Dysphagia最新文献

Oropharyngeal dysphagia (OD) is a prevalent issue in hospitalized COVID-19 patients. This study aimed to determine swallowing abnormalities in post-COVID-19 patients with OD and to determine the potential risk factors of aspiration in patients who have recovered from COVID-19. Screening for OD was done for 310 patients who were discharged from the main university isolation hospital during the study period. A longitudinal descriptive study was carried out on 127 adult post-COVID-19 patients between the ages of 24 and 65 years who failed OD screening at the time of discharge. Instrumental swallowing assessment was done using fiberoptic endoscopic evaluation of swallowing (FEES) at one of two different time points: one-week post-discharge (Group 1) and 3-4 weeks post-discharge (group 2). The prominent swallowing abnormalities were delayed triggering of swallowing reflex, laryngeal penetration, tracheal aspiration, as well as vallecular and pyriform sinuses residue with lower frequencies and milder degrees in group 2 than in group 1 patients. Statistically significant associations were found between the presence of ageusia and anosmia in post-COVID-19 patients and both impaired laryngeal sensation and delayed triggering of the swallowing reflex. Significant associations were detected between aspiration in post-COVID-19 patients and the following factors: higher Eating Assessment Tool (EAT-10) scores, presence of dysphonia, higher respiratory rate, and the longer duration of the use of noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV). The combined higher EAT-10 scores and higher respiratory rate predicted aspiration in post-COVID-19 patients by an overall percentage of 87.1.

Pharyngolaryngeal secretions, penetration, and aspiration belong to the cardinal symptoms of swallowing disorders in head and neck cancer patients. In order to provide safe swallowing diagnostics, it is of interest whether pharyngolaryngeal secretion accumulations can be used as a predictor for penetration and aspiration of food and liquids. This study analyzed the predictive power of pharyngolaryngeal secretion accumulations for the penetration and aspiration in head and neck cancer patients. Between 2016 - 2024, 403 head and neck cancer patients underwent swallowing diagnostics via Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Pharyngolaryngeal secretions were graded with the secretion severity rating scale (SSRS) by Murray et al., penetration and aspiration with the penetration-aspiration scale (PAS) by Rosenbek et al. Both scales were cross-tabulated and correlated with each other. Possible influencing factors on PAS were analyzed by Spearman's correlations and Kruskal-Wallis-H-tests: patients' age, tumor stage and site, type of the oncological therapy, and time of examination. A linear regression and a Categorical Principal Components Analysis were utilized for the same purpose. Higher SSRS and PAS values tended to co-occur. In univariate calculations, the tumor stage and time of examination showed significant correlations with PAS. In multivariate analyses, the tumor stage, patients' age, but above all the SSRS were shown to be significant influencing factors on PAS. Pharyngolaryngeal secretion accumulations can be used for the prediction of aspiration of food and liquids and thus for the improvement of safety of the swallowing diagnostics via FEES.

Fluoroscopy time is an important metric for radiation safety, but how it is related to dysphagia severity as graded by Dynamic Grade of Swallowing Toxicity (DIGEST) criteria and other factors in oncology practice is undocumented. We evaluated the fluoroscopy time for the bolus protocol used at the originating institution of the DIGEST method and assessed the relationship between fluoroscopy time and DIGEST grade, exam indication, and additional parameters. Eleven trials, including specified VARIBAR® barium volumes, were included in the standard bolus protocol. Electronic health record (EHR) 2018-2021 databases were sampled in a retrospective STARI-guided DIGEST implementation evaluation for clinically reported DIGEST grades in the EHR and matched to fluoroscopy time. The study sample included 4,162 modified barium swallow (MBS) examinations. Using generalized linear modeling, we tested log-transformed fluoroscopy time associations with Tukey's adjustment for multiple pairwise comparisons. MBS duration ranged from 0.16 to 11.80 min (Median 2.21, IQR 1.98). Fluoroscopy time was associated with exam indication, cancer diagnosis, setting, and DIGEST grade. Fluoroscopy times increased as the DIGEST severity grade worsened (R² = 0.45, p < .0001). MBS indication was also associated with fluoroscopy time (R² = 0.12, p < .0001), with the shortest times for baseline exams and the longest for excluding leaks (Median1.6 vs. 3.5 min). Median fluoroscopy time was shorter among endocrine and metastatic cancer patients and longer among head and neck cancer patients (2 vs. 3 min, R² = 0.02, p < .0001). Inpatient examinations were longer than outpatient (Median 3.1 vs. 2.2 min, R² = 0.02, p < .0001). The bolus protocol was clinically acceptable within ALARA standards. Clinicians should be mindful of increased fluoroscopy time and optimize exams as clinically indicated in patients with severe dysphagia, leak exclusion, and inpatient studies.

The swallowing function is a major goal of reconstruction for the patients who had hypopharyngeal cancer and received total pharyngolaryngectomy with or without voice reconstruction. We would like to share our experience in reconstruction of swallowing function using jejunum, ileocolon, or anterolateral thigh flap for cervical esophagus. In this study, we proposed that the jejunum flap is the most suitable option for restoring swallowing function, owing to its physiological characteristics. A retrospective study was conducted in 36 patients undergoing reconstruction of cervical esophagus with free jejunum flap (7 cases), ileocolon flap (21 cases), or anterolateral flap (8 cases). Esophagography, time required to achieve swallowing of semisolid diet without tube feeding, changes in body weight before and after the surgery, and ^99mTc for transit scan to evaluate pharyngeal clearance were used to evaluate the swallowing function of the patients. Patients with jejunum flap had the best swallowing function, followed by ileocolon and then ALT flap. Besides, no conduits needed to be modified in jejunum and ileocolon flap. Regarding swallowing function, for patients with longer life expectancy and no contraindication of laparotomy, jejunum flap should be the first choice to obtain optimal swallowing function for cervical esophagus. Anterolateral flap is the easiest and most commonly used flap and provides fair swallowing function if there is no leakage. However, the anterolateral thigh flap tends to develop narrowing on long-term following-up. Based on completeness of pharyngeal transit of bolus and lack of complications, patients with jejunal flap reconstruction showed best swallowing function, followed by ileocolon and then ALT flaps.

Post-stroke dysphagia is a common and debilitating complication affecting millions of people worldwide, often leading to malnutrition, pneumonia, and reduced quality of life. This study, an interim analysis of the Korean Study Cohort for Functional and Rehabilitation, aimed to identify long-term changes and predictive factors associated with post-stroke dysphagia at 3 years after stroke. A total of 4735 patients with acute first-ever stroke, including both ischemic and hemorrhagic subgroups, were followed, and dysphagia was assessed using the ASHA-NOMS scale. All the patients were then followed up for up to 36 months. The results showed significant improvements in dysphagia up to 12 months after stroke in the total and hemorrhagic stroke group, and the decline in swallowing function after 24 months in the total stroke and ischemic stroke groups was a novel finding. The hemorrhagic stroke group showed worsening dysphagia after 30 months. It is unclear whether patients who experienced worsening of swallowing function had other conditions, including new strokes, that might have contributed to this decline. Male gender, age at stroke, K-FAST at 7 days, ASHA-NOMS scale, mRS score at 3 months, and early comprehensive rehabilitation were identified as predictors of a decrease in the ASHA-NOMS score after 24 months. Additionally, the K-MBI score at 3 months post-stroke was found to be a significant factor influencing long-term improvements in swallowing function. These findings suggest that patients should be closely monitored for dysphagia beyond 24 months after stroke onset, as swallowing function may decline over time. During follow-up, it is essential to carefully consider the multiple factors associated with this decline.

Dysphagia is prevalent among elderly and neurologically impaired individuals, causing serious complications such as aspiration pneumonia. Interferential Current Stimulation (IFC), a non-invasive sensory method, may improve swallowing by reducing reflex latency. This study aimed to investigate the effects observed during active IFC stimulation of IFC on swallowing function using Laryngeal Elevation Delay Time (LEDT), Stage Transition Duration (STD), and Penetration-Aspiration Scale (PAS). Forty-six participants (ages 29-98) undergoing videofluoroscopic swallowing studies received IFC stimulation with electrodes bilaterally placed on the thyroid cartilage. Swallowing parameters were analyzed frame-by-frame using ImageJ software. LEDT measured the time from contrast arrival at the bottom of the piriform sinus to maximum laryngeal elevation. STD was the interval from oral bolus transit to pharyngeal swallow initiation. PAS assessed penetration and aspiration severity. LEDT significantly improved from baseline (median [IQR]: 0.15 [0.00-0.35] s) to 10 min during IFC stimulation (0.00 [0.00-0.19] s; p = 0.02, r = 0.46, 95% CI [0.11-0.76]). No significant changes were found in STD (STD1: p = 0.37; STD2: p = 0.37) or PAS scores (PAS1: p = 0.20; PAS2: p = 0.71). Responder analysis indicated substantial individual variability: approximately 70% improved in LEDT, while only 37-45% improved in STD. Higher responder rates were noted among participants with respiratory and cerebral disorders. IFC stimulation significantly shortened swallowing reflex latency (LEDT), suggesting its potential benefit for dysphagia rehabilitation. However, it did not significantly alter stage transition duration (STD) or penetration-aspiration safety (PAS). Further studies should explore long-term effects and optimal stimulation parameters.

Prevalence of dysphagia is high in hospitalised geriatric patients, posing risks of complications including malnutrition, dehydration, aspiration, and pneumonia. These complications may lead to reduced daily functioning, frailty, prolonged hospital stays, readmissions, and mortality. Diagnosing dysphagia in geriatric patients is often challenging due to the complex health conditions of this patient group, and overall these patients are at risk of lack of continuity in patient pathways and unnecessary hospitalisations. Recognising the critical importance of prompt diagnosis and treatment of dysphagia, we developed a dysphagia screening intervention aligned with clinical guidelines and the political focus to improve patient pathways and reduce preventable hospitalisations. This article outlines the development process of a dysphagia screening intervention to geriatric patients (≥ 65 years) admitted to medical inpatient wards. We applied a theory-, evidence- and implementation-based approach combined with stakeholder involvement in adherence to the IdentifyiNg and assessing different approaches to DEveloping compleX intervention (INDEX) guidance, encompassing eleven actions. We developed a dysphagia screening intervention comprising a screening procedure (the 4 Questionnaire Test (4QT), the 30 ml water swallowing test, and an action algorithm) targeting the patient level. Moreover, we developed an implementation strategy (activities necessary for adequate delivery of the dysphagia screening procedure and activities supporting the delivery of the screening procedure) targeting health professionals and the organisational level. The dysphagia screening intervention is now ready for feasibility testing, promising improved health and healthcare services for hospitalised geriatric patients.

Videofluoroscopic Swallowing Study (VFSS) is considered the gold standard for diagnosing swallowing disorders, or dysphagia. However, the interpretation of VFSS is susceptible to human bias and subjectivity, resulting in significant inter- and intra-patient variability. In this context, artificial intelligence (AI) has emerged as a potentially valuable tool for physicians. This study reviews state-of-the-art research utilizing AI to analyze VFSS for the assessment of swallowing disorders and to support clinical decision-making. Our comprehensive analysis highlights substantial progress in areas such as pharyngeal phase detection, segmentation and identification of the bolus and hyoid bone, and penetration-aspiration detection. Despite these advancements, an end-to-end automated AI tool for VFSS analysis has yet to be developed. However, there is considerable potential for AI applications in areas like exploring the clinical relevance of segmented or tracked components and expanding the scope to include more upper aerodigestive components in the analysis. Additionally, we discuss the limitations of current research, including the lack of publicly available datasets, the need to address the generalizability of AI models, the integration of cutting-edge AI techniques, and the clinical implications for speech-language pathologists.

This retrospective cohort study aimed to clarify the concurrent effects of intensity and frequency of early swallowing rehabilitation for post-stroke dysphagia. Using data from acute-care hospitals included in the Japanese Diagnosis Procedure Combination database between April 2020 and March 2021, we identified patients aged ≥65 years with dysphagia after acute stroke on admission who received swallowing rehabilitation within three days of hospitalization. Swallowing rehabilitation within seven days of hospitalization, starting from admission, was categorized into four types according to intensity (long/short per day) and frequency (high/low proportion of days performed). The primary outcomes were presence of dysphagia and recovery of total oral intake at discharge. Generalized estimating equations were used to assess the effects of rehabilitation intensity and frequency, adjusting for patient and hospital characteristics. Of the 4,669 patients with post-stroke dysphagia, 913 underwent swallowing rehabilitation within three days of hospitalization. The proportions of patients with dysphagia and total oral intake at discharge were 80% and 47%, respectively. The intensity and frequency of swallowing rehabilitation were not associated with dysphagia at discharge. Higher intensity or higher frequency was associated with total oral intake at discharge (odds ratio [95% confidence interval]:1.62 [0.93-2.81], 2.00 [1.11-3.60], and 2.75 [1.59-4.76] for low-intensity and high-frequency, high-intensity and low-frequency, and high-intensity and high-frequency groups, respectively). This nationwide study showed that the intensity and frequency of acute-phase swallowing rehabilitation were not associated with recovery from dysphagia after a stroke. However, they were associated with an improved oral intake at discharge.

Multiple Sclerosis (MS) is a common chronic disease among young adults. It affects various aspects of Quality of Life (QOL). Dysphagia is a problem associated with neurological damage in MS patients. This study aimed to compare MS patients' QOL with and without dysphagia. This is a cross-sectional study performed on 40 patients with MS (20 with and 20 without dysphagia) selected from the MS Society members of Ahvaz, Iran. Research tools included the Persian version of Dysphagia in Multiple Sclerosis (DYMUS), Mini-Mental State Examination (MMSE), and Multiple Sclerosis Quality of Life-54 (MSQOL-54). The data were analyzed by SPSS software version 22 and the Mann-Whitney test. The results showed a significant difference in QOL score amongst patients with and without dysphagia. The QOL score of patients with dysphagia was significantly lower than patients without dysphagia. The main differences in the subscale of the QOL Index were mental component and physical activity. MS patients with dysphagia had lower QOL than patients without it. The results show that the quality of life of MS patients with dysphagia is lower than the quality of life of MS patients without dysphagia, and this issue includes different physical and mental aspects of the quality of life of these patients. According to the findings of this study, it seems that early referral of patients with MS to speech and language pathologists for the management of swallowing disorders in the early stages of the disease can be very important and help improve the wellbeing of these patients and their families.