Dysphagia最新文献

Videofluoroscopy, recognized as the gold standard for dysphagia exploration, has inherent limitations, including poor soft tissue discrimination, radiation exposure, and aspiration risk. In response to these challenges, cine-MRI of swallowing has evolved over the past three decades, yielding diverse methodologies and results across various studies.This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, meticulously outlines cine-MRI protocols, applications, advantages, and limitations. Our qualitative analysis encompasses 36 studies involving 715 subjects from 2001 to 2023. Cine-MRI, a promising alternative, provides safe application for dysphagic patients, offering insights into the intricacies of deglutition mechanisms and eliminating the necessity for oral contrast material. Notably, this approach is adaptable to both 1.5 and 3T MRI scanners with specific image acceleration protocols.Despite these merits, a crucial gap remains, as no non-inferiority prospective study has yet been conducted to compare cine-MRI with the gold standard. Additionally, the lack of uniform swallowing assessment criteria and the uncertain impact of the supine position underscore the need for further investigation. In conclusion, while cine-MRI of deglutition emerges as a compelling tool for dysphagia exploration, its precise indications and role in the diagnostic approach to swallowing disorders necessitate comprehensive evaluation in future studies.

The role of pathophysiological deficits in the evolution of dysphagia post-stroke is unclear. This observational, longitudinal study aimed to document the evolution and relationship between strength and precision of submental contraction, and swallowing outcomes at six months. Participants were recruited from a tertiary acute hospital after a first acute stroke. Sociodemographic data and stroke typology were documented. Outcome measures were collected five times across six months. These included: oral diet (FOIS, IDDSI), functional ingestion (TOMASS, TWST), self-reported swallowing-related quality of life (SWAL-QOL), and submental muscle strength and precision contraction as assessed using surface electromyography coupled with biofeedback during saliva swallowing and jaw-opening tasks. Mixed effects models and multiple regressions analyses were conducted. Participants (N = 22, mean age 73.9 ± 14.4 years, 9 males) were recruited at a mean time of 2.8 ± 1.5 days after stroke. Strength parameters (effortful swallow hit rate) improved between ten days and one month post-stroke (p = 0.04). Swallowing temporal precision improved significantly between one and six months (p < 0.01). At six months, participants with decreased swallowing precision also had decreased quality of life (p = 0.04) and increased ingestion time of fluids (p = 0.002). This study is a novel step in exploring the nature and evolution of strength and precision parameters of swallowing muscle activation, and their impact on dysphagia recovery. As swallowing precision was associated with poorer functional outcomes, further studies are warranted to improve early differential diagnosis of patients at risk of chronic dysphagia.

Oculopharyngeal muscular dystrophy (OPMD) is a rare late-onset muscle disease with progressive dysphagia as a major symptom. The Dysphagiameter is a newly developed patient-reported outcome measure (PROM) to assess the severity of dysphagia and its impact in patients with OPMD. This article reports on item reduction and a first assessment of the Dysphagiameter's psychometrics properties, in a French and English-speaking population of individuals with OPMD. Classical test theory and Rasch model were used for item reduction and scoring (n = 162). Construct validity was assessed using the time to drink 80 ml of cold water and the Sydney Swallow Questionnaire (SSQ) (n = 40). Part A of the final PROM resulted in a 21-item scale assessing the capacity to swallow foods of various textures and a 3-item scale assessing the capacity to swallow liquids (Cronbach Alpha = 0.90); the hierarchical structure of the 21-item scale was confirmed with a Rasch analysis (Person separation index = 0.95). Part B resulted in a 6 item-scale assessing the impact on mealtime and a 2-item scale assessing discomfort related to thick saliva (Alpha Cronbach = 0.91 and 0.79). Convergent validity was demonstrated by significant correlations with the SSQ. Known-group validity was supported by the ability of the Dysphagiameter to detect significant differences according to the severity of dysphagia. In summary, the Dysphagiameter-OPMD, a newly developed PROM, exhibits strong psychometric properties and holds promise as a valuable tool for assessing the severity of dysphagia and its impact on individuals with OPMD.

Dysphagia is common in hospitalised children. Clarity regarding its prevalence is required to direct service needs. This review reports oropharyngeal dysphagia prevalence in children admitted to acute and/or critical care, following acute illness, medical or surgical intervention. It also explores patient characteristics significantly associated with oropharyngeal dysphagia in these settings. Five electronic databases (EMBASE, CINAHL, Cochrane, PubMed, Scopus) were searched. Studies identified for inclusion involved children (0-16 years), in acute or critical care settings, where prevalence data for new-onset or worsening oropharyngeal dysphagia was reported. Peer reviewed journal articles, including systematic reviews were included. Data was extracted and synthesised using a purpose designed extraction tool. A total of 7,522 studies were screened and 67 studies met criteria. The most researched populations included congenital heart disease surgeries, posterior fossa tumour resections, stroke and post-extubation dysphagia. Populations with the highest documented dysphagia prevalence were children after posterior fossa tumour resection with a new tracheostomy, children using nasal continuous positive airway pressure, and children following ischemic stroke. Characteristics significantly associated with oropharyngeal dysphagia were younger age, lower weight, longer intubation, upper/middle airway dysfunction (e.g., vocal paresis), and presence of additional comorbidities. This review presents synthesised prevalence data for children in acute and critical care settings with new-onset or worsening oropharyngeal dysphagia. It highlights the broad nature of oropharyngeal dysphagia in hospitalised children and the need for more rigorous research into characteristics associated with increased risk to better support screening and early identification of oropharyngeal dysphagia in these settings.

To investigate the characteristics of respiratory-swallow coordination (RSC) in poststroke dysphagia (PSD) patients following infratentorial stroke (IS) and further explore their association with aspiration. PSD patients after IS and age-matched healthy controls were recruited. Nasal airflow and sound signals were recorded using a nasal cannula-type flow sensor and contact microphone, which were synchronized with videofluoroscopic swallowing studies (VFSS). For healthy controls, only nasal airflow and sound signals recordings were conducted. A 5 ml thickened liquid was utilized during these assessments. The penetration-aspiration scale (PAS) score was determined through VFSS. Various parameters, including swallowing apnoea duration (SAD), swallowing duration (SD), swallowing latency duration (SLD), number of swallows (NS), and RSC patterns, were analysed to assess RSC. A total of 37 patients with PSD following IS-comprising 25 non-aspirators and 12 aspirators-and 31 age-matched healthy controls were included. The PSD patient group exhibited a shorter SAD (p = 0.016), a longer SD (p = 0.000), and fewer NS (p = 0.000) compared to the healthy control group. Among the PSD patients, those who aspirated exhibited a notably shorter SAD (p = 0.018) and longer SD (p = 0.028) compared to non-aspirators. The prevalence of the swallow-inspiration pattern was higher in PSD patients (p = 0.006), particularly among those who aspirated (p = 0.010). Logistic regression analysis and the area under the receiver operating characteristic curve (AUC) indicated that both SAD (AUC = 0.825, p = 0.002) and SD (AUC = 0.757, p = 0.020) were significant predictors of aspiration. The optimal cut-off values for SAD and SD were determined to be 0.19s and 1.93s, respectively. The RSC characteristics in patients with PSD following IS differed from those observed in healthy controls, particularly among patients who experienced aspiration. In these patients, a shorter SAD and longer SD may contribute to an increased risk of aspiration.

The examination of the cranial nerves (CN) provides an accurate analysis of facial-oral integrity, motility and sensitivity that is fundamental to understanding swallowing efficiency. The aim of this cross-sectional study is to verify whether the assessment of CN can provide information on the amount and location of pharyngeal residue and risk of aspiration in patients with neurogenic dysphagia. A total of 96 dysphagic patients have been enrolled. Pharyngeal residue was assessed by the Italian version of the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS) and presence of penetration/aspiration using the Penetration-Aspiration Scale (PAS) during Fiberoptic Endoscopic Evaluation of Swallowing (FEES), while CNs were evaluated using the I&I test. Logistic regression models were used to investigate causal associations; for each of the CN found to be significant, the optimal cut-off to best discriminate healthy patients from those with pathology was calculated. All statistical analyses were performed using R software with the significance level set at P < 0.05. Significant correlations were found between total scores on the I&I test and the PAS and IT-YPRSRS results. Impairment of CN VII was a sensitive and specific predictor of vallecular residue. Deficits of V CN and X CN were predictors of pyriform sinus residue. PAS scores were just below the statistical significance. Assessing CN can provide specific pathophysiological information about pharyngeal residue and risk of penetration/aspiration. These findings could help clinicians understand swallowing issues and early plan targeted interventions.

The lack of patient and public involvement in oropharyngeal dysphagia (OD) intervention studies in Parkinson's disease (PD) can bias the choice of outcomes to be measured in these studies. This study aimed to obtain perspectives of individuals living with OD in PD and family members/caregivers on OD intervention outcomes that are important to them. This is part of a larger Core Outcome Set project. A mixed methods study with an international online cross-sectional survey and subsequent focus groups involving people with OD in PD and family members/caregivers was conducted. Survey results were analyzed using descriptive and inferential statistics. Intervention outcomes rated most important, significantly different, inconclusive, or identified as missing in the survey were clarified in follow-up focus groups with seven previous survey participants. Focus group data were audio recorded, transcribed verbatim and analyzed following inductive and deductive content analysis using NVivo. Twelve outcomes were rated as important by ≥ 80% of the 62 survey participants. The most important outcomes were penetration/aspiration and laryngeal sensation. Fear of choking was added as an important but missing intervention outcome. In the focus groups, findings from the survey were validated. Four content categories with eleven sub-categories were identified. OD intervention outcome priorities by people with OD in PD and family members/caregivers show only partial agreement with outcomes measured in published intervention studies on OD in PD. This highlights the importance of stakeholder involvement in the design and implementation of these studies to make findings relevant to all.

Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterised by an elevated integrated relaxation pressure (IRP) with preserved peristalsis. Most functional EGJOO symptoms are self-limiting. This study aimed to evaluate the risk factors associated with non-resolution of symptoms for functional EGJOO. A retrospective single institution cohort study was performed on patients diagnosed with functional EGJOO on high-resolution manometry (HRM). Clinical, demographic, endoscopic and imaging parameters were recorded. Univariate and multivariate analyses were performed to identify factors associated with reduced likelihood of symptom resolution. Time to symptom resolution was then plotted on a Kaplan-Meier survival analysis. Over a 5-year period, 53 patients (41.5% male, 58.5% female) were diagnosed with functional EGJOO. The median age, body mass index and IRP at 4 s were 47.0 years (interquartile range (IQR): 36.0-58.0), 23.3 kg/m² (IQR: 20.9-26.5) and 39.9 mmHg (IQR: 28.6-52.3) respectively. Dysphagia and atypical chest pain accounted for 36.5% and 21.2% of symptoms respectively. On the univariate analysis, obesity (p = 0.002), heartburn (p = 0.098) and lack of epigastric pain (p = 0.090) were potentially correlated with failure of symptom resolution. In the multivariate analysis, only obesity (OR 0.11, 95% CI: 0.02-0.77; p = 0.026) was significantly associated with reduced likelihood of symptom resolution for EGJOO. On the survival analysis, 87.2% of non-obese patients, in contrast 37.5% of obese patients reported symptom resolution at up to 41-month follow-up period (p = 0.039). Patients with obesity are at an increased likelihood of having persistent symptoms. This association appeared to persist for patients with both manometric and clinically relevant EGJOO.

Adequate upper airway (oral, pharyngeal and laryngeal) sensation is crucial for safe and efficient swallowing and airway protection. Despite its importance, methods of upper airway sensory testing for individuals with dysphagia remain poorly defined. The aim of this study was to summarise and appraise current methods of upper airway sensory testing to inform dysphagia clinical practice and future research directions. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that reported a method of upper airway sensory testing in individuals with dysphagia were included. Of the 1187 studies identified and screened, 54 met the inclusion criteria. Four types of upper airway sensory testing were reported: Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (n = 31), Cough Reflex Testing (n = 22), Gag Reflex Testing (n = 5) and Gustatory (taste) Testing (n = 2). Indeterminate "tests of sensory function" (n = 2) were also reported. Variability in methods was evident across studies and reporting was insufficient for reliable replication. This review provides a comprehensive overview of methods of upper airway sensory testing in the dysphagia literature for dysphagia clinicians and researchers. The results indicate a need to develop a valid and reliable upper airway sensory testing protocol for individuals with dysphagia to improve assessment and targeted treatments.