if certain recommendations are not followed. Our purpose was to systematically review the literature to understand what is known about adherence within the field of dysphagia treatment. We systematically identified 12 studies that tracked and reported patient-specific adherence. In this review, we found that the average adherence rate from these studies ranges between 21.9 and 51.9%. Adherence to prophylactic treatment recommendations for patients with head and neck cancer was the focus in 9/12 studies. The findings of this review identify a large gap in knowledge regarding adherence to dysphagia treatment. Few studies account for adherence within their study designs. When planning dysphagia treatment studies, it is imperative that investigators include information regarding patient adherence to accurately interpret findings. Given the variable adherence rates found in this review, factors influencing patient adherence with dysphagia treatments should be identified to increase adherence in future trials.
      PubDate: 2017-09-30
      DOI: 10.1007/s00455-017-9852-9
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