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Equine Veterinary Journal Jul 2023There is contradictory evidence on the potential benefits of tongue ties on upper airway function and their efficacy in inhibiting intermittent dorsal displacement of...
BACKGROUND
There is contradictory evidence on the potential benefits of tongue ties on upper airway function and their efficacy in inhibiting intermittent dorsal displacement of the soft palate (DDSP) in racehorses.
OBJECTIVES
To test the hypothesis that tongue ties increase the pharyngeal diameter and decrease the occurrence of dynamic airway obstruction in racehorses.
STUDY DESIGN
Prospective, crossover blinded clinical study.
METHODS
Data of 22 Thoroughbred and 8 Standardbred racehorses examined using overground endoscopy under full-intensity exercise on training racetracks with and without fixation of the tongue by use of tongue ties were analysed. Equivalent exercise intensity was ensured by measuring heart rate (bpm), speed (GPS) and venous lactate. Pharyngeal diameter was expressed as pharyngeal-epiglottis (PE) ratios and laryngeal abduction accordingly as laryngeal-median-ratios. Data were analysed using multivariable repeated-measurements ANOVA.
RESULTS
The PE ratio increased significantly from 1.11 ± 0.19 to 1.28 ± 0.30 in all horses between rest and full-intensity exercise (p < 0.01). Multi-variable analysis revealed that this effect decreased significantly by the application of tongue ties (1.15 ± 0.27, p < 0.01). Tongue ties did not influence maximum laryngeal width (p = 0.09) and area (p = 0.2) significantly. DDSP was found in 4 of 30 examinations with tongue tie and in 1 of 30 examinations without tongue tie.
MAIN LIMITATIONS
The study population was not randomly chosen and was heterogeneous. Few horses had a respiratory noise and the prevalence of upper respiratory tract disorders was too low for statistical comparison of the rate of DDSP with and without tongue ties.
CONCLUSIONS
A positive effect of tongue ties on pharyngeal or laryngeal diameters was not found in this study. Therefore, the results of this study do not support the use of tongue ties to enhance upper airway function.
Topics: Horses; Animals; Ankyloglossia; Prospective Studies; Physical Conditioning, Animal; Larynx; Trachea; Palate, Soft; Horse Diseases
PubMed: 36102425
DOI: 10.1111/evj.13867 -
Current Opinion in Otolaryngology &... Dec 2023Dysphagia affects at least 1% of the pediatric population. This prevalence further increases in patients who are born prematurely or who have underlying neuromuscular or... (Review)
Review
PURPOSE OF REVIEW
Dysphagia affects at least 1% of the pediatric population. This prevalence further increases in patients who are born prematurely or who have underlying neuromuscular or cardiopulmonary disorders. A multidisciplinary team approach, including an Otolaryngologist, can help promote an expedited diagnosis and therapeutic regimen, ensuring that the patient receives adequate nutrition needed for growth and development.
RECENT FINDINGS
The development and growth of multidisciplinary aerodigestive clinics have improved outcomes in pediatric patients with dysphagia. If a structural concern is noted on examination, there remain a multitude of medical and surgical options to help improve patient outcomes and swallow. These treatment options are usually multimodality and specific interventions may be employed to target a specific and notable abnormality.
SUMMARY
Pediatric dysphagia is a complex concern. For the otolaryngologist, etiologies with surgical targets may include ankyloglossia, tonsillar hypertrophy, laryngomalacia, laryngo-esophageal cleft, vocal fold movement impairment, and cricopharyngeal achalasia. The development and formalization of a multidisciplinary approach has streamlined and broadened treatment options for these patients. An otolaryngologist is integral as part of the treatment team of these patients.
Topics: Humans; Child; Deglutition Disorders; Otolaryngologists; Otolaryngology; Larynx; Vocal Cords
PubMed: 37820272
DOI: 10.1097/MOO.0000000000000934 -
Medicina (Kaunas, Lithuania) Aug 2023(1) : The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic...
(1) : The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles. The tongue has relations with the suprahyoid and the infrahyoid muscles. The pattern of swallowing evolves gradually from birth to the age of four. If this developmental transition does not occur, the result is persistent infantile or atypical swallowing-an orofacial myofunctional disorder with the tongue in improper position during swallowing, causing strain and stress on the jaw, face, head and neck. In FHP, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement during swallowing. This study assesses the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with FHP. The underlying hypothesis is that without addressing FHP, swallowing rehabilitation remains challenged and potentially incomplete. (2) : A total of 61 participants (12-26 years) meeting the inclusion criteria (FHP and atypical swallowing) were divided into two similar groups. Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, group B only one OMT session per week, for 20 weeks. Exclusion criteria were as follows: ankyloglossia, neurological impairment affecting tongue and swallowing, cervical osteoarticular pathology, other previous or ongoing treatments for FHP and atypical swallowing. (3) : There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR techniques. (4) : The combined therapy proved to be more effective than single OMT therapy.
Topics: Humans; Deglutition; Patients; Cervical Vertebrae; Neck; Posture
PubMed: 37763700
DOI: 10.3390/medicina59091580 -
Otolaryngology--head and Neck Surgery :... May 2024Assess the relationship between public interest in ankyloglossia as determined by internet search volume and real-world medical claims data.
OBJECTIVES
Assess the relationship between public interest in ankyloglossia as determined by internet search volume and real-world medical claims data.
STUDY DESIGN
Retrospective Cohort Study.
SETTING
This retrospective cohort study was conducted using claims data from the Merative™ Marketscan® Research Databases. The internet search data was collected from Google Trends.
METHODS
Annual Google Trends data were compiled using search terms associated with "ankyloglossia" and "frenotomy" for the years 2011 to 2021. We obtained incidence of ankyloglossia diagnoses and frenotomy procedures in children under 12 months from Marketscan relative to all infants enrolled. We compared associations between search and incidence data among US states and over time.
RESULTS
Google search correlated with ankyloglossia incidence (r = 0.4104, P = .0031) and with frenotomy incidence (r = 0.4062, P = .0034) per state. Ankyloglossia diagnoses increased with Google search index (coefficient = 0.336, 95% confidence interval [CI] 0.284, 0.388) and year (coefficient = 0.028, 95% CI 0.025, 0.031). Similarly, frenotomy procedures increased with Google search index (coefficient = 0.371, 95% CI 0.313, 0.429) and year (coefficient = 0.027, 95% CI 0.024, 0.030).
CONCLUSIONS
Associations between online ankyloglossia search trends and both diagnosis and treatment rates, persist across US regions and timeframes. Internet search trends are pivotal in shaping pediatric health care decisions, driving clinical consensus, and disseminating evidence-based information.
Topics: Humans; Ankyloglossia; Retrospective Studies; Infant; United States; Female; Internet; Male; Incidence; Infant, Newborn; Databases, Factual
PubMed: 38219744
DOI: 10.1002/ohn.643 -
European Journal of Paediatric Dentistry Sep 2023In this study we present the new postoperative oro-myofunctional protocol following frenectomy by atmospheric plasma associated with a systemic postural approach, which...
AIM
In this study we present the new postoperative oro-myofunctional protocol following frenectomy by atmospheric plasma associated with a systemic postural approach, which determines functional recovery through body symmetry restoration based on the concepts of the French "Mezieres Method" and postural bench.
METHODS
A total of 130 patients (76 female, 54 male) affected by ankyloglossia of class III/IV, according to Kotlow's Tongue Tie Classification have been treated with atmospheric plasma followed by oro-myofunctional therapy associated with a systemic postural approach. The overall change, improved/worsened speech, feeding, or sleep has been evaluated through the 10 points Parents Speech Satisfaction (PSS) Score after one week and two months.
CONCLUSION
Based on the findings of the current investigation, myofunctional therapy in tongue-tie results in a consistent significant functional ameliorating of feeding capability, speech and sleeping of subject treated as reported with traditional oro-myofunctional therapy.
Topics: Humans; Female; Male; Ankyloglossia; Myofunctional Therapy; Parents; Tongue
PubMed: 37668462
DOI: 10.23804/ejpd.2023.1885 -
Health Technology Assessment... Jul 2023Tongue-tie can be diagnosed in 3-11% of babies, with some studies reporting almost universal breastfeeding difficulties, and others reporting very few feeding... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Tongue-tie can be diagnosed in 3-11% of babies, with some studies reporting almost universal breastfeeding difficulties, and others reporting very few feeding difficulties that relate to the tongue-tie itself, instead noting that incorrect positioning and attachment are the primary reasons behind the observed breastfeeding difficulties and not the tongue-tie itself. The only existing trials of frenotomy are small and underpowered and/or include only very short-term or subjective outcomes.
OBJECTIVE
To investigate whether frenotomy is clinically and cost-effective to promote continuation of breastfeeding at 3 months in infants with breastfeeding difficulties diagnosed with tongue-tie.
DESIGN
A multicentre, unblinded, randomised, parallel group controlled trial.
SETTING
Twelve infant feeding services in the UK.
PARTICIPANTS
Infants aged up to 10 weeks referred to an infant feeding service (by a parent, midwife or other breastfeeding support service) with breastfeeding difficulties and judged to have tongue-tie.
INTERVENTIONS
Infants were randomly allocated to frenotomy with standard breastfeeding support or standard breastfeeding support without frenotomy.
MAIN OUTCOME MEASURES
Primary outcome was any breastmilk feeding at 3 months according to maternal self-report. Secondary outcomes included mother's pain, exclusive breastmilk feeding, exclusive direct breastfeeding, frenotomy, adverse events, maternal anxiety and depression, maternal and infant NHS health-care resource use, cost-effectiveness, and any breastmilk feeding at 6 months of age.
RESULTS
Between March 2019 and November 2020, 169 infants were randomised, 80 to the frenotomy with breastfeeding support arm and 89 to the breastfeeding support arm from a planned sample size of 870 infants. The trial was stopped in the context of the COVID-19 pandemic due to withdrawal of breastfeeding support services, slow recruitment and crossover between arms. In the frenotomy with breastfeeding support arm 74/80 infants (93%) received their allocated intervention, compared to 23/89 (26%) in the breastfeeding support arm. Primary outcome data were available for 163/169 infants (96%). There was no evidence of a difference between the arms in the rate of breastmilk feeding at 3 months, which was high in both groups (67/76, 88% vs. 75/87, 86%; adjusted risk ratio 1.02, 95% confidence interval 0.90 to 1.16). Adverse events were reported for three infants after surgery [bleeding ( = 1), salivary duct damage ( = 1), accidental cut to the tongue and salivary duct damage ( = 1)]. Cost-effectiveness could not be determined with the information available.
LIMITATIONS
The statistical power of the analysis was extremely limited due to not achieving the target sample size and the high proportion of infants in the breastfeeding support arm who underwent frenotomy.
CONCLUSIONS
This trial does not provide sufficient information to assess whether frenotomy in addition to breastfeeding support improves breastfeeding rates in infants diagnosed with tongue-tie.
FUTURE WORK
There is a clear lack of equipoise in the UK concerning the use of frenotomy, however, the effectiveness and cost-effectiveness of the procedure still need to be established. Other study designs will need to be considered to address this objective.
TRIAL REGISTRATION
This trial is registered as ISRCTN 10268851.
FUNDING
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme (project number 16/143/01) and will be published in full in ; Vol. 27, No. 11. See the NIHR Journals Library website for further project information. The funder had no role in study design or data collection, analysis and interpretation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Topics: Female; Humans; Infant; Breast Feeding; Pandemics; Ankyloglossia; Parents; Tongue; Cost-Benefit Analysis
PubMed: 37839892
DOI: 10.3310/WBBW2302 -
Journal of Human Lactation : Official... Feb 2024Breastfeeding behaviors and experiences exist on a continuum. What differentiates normal from dysfunctional is defined by frequency and severity. No current validated...
BACKGROUND
Breastfeeding behaviors and experiences exist on a continuum. What differentiates normal from dysfunctional is defined by frequency and severity. No current validated tool addresses the subjective experience of dyads with a predictive score that can be followed over time.
RESEARCH AIM
To create and validate a self-report tool to assess breastfeeding and evaluate its ability to predict risk of breastfeeding dysfunction.
METHODS
This study used a cross-sectional design to determine the validity of a novel instrument to assess breastfeeding dysfunction. We gave the initial questionnaire to 2085 breastfeeding dyads. We assessed content validity by comparison with other tools. We used exploratory factor analysis with varimax rotation for concept identification and Cronbach's alpha for internal consistency. We employed logistic regression to assess the tool's ability to differentiate between normal breastfeeding and breastfeeding dysfunction.
RESULTS
Factor analysis mapped 17 questions to four concepts to create a score (FLIP; flow, latch, injury [to the nipple], and post-feed behavior). Internal consistency and reliability of the scores in these concepts were acceptable (Cronbach's alpha ≥ 0.087 for all measures). A logistic regression model that controlled for infant age, with a breastfeeding dysfunction risk classification threshold of 60%, yielded a correct classification of 88.7%, with 93.1% sensitivity, 64.6% specificity, and a 6.5% false positive rate.
CONCLUSIONS
The FLIP score was determined to be a valid and reliable instrument for quantifying the severity of breastfeeding dysfunction in children under 1 year old. Further studies will assess its usefulness in the management of breastfeeding dysfunction.
Topics: Infant; Female; Child; Humans; Breast Feeding; Lingual Frenum; Cross-Sectional Studies; Reproducibility of Results; Treatment Outcome
PubMed: 38037896
DOI: 10.1177/08903344231209306 -
IEEE Journal of Translational... 2024Identify infants with abnormal suckling behavior from simple non-nutritive suckling devices.
OBJECTIVE
Identify infants with abnormal suckling behavior from simple non-nutritive suckling devices.
BACKGROUND
While it is well known breastfeeding is beneficial to the health of both mothers and infants, breastfeeding ceases in 75 percent of mother-child dyads by 6 months. The current standard of care lacks objective measurements to screen infant suckling abnormalities within the first few days of life, a critical time to establish milk supply and successful breastfeeding practices.
MATERIALS AND METHODS
A non-nutritive suckling vacuum measurement system, previously developed by the authors, is used to gather data from 91 healthy full-term infants under thirty days old. Non-nutritive suckling was recorded for a duration of sixty seconds. We establish normative data for the mean suck vacuum, maximum suck vacuum, suckling frequency, burst duration, sucks per burst, and vacuum signal shape. We then apply computational methods (Mahalanobis distance, KNN) to detect anomalies in the data to identify infants with abnormal suckling. We finally provide case studies of healthy newborn infants and infants diagnosed with ankyloglossia.
RESULTS
In a series of case evaluations, we demonstrate the ability to detect abnormal suckling behavior using statistical analysis and machine learning. We evaluate cases of ankyloglossia to determine how oral dysfunction and surgical interventions affect non-nutritive suckling measurements.
CONCLUSIONS
Statistical analysis (Mahalanobis Distance) and machine learning [K nearest neighbor (KNN)] can be viable approaches to rapidly interpret infant suckling measurements. Particularly in practices using the digital suck assessment with a gloved finger, it can provide a more objective, early stage screening method to identify abnormal infant suckling vacuum. This approach for identifying those at risk for breastfeeding complications is crucial to complement complex emerging clinical evaluation technology.
CLINICAL IMPACT
By analyzing non-nutritive suckling using computational methods, we demonstrate the ability to detect abnormal and normal behavior in infant suckling that can inform breastfeeding intervention pathways in clinic.Clinical and Translational Impact Statement: The work serves to shed light on the lack of consensus for determining appropriate intervention pathways for infant oral dysfunction. We demonstrate using statistical analysis and machine learning that normal and abnormal infant suckling can be identified and used in determining if surgical intervention is a necessary solution to resolve infant feeding difficulties.
Topics: Humans; Machine Learning; Infant, Newborn; Infant; Female; Sucking Behavior; Male; Signal Processing, Computer-Assisted; Breast Feeding
PubMed: 38765888
DOI: 10.1109/JTEHM.2024.3390589 -
Breastfeeding Medicine : the Official... Nov 2023
Ankyloglossia in Monochorionic Diamniotic and Dichorionic Diamniotic Twins: A Cross-Sectional Study, by Feitosa, et al. Breastfeed Med 2023;18(7):528-533; doi: 10.1089/bfm.2022.0239.
PubMed: 37855881
DOI: 10.1089/bfm.2022.0239.correx -
Otolaryngology--head and Neck Surgery :... Jul 2023
Topics: Humans; Infant; Ankyloglossia; Tongue; Lingual Frenum
PubMed: 36373368
DOI: 10.1177/01945998221119076