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Revista Da Associacao Medica Brasileira... 2024
Topics: Humans; Deglutition Disorders; Aged; Hospitalization; Deglutition; Inpatients
PubMed: 38716948
DOI: 10.1590/1806-9282.20231403 -
American Journal of Speech-language... May 2024This study aimed to determine if cervical bracing with a PMT collar increases risk of airway invasion and pharyngeal residue in elderly patients with dysphagia....
PURPOSE
This study aimed to determine if cervical bracing with a PMT collar increases risk of airway invasion and pharyngeal residue in elderly patients with dysphagia. Additionally, it aimed to identify patient preference for cervical bracing during deglutition.
METHOD
Twenty-one patients underwent a videofluoroscopic swallow study. Thin liquid, nectar thick liquid, pudding, and cracker were administered with cervical collar on and off with order of condition randomized. The Penetration-Aspiration Scale (PAS) was used to grade swallows, with McNemar's test of symmetry used to determine whether the categorical PAS score was similar between conditions. Pharyngeal residue was measured following swallows. Patients were asked which condition they preferred, and which was more comfortable with "no difference" being a selection.
RESULTS
No significant difference in PAS categorization score was measured for any consistency ( = .317-.919). Significantly more pyriform sinus residue was measured in the collar off condition ( = .003), albeit amounts were within normative range, with no difference measured in vallecula residue between conditions ( = .939). Forty-five percent of participants preferred to swallow with the collar off, while 55% indicated no preference. Forty-one percent of participants indicated increased comfort with collar off, while 59% indicated no difference in comfort. No participant preferred swallowing or indicated increased comfort with the collar on.
CONCLUSIONS
Presence of a cervical collar in elderly patients with dysphagia did not result in a significant difference in airway invasion or total pharyngeal residue. There was significantly more residue in the pyriform sinuses when cervical bracing was removed. The majority of patients did not indicate a difference in preference or comfort between collar on/off conditions.
PubMed: 38713804
DOI: 10.1044/2024_AJSLP-23-00394 -
Journal of Reconstructive Microsurgery Jun 2024Speech restoration is important for communication and social activities after pharyngolaryngectomy in head and neck cancer or corrosive injury. Several techniques of...
BACKGROUND
Speech restoration is important for communication and social activities after pharyngolaryngectomy in head and neck cancer or corrosive injury. Several techniques of voice restoration have been developed to improve life quality. The aim of this paper was to focus on the microsurgical transfer of ileocolon flap and outcome of further voice rehabilitation.
PATIENTS AND METHODS
From 2010 to 2022, 69 patients had ileocolon flap at our hospital with postoperative speech training and regular follow-up for over 1 year. The patients received deglutition training first, followed by voice rehabilitation. Voice outcomes were evaluated at an interval of 3 months and finally at 12 months of voice training rehabilitation. Among other examinations, the speech function was evaluated using a 4-point Likert scale and senior surgeon (H-c.C.) scoring system.
RESULTS
The results showed that speech function reached 13.1% of excellent voice, 65.1% of good voice, 13.1% of fair result, and 8.7% of poor result by Likert scales. Meanwhile, the senior surgeon (H-c.C.) score showed 17.4% of excellent, 63.8% of moderate, and 18.8% of poor results. About voice laboratory results, maximal phonation time was 11.0 seconds, and the average number counted in one breath was 15. Loudness and frequency showed 56.0 dB and 105.0 Hz, respectively.
CONCLUSION
The study showed that after voice reconstruction with ileocolon flap followed by the voice rehabilitation program, the patients would have a better understanding of the altered anatomical structures and practice in a more efficient way. Adequate recommendation by the therapists to plastic surgeons for revision surgeries optimized voice function of the patients.
PubMed: 38710224
DOI: 10.1055/a-2320-5029 -
JAMA Internal Medicine Jul 2024
Topics: Humans; Deglutition Disorders; Dementia
PubMed: 38709517
DOI: 10.1001/jamainternmed.2024.0733 -
JAMA Internal Medicine Jul 2024Oropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with...
IMPORTANCE
Oropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes.
OBJECTIVES
To determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium).
MAIN OUTCOMES AND MEASURES
Hospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS).
RESULTS
Of 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91).
CONCLUSIONS AND RELEVANCE
This cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.
Topics: Humans; Deglutition Disorders; Female; Male; Alzheimer Disease; Aged; Aged, 80 and over; Hospitalization; Hospital Mortality; Dementia; Cohort Studies; Length of Stay; Diet
PubMed: 38709510
DOI: 10.1001/jamainternmed.2024.0736 -
Esophagus : Official Journal of the... Jul 2024After laparoscopic fundoplication, 10-20% of patients experience symptom recurrence-often due to resurgence of the hiatal hernia. The standard surgical treatment for...
BACKGROUND
After laparoscopic fundoplication, 10-20% of patients experience symptom recurrence-often due to resurgence of the hiatal hernia. The standard surgical treatment for such cases remains laparoscopic revision fundoplication. However, there is little data on the time frame and anatomic patterns of failed fundoplications. Additionally, few large studies exist on the long-term efficacy and safety of laparoscopic revision fundoplication.
METHODS
In a single-center, retrospective analysis of 194 consecutive revision fundoplications for recurrent reflux disease due to hiatal hernia, we collected data on time to failure and patterns of failure of the primary operation, as well as on the efficacy and safety of the revision.
RESULTS
The median time to failure of the primary fundoplication was 3 years. Most hiatal defects were smaller than 5 cm and located anteriorly or concentric around the esophagus. Laparoscopic redo fundoplication was technically successful in all cases. The short-term complication rate was 9%, mainly dysphagia requiring endoscopic intervention. At a mean follow-up of 4.7 years, 77% of patients were symptom-free, 14% required daily PPI, and 9% underwent secondary revision. Cumulative failure rates were 9%, 23%, and 31% at 1, 5, and 10 years.
CONCLUSION
The majority of failed fundoplications occur within 3 years of primary surgery, with most patients exhibiting anterior or concentric defects. For these patients, laparoscopic revision fundoplication is a safe procedure with a low rate of short-term complications and satisfactory long-term results.
Topics: Humans; Hernia, Hiatal; Fundoplication; Retrospective Studies; Reoperation; Male; Female; Laparoscopy; Middle Aged; Recurrence; Gastroesophageal Reflux; Aged; Adult; Postoperative Complications; Follow-Up Studies; Treatment Failure; Treatment Outcome; Deglutition Disorders; Time Factors; Aged, 80 and over
PubMed: 38709415
DOI: 10.1007/s10388-024-01060-0 -
Fujita Medical Journal May 2024In the present study, we performed a detailed analysis of deglutitive dynamics during sleep in patients with obstructive sleep apnea (OSA) using a methodology developed...
OBJECTIVES
In the present study, we performed a detailed analysis of deglutitive dynamics during sleep in patients with obstructive sleep apnea (OSA) using a methodology developed by Sato et al. We hypothesized that the frequency of deglutition would decrease with increasing severity of OSA. The aim of this study is to clarify the involvement of deglutitive dynamics during sleep in OSA by investigating the correlations between deglutition and sleep parameters.
METHODS
This study included 30 adult patients with OSA. To analyze deglutition dynamics during sleep, surface electromyography recordings of the suprahyoid and thyrohyoid neck muscles, which are involved in deglutition, were performed simultaneous with conventional polysomnography. The "index of deglutition" was defined as the frequency of deglutition per hour of sleep. We examined correlations between this index and sleep parameters (apnea-hypopnea index [AHI], apnea index, hypopnea index, and lowest blood oxygen saturation).
RESULTS
By analyzing the obtained polysomnography and electromyography waveforms, we identified two deglutition patterns with and without respiratory arousal during sleep. We found a significant negative correlation between the index of deglutition in sleep stage 1 and the AHI, with a correlation coefficient of -0.48. (p=0.02).
CONCLUSIONS
In the current study, we distinguished deglutition during sleep with and without arousal. In addition we discovered a significant negative correlation between the index of deglutition in sleep stage 1 and the AHI. This new finding will provide a platform for future research on OSA in aspiration pneumonia.
PubMed: 38708078
DOI: 10.20407/fmj.2023-010 -
Otolaryngologic Clinics of North America Aug 2024
Topics: Humans; Child; Adult; Deglutition; Deglutition Disorders
PubMed: 38705742
DOI: 10.1016/j.otc.2024.04.004 -
American Journal of Otolaryngology 2024TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to...
OBJECTIVE
TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to TORS, this study explores both subjective and objective swallowing outcomes.
STUDY DESIGN
Retrospective and prospective review of the patients who underwent TORS for oropharyngeal malignancy from 2018 to 2023.
SETTING
Single tertiary referral center.
METHODS
Postoperative transnasal feeding tubes were administered to 142 patients undergoing TORS. Data on oncological, clinical, surgical, and pathological parameters, including VFSS records, pain with swallow, and feeding tube removal timing, were collected. Clinical swallow exam (CSE) was conducted on POD-1, with a formal swallow study pursued if inconclusive. Once a safe swallow was confirmed, oral diets were initiated, and the feeding tube removed, with most patients discharged on POD-2.
RESULTS
At an average age of 59.3 years on the day of operation, the palatine tonsil (N = 101) was the predominant subsite. A dobhoff feeding tube was intraoperatively placed in 98 % of patients (N = 139). On POD-1, CSE was conducted in 119 patients, with 26 % (37/119) cleared for total oral diet (NOMS ≥ 4). Additionally, 30 out of 73 VFSS patients were cleared for total oral diet. A total of 54.9 % (78/142) had the feeding tube removed before discharge on POD-2, with a mean time of 6.5 ± 6.6 days. Overall, 71.1 % (101/142) achieved a total oral diet within one week after TORS.
CONCLUSION
Early post-TORS swallowing is vital for oropharyngeal malignancies. VFSS assesses post-operative swallowing safety, allowing most patients to resume total oral nutrition shortly after TORS.
Topics: Humans; Oropharyngeal Neoplasms; Middle Aged; Male; Female; Deglutition Disorders; Retrospective Studies; Prospective Studies; Aged; Deglutition; Fluoroscopy; Enteral Nutrition; Postoperative Complications; Minimally Invasive Surgical Procedures; Video Recording; Adult
PubMed: 38704947
DOI: 10.1016/j.amjoto.2024.104336 -
Brain and Behavior May 2024There have been multiple reports about the occurrence of dysphagia after the contraction of coronavirus disease 2019 (COVID-19). However, a detailed pathology and...
BACKGROUND
There have been multiple reports about the occurrence of dysphagia after the contraction of coronavirus disease 2019 (COVID-19). However, a detailed pathology and epidemiologic relation between COVID-19 infection and dysphagia have yet to be established. Here, we report three cases of unexplained dysphagia after COVID-19 diagnosis, with atypical clinical presentations.
CASE REPORT
All patients showed severe isolated lower cranial nerve involvement with dysphagia and aspiration, which required full tube feeding but showed no evidence of limb weakness or sensory symptoms. All tested positive for anti-ganglioside antibody tests, which all commonly (GD1b, GM1, and GQ1b) are known to have terminal NeuNAc(α2-3)Gal epitope.
DISCUSSION
We report a series of cases featuring severe, isolated dysphagia post-COVID-19 infection, concomitant with positive anti-ganglioside antibodies. One potential etiology is a variant of Guillain-Barré syndrome. Because only isolated dysphagia with sparing of the facial and extraocular muscles was evident in these cases, we explore the association between anti-ganglioside antibodies specific to NeuNAc(α2-3)Gal, which has been frequently associated with the development of bulbar dysfunction. Given that NeuNAc(α2-3)Gal exhibits an affinity for the spike glycoprotein of SARS-CoV-2, a cross-reaction against NeuNAc(α2-3)Gal may possibly contribute to isolated dysphagia following COVID-19 infection.
Topics: Aged; Female; Humans; Male; Autoantibodies; COVID-19; Deglutition Disorders; Gangliosides; Guillain-Barre Syndrome; SARS-CoV-2; Aged, 80 and over
PubMed: 38698593
DOI: 10.1002/brb3.3514