Dysphagia最新文献

Primary sarcopenia, characterized by age-related decline in muscle mass and strength, is increasingly recognized as a contributor to oropharyngeal dysphagia in older adults. Understanding its mechanical and functional components is essential for early detection and intervention. This study aimed to investigate early oropharyngeal swallowing impairments in older adults with primary sarcopenia using a multimodal instrumental assessment and to evaluate the utility of combining different objective measures. In this cross-sectional study, swallowing safety and efficiency were assessed using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale through fiberoptic endoscopic evaluation of swallowing (FEES) in 44 older individuals with primary sarcopenia. Additional assessments included tongue strength measurement, suprahyoid muscle activity using surface electromyography (sEMG), peak cough flow (PCF), and self-perceived swallowing symptoms evaluated using Eating Assessment Tool-10 (EAT-10). According to DIGEST overall score, 20.5% of participants showed no dysphagia (grade 0), while 56.8% had mild (grade 1), and 22.7% had moderate (grade 2) dysphagia. Participants with dysphagia (grades 1-2) showed decreased tongue strength, reduced sEMG amplitudes, longer swallowing durations, and decreased PCF compared to those with grade 0. Although these differences were not statistically significant, a trend toward early functional decline was noted. These findings suggest that in early-stage primary sarcopenia, swallowing safety may be preserved despite mild physiological deficits. This likely reflects the presence of a functional reserve within the swallowing mechanism. However, clinicians should not rely solely on this compensation, as subtle changes may precede clinically significant dysphagia. Early identification and monitoring remain crucial to prevent deterioration in this vulnerable population.

Accurate assessment of swallowing function is essential to prevent aspiration pneumonia and nutritional decline. However, in hospitalized patients, discrepancies are often observed between clinical assessments and the actual oral intake. We retrospectively analyzed 5,091 patients who underwent a videofluoroscopic swallowing study or videoendoscopic evaluation of swallowing (VE) at our hospital between 2018 and 2024. The Discrepancy Index (DI), as the difference between the Food Intake LEVEL Scale and Fujishima's swallowing ability grade, was calculated. Patients with DI ≤ - 2 were classified as the "underestimated group". Logistic regression analysis was conducted to identify the associated factors. The underestimated group accounted for 22.5% of the cases. Female sex (OR = 1.45, p < 0.001), VE use (OR = 1.68, p < 0.001), pulmonary disease (OR = 1.63, p = 0.001), and disuse-related physical decline (hereafter referred to as disuse syndrome) (OR = 1.71, p = 0.001) were significantly associated with underestimation. The subgroup analyses revealed that these associations were more prominent in men with pulmonary and disuse-related conditions. Overestimation though rare (< 3%) was clinically important. Over 20% of patients were likely to receive unnecessarily restrictive diets due to underestimation of their swallowing function. Such underestimation may be influenced by inaccurate assessments or clinicians' safety concerns, as reported in previous studies. Although sex showed a statistical effect on the DI, it did not indicate a consistent pattern of under- or over-estimation between sexes. Timely and accurate assessment of swallowing through an interdisciplinary collaboration is essential to avoid unnecessary fasting, prevent nutritional decline, and reduce the risk of developing sarcopenic dysphagia.

This scoping review aims to describe the oropharyngeal and esophageal swallowing profiles of individuals with Myasthenia Gravis (MG). Given the high prevalence of dysphagia in this population, this review seeks to synthesize existing literature on swallowing impairments and highlight the need for early identification in dysphagia management. This scoping review was conducted in accordance with Joanna Briggs Institute methodology for scoping reviews. Four databases were systematically searched to identify studies that examined swallowing impairments in MG using instrumental assessments. Studies were screened and selected if they utilized instrumental assessments, including Videofluoroscopic Swallowing Study (VFSS), Fiberoptic Endoscopic Evaluation of Swallowing (FEES), and/or esophageal manometry. Included studies were analyzed by two independent reviewers to provide a comprehensive overview of dysphagia across oral, pharyngeal, and esophageal domains using Covidence. A total of 4,305 manuscripts were identified; 1,959 remained after removing duplicates. Following screening titles, abstracts, and full texts, 13 remained. Findings indicate that MG-associated dysphagia affects all domains of swallowing. Disease severity, classified using the Myasthenia Gravis Foundation of America (MGFA) and Osserman classification, was associated with increased dysphagia severity. Studies reported a significant prevalence of silent aspiration, with 75% of silent aspirators developing aspiration pneumonia. This review highlights the high prevalence of dysphagia in MG and the importance of objective assessments in identifying swallowing impairments. Routine instrumental evaluations are essential for managing dysphagia and preventing serious complications such as aspiration pneumonia and myasthenic crisis. Future research should focus on standardizing dysphagia screening and assessment tools for MG.

For patients with head and neck cancer (HNC), radiation therapy is associated with short-term, chronic, and late-onset dysphagia [1-3]. Swallowing exercises and oral intake during radiation may reduce dysphagia shortly after radiation [4-6]. The purpose of this study was to explore the relationship between exercise adherence and feeding tube use and one-year swallowing outcomes. Secondary analysis of RCT of swallowing therapy during definitive radiation-based HNC treatment. Adherence was defined as completing at least 50% of prescribed swallowing exercises during radiotherapy. Feeding tube use was prospectively collected. Outcome measures included the MD Anderson Dysphagia Inventory, Performance Status Scale - Head and Neck, Functional Oral Intake Scale, Penetration Aspiration Scale, Modified Barium Swallow Impairment Profile, and Dynamic Imaging Grade of Swallowing Toxicity scores. One-year follow-up data was available for 64 participants. Adherence criteria was met by 26 participants (41%) while feeding tube use (during treatment) was present in 8/64 participants (12%); only 1 patient had a feeding tube at one year. Adherence was associated with more normal MDADI scores one-year post-treatment (91 vs. 80: p = 0.003), as well as higher PSS normalcy of diet scores (p = 0.03). Feeding tube use was associated with worse maximum PAS scores (p < 0.001), DIGEST scores (Safety p = 0.04; overall grade p = 0.01), and MBS-ImP pharyngeal composite scores (p = 0.008). Adherence to swallowing exercises during radiation therapy is associated with better patient perceived swallow function and diet scores while avoidance of feeding tube placement is associated with better physiologic swallow function one year following radiation therapy.

Background: Recurrent oropharyngeal cancer (rOPC) presents challenging treatment decision-making. Toxicity from previous treatment, coupled with potential functional and quality of life (QoL) morbidity of further treatment(s) can influence decision-making regarding curative and non-curative treatment.

Aim: To investigate swallowing and QoL outcomes, treatment-related priorities, and patient experience before and after rOPC treatment.

Method: Longitudinal, multicentre, mixed method study. Outcomes included the MD Anderson Dysphagia Inventory (MDADI), Performance Status Scale for Head and Neck Cancer (PSS-HN), the University of Washington QoL Questionnaire (UWQoLv4), the Chicago Priority Scale (CPS) and semi-structured interviews.

Results: The sample included 37 participants (prospective n = 25, retrospective n = 12, females n = 6) with a median age of 63 (range 41-88). The majority (n = 21) had curative intent treatment (surgery n = 20 or radiation n = 1). The remainder had non-curative intent immunotherapy (n = 14) or chemotherapy (n = 2). Swallowing and QoL were impaired at baseline; median MDADI composite score: 60 (IQR: 52.15-81.75), median PSS- HN normalcy of diet: (NoD): 50 and UWQoLv4 global health score (GHS): 60 (IQR 40-60). The PSS-HN NoD score deteriorated to 40 at six months. The MDADI and UWQoL data remained impaired. Triangulation with qualitative data revealed agreement with the PSS data and provided context for the relatively stable QoL. Being cured of cancer and living as long as possible remained the key priorities at all timepoints.

Conclusion: In this study swallowing deteriorated with treatment for rOPC. Treatment-related priorities remained focused on cure or survival. If the treatment-related goal was achieved, patients adapted and experienced at least stable QoL regardless of swallowing status.

There is a lack of evidence on training modalities for improving swallowing function in tracheostomized patients. The objective was to investigate the effect of oral neuromuscular training on decannulation and swallowing function in tracheostomized patients with acquired brain injury. A pilot randomized controlled trial with 22 patients, 11 in the intervention group and 11 in the usual care group. Inclusion criteria were: ≥ 18 years, cuffed tracheostomy tube at admission for rehabilitation, and Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) ≥ 4 at admission. Primary outcome was days from baseline until decannulation. Secondary outcomes were swallowing function assessed with FEDSS, Penetration Aspiration Scale (PAS), and the Yale pharyngeal residue scale (Yale scale) at baseline and following 4 weeks intervention. Participants in the two groups were comparable at baseline with regards to demographics and functional level. Difference in time until decannulation in the two groups was expressed with a hazard ratio of 1.40 (95%CI: 0.57; 3.43) in favour of the IQoro group. Swallowing function improved statistically significant in the usual care group on both PAS and Yale scale, whereas improvements in the IQoro group was only observed in FEDSS. Investigating between group differences, there was a statistically significant difference in pharyngeal residue assessed with the Yale Scale-pyriform sinus in favour of usual care (p = 0.018). Training with IQoro did not facilitate improvements in early decannulation or swallowing function compared to usual care. On the contrary, results showed less improvements in pharyngeal residue in the IQoro group compared with the usual care group.

Introduction: Resection of malignancy through maxillectomy and subsequent maxillofacial prosthetics provides adequate swallowing function and rehabilitation. The aim of this study was to verify whether there is association between changes in swallowing and the oropharyngeal geometry in maxillectomy patients with and without using transsurgical palatal obturators (TPO).

Methods: The study includes 7 maxillectomy patients, TPO users who underwent complementary radiotherapy. Outcome variables were investigated by acoustic pharyngometry (APh) and fiberoptic endoscopic evaluation of swallowing (FEES) to assess the oropharyngeal geometry and swallowing, respectively with and without TPO. Sociodemographic and clinical characteristics (postoperative radiotherapy, type of surgery, type of obturator, time elapsed between adaptation and the swallowing test) were evaluated. To compare with and without TPO conditions, Mann-Whitney test and Spearman's correlation coefficient were used.

Results: Swallowing variables: early escape and nasopharyngeal reflux showed better results with TPO (p = 0.021 and p = 0.029, respectively) compared to swallowing without TPO. The oropharyngeal geometry was not statistically associated with swallowing changes.

Conclusion: Oropharyngeal measures by APh compared to the swallowing evaluation by FEES showed a correlation between early escape and longer length of the vocal tract in individuals with TPO. Swallowing in maxillectomy patients showed significant improvement with the use of transsurgical palatal obturator, related to the lack of early escape and absence of nasopharyngeal reflux.