Dysphagia最新文献

Few studies have reported the effects of dysphagia management after esophagectomy in esophageal cancer. We aimed to investigate the impact of liquid modification and chin-tuck posture (head flexion) on reducing airway invasion and pharyngeal residue after esophagectomy. We included patients who underwent esophagectomy between June 2017 and January 2020. A videofluoroscopic swallowing study (VFSS) was conducted on 5 ml liquid boluses with four viscosities: thin, mildly thickened, moderately thickened, and extremely thickened, all administered in a neutral head position. Trials with thin and moderately thickened liquid were repeated with head flexion. The penetration-aspiration scale (PAS) scores and residue grades were compared across viscosities and head positions. Thirty-three patients met the inclusion criteria (mean age 65.3 ± 9.0 years). Moderately and extremely thickened liquids resulted in less frequent penetration or aspiration compared to thin liquids, while mildly thickened liquids showed no significant difference in airway protection. Residue grades did not differ significantly across the viscosities tested. Head flexion did not affect the occurrence of aspiration or residue grades compared with the neutral head position for thin and moderately thickened liquids. Penetration on thin liquid was less frequent in head flexion than in the neutral position. Liquid modification improved swallowing safety by reducing penetration and aspiration without affecting pharyngeal clearance. While the chin-tuck posture did not significantly reduce aspiration, its potential to lessen penetration suggests a role in airway protection that warrants further study. These findings warrant validation in larger studies.

Aspiration Pneumonia has a significant impact on individuals of all age groups, which can result in morbidity and a substantial reduction in the quality of life. The objective of this study was to map, through a scoping review, the risk factors associated to aspiration pneumonia in adult and elderly patients. Mapping and analyzing these factors are essential to understand and manage aspiration pneumonia, contributing significantly to the advancement of knowledge about this clinical condition. This scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and gray literature databases were systematically searched. The acronym 'PCCS' was used to consider the eligibility of studies for this review, where: P = Population (≥ 18 years of age), C = Concept (risk factors), C = Context (aspiration pneumonia), S = Studies (observational, interventional, cross-sectional studies, randomized, non-randomized and pseudo-randomized clinical studies). There were no restrictions regarding gender, ethnicity of individuals, language of the studies and date of publication. A comprehensive literature search was conducted using six electronic databases: EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Livivo, PubMed/Medline, Scopus, and Web of Science. In addition, gray literature was also explored through AshaWire, Google Scholar, Open Gray, and ProQuest. There were no restrictions regarding gender, ethnicity, language, time of publication, or diagnosis. A total of 3,183 articles were identified, including results from the gray literature. After screening, 56 articles were included. Significant risk factors related to aspiration pneumonia were identified. The risks include aspects such as dysphagia, aspiration, nutrition, neurological conditions, malnutrition, dehydration, changes in body mass index, skeletal mass index, mobility, and dependence on activities. Furthermore, hospital institutionalization, including length of stay, endotracheal intubation, and mechanical ventilation, is also associated.

Acoustic analysis is a promising resource for qualifying the clinical evaluation of swallowing and making it more objective. To compare the acoustic parameters of swallowing obtained from the capture of sounds by digital cervical auscultation in adults and older people. This is a cross-sectional study. Six groups were defined based on age range and the presence or absence of oropharyngeal dysphagia (OD): adults (18-59 years) with and without OD (G1 and G2), older individuals aged 60 to 75 years with and without OD (G3 and G4), and older individuals aged 76 years or older with and without OD (G5 and G6). A stethoscope with an amplifier was used to capture swallowing sounds, which were recorded during ingestion. Data analysis was conducted in R, and acoustic analysis was performed in Python. The study sample consisted of 408 participants, totaling 2057 swallows. In the G1 and G2, the magnitude and recurrence parameters differentiated between individuals with and without OD (p < 0.001). Among G3 and G4, the differences involved duration (p = 0.022), magnitude, phase, and recurrence (p < 0.001). Among G5 and G6, significant differences were found in the parameters phase (p = 0.012) and recurrence (p < 0.001). Significant differences in the acoustic parameters of swallowing were observed between groups, demonstrating the impact of age on normal swallowing and dysphagia. Recognizing age-related particularities and defining specific acoustic parameters of swallowing is crucial for enhancing clinical speech therapy practice through more precise and effective interventions.

We present the case of a 2-year-old male with persistent oropharyngeal dysphagia and recurrent aspiration. Feeding difficulties began in the neonatal period, characterized by coughing, wet cry, choking, and cyanosis during feeds. Multiple hospitalizations followed, and flexible endoscopic evaluation of swallowing (FEES) showed mobile vocal folds and pharyngeal pooling and silent aspiration with various consistencies, alongside absent swallow initiation. Videofluoroscopic swallowing studies (VFSS) demonstrated ongoing penetration and aspiration, with contrast coating both, anterior and posterior tracheal wall during pharyngeal phase, leading to gastrostomy placement. What mechanisms might explain persistent severe dysphagia in this child, and what therapeutic strategies could be considered?

The purpose of the current study was to develop a new scale to assess a level of satisfaction associated directly with swallowing ability. First, by interviewing 10 adults with dysphagia, 10 experts, as well as reviewing literature, the initial version of the swallowing satisfaction scale (SSS) was developed. The content validity of the SSS was evaluated using two qualitative and quantitative methods and expert opinions. The qualitative method was also used to determine face validity through interviews with 10 adults with dysphagia. Finally, the reliability of the scale was assessed by determining the values of internal consistency and test-retest reliability. Interviews with patients with swallowing disorders and experts in the field of dysphagia, as well as a literature review, led to the development of an initial version of the SSS with 36 items. After determining content and face validity, the number of items in the scale was reduced to 24. The calculation of Cronbach's alpha coefficient with participation of 53 patients with dysphagia showed the appropriate internal consistency of the SSS (0.968). Moreover, the ICC coefficient of the scale score in the test-retest phase was 0.983 and the ICC of each scale item was between 0.87 and 0.98. In this study, a suitable tool was developed to evaluate the level of satisfaction associated directly with swallowing ability in individuals with dysphagia, and its psychometric properties were investigated. The SSS is a valid and reliable tool with 24 items that can be used by therapists and researchers for clinical or research purposes.

The impact of oropharyngeal dysphagia (OD) on older adults is recognized in Western countries but has not received sufficient attention in China. The dysphagia handicap index (DHI) scale is an OD quality-of-life evaluation instrument. This study evaluated the psychometric properties of the Chinese version of DHI scale in older Chinese adults. A total of 600 older adults were recruited from five nursing homes in one city to complete the 25-item scale. The reliability and validity of the scale were evaluated: internal consistency was investigated using Cronbach's alpha; test-retest reliability was evaluated using the intraclass correlation coefficient; the content validity of the scale was evaluated using content validity ratio; and the factor structure was examined using an exploratory factor analysis, principal component analysis, and confirmatory factor analysis. The scale was divided into three subscales: physical, functional, and emotional. Cronbach's alpha was 0.97 for the entire scale and between 0.89 and 0.94 for the three subscales. The item-to-total correlation coefficients for the three subscales were between 0.63 and 0.92, and the test-retest correlation coefficient was 0.87. The content validity was 0.93. In the factor analysis, these three factors accounted for 75.3% variance of 25 items. The confirmatory factor analysis was significant (p < 0.0001). The Chinese version of dysphagia index scale had good reliability and validity. Thus, it can provide a subjective evaluation of older adults with OD and can be used by clinicians to improve the outcomes of older adults with OD.

Swallowing is a complex neuromuscular process involving the coordination of anatomical structures in the central and peripheral nervous systems. The posture of the head and neck plays a critical role in the biomechanics of swallowing, especially in populations with dysphagia. This systematic review aims to explore the impact of head-neck posture on swallowing kinematics and muscle activation, providing a multidisciplinary perspective for optimizing dysphagia management.A comprehensive literature search was conducted across three databases: PubMed, Web of Science, and LILACS, adhering to the PRISMA guidelines. Studies that specifically addressed swallowing and posture were included, with 25 studies selected for analysis. The results indicate that cranio-cervical flexion ("chin-down" posture) improves laryngeal vestibule closure and reduces aspiration risk, while cranio-cervical extension ("chin-up posture") delays hyoid elevation and increases the risk of pharyngeal residue and aspiration. Additionally, excessive cervical muscle tone alters the kinematics of the hyoid bone, compromising the safety and efficiency of swallowing.Postural interventions, such as chin-tuck maneuvers and head rotations, have shown effectiveness in reducing aspiration and improving swallowing efficiency. However, factors such as muscle fatigue and long-term adherence may limit their effectiveness. Individualized approaches that consider the severity of dysphagia and the patient's functional capabilities are essential.This review highlights the need for further research with large-scale randomized controlled trials to better understand the complex interaction between posture and swallowing. A multidisciplinary approach, involving physiotherapists, speech therapists, and neurologists, is crucial for improving therapeutic outcomes in dysphagia rehabilitation.

The Feeding/Swallowing Impact Survey (FS-IS) is the first validated instrument to measure the impact of Pediatric Feeding Disorder (PFD) on their caregivers. This study aimed to translate and adapt the FS-IS into Italian (FS-IS-IT) and analyze its reliability and validity, for both fathers and mothers. The FS-IS-IT was developed using Beaton et al.'s 5-stage process. This cross-sectional study involved 32 dyads of parents of children with PFD and 15 dyads of caregivers of children with developmental disorders without PFD. Twenty caregivers completed the FS-IS-IT questionnaire twice to ensure test-retest reliability. All caregivers completed the Zarit Burden Inventory (ZBI) and the IDDSI Diet Functional Scale for construct validity analysis. ROC analysis was used to evaluating the diagnostic properties of FS-IS-IT in screening between dyads of children with PFD and dyads without these symptoms. The FS-IS-IT was reliable for both fathers and mothers, with satisfactory internal consistency (mothers' McDonald's ω=0.93; fathers' McDonald's ω=0.94) and test-retest reliability (intraclass correlation coefficient > 0.97). Moderate-to-strong statistically significant correlations (mothers: r(32)=0.73; p =.018; fathers: r(32)=-0.42; p=.018). r(32)=-0.41; p=.018). The FSIS-IT was featured by optimal diagnostics (mothers: AUC=0.97; fathers: AUC=0.94), a cut-off of 1.58 for mothers and 1.65 for fathers has shown good specificity and sensitivity. The FS-IS-IT is a reliable and valid tool for the assessment of the impact of PFD and shows optimal diagnostic properties.

To identify oral health variables associated with laryngotracheal aspiration-related outcomes as determined by swallowing during videofluoroscopy in adults and older adults. This cross-sectional study included 225 persons aged 18 years or older who were referred for clinical evaluation and videofluoroscopy examination due to suspected dysphagia. Oral health status assessment comprised self-reported the number of teeth, use and fit of dentures, xerostomia and satisfaction with chewing. The number of teeth and fit of dentures were also assessed clinically by a speech therapist. Videofluoroscopy followed a standardized protocol. The presence and severity of dysphagia was assessed using the O'Neill Swallowing Scale. The Dysphagia Severity and Outcome Scale defined the occurrence of laryngotracheal penetration or aspiration of food. Results were presented as prevalence ratios and 95% confidence intervals. Poisson regressions with robust variance ran on R version 4.2.1. were used to estimate associations with dysphagia and aspiration. In the multivariate models for aspiration, the following factors were associated with the upper arch: Partial dentition with poorly fitted implants, fixed prostheses (single or multiple), or removable partial dentures (PR, 3.45; 95% CI, 1.15-10.41), partial dentition without rehabilitation with prosthesis (PR, 4.05; 95% CI, 1.46-11.22), edentulism with well-fitted conventional total prosthesis (PR, 4.82; 95% CI, 1.29-17.92), and edentulism without complete dentures (PR, 7.22; 95% CI, 2.25-23.10). For the lower arch, associated factors included: Edentulism with poorly fitted conventional total prosthesis (PR, 8.99; 95% CI, 1.85-43.44), partial dentition without prosthesis (PR, 6.76; 95% CI, 1.67-27.84), and edentulism without prosthesis (PR, 8.69; 95% CI, 1.86-40.63). This study highlights the significant association between poor oral health, dysphagia, and aspiration laryngotracheal, underscoring the need for integrated care between speech-language pathology and dentistry. Our findings provide a foundation for future research that incorporates more robust research designs and oral examinations to explore underlying mechanisms explaining the relation between oral health, dysphagia, and aspiration.

Cervical auscultation, commonly used by speech-language pathologists in some countries as an adjuvant to the clinical feeding evaluation, requires data on acoustic and perceptual profiles of swallowing sounds. Whilst these exists in adults and children, none currently exist for preterm neonates. Our study aims to establish the acoustic and perceptual parameters of swallowing sounds in preterm neonates. Swallowing sounds were recorded on a digital microphone during oral feeding observations. Acoustic parameters of duration, peak frequency, peak power and peak intensity were determined. Perceptual parameters heard pre, during and post-swallows were rated as 'present', 'absent', or 'cannot be determined'. Eighty preterm neonates (43 males; mean age = 33.4 weeks [SD 2.6]) from three Australian special care nurseries demonstrated mean swallow durations of < 1 s. The peak amplitude correlated with the number of medical co-morbidities (r = 0.24; 95%CI 0.03-0.45). Most preterm neonates have coordinated swallows that are loud, quick and completed in < 1 s. The perceptual parameters of a bolus transit sound was consistently present in all preterm neonates. One in five pre-term neonates have an uncoordinated swallow where wheeze, stridor or wet breath sounds were present post-swallow. Our study provides clinicians with acoustic and perceptual parameters to guide use of cervical auscultation in special care nurseries. Future studies should consider simultaneous instrumental assessment to ensure validity when using cervical auscultation to support diagnostic decision-making on swallowing coordination.