Dysphagia最新文献

B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique. This study examined three methods of transducer placement in the coronal plane by two examiners to determine the reliability of measurement of CSA of the geniohyoid muscle. Forty healthy adults participated in the study. Each participant's geniohyoid muscles were imaged using B-mode ultrasound under three transducer placement conditions in the coronal plane by two examiners. Geniohyoid CSA was measured from each ultrasound image. A three-way mixed-methods ANOVA was used to determine whether there were significant differences in geniohyoid CSA among transducer position conditions, trials, and examiners. There were significant differences among the transducer placement conditions, indicating that each condition was measuring a different portion of the muscle. There were no significant differences among repeated trials nor between examiners within each method of transducer placement. All three conditions of transducer placement were reliable at measuring geniohyoid CSA across trials and examiners. This study emphasizes the need for consistency of placement, whichever method is selected. It also highlights the need for researchers to provide a precise description of methods for positioning the transducer so that placement is reproducible.

Dysphagia is a leading cause of morbidity and mortality among individuals with Parkinson's disease (PD). The primary objectives of the present study were to explore patients' narrative reports focused on what information and evaluation and treatment experiences they identified as they manage dysphagia, and to identify practice patterns relevant to dysphagia management. A secondary objective was to produce an educational resource for this population that addressed their questions about dysphagia. A sample of individuals with oropharyngeal dysphagia secondary to PD (n = 25) across all regions of the United States were interviewed using open- and closed questions and a written questionnaire. Verbatim interview transcripts were interrogated using qualitative content analysis (QCA) with an inductive approach to identify themes from the participants' reported knowledge of dysphagia and experiences with swallowing evaluation and treatment. Authors developed a pamphlet addressing common questions that participants posed in the interviews and conducted a member check to revise it with their feedback. Most participants reported having been asked about their swallowing function by a healthcare professional. 60% of the sample reported having had a swallowing evaluation. Only 20% (5/25) of participants reported having completed swallowing therapy. Some participants did not know that swallowing therapy exists. Nearly all participants reported having a strong desire to know more about dysphagia and preferred a pamphlet as a resource format. Few of the study participants had received swallowing therapy, and nearly all participants were eager to learn about the nature of dysphagia, its progression, and treatment options. Given the physical, emotional, and social ramifications of living with dysphagia, access to swallowing education and treatment needs to be a stronger focus of PD management.

Around 80% of persons with Parkinson's disease (PD) present symptoms of dysphagia. Although cognitive impairment may contribute to dysphagia, few studies have investigated the association between the PD neuropsychological profile and objective measures of swallowing dysfunction. Since the swallowing function comprises involuntary but also voluntary actions, we hypothesize that specific measures of attention and executive functions can be underlined in PD-related dysphagia. Therefore, the aim of this study was to extensively investigate the correlation and the relationship between attentive and executive functions and safety/efficiency of pharyngeal phase of swallowing in people with PD. All participants received a fiberoptic endoscopic evaluation of swallowing and were evaluated using the Penetration Aspiration Scale (PAS); the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and the Functional Oral Intake Scale (FOIS-IT). Participants also underwent a neuropsychological assessment covering global cognitive status, attention, and frontal executive functions. Correlations and associations between neuropsychological measures and swallowing components were calculated. Twenty-one participants with PD (mean age 69.38 ± 6.58 years, mean disease duration 8.38 ± 5.31 years; mean MDS-UPDRS III 43.95 ± 24.18) completed all evaluations. The most significant correlations were found between attentive functions (i.e., Stroop Time), and executive functions (i.e., Raven's Progressive Matrices, Digit Backward and Semantic Fluency), and FOIS-IT, PAS, and IT-YPRSRS sinuses and valleculae. These associations were not influenced by disease duration. These results suggest that a dysfunction to attentional processes and/or to executive functions can contribute to penetration and the presence of pharyngeal residue in participants with middle-stage PD.

The assessment of pharyngeal residues during fiberoptic endoscopic evaluation of swallowing (FEES) is based on visual-perceptual scales that involve clinical subjectivity. Training might be helpful to increase agreement among clinicians. This paper aims to assess the efficacy of training for the assessment of pharyngeal residue in FEES frames and videos through the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Twenty-nine clinicians (Phoniatricians, Otorhinolaryngologists, Speech and Language Pathologists) and 47 students in Speech and Language Pathology participated in this study. Fourteen clinicians were randomly allocated to the training group, whilst the remaining 15 served as a control group; all the students participated in the training. Participants scored 30 pairs of videos and frames using the YPRSRS twice, before and after the training for the training groups and at least two weeks apart for the control group. Construct validity, defined as the agreement between each rater and the experts' scores, and inter-rater reliability were compared among the groups and between the first and the second assessments to verify the efficacy of the training. Construct validity significantly improved at the second assessment in the training group for the pyriform sinuses videos (baseline 0.71 ± 0.04, post-training 0.82 ± 0.05, p = .049) and in the students' group for the valleculae (baseline 0.64 ± 0.02, post-training 0.84 ± 0.02, p < .001) and pyriform sinuses videos (baseline 0.55 ± 0.03, post-training 0.77 ± 0.02, p < .05). No significant differences were found in the inter-rater reliability in any group. In conclusion, the training seems to improve participants' agreement with experts in scoring the YPRSRS in FEES videos.

While functional endoscopic evaluation of swallowing (FEES) is the most useful diagnostic test for the evaluation of dysphagia, it cannot evaluate the esophageal phase of swallowing. To evaluate if a modification for the FEES exam by swallowing an empty capsule and screening of the upper esophagus could be used for early detection of esophageal dysphagia. A prospective, single-center, pilot study. At the end of a standard FEES exam, the patients were asked to swallow an empty capsule. Fifteen seconds later, the endoscope was inserted into the upper esophagus. A pathological capsule test was defined when the capsule was seen in the esophagus. In such cases, the patient was advised to undergo a gastroscopy, MBS, or esophageal manometry, which were compared to the results of the capsule test. The capsule test was utilized in 109 patients. A pathological capsule test was found in 55 patients (57.8%). In 48 patients (87.3%), an isolated or combined esophageal dysphagia was seen. The accuracy value of the capsule test compared to gastroenterology tests was 83.3%, sensitivity 88.46%, specificity 75%, PPV 85%, and NPV 80%. A modification of the standard FEES exam by including an empty capsule swallow test with an upper esophagus examination may provide a useful screening tool for esophageal dysphagia.

The goal of this study was to identify which anatomical and dosimetric changes correlated with late patient-reported dysphagia throughout the course of head and neck chemo-radiotherapy treatment. The patient cohort (n = 64) considered oropharyngeal and nasopharyngeal patients treated with curative intent, exhibiting no baseline dysphagia with a follow-up time greater than one year. Patients completed the MD Anderson Dysphagia Inventory during a follow-up visit. A composite score was measured ranging from 20 to 100, with a low score indicating a high symptom burden; a score ≤60 indicated patient-reported dysphagia. The pharyngeal (PCM) and cricopharyngeal constrictor muscles (CPM) were contoured on a planning CT image and adapted to weekly cone-beam CT anatomy using deformable image registration and dose was accumulated using weighted dose-volume histogram curves. The PCM and CPM were examined for volume, thickness, and dosimetric changes across treatment with the results correlated to symptom group. Anatomical evaluation indicated the PCM thickness increased more during treatment for patients with dysphagia, with base of C2 vertebrae (p = 0.04) and superior-inferior middle PCM (p = 0.01) thicknesses indicating a 1.0-1.5 mm increase. The planned and delivered mean dose and DVH metrics to PCM and CPM were found to be within random error measured for the dose accumulation, indicating delivered and planned dose are equivalent. The PCM and CPM organs were found to lie approximately 5 mm closer to high dose gradients in patients exhibiting dysphagia. The volume, thickness, and high dose gradient metrics may be useful metrics to identify patients at risk of late patient-reported dysphagia.

This scoping review aimed to identify methodological procedures for acquiring and analyzing ultrasound images related to swallowing in adults and older adults. The inclusion criteria were based on the PCC strategy (participants, concept, and context), as follows: population (adults and older adults), concept (ultrasound assessment), and context (swallowing assessment). The review included observational, experimental, descriptive, and analytical studies and excluded those that were not available in full, animal studies, in vitro studies, letters to the editor, errata, study protocols, and those that used ultrasound for purposes other than swallowing. There were no language and time restrictions. Two independent blinded professionals selected 81 articles that met the inclusion criteria from different databases. The most evaluated parameters included tongue morphology and movements, hyoid bone displacement, swallowing muscle area, and pharyngeal residue detection, such as pharyngeal wall mobility. They used convex and linear transducers (3 MHz to 8 MHz) positioned in the submental, laryngeal, and lateral regions of the neck. The subjects were seated and instructed to eat different food volumes and consistencies. The literature mapping showed that ultrasound is a promising diagnostic tool, helping clinicians understand swallowing disorders, as it provides static and dynamic images in different modes and positions. Also, patients receive real-time biofeedback of changes related to dysphagia.

The objective of this study was to create a Turkish language adaptation of the Boston Residue and Clearance Scale (BRACS), a validated and reliable tool. The BRACS scale was first translated into Turkish and a Turkish version was subsequently developed. Fiberoptic endoscopic examination of swallowing (FEES) was administered to collect data from 25 dysphagic patients who were hospitalized after a stroke. The recorded films were subjected to editing procedures to ensure their appropriateness for the assessment of swallowing disorders and were then dispatched to a panel of five speech and language therapists for evaluation using the adaptation of the BRACS instrument. The scoring by the experts was evaluated using both explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity, item reliability, and construct (composite) reliability were measured by calculating the average variance extracted (AVE) values. For the 12 location items, EFA revealed 3 main latent factors: the laryngeal vestibule and the oropharynx and hypopharynx. The Turkish BRACS had excellent inter-rater reliability (Krippendorff's alpha coefficient values ranged from 0.93 to 0.95) and high internal consistency (Cronbach's alpha values ranged from 0.88 to 0.93). Inter-rater ICCs for the first and second sessions were 0.83 and 0.85, respectively. CFA showed that all fitted criteria reached acceptable or perfect fit levels. The findings indicated that the proposed factor structure was validated. The AVE values are between 0.61 and 0.73 which was taken as evidence of convergent validity. The Turkish adaptation of the BRACS tool demonstrates both reliablity and validity, rendering it a useful and credible tool for assessing residual severity, particularly in clinical settings.

Background: COVID-19 can lead to impairment of neural networks involved in swallowing, since the act of swallowing is coordinated and performed by a diffuse brain network involving peripheral nerves and muscles. Dysphagia has been identified as a risk and predictive factor for the severest form of SARS-CoV-2 infection.

Objectives: To investigate the association between swallowing disorders and COVID-19 in patients hospitalized for COVID-19.

Methods: We collected demographic data, medical information specific to dysphagia and data on medical treatments of patients with COVID-19.

Results: A total of 43 hospitalized COVID-19 patients were enrolled in the study. Twenty (46%) were evaluated positive for dysphagia and 23 (54%) were evaluated negative. Neurocognitive disorders and diabetes were mostly associated with patients who resulted positive for dysphagia. Respiratory impairment caused by COVID-19 seems to be a cause of dysphagia, since all patients who needed oxygen-therapy developed symptoms of dysphagia, unlike patients who did not. In the dysphagic group, alteration of the swallowing trigger resulted in the severest form of dysphagia. An association was found between the severest form of COVID-19 and dysphagia. This group consisted predominantly of males with longer hospitalization.

Conclusions: Identification of COVID-19 patients at risk for dysphagia is crucial for better patient management.