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Otolaryngologic Clinics of North America Apr 2024Eosinophilic esophagitis is a male-predominant disease with presentations ranging from nonspecific feeding issues to dysphagia and food impaction. The currently proposed... (Review)
Review
Eosinophilic esophagitis is a male-predominant disease with presentations ranging from nonspecific feeding issues to dysphagia and food impaction. The currently proposed pathophysiology is a combination of genetics, allergens, and epithelial barrier impairment. Diagnosis is reliant on history, endoscopic examination, and biopsy. Recent guidelines recognize the role of concurrent gastroesophageal reflux disease. Treatment is based on 3 paradigms: diet, drugs, and dilation. Drug therapy has historically focused on topical corticosteroids; as of 2022, dupilumab was approved for targeted biologic therapy. Dilation is reserved for symptomatic and anatomic management. As this clinical entity is better understood, additional therapies will hopefully be developed.
Topics: Male; Humans; Eosinophilic Esophagitis; Otolaryngologists; Gastroesophageal Reflux; Deglutition Disorders; Enteritis; Eosinophilia; Gastritis
PubMed: 37951721
DOI: 10.1016/j.otc.2023.10.004 -
Journal of Speech, Language, and... Oct 2023Swallowing efficiency impairments are the most prevalent and earliest manifestation of dysphagia in people with amyotrophic lateral sclerosis (pALS). We aimed to profile...
PURPOSE
Swallowing efficiency impairments are the most prevalent and earliest manifestation of dysphagia in people with amyotrophic lateral sclerosis (pALS). We aimed to profile number of swallows elicited in pALS across thin liquid, moderately thick liquid, extremely thick liquid, and crackers compared to expected healthy reference data and to determine relationships between degree of pharyngeal residue, number of elicited swallows, and swallowing safety.
METHOD
pALS underwent standardized videofluoroscopic swallowing studies of 10 bolus trials. Trained raters performed duplicate, independent, and blinded ratings to derive Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) efficiency and safety grades and Analysis of Swallowing Physiology: Events, Kinematics, and Timing (ASPEKT) percent total pharyngeal residue. Number of swallows per bolus was quantified (1 = typical, 2 = atypically high, 3 = extremely high). Kruskal-Wallis, Pearson chi-square, and odds ratio analyses were performed at bolus and participant levels.
KEY RESULTS
At the bolus level ( = 2,523), number of swallows per bolus was observed to be, in rank order, as follows: atypically high (49.1%), extremely high (28.5%), and typical (22.4%). Mean number of swallows significantly differed by International Dysphagia Diet Standardisation Initiative level ( < .0001), with a higher number of swallows elicited in pALS for moderately thick versus thin liquids, extremely thick liquids, and crackers, < .0001. Number of swallows per bolus increased with increasing DIGEST efficiency grades ( < .0001). Positive correlations were observed between ASPEKT percent residue and number of swallows for thin ( = .24) and moderately thick ( = .16) liquids, < .05. DIGEST efficiency and safety grades were not significantly associated ( > .05).
CONCLUSION AND INFERENCES
pALS demonstrated a higher number of swallows per bolus compared to healthy reference data that may represent a compensation for reductions in swallowing efficiency to clear pharyngeal residue.
Topics: Humans; Deglutition Disorders; Amyotrophic Lateral Sclerosis; Deglutition; Fluoroscopy; Food; Pharynx
PubMed: 37591233
DOI: 10.1044/2023_JSLHR-23-00209 -
CNS Neuroscience & Therapeutics Mar 2024Electroacupuncture (EA) at the Lianquan (CV23) could alleviate swallowing dysfunction. However, current knowledge of its neural modulation focused on the brain, with...
AIMS
Electroacupuncture (EA) at the Lianquan (CV23) could alleviate swallowing dysfunction. However, current knowledge of its neural modulation focused on the brain, with little evidence from the periphery. Transient receptor potential channel vanilloid subfamily 1 (TRPV1) is an ion channel predominantly expressed in sensory neurons, and acupuncture can trigger calcium ion (Ca ) wave propagation through active TRPV1 to deliver signals. The present study aimed to investigate whether TRPV1 mediated the signal of EA to the primary sensory cortex (S1) during regulation of swallowing function.
METHODS
Blood perfusion was evaluated by laser speckle contrast imaging (LSCI), and neuronal activity was evaluated by fiber calcium recording and c-Fos staining. The expression of TRPV1 was detected by RNA-seq analysis, immunofluorescence, and ELISA. In addition, the swallowing function was assessed by in vivo EMG recording and water consumption test.
RESULTS
EA treatment potentiated blood perfusion and neuronal activity in the S1, and this potentiation was absent after injecting lidocaine near CV23. TRPV1 near CV23 was upregulated by EA-CV23. The blood perfusion at CV23 was decreased in the TRPV1 hypofunction mice, while the blood perfusion and the neuronal activity of the S1 showed no obvious change. These findings were also present in post-stroke dysphagia (PSD) mice.
CONCLUSION
The TRPV1 at CV23 after EA treatment might play a key role in mediating local blood perfusion but was not involved in transferring EA signals to the central nervous system (CNS). These findings collectively suggested that TRPV1 may be one of the important regulators involved in the mechanism of EA treatment for improving swallowing function in PSD.
Topics: Mice; Animals; Electroacupuncture; Deglutition; Calcium; Acupuncture Therapy; Central Nervous System; Stroke; TRPV Cation Channels; Acupuncture Points
PubMed: 37718934
DOI: 10.1111/cns.14457 -
The Laryngoscope May 2024Little is known about pharyngeal shortening (PShort) during swallowing. This observational study measured PShort during swallowing in healthy adults and compared it to... (Observational Study)
Observational Study
BACKGROUND
Little is known about pharyngeal shortening (PShort) during swallowing. This observational study measured PShort during swallowing in healthy adults and compared it to patients with swallowing impairments of different aetiologies.
METHODS
275 healthy volunteers (19-99 years) and 75 dysphagic patients (25 with head and neck cancer, 25 with Parkinson's, 25 with stroke) underwent videofluoroscopy. A novel quantitative measure of PShort for 1, 3, and 20 mL thin liquid barium and 3 mL paste boli was determined and compared across age, sex, bolus type and patient cohort.
RESULTS
PShort ranged from 1.05 to 4.41 cm across bolus types with larger displacements for 20 mL (M: 2.52 cm) and paste (M: 2.43 cm) compared with 1 mL (M: 2.36 cm) and 3 mL (M: 2.41 cm). PShort correlated with sex, height, and cohort but not age. Inter-rater reliability for three raters was substantial (intraclass correlation >0.80).
CONCLUSIONS
This novel fluoroscopic measure of PShort is reliable and demonstrates quantitative changes in vertical pharyngeal displacement in healthy and swallow-impaired adults related to sex, size, and bolus type.
LEVEL OF EVIDENCE
3 Laryngoscope, 134:2121-2126, 2024.
Topics: Adult; Humans; Reproducibility of Results; Deglutition Disorders; Deglutition; Pharynx; Fluoroscopy
PubMed: 37916781
DOI: 10.1002/lary.31149 -
The Laryngoscope Mar 2024Expiratory muscle strength training (EMST) and sensorimotor training of airway protection (smTAP) are two exercises intended to improve cough and swallowing in people... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Expiratory muscle strength training (EMST) and sensorimotor training of airway protection (smTAP) are two exercises intended to improve cough and swallowing in people with Parkinson's Disease (PwPD). The aims of this study were to (1) examine whether EMST or smTAP elicit changes to vocal fold bowing; and (2) describe the safety of EMST and smTAP as it relates to the development of vocal fold lesions.
METHOD(S)
This was a secondary analysis of data from PwPD who completed EMST or smTAP as part of a prospective randomized controlled trial. Vocal fold bowing (BI) and the presence of laryngeal lesions were blindly analyzed from flexible endoscopic evaluation of swallowing (FEES) using ImageJ software and operational definitions. Linear regression was used to examine the influence time (pre- vs. post-therapy) and therapy (EMST vs. smTAP) on vocal fold bowing. Descriptive statistics were used to describe the presence of laryngeal lesions.
RESULT(S)
Overall, 56 participants were included, 28 per group. The median BI scores pre- and post-therapy were 8.2% and 8.3% for the EMST group and 11.3% and 8.4% for the smTAP group, respectively. Statistical analyses revealed insufficient evidence to suggest an effect of time and treatment type on BI (p > 0.05) or on the presence of vocal fold lesions (p > 0.05).
CONCLUSION
Based on these and previous findings, it appears that changes in vocal fold bowing do not drive treatment effects following EMST and smTAP. Also, this study further supports the safety of smTAP and EMST despite the required forceful exhalation and repetitive coughing.
LEVEL OF EVIDENCE
4 Laryngoscope, 134:1127-1132, 2024.
Topics: Humans; Vocal Cords; Deglutition; Prospective Studies; Deglutition Disorders; Cough
PubMed: 37497803
DOI: 10.1002/lary.30922 -
Journal of Speech, Language, and... Sep 2023Despite co-occurrence of swallowing and speech disorders in childhood, there is limited research on shared and separate neuromuscular underpinnings of these functions....
PURPOSE
Despite co-occurrence of swallowing and speech disorders in childhood, there is limited research on shared and separate neuromuscular underpinnings of these functions. The purpose of this study was to (a) compare neuromuscular control of swallowing and speech between younger and older children and (b) determine similarities and differences in neuromuscular control of swallowing and speech.
METHOD
Twenty-six typically developing children (thirteen 7- to 8-year-olds and thirteen 11- to 12-year-olds) completed this cross-sectional study. Neuromuscular control was evaluated using surface electromyography of submental muscles and superior and inferior orbicularis oris muscles during parallel tasks of swallowing and speech. Outcome measures included normalized mean amplitude, burst duration, time to peak amplitude, and bilateral synchrony, which were examined using mixed-effects models.
RESULTS
For normalized mean amplitude, burst duration, and time to peak amplitude, there were significant two- and three-way interactions between muscle group, task, and age group, indicating that older and younger children demonstrated different muscle activation patterns, and these patterns varied by muscle and task. No differences were noted between groups for bilateral synchrony. For parallel tasks, children demonstrated different magnitudes of normalized mean amplitude and time to peak amplitude of speech and swallowing. However, they demonstrated a similar pattern: increases in magnitude as task complexity increased.
CONCLUSIONS
Children continue to demonstrate refinement of their neuromuscular control of swallowing and speech between 7-8 and 11-12 years of age, and there are both shared and separate elements of neuromuscular control between these two vital functions. To improve generalizability of findings, future research should include longitudinal analysis of swallowing and speech development, as well as measures of central neurophysiology.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.23796258.
Topics: Child; Humans; Adolescent; Deglutition; Speech; Cross-Sectional Studies; Electromyography; Speech Disorders
PubMed: 37549377
DOI: 10.1044/2023_JSLHR-23-00059 -
CoDAS 2023To synthesize the scientific knowledge on which measurements of hyoid bone movement during swallowing are obtained by ultrasonography and how to extract these measures. (Review)
Review
PURPOSE
To synthesize the scientific knowledge on which measurements of hyoid bone movement during swallowing are obtained by ultrasonography and how to extract these measures.
RESEARCH STRATEGIES
The PECO question and combinations of descriptors and keywords were formulated in the electronic databases Medline/PubMed, EMBASE, Web of Science, Scopus and Lilacs.
SELECTION CRITERIA
Articles that used ultrasonography to analyze measurements of hyoid bone movement during swallowing were included, regardless of language, year of publication, or presence of deglutition disorders.
DATA ANALYSIS
The included articles were analyzed for: year, study site, study design, population, sample size, equipment used, transducer positioning, measurements obtained, method of extraction, and reliability of measurements.
RESULTS
Twenty-six articles met the eligibility criteria. The most frequent measurement was hyoid movement maximum amplitude, followed by time and velocity. There was great variability in the study population, equipment used, positioning of the transducer and method of extraction of the measurements. Thus, it was not possible to find a standard model to extract the measures. The level of reliability was investigated in only eight articles.
CONCLUSION
Amplitude, time and velocity are the measures of hyoid bone movement during swallowing that can be obtained by ultrasonography. There is no standardization on how to extract these measurements.
Topics: Humans; Deglutition; Hyoid Bone; Reproducibility of Results; Movement; Deglutition Disorders; Ultrasonography
PubMed: 37466503
DOI: 10.1590/2317-1782/20232022002pt -
Journal of Oral Rehabilitation Oct 2023With the ageing process changes in the musculature of oro-facial structures take place, consequently there is a reduction in the strength and mobility of the lips,... (Observational Study)
Observational Study
BACKGROUND
With the ageing process changes in the musculature of oro-facial structures take place, consequently there is a reduction in the strength and mobility of the lips, tongue and cheeks.
OBJECTIVE
The aim of this study was to correlate oro-facial structures and chewing and swallowing functions among a group of senior citizens and young adults and check the influence of lip and tongue pressure of these functions.
METHODS
This is an observational, cross-sectional and analytical study. Thirty seniors with an average age of 67.13 years and 30 young adults with an average age of 22.03 years participated in the study. The Oro-facial Myofunctional Assessment Protocol with Scores for the Elderly and the Oro-facial Myofunctional Assessment Protocol with Expanded Scores were also used. The evaluation of the force of pressure of the lips and tip and dorsum of the tongue was carried out using the Biofeedback device Pró-Fono: Lip and Tongue Pressure.
RESULTS
Young adults had a higher evaluation score for the aspect/posture of the face, cheeks, lips, mentalis muscle, tongue, mobility of lips, tongue, jaw and cheeks, chewing and swallowing functions, total time and chewing strokes, and tip pressure and dorsum of tongue. According to the Structural Equation Modelling, a direct relationship was found between the tongue dorsum pressure force and the swallowing function.
CONCLUSION
With healthy ageing changes occurring in the appearance, posture and mobility of the lips, tongue, jaw and cheeks, with the seniors and reduced performance of chewing and swallowing functions.
Topics: Young Adult; Humans; Aged; Adult; Tongue; Lip; Cross-Sectional Studies; Pressure; Deglutition; Mastication
PubMed: 37282365
DOI: 10.1111/joor.13531 -
Revista Da Associacao Medica Brasileira... 2023This study investigated the efficacy of kinesiology taping application in premature infants with dysphagia. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study investigated the efficacy of kinesiology taping application in premature infants with dysphagia.
METHODS
A total of 60 premature newborns (born ≤37weeks' gestational age who reached the age ≥34 weeks of postmenstrual age) with sucking and swallowing problems were randomly assigned to the kinesiology taping group [n=31; 18 males, 13 females; mean postmenstrual age 35.4 weeks (SD 0.9 weeks, range 34-38 weeks)] or control group without kinesiology taping application [n=29; 16 males, 13 females; mean postmenstrual age age 35.6 weeks (SD 1.4 weeks, range 34-40 weeks)].
RESULTS
Kinesiology taping group yielded significant improvement in the oral reflexes (p<0.001) and in the sucking functions including tongue movement, sucking power, number of sucks and sucking pause, maintenance of alertness, jaw movement, tongue cupping, and maintenance of rhythm (p<0.001, p=0.011, p=0.002, and p=0.001, respectively). There was a significant difference in favor of the taping group with respect to the number of neonates whose feeding improved (26 (84%) vs. 7 (24%), p<0.001).
CONCLUSION
The results of this study show that kinesiology taping can be applied as a safe and effective method to improve feeding functions in premature infants with sucking and swallowing difficulties.
Topics: Male; Infant; Female; Humans; Infant, Newborn; Deglutition Disorders; Deglutition; Pilot Projects; Infant, Premature; Gestational Age
PubMed: 37820176
DOI: 10.1590/1806-9282.20230383 -
Journal of Oral Rehabilitation Dec 2023Dysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety...
BACKGROUND
Dysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety and increase the risk of pulmonary aspiration.
OBJECTIVE
To verify the relationship between tongue pressure and airway protection in PD patients: (1) comparing tongue pressure measures and physiological events in the pharyngeal phase of swallowing between PD and controls and (2) analysing the association between tongue pressure and LVC in the PD group.
METHODS
Twenty-three patients with idiopathic PD (64.9 years) and 24 healthy controls (64.1 years) participated in this study. All participants underwent the following procedures to verify tongue pressure measurements using the Iowa Oral Performance Instrument: maximum anterior and posterior pressure, isotonic and isometric tongue endurance and anterior and posterior tongue pressure during saliva swallowing. To verify swallowing safety, videofluoroscopic swallowing studies focusing on the pharyngeal phase were performed based on the MBSImP protocol.
RESULTS
Compared to healthy controls, PD exhibited a statistically significant decline in tongue pressure tasks: posterior maximum pressure, isotonic endurance, anterior and posterior isometric endurance and tongue pressure during posterior swallowing. Patients with PD had worse pharyngeal scores, including LVC scores, than controls. PD and incomplete LVC had lower anterior isometric endurance scores when compared to those with complete LVC.
CONCLUSION
PD with incomplete LVC scored lower in the anterior isometric endurance task. We observed a potential clinical use of this task for the assessment and management of dysphagia in patients with PD.
Topics: Humans; Deglutition Disorders; Tongue; Parkinson Disease; Pressure; Deglutition
PubMed: 37605286
DOI: 10.1111/joor.13568