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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  [2351 journals]
  • The Criteria of Thickened Liquid for Dysphagia Management in Japan
    • Authors: Emi Watanabe; Yoshie Yamagata; Junko Fujitani; Ichiro Fujishima; Koji Takahashi; Risa Uyama; Hiro Ogoshi; Akiko Kojo; Hiroshi Maeda; Koichiro Ueda; Jun Kayashita
      Pages: 26 - 32
      Abstract: In Japan, the viscosity of thickened liquids is different among hospitals and nursing homes. In order to standardize viscosity of thickened liquids, the dysphagia diet committee of the Japanese Society of Dysphagia Rehabilitation developed the Japanese Dysphagia Diet 2013 (JDD2013). To decide on a definition of thickened liquids, the committee reviewed categories from other countries. Especially, the criteria of the USA and Australia were used as references. The definition had three levels: mildly thick, moderately thick, and extremely thick. Then a sensory evaluation by health care workers was carried out to decide the viscosity range of each level, and a draft document was made. After collecting public comments, follow-up experiments using thickened water with thickeners using xanthan gum were performed, and the JDD2013 (Thickened Liquid) was determined. The JDD2013 (Thickened Liquid) evaluated the drinking properties, visual properties, and viscosity values of each level. The shear rate of 50 s−1 was adopted to measure the viscosity with a cone and plate type viscometer to duplicate the measurement criteria used by the USA. We also set the values of the JDD2013 with the Line Spread Test to promote the use of guidelines in clinical practice. We believe the JDD2013 standards help hospitals and other settings that care for people with dysphagia to use the same thickness level and the same labels. In the future, the JDD2013 levels will be compared with new international guidelines to help with international understanding of the JDD2013 levels.
      PubDate: 2018-02-01
      DOI: 10.1007/s00455-017-9827-x
      Issue No: Vol. 33, No. 1 (2018)
  • Spatial Characteristics of Jaw Movements During Chewing in Children with
           Cerebral Palsy: A Pilot Study
    • Authors: Ignatius S. B. Nip; Erin M. Wilson; Lucia Kearney
      Pages: 33 - 40
      Abstract: This study compared jaw motion between children with cerebral palsy (CP) and their typically-developing (TD) peers during chewing. The jaw movements of 11 children with spastic CP (GMFCS levels II–V) all of whom were exclusively oral feeders with no reported clinical issues with feeding [mean age = 7.49 (2.30) years; 7 males, 4 females] and 11 age- and sex-matched TD peers [mean age = 7.54 (2.35) years] were recorded using optical motion capture. Participants chewed five trials of three different consistencies, including puree, mechanical soft, and solid. For each chewing sequence, the path distance (total amount of distance traveled by the jaw), average jaw speed, and working space (total 3-dimensional size of the jaw movements during chewing) were calculated. The CP group had greater path distances for mechanical soft and solids (p < 0.001) and larger working spaces (p < 0.001) than the TD group. Consistency differences were also found with path distances increasing for both groups with increased bolus consistency (p < 0.001). Puree was chewed most slowly for both groups (p = 0.05) and was associated with smaller working space than the other consistencies for both groups (p < 0.001). The TD group demonstrated slower speeds for mechanical soft as compared to solids (p = 0.05), a finding which was not observed in the CP group. The results suggest children with CP showed jaw movement differences during chewing despite being exclusive oral eaters with no reports of clinical feeding or deglutition disorders. Food consistency also influenced jaw movements in both children with CP and their TD peers.
      PubDate: 2018-02-01
      DOI: 10.1007/s00455-017-9830-2
      Issue No: Vol. 33, No. 1 (2018)
  • Differential Response Pattern of Oropharyngeal Pressure by Bolus and Dry
    • Authors: Mana Hasegawa; Masayuki Kurose; Keiichiro Okamoto; Yoshiaki Yamada; Takanori Tsujimura; Makoto Inoue; Taisuke Sato; Takatsune Narumi; Noritaka Fujii; Kensuke Yamamura
      Pages: 83 - 90
      Abstract: The aim of this study was to determine if bolus and dry swallow showed similar pressure changes in the oropharynx using our newly developed device. A unique character of it includes that baropressure can be measured with the sensor being placed in the balloon and can assess the swallowing mechanics in terms of pressure changes in the oropharynx with less influences of direct contacts of boluses and oropharyngeal structures during swallow indirectly. Fifteen healthy subjects swallowed saliva (dry), 15 ml of water, 45 ml of water, and 15 ml of two different types of food in terms of viscosity (potage soup-type and mayonnaise-type foods). Suprahyoid muscle activity was recorded simultaneously. Three parameters, area under the curve (AUC), peak amplitude, and duration of pressure, were analyzed from each swallow. Almost all of the bolus swallowing events had biphasic baropressure responses consisting of an early phase and late phase (99%), whereas 90% of the saliva swallowing events had a single phase. AUC, peak, and duration displayed greater effects during the late phase than during the early phase. Baropressure of the early phase, but not of the late phase, significantly increased with increasing volume; however, small but significant viscosity effects on pressure were seen during both phases. Peak pressure of the late phase was preceded by maximum muscle activity, whereas that of the early phase was seen when muscle activity displayed a peak response. These findings indicated that our device with the ability to measure baropressure has the potential to provide additional parameter to assess the swallow physiology, and biphasic baropressure responses in the early and late phases could reflect functional aspects of the swallowing reflexes.
      PubDate: 2018-02-01
      DOI: 10.1007/s00455-017-9836-9
      Issue No: Vol. 33, No. 1 (2018)
  • Effectiveness of a New Lead-Shielding Device and Additional Filter for
           Reducing Staff and Patient Radiation Exposure During Videofluoroscopic
           Swallowing Study Using a Human Phantom
    • Authors: Yoshiaki Morishima; Koichi Chida; Yoshikazu Muroya; Yoshiya Utsumi
      Pages: 109 - 114
      Abstract: Interventional radiology procedures often involve lengthy exposure to fluoroscopy-derived radiation. We therefore devised a videofluoroscopic swallowing study (VFSS) procedure using a human phantom that proved to protect the patient and physician by reducing the radiation dose. We evaluated a new lead-shielding device and separately attached additional filters (1.0-, 2.0-, and 3.0-mm Al filters and a 0.5-mm Cu filter) during VFSS to reduce the patient’s entrance skin dose (ESD). A monitor attached to the human phantom’s neck measured the ESD. We also developed another lead shield (VFSS Shielding Box, 1.0-mm Pb equivalent) and tested its efficacy using the human phantom and an ionization chamber radiation survey meter with and without protection from scattered radiation at the physician’s position on the phantom. We then measured the scattered radiation (at 90 and 150 cm above the floor) after combining the filters with the VFSS Shielding Box. With the additional filters, the ESD was reduced by 15.4–55.1%. With the VFSS Shielding Box alone, the scattered radiation was reduced by about 10% compared with the dose without additional shielding. With the VFSS Shielding Box and filters combined, the scattered radiation dose was reduced by a maximum of about 44% at the physician’s position. Thus, the additional lead-shielding device effectively provided protection from scattered radiation during fluoroscopy. These results indicate that the combined VFSS Shielding Box and filters can effectively reduce the physician’s and patient’s radiation doses.
      PubDate: 2018-02-01
      DOI: 10.1007/s00455-017-9839-6
      Issue No: Vol. 33, No. 1 (2018)
  • Reliability and Validity of the MD Anderson Dysphagia Inventory Among
           Japanese Patients
    • Authors: Yuhei Matsuda; Manabu Kanazawa; Yuriko Komagamine; Masashi Yamashiro; Sumio Akifusa; Shunsuke Minakuchi
      Pages: 123 - 132
      Abstract: This study aimed to validate the Japanese version of a dysphagia-specific quality of life questionnaire, the MD Anderson Dysphagia Inventory (MDADI-J), and to verify trends between MDADI-J and Functional Oral Intake Scale (FOIS) scores. The original 20 MDADI items were translated using a forward–backward method following accepted cultural adaptation guidelines. Seventy-two patients with a history of head and neck cancer treatment completed the MDADI-J between October 2015 and August 2016. Concurrent validity was determined by correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) instruments. Discriminant validity was examined using cancer stage grouping between stages I–II and III–IV. Additionally, trends between the FOIS and the MDADI-J total scores were analyzed using a trend test. The Cronbach’s α coefficient of the MDADI-J total score was 0.92, indicating high internal consistency. The average inter-item correlation coefficients ranged from 0.39 to 0.49. ICC, an indicator of test–retest reliability, was 0.84 for the total score, and 0.58 to 0.81 for individual subscales. The total score and all subscales were significantly associated with the scores for each factor of the EORTC QLQ-C30 and EORTC QLQ-H&N35. The total score and all subscales were significantly different between clinical tumor stages I–II and III–IV. The total scores all increased with the progress of the FOIS. In conclusion, this study validated the Japanese version of the MDADI and showed that as FOIS scores deteriorate, MDADI-J scores tend to constantly decrease.
      PubDate: 2018-02-01
      DOI: 10.1007/s00455-017-9842-y
      Issue No: Vol. 33, No. 1 (2018)
  • Changes in Swallowing-Related Quality of Life After Endoscopic Treatment
           for Zenker’s Diverticulum Using the SWAL-QOL Questionnaire
    • Authors: Keith Siau; Linzie Priestnall; Chris J. J. Mulder; Sauid Ishaq
      Pages: 136 - 137
      PubDate: 2018-02-01
      DOI: 10.1007/s00455-017-9840-0
      Issue No: Vol. 33, No. 1 (2018)
  • Reply to the Letter to the Editor Concerning: ‘Changes in
           Swallowing-Related Quality of Life After Endoscopic Treatment for
           Zenker’s Diverticulum Using SWAL-QOL Questionnaire’
    • Authors: Charlotte Colpaert; O. M. Vanderveken; P. Van de Heyning; C. Van Laer
      Pages: 138 - 139
      PubDate: 2018-02-01
      DOI: 10.1007/s00455-017-9848-5
      Issue No: Vol. 33, No. 1 (2018)
  • Society for Neuroscience 2017 Satellite Symposium on Feeding and
           Swallowing: From Neural Mechanisms to Rehabilitation
    • PubDate: 2018-03-12
      DOI: 10.1007/s00455-018-9887-6
  • Reliability of Untrained and Experienced Raters on FEES: Rating Overall
           Residue is a Simple Task
    • Authors: Jessica M. Pisegna; James C. Borders; Asako Kaneoka; Wendy J. Coster; Rebecca Leonard; Susan E. Langmore
      Abstract: The purpose of this study was to investigate the reliability of residue ratings on Fiberoptic Endoscopic Evaluation of Swallowing (FEES). We also examined rating differences based on experience to determine if years of experience influenced residue ratings. A group of 44 raters watched 81 FEES videos representing a wide range of residue severities for thin liquid, applesauce, and cracker boluses. Raters were untrained on the rating scales and simply rated their overall impression of residue amount on a visual analog scale (VAS) and a five-point ordinal scale in a randomized fashion across two sessions. Intra-class correlation coefficients, kappa coefficients, and ANOVAs were used to analyze agreement and differences in ratings. Residue ratings on both the VAS and ordinal scales had acceptable inter- and intra-rater reliability. Inter-rater agreement was acceptable (ICC > 0.7) for all comparisons. Intra-rater agreement was excellent on the VAS scale (rc = 0.9) and good on the ordinal scale (k = 0.78). There was no significant difference between expert ratings and other raters based on years of experience for cracker ratings (p = 0.2119) and applesauce ratings (p = 0.2899), but there was a significant difference between clinicians on thin liquid ratings (p = 0.0005). Without any specific training, raters demonstrated high reliability when rating the overall amount of residue on FEES. Years of experience with FEES did not influence residue ratings, suggesting that expert ratings of overall residue amount are not unique or specialized. Rating the overall amount of residue on FEES appears to be a simple visual-perceptual task for puree and cracker boluses.
      PubDate: 2018-03-07
      DOI: 10.1007/s00455-018-9883-x
  • Correlation of Patient- and Physician-Scored Dysphagia with
           Videofluoroscopies in Patients Treated with Radiotherapy for Head and Neck
    • Authors: D. Nevens; A. Goeleven; F. Duprez; A. Laenen; E. Dejaeger; W. De Neve; S. Nuyts
      Abstract: The aim of this study was to investigate the correlation between patient-scored dysphagia and physician-scored dysphagia in head and neck cancer patients treated with radiotherapy. Furthermore, we wanted to compare both patient- and physician-scored dysphagia with dysphagia evaluated on swallowing videofluoroscopies. Sixty-three patients from two different centers treated with radiotherapy for head and neck cancer were evaluated in the current study. Swallowing videofluoroscopies at baseline, 6, and 12 months following radiotherapy were evaluated by 2 observers using the Penetration Aspiration Scale (PAS) and Swallowing Performance Status Scale (SPS) and correlated with patient and physician scored dysphagia. We observed a significant association between physician and patient scored dysphagia (p < 0.01), pre-treatment and post-treatment. Furthermore, the risk of observing dysphagia on videofluoroscopies increased significantly with increasing scores of both physician as well as patient scored dysphagia, and this at all assessed time-points. Patient-scored dysphagia correlates better with dysphagia evaluated by the PAS. Physician-scored dysphagia, however, correlates better with dysphagia as evaluated using the SPS. Both physician- and patient-scored dysphagia correlate well with dysphagia evaluated on videofluoroscopies. Since patient-scored dysphagia correlates better with PAS and changes in the PAS score, and physician-scored dysphagia correlates better with SPS, we advocate to use both patient- and physician-scored dysphagia in future trials.
      PubDate: 2018-03-03
      DOI: 10.1007/s00455-018-9888-5
  • Screening for Dysphagia in Adult Patients with Stroke: Assessing the
           Accuracy of Informal Detection
    • Authors: Victoria Sherman; Heather Flowers; Moira K. Kapral; Gordon Nicholson; Frank Silver; Rosemary Martino
      Abstract: Early identification of dysphagia by screening is recommended best practice for patients admitted to hospital with acute stroke. Screening can reduce the risk of pneumonia and promote stroke recovery, yet some institutions do not utilize a formal screening protocol. This study assessed the accuracy of informal dysphagia detection prior to implementation of a formal screening protocol. We conducted a secondary analysis of data captured between 2003 and 2008 from a sample of 250 adult stroke survivors admitted to a tertiary care centre. Using a priori criteria, patient medical records were reviewed for notation about dysphagia; if present, the date/time of notation, writer’s profession, and suggestion of dysphagia presence. To assess accuracy of notations indicating dysphagia presence, we used speech language pathology (SLP) assessments as the criterion reference. There were 221 patient medical records available for review. Patients were male (56%), averaged 68 years (SD = 15.0), with a mean Canadian Neurological Scale score of 8.1 (SD = 3.0). First notations of swallowing by SLP were excluded. Of the remaining 170 patients, 147 (87%) had first notations (104 by nurses; 40 by physicians) within a median of 24.3 h from admission. Accuracy of detecting dysphagia from informal notations was low, with a sensitivity of 36.7% [95% CI, 24.9, 50.1], but specificity was high (94.2% [95% CI, 86.5, 97.9]). Informal identification methods, although timely, are suboptimal in their accuracy to detect dysphagia and leave patients with stroke at risk for poor health outcomes. Given these findings, we encourage the use of psychometrically validated formal screening protocols to identify dysphagia.
      PubDate: 2018-03-01
      DOI: 10.1007/s00455-018-9885-8
  • Factors Contributing to Hydration, Fluid Intake and Health Status of
           Inpatients With and Without Dysphagia Post Stroke
    • Authors: Jo Murray; Ingrid Scholten; Sebastian Doeltgen
      Abstract: Dysphagia has been strongly associated with poor hydration in acute stroke settings. However, in sub-acute settings, the contribution to dehydration of dysphagia in combination with other common stroke comorbidities has not been explored. The aim of this study was to investigate which demographic and stroke comorbidities, including dysphagia, contribute most significantly to oral fluid intake, hydration status and specific adverse health outcomes for patients in sub-acute rehabilitation following stroke. Data from 100 inpatients from three Australian rehabilitation facilities (14 with confirmed dysphagia and 86 without dysphagia) were analysed. Hierarchical multiple regressions were conducted to determine which demographic or stroke comorbidities were most predictive of each outcome: average daily fluid intake; Blood urea nitrogen/creatinine (BUN/Cr) ratio as an index of hydration and medically diagnosed adverse events of pneumonia, dehydration, urinary tract infection or constipation. Average daily beverage intake (M = 1448 ml, SD 369 ml) was significantly and independently predicted by Functional Independence Measure (FIM) at admission (F change = 9.212, p = 0.004). BUN/Cr ratio (M = 20, SD 5.16) was predicted only by age (F change = 4.026, p = 0.049). Adverse health events, diagnosed for 20% of participants, were significantly predicted by Admission FIM (OR 1.040, 95% CI 1.001, 1.081, p = 0.047). Dysphagia was not a significant predictor of any of the outcomes measured. Rather, overall functional dependency was the most significant predictor of poor oral fluid intake and fluid-related adverse health outcomes in sub-acute stroke. Clinical Trial number: Data for the post hoc analysis presented in this article came from the registered trial ACTRN12610000752066.
      PubDate: 2018-03-01
      DOI: 10.1007/s00455-018-9886-7
  • Neural Mechanisms of Swallowing Dysfunction and Apraxia of Speech in Acute
    • Authors: Lydia A. Trupe; Rachel W. Mulheren; Donna Tippett; Argye E. Hillis; Marlís González-Fernández
      Abstract: Speech and swallowing utilize overlapping anatomy and are thus inherently related processes. We sought to identify common neural mechanisms between risk of swallowing dysfunction and apraxia of speech (AOS). This was a retrospective analysis using data from a prospectively collected cohort. Left hemisphere stroke patients (68 subjects) tested with the Apraxia Battery for Adults II, a swallow screen, and MRI were included in the study. Main outcome measure was the presence of AOS or aspiration risk after stroke. We identified a significant association between AOS measures and increased aspiration risk (defined by failed swallow screen; p = 0.04; OR 5.2). Lesions in pars opercularis of Broca’s area (BA 44) were associated with both AOS (p = 0.044; OR 9.7) and increased aspiration risk (p = 0.04; OR 5) but deficits rarely co-occurred in the same cases. Lesions in left premotor cortex (BA 6) were not significantly associated with increased aspiration risk (p = 0.06; OR 3.3) but were significantly associated with AOS (p = 0.008; OR 7). Impaired swallowing function was also associated with lesions in Wernicke’s area (BA 22; p = 0.05; OR 3.5) and pars triangularis (BA 45; p = 0.02; OR 6.8). AOS and risk of aspiration are associated in patients with acute left hemisphere stroke. Acute infarct in the pars opercularis of Broca’s area is associated with both deficits, though they rarely co-occur in the same individual. The co-occurrence of AOS and risk of aspiration likely reflects dependence on closely related neural structures.
      PubDate: 2018-02-24
      DOI: 10.1007/s00455-018-9879-6
  • Maturation of the Coordination Between Respiration and Deglutition with
           and Without Recurrent Laryngeal Nerve Lesion in an Animal Model
    • Authors: Ashley Ballester; François Gould; Laura Bond; Bethany Stricklen; Jocelyn Ohlemacher; Andrew Gross; Katherine DeLozier; Randall Buddington; Karyl Buddington; Nicole Danos; Rebecca German
      Abstract: The timing of the occurrence of a swallow in a respiratory cycle is critical for safe swallowing, and changes with infant development. Infants with damage to the recurrent laryngeal nerve, which receives sensory information from the larynx and supplies the intrinsic muscles of the larynx, experience a significant incidence of dysphagia. Using our validated infant pig model, we determined the interaction between this nerve damage and the coordination between respiration and swallowing during postnatal development. We recorded 23 infant pigs at two ages (neonatal and older, pre-weaning) feeding on milk with barium using simultaneous high-speed videofluoroscopy and measurements of thoracic movement. With a complete linear model, we tested for changes with maturation, and whether these changes are the same in control and lesioned individuals. We found (1) the timing of swallowing and respiration coordination changes with maturation; (2) no overall effect of RLN lesion on the timing of coordination, but (3) a greater magnitude of maturational change occurs with RLN injury. We also determined that animals with no surgical intervention did not differ from animals that had surgery for marker placement and a sham procedure for nerve lesion. The coordination between respiration and swallowing changes in normal, intact individuals to provide increased airway protection prior to weaning. Further, in animals with an RLN lesion, the maturation process has a larger effect. Finally, these results suggest a high level of brainstem sensorimotor interactions with respect to these two functions.
      PubDate: 2018-02-24
      DOI: 10.1007/s00455-018-9881-z
  • Race Differences in Gastrostomy Tube Placement After Stroke in
           Majority-White, Minority-Serving, and Racially Integrated US Hospitals
    • Authors: Roland Faigle; Lisa A. Cooper; Rebecca F. Gottesman
      Abstract: We sought to determine individual and system contributions to race disparities in percutaneous endoscopic gastrostomy (PEG) tube placement after stroke. Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic/racial minority stroke patients (< 25% ethnic/racial minorities [“majority-white hospitals”], 25–50% ethnic/racial minorities [“racially integrated hospitals”], or > 50% ethnic/racial minorities [“minority-serving hospitals”]). Logistic regression was used to evaluate the association between ethnicity/race and PEG utilization within and between the different hospital strata. Among 246,825 stroke admissions, patients receiving care in minority-serving hospitals had higher odds of PEG compared to patients in majority-white hospitals, regardless of individual patient race (adjusted odds ratio [OR] 1.24, 95% CI 1.12–1.38). Ethnic/racial minorities had higher odds of PEG than whites in any hospital strata; however, this discrepancy was largest in majority-white hospitals (OR 1.62, 95% CI 1.48–1.76), and smallest in minority-serving hospitals (OR 1.22, 95% CI 1.11–1.33; p for interaction < 0.001). Ethnic/racial minority patients had similar odds of PEG in any hospital strata, while white patients had increasing odds of PEG in racially integrated and minority-serving compared to majority-white hospitals (OR 1.28, 95% CI 1.15–1.43 in racially integrated, and OR 1.39, 95% CI 1.23–1.57 in minority-serving, compared to majority-white hospitals, p for trend < 0.001). The likelihood of PEG after ischemic stroke was increased in minority-serving compared to majority-white hospitals. White patients had higher odds of PEG in minority-serving compared to majority-white hospitals, indicating a systemic difference in PEG placement across hospitals.
      PubDate: 2018-02-21
      DOI: 10.1007/s00455-018-9882-y
  • Temporal Trends of Pediatric Dysphagia in Hospitalized Patients
    • Authors: Joshua Horton; Carlyn Atwood; Sharon Gnagi; Ronald Teufel; Clarice Clemmens
      Abstract: The objective of this study was to determine temporal trends of dysphagia diagnoses in hospitalized children. This is a retrospective observational study from the 1997–2012 Kids’ Inpatient Database (KID) conducted in the setting of weighted hospitalizations in a KID participating center. More than 6 million pediatric admissions were captured in each triennial KID report. Main outcomes included triennial rates of dysphagia diagnosis in hospitalized pediatric patients, and secondary outcomes included rates of dysphagia in premature and low-birthweight infants. Dysphagia diagnoses were coded in 5107/6607653 (0.08%) of these admissions in 1997, rising to 27,464/6,675,222 (0.41%) in 2012 (p < 0.001). The portion of these diagnoses in premature neonates has been increasing over time from 162/9551 (1.7%) in 2003 to 1027/27,464 (3.7%) by 2012 (p < 0.001). Similarly, low-birthweight children constituted 40/5107 (0.8%) of dysphagia diagnoses in 1997, a number that increased to 762/27,464 (2.8%) in 2012. Rates of dysphagia are increasing nationally, particularly in premature and low-birthweight infants, which may represent an increase alongside other neuroanatomic abnormalities. This growing problem illustrates the need for better data on the comparative efficacy of diagnostic and treatment modalities.
      PubDate: 2018-02-20
      DOI: 10.1007/s00455-018-9884-9
  • Double Blind Study Investigating the Effect of Different Voice Prostheses
           on Ease of Swallowing and Residue Post Laryngectomy
    • Authors: Margaret M. Coffey; Neil Tolley; David Howard; Mary Hickson
      Abstract: Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.
      PubDate: 2018-02-19
      DOI: 10.1007/s00455-018-9880-0
  • Superior and Anterior Hyoid Displacement During Swallowing in
           Non-Dysphagic Individuals
    • Authors: James Curtis; Jonelyn Langenstein; Sarah Schneider
      Abstract: The Dynamic Swallow Study (DSS) is a methodology used to objectively and quantitatively assess swallowing kinematics during Videofluoroscopic Swallow Studies (VFSS). No DSS normative data exist delineating superior and anterior hyoid displacement (Hsup and Hant, respectively), nor the ratio between Hsup and Hant (SAratio). The aims of this study were to (1) establish normative data for Hsup, Hant, and SAratio and (2) assess the effects of age, sex, and bolus size on these measures in non-dysphagic patients, within the context of DSS. VFSSs were reviewed for consecutive elderly (≥ 65 years) and non-elderly (< 65 years) male and female non-dysphagic patients. Measurements of Hsup, Hant, and SAratio were made using a novel measurement methodology within the context of the Dynamic Swallow Study (DSS) protocol. Statistical analysis was performed to establish interaction effects and main effects of age, sex, and bolus size on Hsup, Hant, and SAratio. Descriptive statistics (mean ± standard deviations) are outlined for Hsup, Hant, and SAratio. Hsup was significantly effected by bolus size and age. Additionally, a significant three-way interaction of age, sex, and bolus size was observed. Hant was significantly effected by bolus size and sex, but no two- or three-way interactions were present. Neither bolus size, age, nor sex significantly effected SAratio. Age, sex, and bolus size normative data were established for Hsup, Hant, and SAratio for VFSS kinematic analysis. By outlining these measures, one can more thoroughly evaluate the areas of specific swallowing impairment, better determine the therapy targets, and track changes over time.
      PubDate: 2018-02-14
      DOI: 10.1007/s00455-018-9878-7
  • Short-Term Effects of Cold Liquids on the Pharyngeal Swallow in Preterm
           Infants with Dysphagia: A Pilot Study
    • Authors: Louisa Ferrara; Ranjith Kamity; Shahidul Islam; Irene Sher; Dan Barlev; Laurie Wennerholm; Fran Redstone; Nazeeh Hanna
      Abstract: Cold stimulation reduces airway compromise in adults with dysphagia. However, there is no sufficient evidence to support its use in the pediatric population. The primary goal of this pilot study is to assess the effect of cold liquid on the pharyngeal swallow mechanism in preterm infants with dysphagia. We hypothesized that thermal stimulation from cold liquid will decrease the risk of airway compromise in dysphagic preterm infants. Nine preterm infants with clinical symptoms of dysphagia were included. Video fluoroscopic swallow studies were used to assess the swallowing mechanism of each participant. The occurrence of swallow dysfunctions under room temperature liquid swallows (RTS) vs. short period cold liquid swallows (CS) was compared. Paired t test was used to test significance. The occurrence of deep penetration (p = 0.007) and aspiration (p = 0.002) decreased significantly in the CS condition compared with the RTS condition. There was a trend of less nasopharyngeal reflux with CS but did not reach statistical significance (p = 0.084). No differences were noted for mild penetration (p = 0.824). CS reduced airway compromise in dysphagic preterm infants compared to RTS. These data provide important information regarding the immediate effects of CS on pharyngeal swallowing in preterm infants with dysphagia. However, further investigation regarding its sustained effects is required before introducing to clinical practice.
      PubDate: 2018-02-12
      DOI: 10.1007/s00455-018-9877-8
  • Interdisciplinary Telemedicine in the Management of Dysphagia in Head and
    • Authors: Mydhili Mayadevi; Krishnakumar Thankappan; Shashikant Vishnubhai Limbachiya; Sivakumar Vidhyadharan; Brenda Villegas; Melody Ouyoung; Deepak Balasubramanian; Jayakumar R. Menon; Uttam Sinha; Subramania Iyer
      Abstract: The study considered the feasibility and impact of interdisciplinary telemedicine discussions in the management of post-treatment dysphagia in patients with head and neck tumors. This is a retrospective analysis of patients with persistent dysphagia after treatment for head and neck pathology, at an institute in India. The cases were discussed in the telemedicine meeting conducted between host institute and a second unit in the United States. A monthly meeting was organized, using an internet-based video conference system. The ongoing swallowing problems and management were presented, and through discussions, a plan for further management was formulated and carried out. The Functional Oral Intake Scale (FOIS) was measured before and after the implementation of the plan. Twenty-six patients were discussed, out of which, 22 were head and neck malignancies. The recommendations concurred with that of the host unit in 18, differed for three and additive in five patients. The pre-treatment mean FOIS was 1.46 with a standard deviation of 0.989 and post-treatment mean improved to 3.92 with a standard deviation of 1.809 (p < 0.0001). The present study supports the success of an interdisciplinary telemedicine meeting to manage difficult cases of dysphagia in head and neck. The outcome in terms of the FOIS score improved significantly after implementing them. In addition to the direct patient benefits, the meeting helped to facilitate interdepartmental collaboration between two units treating similar sets of patients across the globe, in specialized clinical areas like dysphagia management.
      PubDate: 2018-02-05
      DOI: 10.1007/s00455-018-9876-9
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