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Primary Care Sep 2023Dysphagia is an important clinical symptom that increases in prevalence with age. Both oropharyngeal and esophageal processes can contribute to dysphagia, and these can... (Review)
Review
Dysphagia is an important clinical symptom that increases in prevalence with age. Both oropharyngeal and esophageal processes can contribute to dysphagia, and these can be differentiated with a careful history. Neuromuscular processes are more prevalent than structural causes in oropharyngeal dysphagia, therefore, investigation should start with a modified barium swallow. In contrast, structural processes dominate in esophageal dysphagia, and endoscopy can offer biopsy and therapy by way of dilation. Manometry is performed for esophageal dysphagia when no structural etiology is found. Specific management of dysphagia is dependent on the etiology and mechanism of dysphagia.
Topics: Humans; Deglutition Disorders; Biopsy; Manometry
PubMed: 37516505
DOI: 10.1016/j.pop.2023.03.001 -
JPMA. the Journal of the Pakistan... Aug 2023Dysphagia is a medical condition that makes it difficult for a person to eat or swallow. It is estimated that 590 million people worldwide have dysphagia. The causes are... (Review)
Review
Dysphagia is a medical condition that makes it difficult for a person to eat or swallow. It is estimated that 590 million people worldwide have dysphagia. The causes are varied and include neurological disorders like stroke and motor neuron disease, head and neck cancer, neuromuscular diseases, inflammatory diseases such as dermatomyositis, dementia, cervical spinal cord injury, and anterior vertebral ossification. The assessment and screening of dysphagia consists of a questionnaire-based interview, mealtime observation, and, if deemed necessary by a screening test or instrumental examination by specialists. Treatment is based on the diagnosis, patients' cognition and information gathered by screening and clinical evaluation. Patient's function can be improved only when treatment is comprehensive and includes compensatory feeding using an adjusted swallowing diet, compensatory posture adjustment, and nutritional improvement. We present a brief overview of the assessment and management strategies for dysphagia.
Topics: Humans; Cognition; Deglutition; Deglutition Disorders; Medicine; Posture
PubMed: 37697781
DOI: 10.47391/JPMA.23-61 -
MMW Fortschritte Der Medizin Feb 2024
Topics: Humans; Deglutition; Pharyngitis
PubMed: 38332261
DOI: 10.1007/s15006-023-3539-y -
The British Journal of Radiology Sep 2023The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who... (Review)
Review
The pharynx plays a significant role in swallowing and speech, and this is reflected in both its complex anatomy and degree of physiological motility. Patients who present with pharynx-related symptoms such as sore throat, globus, dysphagia or dysphonia will usually undergo visual and nasal endoscopic examination in the first instance. Imaging is frequently required to supplement clinical assessment and this typically involves MRI and CT. However, fluoroscopy, ultrasound and radionuclide imaging are valuable in certain clinical situations. The aforementioned complexity of the pharynx and the myriad of pathologies which may arise within it often make radiological evaluation challenging. In this pictorial review, we aim to provide a brief overview of cross-sectional pharyngeal anatomy and present the radiological features of a variety of pharyngeal pathologies, both benign and malignant.
Topics: Humans; Pharynx; Cross-Sectional Studies; Deglutition Disorders; Deglutition; Fluoroscopy
PubMed: 37334795
DOI: 10.1259/bjr.20230046 -
Revista de Gastroenterologia de Mexico... 2023
Topics: Humans; Deglutition Disorders; Tomography, X-Ray Computed
PubMed: 38030418
DOI: 10.1016/j.rgmxen.2023.07.004 -
Critical Care (London, England) Jul 2023The resumption of oral feeding and free from pneumonia are important therapeutic goals for critically ill patients who have been successfully extubated after prolonged... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial.
BACKGROUND
The resumption of oral feeding and free from pneumonia are important therapeutic goals for critically ill patients who have been successfully extubated after prolonged (≥ 48 h) endotracheal intubation. We aimed to examine whether a swallowing and oral-care (SOC) program provided to critically ill patients extubated from prolonged mechanical ventilation improves their oral-feeding resumption and reduces 30-day pneumonia incidence.
METHODS
In this randomized, open-label, controlled trial, participants were consecutively enrolled and randomized to receive the SOC program or usual care. The interventions comprised three protocols: oral-motor exercise, sensory stimulation and lubrication, and safe-swallowing education. Beginning on the day following patient extubation, an SOC nurse provided the three-protocol care for seven consecutive days or until death or hospital discharge. With independent outcome assessors, oral-feeding resumption (yes, no) corresponded to level 6 or level 7 on the Functional Oral Intake Scale (censored seven days postextubation) along with radiographically documented pneumonia (yes, no; censored 30 days postextubation), abstracted from participants' electronic medical records were coded.
RESULTS
We analyzed 145 randomized participants (SOC group = 72, control group = 73). The SOC group received, on average, 6.2 days of intervention (14.8 min daily) with no reported adverse events. By day 7, 37/72 (51.4%) of the SOC participants had resumed oral feeding vs. 24/73 (32.9%) of the control participants. Pneumonia occurred in 11/72 (15.3%) of the SOC participants and in 26/73 (35.6%) of the control participants. Independent of age and intubation longer than 6 days, SOC participants were likelier than their control counterparts to resume oral feeding (adjusted hazard ratio, 2.35; 95% CI 1.38-4.01) and had lower odds of developing pneumonia (adjusted odds ratio, 0.28; 95% CI 0.12-0.65).
CONCLUSIONS
The SOC program effectively improved patients' odds that oral feeding would resume and the 30-day pneumonia incidence would decline. The program might advance dysphagia care provided to critically ill patients extubated from prolonged mechanical ventilation.
TRIAL REGISTRATION
NCT03284892, registered on September 15, 2017.
Topics: Humans; Deglutition; Airway Extubation; Critical Illness; Deglutition Disorders; Pneumonia
PubMed: 37438759
DOI: 10.1186/s13054-023-04568-6 -
European Archives of... Jun 2024To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce... (Review)
Review
PURPOSE
To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce the risk of aspiration without sacrificing vocal function.
METHODS
We searched the PubMed database and used Google Scholar search engine to find studies discussing the different swallowing improvement surgeries. A manual search of references in selected articles and reviews was done as well. No chronologic limitation was set for the studies; however, only articles written in English and Japanese were considered. Due to the nature of this article, no particular inclusion or exclusion criteria were set when searching for studies to be used as references; however, all relevant studies were reviewed and agreed upon by the authors for inclusion in this review article.
RESULTS/DISCUSSION
Surgeries to improve swallowing function can be categorized into those that reinforce nasopharyngeal closure or pharyngeal contraction, improve laryngeal elevation or pharyngoesophageal segment opening, and those that improve vocal fold closure to protect the airway during swallowing. They are an effective alternative treatment that may significantly improve these patients' quality of life. Swallowing rehabilitation with the altered pharyngolaryngeal structures is required post-operatively to significantly improve patients' dysphagia.
CONCLUSIONS
Surgeries to improve swallowing function address specific dysfunctional sites involved in the swallowing mechanism. Choosing the most appropriate surgery for each patient requires knowledge of the pathophysiology for their dysphagia and detailed pre-operative work-up.
Topics: Humans; Deglutition; Deglutition Disorders; Larynx; Otorhinolaryngologic Surgical Procedures; Pharynx
PubMed: 38265461
DOI: 10.1007/s00405-024-08452-z -
Der Nervenarzt Aug 2023
Topics: Humans; Deglutition Disorders; Deglutition
PubMed: 37550472
DOI: 10.1007/s00115-023-01494-4 -
International Journal of Nursing Studies Feb 2024Although swallowing exercises are a fundamental treatment for dysphagia, few studies have evaluated the effectiveness of swallowing training in patients with Alzheimer's... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although swallowing exercises are a fundamental treatment for dysphagia, few studies have evaluated the effectiveness of swallowing training in patients with Alzheimer's disease.
METHODS
We recruited 93 patients with Alzheimer's disease from three hospitals in Guangdong, China. This was a parallel armed randomized controlled trial that randomly assigned patients to intervention (n = 48) and control (n = 45) groups. The intervention group adopted systematic stepwise swallowing training for four weeks based on routine dysphagia care. The control group implemented routine dysphagia care, including diet and posture management and health education about swallowing dysfunction. The swallowing function was the primary outcome, which was assessed using the Water Swallowing Test and Standard Swallowing Assessment. An abnormal eating behavior questionnaire was used to assess the incidence of aberrant eating behavior in patients with Alzheimer's disease. The Mini-Nutritional Assessment Short Form and Barthel index were adopted to evaluate the nutritional status and ability to carry out daily activities between groups. SPSS software was used to perform the chi-square test, t-test, and generalized estimation equation for data analysis.
RESULTS
We analyzed the effects of the stepwise swallowing training program using the generalized estimating equation method. The intervention group exhibited greater improvements in their swallowing function (Water Swallowing Test: β = -3.133, 95 % CI: -4.113, -2.154, P < 0.001; Standard Swallowing Assessment: β = -5.813, 95 % CI: -7.782, -3.844, P < 0.001), abnormal eating behaviors (abnormal eating behavior questionnaire: β = -13.324, 95 % CI: -21.643, -5.005, P = 0.002), daily function (Barthel index: β = 11.280, 95 % CI: 4.021, 18.540, P = 0.002), and nutritional status (Mini-Nutritional Assessment Short Form: β = 2.402, 95 % CI: 1.313, 3.490, P < 0.001) over time than the routine-care group in the fourth week.
CONCLUSIONS
Stepwise swallowing training is a safe and effective intervention for managing dysphagia and other related symptoms in patients with Alzheimer's disease.
Topics: Humans; Deglutition; Deglutition Disorders; Alzheimer Disease; Nutritional Status; Water
PubMed: 38070229
DOI: 10.1016/j.ijnurstu.2023.104649 -
Der Nervenarzt Aug 2023Post-stroke dysphagia is highly prevalent and leads to severe complications, such as aspiration pneumonia and malnutrition. Despite the high clinical relevance dysphagia... (Review)
Review
BACKGROUND
Post-stroke dysphagia is highly prevalent and leads to severe complications, such as aspiration pneumonia and malnutrition. Despite the high clinical relevance dysphagia management is heterogeneous and often inadequate.
OBJECTIVE
The aim of this review article is to provide an overview of the diagnostic and treatment strategies for post-stroke dysphagia based on recent studies.
MATERIAL AND METHODS
Narrative literature review.
RESULTS
Dysphagia screening should be performed as early as possible in every stroke patient, e.g., with a simple water swallowing test or a multiconsistency protocol. Subsequently, flexible endoscopic evaluation of swallowing (FEES) is indicated in patients with abnormal screening results or existing risk factors for dysphagia. Dietary modifications, oral hygiene measures, and nutritional therapy can help reduce complications. Behavioral swallowing therapy or experimental therapies, such as neurostimulation procedures and pharmacological approaches aim to improve swallowing function and have shown promising results in studies.
CONCLUSION
Timely management of dysphagia is necessary to reduce complications.
Topics: Humans; Deglutition Disorders; Stroke; Deglutition; Pneumonia, Aspiration; Risk Factors
PubMed: 37160432
DOI: 10.1007/s00115-023-01483-7