Dysphagia最新文献

Previous studies have shown that intermittent theta burst stimulation (iTBS) can promote the recovery of swallowing function in stroke patients. However, the therapeutic mechanism is not well understood. No study has elucidated the swallowing mechanism of iTBS and its cortical excitability changes in controlled healthy samples. Changes in cortical excitability can reflect the improvement of swallowing function. The purpose of this study was to observe the activation of the cerebral cortex during voluntary swallowing in healthy adults and to investigate the direct effect of cerebellar iTBS on the excitability of the pharyngeal motor cortex, to explore further the potential mechanisms by which cerebellar iTBS improves swallowing function. Thirty healthy subjects were recruited for this study and randomized to left and right cerebellar iTBS stimulation. The order of stimulation of the left and right cerebellum was randomized, and the stimulation interval was approximately one week. Functional near-infrared spectroscopy (fNIRS) was used to assess brain activation before and after iTBS stimulation and the parameter "β-value." fNIRS was paradigmatized as a classical block task, and the whole procedure consisted of three identical blocks, each consisting of a 30-s swallowing task and a 30-s rest period. Bilateral superior temporal gyrus (STG), middle temporal gyrus (MTG), primary motor cortex (PMC), pre-motor and supplementary motor cortex (PSMC), primary somatosensory cortex (PSC), pars triangularis (PTG), frontopolar area (FPA), frontal eye fields (FEF), and dorsolateral prefrontal area (DLPFC)were significantly activated during the performance of a voluntary swallowing task. Compared with pre-stimulation, the beta values significantly increased in channels 5 (P = 0.013), 17 (P = 0.025), 18 (P = 0.027), 19 (P = 0.046), 34 (P = 0.045), and 37(P = 0.045) after left cerebellar stimulation; After cerebellar right side stimulation, the beta values significantly increased in channels 3 (P = 0.043), 18 (P = 0.022), 20 (P = 0.047), 38 (P = 0.032), 46 (P = 0.028), and 48 (P = 0.028). Bilateral STG, MTG, PMC, PSMC, PSC, PTG, FPA, FEF, and DLPFC were involved in regulating volitional swallowing. Both iTBS to the left and right cerebellum significantly increased the excitability of swallowing cortical areas under a swallowing-specific task.

Bolus manipulation, such as volume reduction, is a common treatment strategy for managing dysphagia and reducing aspiration risk. However, limited evidence exists regarding the effects of specific verbal instructions on reducing bolus size. This prospective, randomized, repeated measure study aimed to establish reference points for bolus size based on different instructions (i.e., take a drink; take a comfortable sip; take a small sip; take a small sip like it is hot coffee), cup size (4-oz size cup vs. 8-oz size cup) and delivery methods (straw vs. cup) using room temperature water. This study hypothesized there would be differences observed in bolus size consumed based upon the verbal instruction, cup size, and delivery method. A total of 100 participants, including 50 healthy controls and 50 patients, participated in this study, consuming 8 boluses each for a total of 800 boluses. Statistical analysis revealed significant differences in volume consumed among the four instructions (F = 191.578, p ≥ .0001). Participants consumed the largest volumes following the instruction "take a drink" (mean bolus size 27.88 mL; SD = 17.58) and the smallest volumes following the instruction "take a small sip like it is hot coffee" (mean bolus size 5.57 mL, SD = 4.72). The results provide evidence to support that specific verbal instruction influences bolus size. It is crucial for the dysphagia rehabilitation team to understand the potential impact of verbal instruction and cueing on bolus size to facilitate a safe swallow.

Poor oral health and dysphagia are common age-related conditions, yet their interrelationship in Chinese community-dwelling older adults remains underexplored. To investigate the association between oral health and dysphagia in Chinese community-dwelling older adults using a dual-method screening. Cross-sectional study. Community health centers across Zhejiang Province, China. 3325 adults aged ≥ 65 years. Oral health was assessed via the Oral Health Assessment Tool (OHAT), and dysphagia was screened for using the Water Swallowing Test (WST) and the Eating Assessment Tool-10 (EAT-10). Multivariate logistic regression adjusted for confounders. Poor oral health prevalence was 78.9% (n = 2,622), and dysphagia prevalence was 17.7% (n = 587). Higher OHAT scores (OR = 1.094, 95% CI:1.023-1.170), dry lips (OR = 1.432), reduced saliva (OR = 1.454), fewer natural teeth (OR = 1.160), and dental pain (OR = 1.303) were significantly associated with dysphagia. We demonstrate that compromised oral health is an independent determinant of dysphagia in the Chinese geriatric population. These results compel the integration of mandatory oral health screenings within geriatric care protocols and the establishment of dentist-speech therapist-nutritionist teams as a critical standard for optimizing dysphagia outcomes.

Tonsillectomy is a common surgical procedure performed by otolaryngologists, primarily indicated for the management of recurrent tonsillitis and obstructive sleep apnea. While postoperative pain and hemorrhage are well-recognized complications, persistent dysphagia following tonsillectomy is rare. In such cases, a comprehensive evaluation is warranted to identify potential mechanical or functional causes. Psychogenic dysphagia is a diagnosis of exclusion and may significantly affect a patient's quality of life. Timely intervention, including detailed swallowing assessment and multidisciplinary team involvement, is essential for optimal recovery. This report presents a case of a 42-year-old male who underwent elective tonsillectomy complicated with secondary postoperative hemorrhage, followed by the development of severe dysphagia attributed to a psychogenic etiology.

Tongue motor impairment has been documented and associated with the severity of dysphagia in patients with Parkinson's disease (PD). Yet, no study investigates the relation between tongue measures and oral phase, swallowing performance during meal, and nutrition in this population. The study aims to measure maximum isometric tongue pressure (MIP) and endurance in patients with PD and to study their association with swallowing- and meal-related safety and efficiency, oral phase efficiency, diet type, and malnutrition risk. Thirty-tree patients with PD were enrolled. Tongue MIP and endurance were measured using the Iowa Oral Performance Instrument. Patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Meal safety and efficiency were evaluated with the Mealtime Assessment Scale (MAS), while the Test of Masticating and Swallowing Solids (TOMASS) was used to analyze oral phase efficiency. Diet type was described according to the Functional Oral Intake Scale (FOIS) and malnutrition risk was assessed using the Mini Nutritional Assessment (MNA). The median MIP was 40 kPa, while the median tongue endurance was 14 s. At univariate regression analysis, both MIP and tongue endurance were significantly (p < 0.05) associated with TOMASS, MAS, FOIS, and MNA, while a significant association with FEES was only found between MIP and the severity of residue in the pyriform sinus with liquids. In conclusion, reduced tongue strength and endurance seem to be associated with the worsening of oral phase efficiency, swallowing performance during meal, diet type and malnutrition risk, but not with pharyngeal signs of dysphagia in PD.

Swallowing function is affected in patients with lateral medullary syndrome (LMS) due to impaired swallowing central pattern generator, but it remains unclear whether their cortical function is affected. To determine the level of cortical involvement during swallowing in LMS dysphagia patients. This is a cross-sectional study carried out from May 2023 and January 2024 in China. 21 patients with LMS dysphagia and 20 age-matched healthy controls were recruited. Functional near-infrared spectroscopy with 39 channels was utilized to detect the cortical hemodynamic changes when repeated salivary swallowing. Cortical activation and functional connectivity during swallowing were analyzed. Compared with healthy subjects, patients with LMS demonstrated reduced activation in bilateral dorsolateral prefrontal cortex(DLPFC), left temporopolar area, frontopolar area(PFA), and right pre-motor and supplementary motor cortex(pSMC) (channel 11, P = 0.031; channel 12, P = 0.042; channel 15, P = 0.042; channel 19, P = 0.031; channel 24, P = 0.031; channel 25, P = 0.031). The activation of patients with LMS in right primary somatosensory cortex (PSC), supramarginal gyrus (SMG), FPA and left pars triangularis (PTG) was negatively correlated with the PAS score (channel1, P = 0.019; channel 2, P = 0.005; channel 23, P = 0.017; channel 27, P = 0.047). The activation in right PSC and SMG was negatively correlated with the stroke duration (channel 2, P = 0.026; channel 16, P = 0.018). There is no difference in the mean functional connectivity strength between the channels of patients with LMS and healthy subjects (P = 0.565). The functional connectivity strength between the bilateral temporopolar areas was reduced in patients with LMS compared with healthy subjects(P = 0.015). Although the lesion site of patients with LMS dysphagia is in the medulla oblongata, cortical activation and functional connectivity during swallowing differ from those of healthy subjects, which may be related to damage of the ascending sensory pathways and cortical-medullary diaschisis.

According to the results of the article "Assessing Public Awareness and Understanding of Dysphagia: A Representative Survey of US Adults", there is a specific gap in public knowledge regarding dysphagia, its impacts, and the professionals responsible for its treatment. This gap is notable in the healthcare field and corroborates the scarcity of research on this topic. We respectfully advocate for this in this letter, explaining the need for this perspective, both academically and in the creation of public policies.

To evaluate the effect of adding biofeedback to standard therapy in the rehabilitation of post-stroke dysphagia through a systematic review and meta-analysis. A comprehensive literature search was conducted in MEDLINE and EMBASE using the PICO framework and adhering to PRISMA guidelines. Four independent reviewers screened and selected studies for inclusion. Only randomized controlled trials were included in the meta-analysis. Risk of bias was evaluated using the Cochrane ROB-2 tool, and the certainty of evidence was rated according to the GRADE approach. Of the 118 studies initially retrieved, five met the criteria for inclusion in the quantitative analysis. All selected trials used surface electromyography (sEMG) biofeedback alongside conventional therapy. The primary outcomes evaluated were incidence of pneumonia, nasogastric tube removal, quality of life, and dysphagia severity. While the addition of biofeedback appeared to be associated with a higher rate of tube removal and some improvement in quality of life, no statistically significant difference was found in terms of clinical severity. Most outcomes were graded as having very low certainty due to imprecision and limited sample sizes. Biofeedback may offer added value to standard post-stroke dysphagia therapy, particularly in enhancing certain clinical outcomes such as transition to oral feeding and perceived quality of life. While initial findings are promising, more robust evidence is needed to fully establish the clinical role of biofeedback in this context.

Few studies have reported the effects of dysphagia management after esophagectomy in esophageal cancer. We aimed to investigate the impact of liquid modification and chin-tuck posture (head flexion) on reducing airway invasion and pharyngeal residue after esophagectomy. We included patients who underwent esophagectomy between June 2017 and January 2020. A videofluoroscopic swallowing study (VFSS) was conducted on 5 ml liquid boluses with four viscosities: thin, mildly thickened, moderately thickened, and extremely thickened, all administered in a neutral head position. Trials with thin and moderately thickened liquid were repeated with head flexion. The penetration-aspiration scale (PAS) scores and residue grades were compared across viscosities and head positions. Thirty-three patients met the inclusion criteria (mean age 65.3 ± 9.0 years). Moderately and extremely thickened liquids resulted in less frequent penetration or aspiration compared to thin liquids, while mildly thickened liquids showed no significant difference in airway protection. Residue grades did not differ significantly across the viscosities tested. Head flexion did not affect the occurrence of aspiration or residue grades compared with the neutral head position for thin and moderately thickened liquids. Penetration on thin liquid was less frequent in head flexion than in the neutral position. Liquid modification improved swallowing safety by reducing penetration and aspiration without affecting pharyngeal clearance. While the chin-tuck posture did not significantly reduce aspiration, its potential to lessen penetration suggests a role in airway protection that warrants further study. These findings warrant validation in larger studies.

Aspiration Pneumonia has a significant impact on individuals of all age groups, which can result in morbidity and a substantial reduction in the quality of life. The objective of this study was to map, through a scoping review, the risk factors associated to aspiration pneumonia in adult and elderly patients. Mapping and analyzing these factors are essential to understand and manage aspiration pneumonia, contributing significantly to the advancement of knowledge about this clinical condition. This scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and gray literature databases were systematically searched. The acronym 'PCCS' was used to consider the eligibility of studies for this review, where: P = Population (≥ 18 years of age), C = Concept (risk factors), C = Context (aspiration pneumonia), S = Studies (observational, interventional, cross-sectional studies, randomized, non-randomized and pseudo-randomized clinical studies). There were no restrictions regarding gender, ethnicity of individuals, language of the studies and date of publication. A comprehensive literature search was conducted using six electronic databases: EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Livivo, PubMed/Medline, Scopus, and Web of Science. In addition, gray literature was also explored through AshaWire, Google Scholar, Open Gray, and ProQuest. There were no restrictions regarding gender, ethnicity, language, time of publication, or diagnosis. A total of 3,183 articles were identified, including results from the gray literature. After screening, 56 articles were included. Significant risk factors related to aspiration pneumonia were identified. The risks include aspects such as dysphagia, aspiration, nutrition, neurological conditions, malnutrition, dehydration, changes in body mass index, skeletal mass index, mobility, and dependence on activities. Furthermore, hospital institutionalization, including length of stay, endotracheal intubation, and mechanical ventilation, is also associated.