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.

Sarcopenia is a progressive skeletal muscle disorder characterized by the loss of muscle mass and function, which has been associated with an increased risk of dysphagia. Although previous studies have established an association between sarcopenia and dysphagia, the precise prevalence of dysphagia in patients with sarcopenia remains inadequately determined. This study aims to investigate the prevalence and risk factors of dysphagia in patients with sarcopenia. We systematically searched the PubMed, Embase, Cochrane Library, Medline, Web of Science, Scopus, CNKI, Wan Fang, and CBM for studies related to sarcopenia and dysphagia published from the establishment of the databases until January 16, 2025. Relevant literature on the coexistence of sarcopenia and dysphagia was retrieved, followed by a meta-analysis performed using Stata 15.0. The prevalence and risk factors of dysphagia in patients with sarcopenia were analyzed. A total of 24 studies comprising 9,543 patients were included in the analysis. The pooled prevalence of dysphagia in patients with sarcopenia was 31% (95% confidence interval [CI]: 0.22-0.40). Age (OR = 1.65, 95% CI: 0.75-3.66), tongue strength (OR = 0.96, 95% CI: 0.89-1.04), and malnutrition (OR = 1.83, 95% CI: 0.46-7.26) were identified as major risk factors for dysphagia in patients with sarcopenia. In conclusion, the prevalence of dysphagia in patients with sarcopenia was 31%, with age, tongue strength, and malnutrition identified as primary risk factors. However, due to the limited number of studies included and the failure to combine multiple individual risk factors, the clinical significance needs further investigation. Future multi-regional studies are required to confirm these factors.

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.

The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) is a psychometric tool used during modified barium swallow studies (MBSSs) to grade swallowing safety, efficiency, and overall pharyngeal swallow function ranging from 0 (no impairment) to 4 (life-threatening). DIGEST was originally validated on a protocol without routine inclusion of thickened liquids. To ensure stability of DIGEST in different settings, we aimed to assess whether DIGEST grades remained stable when derived from a bolus protocol with or without standard inclusion of thickened liquids. MBSSs from 118 unique participants were retrospectively analyzed by 4 reliable raters using a master protocol of thin, thickened, pudding, and solid boluses. DIGEST grades were derived from four bolus protocol conditions: (1) DIGEST core protocol (without thickened liquids); (2) core plus mildly thick liquid; (3) core plus moderately thick; and (4) core plus mildly and moderately thick. Prevalence and Bias-Adjusted Kappa (PABAK) values were calculated to determine agreement of DIGEST grades between the core protocol and variations. PABAK ranged from 0.83 to 1.00 (near-perfect to perfect agreement). In rare instances where thickened liquids affected grades, they invariably worsened by one grade. There was no clear change-driving bolus type for this effect. Safety was more susceptible to change than efficiency. Inclusion of thickened liquids does not appear necessary in a minimum bolus protocol for DIGEST. Clinicians and researchers who wish to routinely include thickened liquids in their protocol should be aware that DIGEST grades may be worsened by one in a minority of cases and that safety grades appear more likely to be affected than efficiency grades.

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.