Dysphagia最新文献

With the advancement of medicine, the survival rate of patients with brain injuries has significantly increased. Among these patients, some remain in a chronic state of altered consciousness and experience difficulties in swallowing. Swallowing difficulties can lead to clinical issues such as aspiration and malnutrition. Since swallowing function is closely related to the level of consciousness, effective oral swallowing is an early sign of consciousness recovery. The relationship between swallowing difficulties and the prognosis and quality of life of patients with consciousness disorders is increasingly recognized by scholars. However, patients with consciousness disorders often find it difficult to cooperate with treatments for swallowing difficulties, resulting in a lack of effective treatment options for swallowing difficulties associated with altered consciousness. This article discusses the correlation between consciousness disorders and swallowing difficulties, the physiology of swallowing, the main issues faced by patients with consciousness disorders regarding swallowing difficulties. Specifically the lack of an effective oral swallowing phase, as well as the available assessment tools and treatment methods for swallowing difficulties in these patients.

Functional swallowing is imperative to sustain life and maintain health, necessitating healthcare providers' competence in managing swallowing disorders. This scoping review aims to identify and compare how competence in dysphagia management is assessed among healthcare providers. Our search identified 11 final records, demonstrating the limited existing literature. Overall, no specific standardized protocol currently exists for the assessment of dysphagia competence across healthcare disciplines. Therefore, developing a standardized metric to assess competence in dysphagia management among healthcare providers would not only improve training in dysphagia management by creating a consistent standard for healthcare providers' competence, but also promote equitable and effective care delivery across diverse healthcare settings, improving outcomes for individuals with swallowing disorders on a global scale.

Botulinum toxin (BoNT), a neurotoxic protein produced by Clostridium botulinum, is widely used for cosmetic and therapeutic purposes, including managing muscle hyperactivity, movement disorders, and chronic migraines by blocking acetylcholine release at neuromuscular junctions. While generally safe, it can cause localized adverse effects (erythema, ptosis, pain) and rare systemic complications (dysphagia, dysarthria, respiratory distress), particularly with improper dosing. From August 2024, This case report presents three female patients, aged 25, 50, and 49, in the Affiliated Hospital of Yunnan University, who experienced severe complications following the injection of botulinum toxin. The first patient, developed dysarthria and dysphagia 18 days post-injection, with a history of administration in northern Myanmar. The second patient, reported similar symptoms 3 days after a lesser dosage was injected into her masseter muscles. The third patient, exhibited fatigue and difficulty in eye opening and swallowing 7 days after receiving botulinum toxin. The symptoms of all patients were significantly improved after receiving symptomatic treatment in our hospital. The three cases presented are significant as they highlight the potential complications arising from botulinum toxin injections, particularly when used for cosmetic purposes. Botulinum toxin, though effective for cosmetic and therapeutic applications, carries risks of localized (muscle weakness, ptosis, bone loss) and systemic complications (generalized weakness, botulism), particularly near critical anatomical structures. Dysphagia and dysarthria, observed in cases post-injection, likely arise from toxin diffusion causing unintended muscle impairment. Treatment outcomes vary, with supportive care or invasive interventions often yielding limited improvement, highlighting management challenges. Clinicians must prioritize patient education, informed consent, and vigilant post-treatment monitoring for neurological symptoms. Future guidelines should standardize safe administration practices-optimizing dosage, injection sites, and follow-up-while enhanced practitioner training and multidisciplinary approaches are critical to mitigating risks and improving outcomes. This underscores the imperative for heightened clinical awareness and robust safety protocols to safeguard patient welfare.

Dysphagia is a complication that may occur after thyroidectomy or other head and neck surgeries. This complaint is usually associated with inferior and superior laryngeal nerve dysfunction, but it can also occur without nerve damage. The aim of this study is to evaluate the frequency, severity, and clinical course of dysphagia developing in the early and late periods after thyroid and parathyroid surgeries, to determine its effects on patients' postoperative quality of life, and to contribute to optimal management strategies. Between January 2016 and September 2017, a total of 76 patients were prospectively evaluated: 25 who underwent parathyroidectomy (Group 1), 26 who underwent total thyroidectomy with central neck dissection (Group 2), and 25 who underwent total thyroidectomy without central neck dissection (Group 3). Swallowing function and postoperative quality of life were assessed using fiberoptic endoscopic evaluation of swallowing (FEES), the Swallowing Quality of Life questionnaire (Swal-QoL), and the Eating Assessment Tool (EAT-10), applied preoperatively, at postoperative week 1 (early postoperative period, EPO), and at week 8 (late postoperative period, LPO). Early postoperative swallowing changes were observed in 16% of parathyroidectomy patients, 20% of thyroidectomy patients without central neck dissection, and 36% of those with central dissection. Significant between-group differences were found for FEES liquid swallows (p = 0.006), EAT-10 (p = 0.003, p = 0.001), and Swal-QoL scores (p = 0.011, p = 0.001). Longitudinal analysis showed significant changes in EAT-10 and Swal-QoL across all periods (p < 0.001). While parathyroidectomy patients showed only minimal transient changes, thyroidectomy with central dissection caused early FEES impairments and persistent subjective complaints, and thyroidectomy without dissection mainly affected patient-reported outcomes despite normal FEES findings. This study demonstrates that dysphagia is common after thyroid and parathyroid surgery and that its course is closely related to the extent of surgery. While swallowing function is largely preserved after parathyroidectomy, thyroidectomy without central neck dissection may lead to significant reductions in quality of life. In patients undergoing thyroidectomy with central neck dissection, early objective impairments and persistent late subjective complaints were observed. As the extent of surgery increases, the risk of dysphagia also rises, and subjective symptoms may persist even after objective findings return to normal. Therefore, routine postoperative swallowing assessment, comprehensive preoperative counseling, and, when necessary, early rehabilitation programs are critical to preserving long-term quality of life.

Fragmentation of the liquid bolus during swallowing may enhance the risk of airway exposure to the passing bolus and thereby increase vulnerability for aspiration. Our goal was to develop an experimental and a computational model that depicts how physical forces applied to a model bolus affect cohesion during simulated swallowing. A physical replica of the oral cavity was created through 3D printing to emulate the bolus-accommodating tongue within the oral cavity. The intent was to assess the effect of linear force applied to the bolus, similar to that of the deforming tongue during bolus propulsion through the acceleration and rapid deceleration of a pulley system, and to assess the ensuing degree of bolus fragmentation. Upon enaction of linear force applied to the contained bolus, a portion of the bolus characteristically fragmented and exited the device with measurable displacement velocity. Experimental and computational results demonstrated that the degree of bolus fragmentation increased as a function of bolus volume and velocity and decreased as a function of viscosity. We deduce that these physical attributes of the fluid bolus, when combined with the timing of laryngeal closure, pharyngeal peristalsis, and inspiratory air flow, contribute to an multi-component model of aspiration vulnerability during swallowing.

Previous research in healthy individuals has demonstrated that fast bolus progression of thin liquid results in earlier true vocal fold (TVF) closure compared to thick liquid. This study investigated whether this timing adjustment occurred in individuals with stroke and whether dysphagia severity affected this adjustment. This retrospective observational study included 54 participants with stroke (37 males, 17 females, mean [standard deviation] age: 63.7 [13.8] years) who underwent CT swallow studies with thick and thin liquids (10 ml each). The onset of TVF closure, laryngeal vestibule (LV) closure, maximum epiglottic inversion, and bolus head progression were compared between 2 consistencies. Subgroup analysis was based on the Dysphagia Severity Scale (DSS). The results showed that thin liquid reached the vallecula, hypopharynx, and esophagus significantly earlier than thick liquid. Onset of TVF closure was significantly earlier with thin liquid (median: 0.2 s [range: -1.5 to 0.5] vs. 0.3 s [range: -1.7 to 0.6], p = 0.020) with no significant differences in onset of LV closure or maximum epiglottic inversion. Subgroup analysis revealed significantly earlier TVF and LV closure with thin liquid only in the mild (DSS 5 and 6) group. Patients with moderate (DSS 4) and moderately severe (DSS 3) dysphagia did not show these differences. In conclusion, TVF and LV closure occurred earlier in response to faster bolus transport in stroke patients. However, this finding varied by dysphagia severity and was absent in the groups with more severe dysphagia. These data support the idea that TVF and LV adjustments are important factors in airway protection.

This report describes a case in which a patient with an open tracheostomy, following surgery for severe dysphagia, acquired vacuum swallowing and exhibited rapid bolus inflow into the esophagus. A 39-year-old man with bulbar palsy caused by medullary surgery demonstrated impaired pharyngeal contraction and upper esophageal sphincter opening. After undergoing laryngeal suspension and cricopharyngeal myotomy, videofluoroscopic evaluation of swallowing revealed rapid passage of the bolus from the pharynx into the esophagus. High-resolution manometry demonstrated markedly negative intraesophageal pressure accompanied by simultaneous elevation of lower esophageal sphincter pressure during swallowing. These findings suggest that the patient had spontaneously acquired vacuum swallowing despite the presence of a tracheostoma communicating with the atmosphere. Recognition of this compensatory mechanism is important because it may facilitate bolus transport in individuals with tracheostomy. Increased awareness of this swallowing pattern may prevent underdiagnosis and offer new insights into rehabilitation strategies for dysphagia.

This study investigated clinical and anthropometric parameters, including ultrasound-derived swallowing muscle measurements, for predicting clinically significant swallowing penetration in sarcopenic older adults. Eighty adults aged ≥ 65 years (50 sarcopenic, 30 controls) attending a university hospital geriatric clinic were enrolled. Exclusion criteria were major neurological disorders, malignancy, head and neck surgery/radiotherapy, advanced organ failure, severe COPD, and rheumatologic disease. All underwent comprehensive geriatric assessments, including frailty (Fried criteria), cognitive and nutritional screening, EAT-10, and ultrasound-based sarcopenia assessment. Sarcopenia was defined as low handgrip strength and low STAR index (anterior thigh muscle thickness/BMI) using national cut-offs. Swallowing-related muscle thickness (genioglossus, geniohyoid, tongue), geniohyoid area, and elevation were measured ultrasonographically. Sarcopenic patients consenting to fiberoptic endoscopic evaluation of swallowing (FEES) were assessed using the Penetration-Aspiration Scale (PAS); PAS ≥ 3 indicated clinically significant penetration. Participants' mean age was 75.86 ± 6.89 years. Sarcopenic individuals were older, predominantly male, with lower genioglossus and tongue thickness, higher frailty scores, lower MMSE, and greater prevalence of diabetes and coronary artery disease. Among sarcopenic patients, 20% exhibited significant penetration. These patients had smaller arm/calf circumferences, slower gait speed, and higher EAT-10 scores, but no significant differences in swallowing muscle measurements or cognitive and nutritional status. Multivariate analysis identified lower calf circumference as the sole independent predictor (OR: 0.772, 95% CI: 0.613-0.972, p = 0.027). A threshold ≤ 32 cm yielded an AUC of 0.733 (p = 0.025), with 70% sensitivity and 77.5% specificity. In sarcopenic older adults, calf circumference is an independent, non-invasive predictor of clinically significant swallowing penetration, outperforming ultrasound-based swallowing muscle metrics in aspiration risk screening.