Dysphagia最新文献

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.

Dysphagia, common among older adults, leads to significant morbidity and potential mortality. The role of preventative exercises in healthy, community-dwelling elderly people remains to be understood. In this systematic review, we aimed to understand whether preemptive exercise programs can improve swallowing in healthy older adults. Articles published from 1990 to 2023 were included and identified through searches of MEDLINE, EMBASE and Cochrane databases by a medical librarian using the keywords "presbyphagia" and" aging" and "dysphagia" and "management", as well as "therapy" and "treatment", "swallowing therapy", and the combinations of these keywords. Of 2269 abstracts initially screened, 15 full-text articles were included in this review, consisting of 454 patients. Of the 15 studies included, ten were randomized controlled, three non-randomized clinical trial, one a prospective cohort study, and one an interventional study. The reported age range of the participants was between 60 and 91 years-old. Sixty-two percent of the participants were elderly females. In terms of interventions, nine studies employed tongue strengthening exercises, five utilized swallowing resistance techniques, two involved pronunciation and karaoke practice, two focused on recline and head lift exercises, one utilized high-speed jaw opening exercises, and one employed electrical stimulation of swallowing muscles. Swallowing exercises strengthen targeted muscle groups in healthy older adults and can be utilized to prevent swallowing problems that occur with aging. Further longitudinal studies are needed to understand the benefits of preventative therapy models. Level of Evidence: Level 4.

We present an unusual case of a 62-year-old male presenting with contralateral hypoglossal and recurrent laryngeal nerve palsies following endotracheal intubation for emergency cardiac surgery. Postoperative, the patient was referred to Speech and Language Therapy due to concerns regarding the safety of his swallow. Oromotor assessment revealed left-sided tongue weakness and aphonia. Flexible endoscopic evaluation of swallowing (FEES) revealed a right vocal cord palsy and severe oropharyngeal dysphagia. There were no other focal neurological signs. An MRI head did not demonstrate a medial medullary stroke or other intracranial lesion. CT neck showed no abnormality identified in relation to the course of the right vagus nerve or recurrent laryngeal nerve at the skull base or through the neck respectively. The patient required a gastrostomy for nutrition and hydration. He continued to be assessed at several month intervals over the course of a year using FEES to obtain a range of voice, secretion and swallowing outcome measures. The patient commenced intensive dysphagia therapy targeting pharyngeal drive, hyolaryngeal excursion and laryngeal sensation. Swallow manoeuvres were trialled during FEES and a head-turn to the side of the vocal cord palsy during deglutition reduced aspiration risk which expedited return to oral intake. The patient had partial recovery over twelve months. Hypoglossal nerve palsy completely resolved. The right vocal cord remained paralysed however the left vocal cord compensated enabling the patient to produce a normal voice. The patient was able to take thin fluids and regular diet and the gastrostomy was removed.

Dysphagia is one of the most common symptoms of stroke and can lead to other complications such as pneumonia, dehydration, and malnutrition. This retrospective cohort study evaluated the predictive value of a comprehensive swallowing assessment tool, the Mann Assessment of Swallowing Ability (MASA), in the acute phase of stroke for oral intake status at discharge. Among 1,133 consecutive patients with acute stroke, 512 patients whose swallowing function was assessed using the MASA within 24 h of admission were included. Data including demographic information, stroke severity, MASA, Oral Health Assessment Tool, body mass index, and serum albumin level were collected. Predictive factors for oral intake were analyzed using a multiple logistic regression model, and the receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of the MASA score for determining oral intake at discharge. Oral intake at discharge was established in 69.1% of the cohort (354/512). The multiple logistic regression analysis identified a higher MASA score, younger age, and higher serum albumin level as significant predictors of oral intake at discharge. The cutoff value of the MASA score for oral intake was 136.5 points, with an area under the ROC curve of 0.87. These findings suggest that the MASA is a valid tool for predicting oral intake in patients with dysphagia during the acute phase of stroke.

Parkinson's Disease (PD) is a progressive neurodegenerative disease, with hallmark symptomology typically consisting of tremor, bradykinesia, and rigidity. Though the classic "pill-rolling" rest tremor in the hand or upper limb are often the most salient, it can occur throughout the body including the lower limbs, jaw, face, or tongue. There have been investigations into other motor related phenomena potentially affecting swallow function in PwPD previously. However, there have been no investigations of how oropharyngeal resting tremor in structures such as the tongue or larynx explicitly affects swallowing physiology. A retrospective analysis of previously conducted VFSS on 34 patients diagnosed with idiopathic PD (IPD) was performed to examine how individuals that displayed resting tremor during VFSS (Tremor +) and those who did not (Tremor-) differ in swallowing function. Measures of swallowing function including timing intervals of key swallow events, post-swallow residue, and penetration-aspiration scale (PAS) scores were recorded, and key demographic information including time since diagnosis and medication status were extracted from the medical records available. Multivariate models were used to identify differences between tremor groups for timing intervals and post-swallow residue, and chi-squares were computed for differences in PAS score distribution by group and bolus. Sixty-eight percent (23/34) of this sample displayed oropharyngeal resting tremor in at least one structure during VFSS. There were no instances of other tremor types observed in this sample. All participants were taking medication to manage PD symptomology. Significant effects of tremor group were observed for swallow timing intervals related to airway closure (p < 0.001), post-swallow residue (p < 0.05), and swallow safety at the bolus level in the Tremor + group (p < 0.001). These results suggest that PwPD who present with resting tremor in oropharyngeal structures may manifest with different variations in swallowing physiology, including altered timings of swallow events, increased pharyngeal residue, and greater associations of airway invasion with thinner and larger volume boluses. This study highlights the need for substantially more research into how motor fluctuations and phenotypes of PwPD contribute to alterations in swallowing function.

Currently, no objective method exists to measure the extent of fibrosis in swallowing musculature in head and neck cancer (HNC) patients. We developed and psychometrically tested a method of quantifying fibrosis volume using magnetic resonance imaging (MRI). The overall aim of this study was to determine if clinical MRI is a reliable tool to measure fibrosis of the pharyngeal musculature in patients with HNC managed with RT and to assess its potential to capture changes in fibrosis over time. Eligible participants were adults with HNC treated with radiation therapy (RT) who received minimally two MRIs and videofluoroscopic swallow (VFS) studies from baseline (pre-RT) up to 1-year post-RT. Two neuroradiologists independently contoured fibrosis volume in batches from MRIs using Vitrea™. Sufficient inter-rater reliability was set at Intraclass Correlation Coefficient (ICC) > 0.75. Two speech-language pathologists independently rated VFSs for swallowing impairment using standardized scales, with discrepancies resolved by consensus. MRI and VFS scores were correlated using Spearman's rank coefficient. Participants included 42 adults (male = 33); mean age 59 (SD = 8.8). ICC (95% Confidence Interval) for fibrosis volume was 0.34 (0, 0.76) for batch one and 0.43 (0, 0.82) for batch two. Consensus meetings were held after each batch. Sufficient reliability was reached by batch three (ICC = 0.95 (0.79, 0.99)). Fibrosis volume increased significantly from 3 to 12 months (mean change = 1.28 mL (SD = 5.21), p = 0.006), as did pharyngeal impairment from baseline to 12 months (mean score change = 3.05 (SD = 3.02), p = 0.003). Fibrosis volume moderately correlated with pharyngeal impairment at 3 and 12 months (0.49, p = 0.004 and 0.59, p = 0.005, respectively). We demonstrated a reliable measure of fibrosis volume in swallowing musculature from existing clinical MRIs and identified that larger fibrosis volume was associated with worse swallowing function. The reliable capture of fibrosis volume offers a pragmatic method for early detection of fibrosis and concomitant dysphagia.

The Repetitive Saliva Swallow Test (RSST) is a screening test for oropharyngeal dysphagia during which the subject is asked to perform as many empty swallows as possible in 30 s. Previous validation studies found a cutoff value of 3 > swallows as pathological. The aims of this study were to establish the normative values of the RSST and to examine the effect of clinical factors on RSST scores in healthy adults. A cross-sectional study of 280 adults. An equal number of females and males were recruited for each decade of life, ages 20 to 90 years. Patients reporting swallowing difficulties, history of neurologic disorders, or head and neck surgery or radiation were excluded. Data collected included RSST scores, number and type of comorbidities, number of prescribed medications, body mass index, smoking habits, and self-assessment xerostomia questionnaire. The mean RSST score for the entire cohort was 7.01 ± 2.86. Males had a higher RSST score (7.6 ± 3.04 compared to 6.47 ± 2.56, p = 0.001). Age showed an inverse correlation with RSST scores (Pearson's Correlation Coefficient (PCC) = -0.463, p < 0.0001), as well as body mass index, BMI (PCC = -0.2, p < 0.0001), number of co-morbidities (PCC=-0.344, p < 0.0001) and number of prescribed medications (PCC= -0.425, p < 0.0001). Self-reported amount of saliva positively correlated (PCC = 1.05, p = 0.04) with RSST scores. A multivariate logistic regression analysis was performed. Age, sex, BMI, and number of prescribed medications were found as significant independent factors on RSST scores. RSST scores in healthy adults decline with age and are lower in females, individuals taking multiple medications and with higher BMI. Mean RSST for all age groups did not fall beneath the previously established pathological cut-off.