Dysphagia最新文献

Prevalence of dysphagia is high in hospitalised geriatric patients, posing risks of complications including malnutrition, dehydration, aspiration, and pneumonia. These complications may lead to reduced daily functioning, frailty, prolonged hospital stays, readmissions, and mortality. Diagnosing dysphagia in geriatric patients is often challenging due to the complex health conditions of this patient group, and overall these patients are at risk of lack of continuity in patient pathways and unnecessary hospitalisations. Recognising the critical importance of prompt diagnosis and treatment of dysphagia, we developed a dysphagia screening intervention aligned with clinical guidelines and the political focus to improve patient pathways and reduce preventable hospitalisations. This article outlines the development process of a dysphagia screening intervention to geriatric patients (≥ 65 years) admitted to medical inpatient wards. We applied a theory-, evidence- and implementation-based approach combined with stakeholder involvement in adherence to the IdentifyiNg and assessing different approaches to DEveloping compleX intervention (INDEX) guidance, encompassing eleven actions. We developed a dysphagia screening intervention comprising a screening procedure (the 4 Questionnaire Test (4QT), the 30 ml water swallowing test, and an action algorithm) targeting the patient level. Moreover, we developed an implementation strategy (activities necessary for adequate delivery of the dysphagia screening procedure and activities supporting the delivery of the screening procedure) targeting health professionals and the organisational level. The dysphagia screening intervention is now ready for feasibility testing, promising improved health and healthcare services for hospitalised geriatric patients.

Videofluoroscopic Swallowing Study (VFSS) is considered the gold standard for diagnosing swallowing disorders, or dysphagia. However, the interpretation of VFSS is susceptible to human bias and subjectivity, resulting in significant inter- and intra-patient variability. In this context, artificial intelligence (AI) has emerged as a potentially valuable tool for physicians. This study reviews state-of-the-art research utilizing AI to analyze VFSS for the assessment of swallowing disorders and to support clinical decision-making. Our comprehensive analysis highlights substantial progress in areas such as pharyngeal phase detection, segmentation and identification of the bolus and hyoid bone, and penetration-aspiration detection. Despite these advancements, an end-to-end automated AI tool for VFSS analysis has yet to be developed. However, there is considerable potential for AI applications in areas like exploring the clinical relevance of segmented or tracked components and expanding the scope to include more upper aerodigestive components in the analysis. Additionally, we discuss the limitations of current research, including the lack of publicly available datasets, the need to address the generalizability of AI models, the integration of cutting-edge AI techniques, and the clinical implications for speech-language pathologists.

This retrospective cohort study aimed to clarify the concurrent effects of intensity and frequency of early swallowing rehabilitation for post-stroke dysphagia. Using data from acute-care hospitals included in the Japanese Diagnosis Procedure Combination database between April 2020 and March 2021, we identified patients aged ≥65 years with dysphagia after acute stroke on admission who received swallowing rehabilitation within three days of hospitalization. Swallowing rehabilitation within seven days of hospitalization, starting from admission, was categorized into four types according to intensity (long/short per day) and frequency (high/low proportion of days performed). The primary outcomes were presence of dysphagia and recovery of total oral intake at discharge. Generalized estimating equations were used to assess the effects of rehabilitation intensity and frequency, adjusting for patient and hospital characteristics. Of the 4,669 patients with post-stroke dysphagia, 913 underwent swallowing rehabilitation within three days of hospitalization. The proportions of patients with dysphagia and total oral intake at discharge were 80% and 47%, respectively. The intensity and frequency of swallowing rehabilitation were not associated with dysphagia at discharge. Higher intensity or higher frequency was associated with total oral intake at discharge (odds ratio [95% confidence interval]:1.62 [0.93-2.81], 2.00 [1.11-3.60], and 2.75 [1.59-4.76] for low-intensity and high-frequency, high-intensity and low-frequency, and high-intensity and high-frequency groups, respectively). This nationwide study showed that the intensity and frequency of acute-phase swallowing rehabilitation were not associated with recovery from dysphagia after a stroke. However, they were associated with an improved oral intake at discharge.

Multiple Sclerosis (MS) is a common chronic disease among young adults. It affects various aspects of Quality of Life (QOL). Dysphagia is a problem associated with neurological damage in MS patients. This study aimed to compare MS patients' QOL with and without dysphagia. This is a cross-sectional study performed on 40 patients with MS (20 with and 20 without dysphagia) selected from the MS Society members of Ahvaz, Iran. Research tools included the Persian version of Dysphagia in Multiple Sclerosis (DYMUS), Mini-Mental State Examination (MMSE), and Multiple Sclerosis Quality of Life-54 (MSQOL-54). The data were analyzed by SPSS software version 22 and the Mann-Whitney test. The results showed a significant difference in QOL score amongst patients with and without dysphagia. The QOL score of patients with dysphagia was significantly lower than patients without dysphagia. The main differences in the subscale of the QOL Index were mental component and physical activity. MS patients with dysphagia had lower QOL than patients without it. The results show that the quality of life of MS patients with dysphagia is lower than the quality of life of MS patients without dysphagia, and this issue includes different physical and mental aspects of the quality of life of these patients. According to the findings of this study, it seems that early referral of patients with MS to speech and language pathologists for the management of swallowing disorders in the early stages of the disease can be very important and help improve the wellbeing of these patients and their families.

The super-supraglottic swallow (SSGS) improves laryngeal closure, and head flexion compensates for inadequate closure of the airway. These two procedures are typically utilized by speech-language pathologists for specific patient populations. This study compared the effect of the SSGS with head flexion (i.e., modified SSGS [mSSGS]) on laryngeal closure with that of usual swallowing and the SSGS in healthy individuals. Twenty-one healthy volunteers were instructed to swallow 4 ml of thin liquid barium in a sitting position during usual swallowing, SSGS, and mSSGS under X-ray fluoroscopy. The primary outcome was the distance between the epiglottis and arytenoid (DEA) at onset of the swallowing reflex. The secondary outcomes were DEA before onset of the swallowing reflex, the head flexion angle before and at onset of the swallowing reflex, and the Penetration-Aspiration Scale (PAS) score. The relative ease of performing the mSSGS compared with the SSGS was evaluated using a 7-point Likert scale. DEA at onset of the swallowing reflex was significantly shorter with mSSGS than with usual swallowing (P < 0.001) or the SSGS (P = 0.006). DEA before swallowing was also significantly shorter with the mSSGS than with usual swallowing (P < 0.001) and the SSGS (P = 0.006). PAS score was 1 in all trials. The median Likert score was 3, indicating that the SSGS was easier than the mSSGS. The findings suggest that the mSSGS maneuver enhances laryngeal closure more than the SSGS maneuver and usual swallowing.

The purpose of this study is to determine if speech-language pathologists' (SLP) ratings of palpated hyolaryngeal excursion (pHLE) during a clinical swallow evaluation (CSE) are predictive of spatial measures of hyolaryngeal excursion determined by instrumentation (iHLE). Adults between the ages of 18-99 were recruited with a physician referral to complete a CSE and videofluoroscopy swallow study. Four SLP investigators completed ratings of pHLE palpation during a CSE. Spatial measures of hyoid peak elevation were taken from videofluoroscopy swallow studies. Statistical analyses included multiple linear regression to determine the best-fitting model to predict iHLE from palpated ratings. Data from 77 volunteers (44 female, mean age 71.6) were used for statistical analyses. The linear regression model indicated three significant predictors of superior (upward) hyoid peak position, including palpation, bolus consistency, and the number of swallows. There were no significant predictors of anterior (forward) hyoid peak position from the tested factors. The emergence of these significant predictors suggests that palpation may provide insight into superior HLE movements during a CSE. Next steps will be to determine if palpation improves SLPs' diagnostic accuracy and clinical decision-making during swallow assessment without instrumentation.

Dysphagia among end-of-life patients in palliative care is debilitating and requires symptomatic management. Current methods involving usage of IV fluids, total parenteral nutrition, intermittent oral liquid feeds, use of naso-gastric tubes or administration of nasal saline drops are inadequate in providing relief to the patient, warranting exploration of newer methods. At SSCHRC, a novel intervention of intranasal administration of Bupivacaine, a widely used anesthetic has been used successfully to treat end-of-life cancer patients, providing temporary relief for about half an hour with each administration, facilitating food and water intake. This study is aimed as a pilot to assess the feasibility of the study design in gathering molecular data on the effect of the treatment, especially on the mucin related pathways. Using throat swabs of patients, we obtained bulk RNAseq transcriptomes before and after the treatment. We analyze patterns of differential expression and use a genome-wide protein-protein interaction network approach to infer the affected pathways and processes. Our results indicate that the Bupivacaine treatment shows variation in gene expression in key genes and pathways that could potentially explain reduction in mucin secretion leading to relieving symptoms of dysphagia. It provides support for conducting a larger clinical study in order to study the effect in a larger cohort.

Swallowing difficulties are common in head and neck cancer (HNC) patients, significantly affecting nutrition and quality of life. Early identification of risk factors is essential for timely intervention. A retrospective analysis of 244 newly diagnosed HNC patients was conducted. Swallowing function was assessed using the Penetration-Aspiration Scale (PAS) alongside subjective measures, including the Eating Assessment Tool (EAT-10) and Functional Oral Intake Scale (FOIS). PAS served as the gold standard for identifying aspiration risk factors. Aspiration events, defined as a PAS score of ≥ 6, varied by tumor site. The highest rate of aspiration events was observed in patients with hypopharyngeal cancers (35%), followed by oropharyngeal (24%), oral cavity (12%), and laryngeal cancers (11%). Notably, no aspiration events were identified in cases of nasopharyngeal carcinoma. Multivariate logistic regression analyses identify age, BMI and tumor site as independent predictors of aspiration. A prediction model was then created as follows: Score = (0.060 × Age) - (0.120 × BMI) + 1.587 (if tumor site is oral cavity) + 1.915 (if tumor site is oropharynx) + 2.425 (if tumor site is hypopharynx) + 0 (if tumor site is larynx, nasopharynx, or other sites) - 5.552. This model achieved an AUC of 0.78, with an optimal cutoff score of -2.15, yielding a sensitivity of 45%, specificity of 93%, and accuracy of 86% for predicting aspiration risk. This research highlights the multifactorial nature of dysphagia in HNC patients and introduces a predictive model for aspiration risk. Early identification of high-risk patients enables timely swallowing evaluations and interventions, improving safety and quality of life.

To identify in the literature which pharyngolaryngeal abnormalities (PLA) co-occur or are associated with oropharyngeal dysphagia when viewed via nasoendoscopy. Flexible Endoscopic Evaluation of Swallowing (FEES) is an examination used to assess swallowing. Currently there are no standardized frameworks to observe and report on PLAs observed during a FEES procedure to support diagnostics and inform management. Multiple databases (Scopus (Elsevier), Medline (Ovid), CINAHL (EBSCO) and EMBASE (Ovid)) were searched against inclusion criteria from 1980 to 2024. Key search terms included variations of larynx, pharynx, FEES, and oropharyngeal dysphagia. The study utilized PRISMA-ScR reporting items. Two independent reviewers screened in two phases. Reporting of PLAs with oropharyngeal dysphagia was represented using frequency of co-occurrence and, where available, any statistical analyses attempting to demonstrate an association. Prevalence was calculated for PLA and presence of signs/symptoms of oropharyngeal dysphagia. 117 articles were included for full text review. Data were synthesized into 24 PLA within six categories. PLAs with both frequency of co-occurrence and statistical analysis attempting to demonstrate an association with oropharyngeal dysphagia included unilateral vocal fold motion impairment (UVFMI), velopharyngeal insufficiency, arytenoid motion impairment, incomplete glottic closure, vocal fold atrophy/bowing, edema, and hematoma. This scoping review presents evidence relating to PLAs seen via nasoendoscopy and their reported co-occurrence with oropharyngeal dysphagia. Overall, seven PLA were shown to have an association with oropharyngeal dysphagia, and a further 11 PLA had frequency of co-occurrence with oropharyngeal dysphagia without statistical analysis to support association. Whilst these findings suggest a relationship between PLA and oropharyngeal dysphagia, further research is required to confirm causation of each PLA on swallowing function. Systematic swallowing assessment and use of outcome measures that consider the presence of pharyngolaryngeal abnormalities, will help generate rigorous evidence that is needed to advance precision in diagnostics of swallowing impairment and subsequent interventions.