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European Archives of... May 2019Although office-based transnasal esophagoscopy has been investigated extensively, a cost analysis is still lacking. We performed a cost analysis combined with... (Clinical Trial)
Clinical Trial
PURPOSE
Although office-based transnasal esophagoscopy has been investigated extensively, a cost analysis is still lacking. We performed a cost analysis combined with feasibility study for two diagnostic processes: patients with globus pharyngeus and/or dysphagia, and hypopharyngeal carcinoma.
METHODS
Prospective cohort study.
RESULTS
Forty-one procedures were performed, of which 35 were fully completed. The procedure was well tolerated with mild complaints such as nasal or pharyngeal pain and burping. Four complications occurred: two minor epistaxis and two vasovagal reactions. In patients with globus pharyngeus and/or dysphagia, transnasal esophagoscopy resulted in a cost saving of €94.43 (p 0.026) per procedure, compared to our regular diagnostic process. In patients with suspicion of hypopharyngeal carcinoma, cost savings were €831.41 (p 0.000) per case.
CONCLUSIONS
Cost analysis showed that office-based transnasal esophagoscopy can provide significant cost savings for the current standard of care. Furthermore, this procedure resulted in good patient acceptability and few complications.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Cost Savings; Cost-Benefit Analysis; Deglutition Disorders; Esophagoscopy; Feasibility Studies; Female; Health Care Costs; Humans; Hypopharyngeal Neoplasms; Male; Middle Aged; Netherlands; Nose; Pharyngeal Diseases; Prospective Studies
PubMed: 30806806
DOI: 10.1007/s00405-019-05357-0 -
European Archives of... Jun 2022Oropharyngeal dysphagia (OD) is a common phenomenon in otorhinolaryngology and phoniatrics. As both sub-disciplines have a strong tradition and clinical experience in... (Review)
Review
PURPOSE
Oropharyngeal dysphagia (OD) is a common phenomenon in otorhinolaryngology and phoniatrics. As both sub-disciplines have a strong tradition and clinical experience in endoscopic assessment of the upper aerodigestive tract, the implementation of fiberoptic endoscopic evaluation of swallowing (FEES) was an almost self-evident evolution. This review aims to provide an update on FEES and the role of phoniatricians and otorhinolaryngologists using FEES in Europe.
METHODS
A narrative review of the literature was performed by experts in the field of FEES both in the clinical context and in the field of scientific research.
RESULTS
FEES is the first-choice OD assessment technique for both phoniatricians and otorhinolaryngologists. FEES is becoming increasingly popular because of its usefulness, safety, low costs, wide applicability, and feasibility in different clinical settings. FEES can be performed by health professionals of varying disciplines, once adequate knowledge and skills are acquired. FEES aims to determine OD nature and severity and can provide diagnostic information regarding the underlying etiology. The direct effect of therapeutic interventions can be evaluated using FEES, contributing to design the OD management plan. Standardization of FEES protocols and metrics is still lacking. Technological innovation regarding image resolution, frame rate frequency, endoscopic light source specifications, and endoscopic rotation range has contributed to an increased diagnostic accuracy.
CONCLUSION
The rising number of phoniatricians and otorhinolaryngologists performing FEES contributes to the early detection and treatment of OD in an aging European population. Nevertheless, a multidisciplinary approach together with other disciplines is crucial for the success of OD management.
Topics: Aging; Deglutition; Deglutition Disorders; Endoscopy; Fiber Optic Technology; Humans
PubMed: 34779927
DOI: 10.1007/s00405-021-07161-1 -
Arquivos de Gastroenterologia 2020Dysphagia management, from screening procedures to diagnostic methods and therapeutic approaches, is about to change dramatically. This change is prompted not solely by... (Review)
Review
Dysphagia management, from screening procedures to diagnostic methods and therapeutic approaches, is about to change dramatically. This change is prompted not solely by great discoveries in medicine or physiology, but by advances in electronics and data science and close collaboration and cross-pollination between these two disciplines. In this editorial, we will provide a brief overview of the role of artificial intelligence in dysphagia management.
Topics: Artificial Intelligence; Deglutition Disorders; Humans
PubMed: 33331470
DOI: 10.1590/S0004-2803.202000000-66 -
Journal of Veterinary Internal Medicine Jul 2019Characterization of the clinical signs, response to treatment and prognosis can be useful information for decision-making when evaluating cattle with pharyngeal trauma.
BACKGROUND
Characterization of the clinical signs, response to treatment and prognosis can be useful information for decision-making when evaluating cattle with pharyngeal trauma.
OBJECTIVE
To describe the signalment, history, clinicopathologic, endoscopic, ultrasonographic, radiographic, and postmortem findings as well as treatments and outcomes of cattle diagnosed with pharyngeal perforation/trauma.
ANIMALS
Review of medical records of cattle >1 month of age admitted to a Veterinary Teaching Hospital from 1995 to 2017.
METHODS
Retrospective study. Review of medical records of cattle with pharyngeal perforation/trauma identified by oral or endoscopic examination in hospital setting.
RESULTS
Twenty-seven out of 7550 (0.36%) cases met the inclusion criteria. Pharyngeal perforation/trauma was associated with the administration of a bolus in 24 (89%) cows and a magnet in 3 (11%) cases. The boluses contained monensin (n = 12), calcium salts (n = 5), iodine (n = 1), aspirin (n = 1), vitamins (n = 1), and an unknown product (n = 4). The primary clinical signs were dysphagia, swelling of the throatlatch, subcutaneous emphysema, swelling, and pain on palpation of the throatlatch. Seventeen (63%) cows were discharged whereas 10 (37%) were euthanized. Median time between the suspected traumatic event and hospital admission was 1 day (range: 0.5-3 days) and 2 days (range: 0.5-15) for surviving and nonsurviving cattle, respectively. All 5 cows that suffered pharyngeal trauma associated with administration of calcium salt bolus were euthanized.
CONCLUSIONS AND CLINICAL IMPORTANCE
Pharyngeal trauma is a rare condition in cattle. Case fatality rate increases if not diagnosed and treated promptly. The nature of the penetrating foreign body influences the outcome.
Topics: Administration, Oral; Animals; Calcium Compounds; Cattle; Female; Foreign Bodies; Magnets; Monensin; Pharyngeal Diseases; Pharynx; Prognosis; Retrospective Studies
PubMed: 31058361
DOI: 10.1111/jvim.15510 -
Ear, Nose, & Throat Journal Sep 2021Pharyngeal ectopic thymus is a rare cause of pharyngeal masses and is rarely considered in the differential diagnosis of neck and head masses in children. In this paper,...
Pharyngeal ectopic thymus is a rare cause of pharyngeal masses and is rarely considered in the differential diagnosis of neck and head masses in children. In this paper, the case of an infant with a pharyngeal ectopic thymus is presented and our intraoral surgical approach in the patient's treatment is described.
Topics: Choristoma; Diagnosis, Differential; Female; Humans; Infant, Newborn; Medical Illustration; Pharyngeal Diseases; Pharynx; Thymus Gland
PubMed: 32320300
DOI: 10.1177/0145561320918434 -
Annals of Palliative Medicine Sep 2023Pharyngocutaneous fistula is a serious complication after head and neck reconstruction and concurrent chemoradiotherapy, yet no consensus or practical protocols... (Review)
Review
Pharyngocutaneous fistula is a serious complication after head and neck reconstruction and concurrent chemoradiotherapy, yet no consensus or practical protocols regarding the surgical timing and specific procedures could be found in the current literature. The authors aimed to review their clinical experience in surgical management and develop an algorithmic approach accordingly. A retrospective review of all hypopharyngeal cancer patients who developed pharyngocutaneous fistula during 2017 to 2021 at E-Da Hospital was conducted. Seventeen patients developed pharyngocutaneous fistula in all 321 pharyngeal cancer admissions during this period. Three patients received interventions at acute stage (≤2 weeks), with two direct repairs Three patients received interventions at acute stage (≤2 weeks), with two direct repairs and one regional flap coverage then negative pressure wound therapy. Nine received interventions at subacute stages (2 weeks to 3 months), with 4 resolved after debridement and direct repair yet another 4 underwent regional flap reconstruction and 1 free flap reconstruction. Five chronic fistula (>3 months) received secondary reconstructions utilizing a double-layered repair of local turn-over flaps for the internal mucosal opening and another flap harvest (four regional flaps and one free flap) to cover the outer skin defect. All patients after the palliative surgery achieved complete remission of fistula at follow follow-up. Different conservative and surgical approaches should be adopted according to the acute, subacute, and chronic stages of pharyngocutaneous fistula after palliative head and neck reconstructions.
Topics: Humans; Cutaneous Fistula; Head and Neck Neoplasms; Pharyngeal Diseases; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Surgical Flaps
PubMed: 37691332
DOI: 10.21037/apm-22-1475 -
Otolaryngologia Polska = the Polish... Jun 2020<b>Introduction:</b> Patient-reported outcome measures have been used within the otorhinolaryngologic disorders' field for many years to compare patient's...
<b>Introduction:</b> Patient-reported outcome measures have been used within the otorhinolaryngologic disorders' field for many years to compare patient's perception of the severity of symptoms and the effectiveness of a therapeutic approach. Questionnaires that evaluate dysphagia are relatively complex instruments aimed mostly at patients with neurological or malignant diseases. The ICD-10 classification specifies only one broad term - dysphagia (R13). Introduction of Muscle Tension Dysphagia (MTDg) in 2016 by Kang completed the spectrum of the nomenclature. This dysphagia type is defined as a type of laryngeal muscle tension disorder manifesting primarily as swallowing difficulty with or without any accompanying organic cause, laryngeal hyperresponsiveness and/or nonspecific laryngeal inflammation. <br><b>Aim:</b> Since there were no clear diagnostic and therapeutic perspectives on the group of patients with MTDg, the aim of this work was to analyse selected diagnostic tools used for the evaluation of swallowing disorders in the context of finding the most suitable tools for patients with Muscle Tension Dysphagia. <br><b>Material and method:</b> The material of the work included 61 patients. Each patient underwent otolaryngologic, phoniatric and speech therapist's examination, Functional Endoscopic Evaluation of Swallowing (FEES) and filled out questionnaires concerning dysphonia and dysphagia symptoms. <br><b>Results:</b> The results of the work showed that patients with MTDg were characterised by correct results of FEES examination, prolonged swallowing, features of inappropriate mucous and oropharyngeal muscle function. <br><b>Conclusions:</b> The Swallowing Disorder Scale (SDS), developed by the authors, correlated best with the cause of dysphagia. The questionnaire corresponded well with the degree of severity. In the diagnostic process of MTDg one of the key tasks is the differentiation with patients with non-normative swallowing patterns. Apart from specialistic consultations with otolaryngologist and speech therapist, while diagnosing MTDg we recommend using objective (FEES, videofluroscopy, SEMG) and subjective (SDS, DHI, EAT-10 surveys) assessment tools. In our opinion, the inclusion of questionnaires to detect reflux syndromes is also important in the causal treatment of ailments.
Topics: Deglutition Disorders; Dysphonia; Hoarseness; Humans; Muscle Tonus; Surveys and Questionnaires
PubMed: 33724224
DOI: 10.5604/01.3001.0014.1997 -
Revue Medicale de Liege May 2023Globus pharyngeus is a very common symptom in the general population. It is defined as a sensation of lump or foreign body in the throat, generally not accompanied by... (Review)
Review
Globus pharyngeus is a very common symptom in the general population. It is defined as a sensation of lump or foreign body in the throat, generally not accompanied by pain and relieved by eating. This last notion makes the differential diagnosis with dysphagia, which requires a different management. Its possible etiologies are complex and multiple, both organic and psychological, and many of them are still debated. Therefore, there is no consensus on the management and the treatment of globus pharyngeus. The purpose of this narrative review of the literature is to synthesize the current evidence regarding the causes, diagnostic strategy, and therapeutic management of globus pharyngeus.
Topics: Humans; Globus Sensation; Deglutition Disorders; Pain
PubMed: 37350204
DOI: No ID Found -
PloS One 2022During the early stages, Parkinson's disease (PD) is well recognized as an asymmetric disease with unilateral onset of resting tremor with varying degrees of rigidity,...
INTRODUCTION
During the early stages, Parkinson's disease (PD) is well recognized as an asymmetric disease with unilateral onset of resting tremor with varying degrees of rigidity, and bradykinesia. However, it remains unknown if other impairments, such as swallowing impairment (i.e., dysphagia), also present asymmetrically.
PURPOSE
The primary aim of this study was to examine muscle activity associated with swallow on the most affected side (MAS) and least affected side (LAS) in persons with PD. A secondary aim was to explore the relationship between differences in muscle activity associated with swallow and subjective reports of swallowing impairment and disease severity.
METHODS
Function of muscles associated with swallowing was assessed using surface electromyography placed over the right and left submental and laryngeal regions during three swallows for a THIN and THICK condition. The Swallowing Quality of Life (SWAL-QOL) questionnaire and the Unified Parkinson's Disease Rating Scale (UPDRS) were collected as measures of subjective swallow impairment and disease severity, respectively.
RESULTS
Thirty-five participants diagnosed with idiopathic PD and on a stable antiparkinsonian medication regimen completed this study. Results revealed no significant mean difference in muscle activity during swallow between the more and less affected side. For the laryngeal muscle region, a significant difference in coefficient of variation between the MAS and LAS was revealed for peak amplitude for the THIN swallow condition. For the laryngeal muscle region, a significant association was revealed between muscle activity and disease severity but not subjective reports of swallowing impairment.
CONCLUSION
Superficially it appears that swallowing impairment present symmetrical during the early stages of PD, however, our variability data indicates otherwise. These results will be used to inform future studies in specific types of swallowing impairment (i.e., oral dysphagia, pharyngeal dysphagia, and esophageal dysphagia), disease progression, and overall asymmetry.
Topics: Aged; Deglutition; Deglutition Disorders; Electromyography; Female; Humans; Laryngeal Muscles; Male; Middle Aged; Parkinson Disease; Quality of Life; Severity of Illness Index; Surveys and Questionnaires
PubMed: 35180221
DOI: 10.1371/journal.pone.0262424 -
American Journal of Physiology.... Apr 2022In Parkinson's disease (PD), oropharyngeal dysphagia is common and clinically relevant. The neurophysiology of dysphagia in PD is complex and incompletely understood....
In Parkinson's disease (PD), oropharyngeal dysphagia is common and clinically relevant. The neurophysiology of dysphagia in PD is complex and incompletely understood. The aim of the study was to determine the changes in oropharyngeal deglutitive pressure dynamics in PD and to correlate these with clinical characteristics including dysphagia and PD severity. In prospective consecutive series of 64 patients with PD [mean age: 66.9 ± 8.3 (SD)], we evaluated dysphagia severity clinically as well as with Sydney Swallow Questionnaire (SSQ) and Swallow Quality-of-Life Questionnaire (SWAL-QOL). PD severity was assessed with Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). We used high-resolution pharyngeal impedance manometry (HRPIM) to objectively evaluate swallow function and compared data from 23 age-matched healthy controls [mean age 62.3 ± 9.1 (SD)]. Metrics assessed were upper esophageal sphincter (UES), integrated relaxation pressure (IRP), relaxation time (RT), maximum opening (MaxAdm), and pharyngeal intrabolus pressure (IBP) and pharyngeal contractility (PhCI). Mean MDS-UPDRS score was positively associated with dysphagia severity on SSQ and SWAL-QOL. HRPIM in PD compared with controls showed impaired UES relaxation parameters, with shorter RT, and elevated IRP and IBP. MaxAdm was not affected. The overall pharyngeal contractility was significantly higher in PD. Only the IBP and IRP were associated with PD severity and only IBP was significantly associated with dysphagia severity. UES dysfunction leading to increased flow resistance is common in patients with PD and correlates with dysphagia severity. Increased flow resistance may suggest impaired UES relaxation and/or impaired neuromodulation to bolus volume. In Parkinson's disease, objective assessment of swallow function with high-resolution impedance manometry identifies upper esophageal sphincter dysfunction leading to increased flow resistance.
Topics: Aged; Deglutition; Deglutition Disorders; Esophageal Sphincter, Upper; Humans; Manometry; Middle Aged; Parkinson Disease; Pressure; Prospective Studies; Quality of Life
PubMed: 35138164
DOI: 10.1152/ajpgi.00314.2021