RESUMO
OBJECTIVE: To compare awake endoscopy with Müller's maneuver (MM) during both sitting and supine positions, with drug-induced sleep endoscopy (DISE) as regard determination of different levels, patterns, and degrees of collapse of the upper airway in adult patients with obstructive sleep apnea (OSA). METHODS: The study included adult patients with OSA symptoms, who had apnea hypopnea index (AHI) > 15. Patients were examined by MM in a sitting position, then during supine position; DISE then followed. Site, pattern, and degree of obstruction were assessed by experienced examiners according to the nose oropharynx hypopharynx and larynx classification. RESULTS: Eighty-one adult subjects were included. The most common pattern of collapse at the retro-palatal level was the concentric pattern, while the predominant pattern at the hypopharyngeal level was the lateral wall collapse. The analysis of the pattern of collapse of the study group revealed that the individual pattern did not change (for the same patient at the same level) in the majority of patients whatever the maneuver or the position. CONCLUSION: This study demonstrates the feasibility of positional awake endoscopy for providing valuable surgical information as regard level, pattern, and degree of severity in OSA. The data of positional awake endoscopy were comparable to those gained from DISE with less morbidity and costs. The idea and results of this work provide a useful foundation for future research in this area. Multicenter studies are encouraged to obtain more reliable conclusions and more clear standards aiming at a better surgical planning. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2269-2274, 2020.
Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Endoscopia/métodos , Posicionamento do Paciente/métodos , Apneia Obstrutiva do Sono/diagnóstico , Vigília/fisiologia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Hipofaringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Orofaringe/fisiopatologia , Palato/fisiopatologia , Estudos Prospectivos , Postura Sentada , Sono , Medicamentos Indutores do Sono/administração & dosagem , Decúbito Dorsal/fisiologia , Adulto JovemRESUMO
The objectives of this study are to investigate swallowing and its coordination with respiration in patients with obstructive sleep apnea (OSA). This is a prospective cohort study conducted in a tertiary referred Medical Center. A non-invasive method of assessing swallowing was used to detect the oropharyngeal swallowing parameters and the coordination with respiration during swallowing. The system used to assess swallowing detected: (1) movement of the larynx using a force-sensing resistor; (2) submental muscle activity using surface electromyography; and (3) coordination with respiration by measuring nasal airflow. Five sizes of water boluses (maximum 20 mL) were swallowed three times, and the data recorded and analyzed for each participant. Thirty-nine normal controls and 35 patients with OSA who fulfilled the inclusion criteria were recruited. The oropharyngeal swallowing parameters of the patients differed from the controls, including longer total excursion duration and shorter duration of submental muscles contraction. A longer swallowing respiratory pause (SRP), temporary coordination with respiration during swallowing, was demonstrated in the patients compared with the controls. The frequency of non-expiratory/expiratory pre- and postswallowing respiratory phase patterns of the patients was similar with the controls. There was significantly more piecemeal deglutition in OSA patients when clumping 10- and 20-mL water boluses swallowing together (p = 0.048). Oropharyngeal swallowing and coordination with respiration affected patients with OSA, and it could be detected using a non-invasive method. The results of this study may serve as a baseline for further research and help advance research methods in obstructive sleep apnea swallowing studies.
Assuntos
Deglutição/fisiologia , Eletromiografia/métodos , Orofaringe/fisiopatologia , Respiração , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , Estudos de Casos e Controles , Humanos , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contração Muscular , Estudos ProspectivosRESUMO
PURPOSE: Interstitial radiofrequency (RF) surgery of the soft palate (SP) is an established option in the treatment of habitual snoring. The decision-making process in the management of habitual snoring would benefit from diagnostic guidelines for oropharyngeal findings. Our aim was to investigate the correlation of systematic clinical pretreatment oropharyngeal examination scores with the efficacy of interstitial RF surgery of SP in a multi-center study. METHODS: Seventy-four patients (58 (78%) males and 16 (22%) females) with the median age of 42 years (range, 23-64), pre-treatment BMI of 25.6 kg/m(2) (range, 20.0-28.0), and preoperative AHI of three events/h (range, 0-10), received a single session of RF surgery. Thirty-two, five, 16, and 21 patients, respectively, were treated at the participating centers with a follow-up time of 13 weeks (range 12-16). The primary outcome measure was the efficacy of the treatment on snoring assessed by the patient and the bed partner with visual analog scale (VAS). RESULTS: The snoring showed a significant change demonstrating decreased snoring (VASpatpre 7 (range, 5-10) ≥VASpatpost 4.25 (range, 1-8), P < 0.001, VASbedppre 8 (range, 4-10) ≥VASbedppost 5 (range, 1-10), P < 0.001). Twenty-one patients (28.4%) experienced a successful treatment outcome. The increased grade of the uvula had a negative impact on the snoring results. CONCLUSION: Systematic clinical pretreatment oropharyngeal examination scores showed that the increasing grade of the uvula correlated significantly with the short-term post-treatment change in snoring. We suggest that patients with habitual snoring and uvula grade III should be initially treated with SP interstitial RF surgery and concomitant uvular surgery. A grading tool is proposed for oropharyngeal examination to help in the most appropriate treatment decision for each individual snoring patient.
Assuntos
Ablação por Cateter , Orofaringe/fisiopatologia , Palato Mole/fisiopatologia , Palato Mole/cirurgia , Cuidados Pré-Operatórios , Ronco/fisiopatologia , Ronco/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Resultado do Tratamento , Úvula/fisiopatologia , Úvula/cirurgia , Adulto JovemRESUMO
The SWAL-QOL outcomes tool was constructed for use in clinical research for patients with oropharyngeal dysphagia. The SWAL-QOL was constructed a priori to enable preliminary psychometric analyses of items and scales before its final validation. This article describes data analysis from a pretest of the SWAL-QOL. We evaluated the different domains of the SWAL-QOL for respondent burden, data quality, item variability, item convergent validity, internal consistency reliability as measured by Cronbach's alpha, and range and skewness of scale scores upon aggregation and floor and ceiling effects. The item reduction techniques outlined reduced the SWAL-QOL from 185 to 93 items. The pretest of the SWAL-QOL afforded us the opportunity to select items for the ongoing validation study which optimally met our a priori psychometric criteria of high data quality, normal item distributions, and robust evidence of item convergent validity.
Assuntos
Transtornos de Deglutição , Orofaringe/fisiopatologia , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Psicometria/estatística & dados numéricos , Qualidade de Vida , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
There is no evaluation of the evidence for the screening of oropharyngeal dysphagia in stroke. We reviewed the literature on clinical screening for oropharyngeal dysphagia in adults with stroke to determine (a) the accuracy of different screening tests used to detect dysphagia defined by abnormal oropharyngeal physiology on videofluoroscopy and (b) the health outcomes reported and whether screening alters those outcomes. Peer-reviewed English-language and human studies were sought through Medline (from 1966 to July 1997) by using the key words cerebrovascular disorders and deglutition disorders, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Of the 154 sources identified, 89 articles were original, peer-reviewed, and focused on oropharyngeal dysphagia in stroke patients. To evaluate the evidence, the next selection identified 10 articles on the comparison of screening and videofluoroscopic findings and three articles on screening and health outcomes. Evidence was rated according to the level of study design by using the values of the Canadian Task Force on Periodic Health Examination. From the identified screening tests, most of the screenings were related to laryngeal signs (63%) and most of the outcomes were related to physiology (74%). Evidence for screening accuracy was limited because of poor study design and the predominant use of aspiration as the diagnostic reference. Only two screening tests were identified as accurate: failure on the 50-ml water test (likelihood ratio = 5.7, 95% confidence interval = 2.5-12.9) and impaired pharyngeal sensation (likelihood ratio = 2.5, 95% confidence interval = 1.7-3.7). Limited evidence for screening benefit suggested a reduction in pneumonia, length of hospital stay, personnel costs, and patient charges. In conclusion, screening accuracy needs to be assessed by using both abnormal physiology and aspiration as diagnostic markers for dysphagia. Large well-designed trials are needed for more conclusive evidence of screening benefit.
Assuntos
Transtornos de Deglutição/diagnóstico , Programas de Rastreamento , Orofaringe/fisiopatologia , Doenças Faríngeas/diagnóstico , Acidente Vascular Cerebral/complicações , Adulto , Cinerradiografia , Deglutição/fisiologia , Fluoroscopia , Corpos Estranhos/etiologia , Preços Hospitalares , Custos Hospitalares , Humanos , Laringe/fisiopatologia , Tempo de Internação , Pneumonia Aspirativa/prevenção & controle , Guias de Prática Clínica como Assunto , Sensação/fisiologia , Resultado do TratamentoRESUMO
OBJECTIVE: Oral-pharyngo-esophageal scintigraphy (OPES) proved to be able to demonstrate the pharyngeal residue of the radioactive bolus after deglutition and the presence and amount of tracheobronchial aspiration, and to calculate exactly the transit time of the various swallowing phases. The aim of this study was to evaluate the real objective effectiveness of OPES in order to assess the degree of swallowing recovery after horizontal supraglottic laryngectomy (HSL). METHODS: Nineteen patients entered the study, and 17 healthy subjects were included as control group (group 1). Nineteen patients in whom HSL had been performed at least 1 year before underwent OPES. They were divided into two groups: 13 patients (group 2) in whom the tracheal cannula had been removed and swallowing, phonatory, and respiratory functions were satisfactory and 6 patients (group 3) in whom the tracheostomy tube was still in situ for aspiration of liquids and scarring of the laryngeal vestibule. RESULTS: Our results showed that in the patients who underwent HSL, all scintigraphic semiquantitative parameters and particularly aspiration percentage values and Pharyngeal Ritention Index (PRI) at 10 and 60 seconds were able to pinpoint some residual "subclinical" alteration and/or minimal surgical sequelae frequently observed after this kind of functional surgery, even though a substantially satisfactory recovery was achieved clinically (group 2 versus group 1). In addition, aspiration amounts in group 3 were markedly higher than those in group 2 (p < .0002), and mean PRI values at 10 and 60 seconds were significantly different (p < .0001) from normal mean control values (group 1). CONCLUSION: Oral-pharyngo-esophageal scintigraphy may be regarded as a noninvasive, well-tolerated technique, with a radiation body burden within satisfactory limits of radioprotection. It appeared to be also sensitive in assessing the swallowing recovery after HSL.
Assuntos
Deglutição/fisiologia , Esôfago/diagnóstico por imagem , Laringectomia , Orofaringe/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Esôfago/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Orofaringe/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Cintilografia , Compostos Radiofarmacêuticos , Estatísticas não Paramétricas , Coloide de Enxofre Marcado com Tecnécio Tc 99mRESUMO
OBJECTIVE: The purpose of the current report is to evaluate the ability of videoendoscopic swallowing study in assessing pharyngeal propulsion and aspiration episodes when compared with videofluoroscopy and manometry. STUDY DESIGN: Prospective study. METHODS: Thirty-four patients with oropharyngeal dysphagia underwent videoendoscopy of swallowing to assess pharyngeal propulsion as pathologic or nonpathologic, and aspiration. These features were compared with those found on manometry and videofluoroscopy, which were considered as the reference examinations. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy were estimated, with their 95% confidence intervals. RESULTS: A total agreement between videoendoscopy and videofluoroscopy was found in 76.4% of cases for pharyngeal propulsion and in 82.3% for aspiration. This rate for pharyngeal propulsion reached 82.3% between videoendoscopy and manometry. Moreover, in 24 cases (70.5%) in which videofluoroscopy and manometry agreed for pharyngeal propulsion, 22 were assessed similarly through fiberoscopy. When using fluoroscopy and manometry as reference examinations, videoendoscopy detected nearly 90% (95% confidence interval [CI] = 0.80, 1.0) of impaired pharyngeal propulsion. Concerning aspiration, 70% (95% CI = 0.54, 0.85) of events detected by videoendoscopy were also observed on videofluoroscopy. Sensitivity, specificity, and positive and negative predictive values of videoendoscopy reached a higher rate (90% to 92.8%) when agreement was found between fluoroscopy and manometry. CONCLUSIONS: Videoendoscopy is an examination that can be used to detect inexpensively pharyngeal propulsion disorders and aspiration episodes.
Assuntos
Transtornos de Deglutição/fisiopatologia , Endoscopia , Fluoroscopia , Manometria , Orofaringe/fisiopatologia , Faringe/fisiopatologia , Gravação em Vídeo , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalos de Confiança , Deglutição/fisiologia , Feminino , Corpos Estranhos/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , TraqueiaRESUMO
Neurologic and mechanical abnormalities of the oropharynx often result in oropharyngeal dysphagia. Assessment of dysphagia and its treatment has been limited largely to measurement of the biomechanical aspects of bolus flow. This article reviews the measurement tools in current use and in development for assessing oropharyngeal dysphagia in terms of the "value compass" for health services. A number of measurement needs for this clinical population are identified and discussed.
Assuntos
Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/terapia , Orofaringe , Adulto , Transtornos de Deglutição/diagnóstico , Comportamento de Ingestão de Líquido , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Estado Nutricional , Orofaringe/fisiopatologia , Satisfação do Paciente , Pneumonia Aspirativa/prevenção & controle , Qualidade de Vida , Resultado do Tratamento , WisconsinRESUMO
OBJECTIVE: To compare the cost and functional results of free and pedicled soft tissue reconstruction after posterior oral cavity and oropharyngeal extirpation. DESIGN: Retrospective study of 53 consecutive patients undergoing extirpation with primary soft tissue reconstruction from January 1, 1991, to December 31, 1995. Median follow-up was 298 days. SETTING: Academic tertiary care medical center. INTERVENTION: Twenty-four patients underwent reconstruction with a pedicled pectoralis major myocutaneous flap (PMMF); 29 patients, with a fasciocutaneous free flap (FF) (27 radial forearm, 1 lateral arm, and 1 scapular). MAIN OUTCOME MEASURES: Direct (inpatient hospital resources used and monetary costs) and intangible (post-operative complications and function) costs. RESULTS: Operative time was longer for FF reconstructions (P = .003), but both patient groups had similar intensive care unit and hospital stays. Treatment cost for FF reconstructions was $41,122, compared with $37,160 for PMMF reconstructions (P = .003). This difference was due to increased professional fees for FF reconstruction (P < .001) which was offset by intangible cost differences. The PMMF group tended toward an increased rate of flap-related complications, compared with the FF group. At last follow-up, 4 patients in the FF group (15%) and 3 in the PMMF group (15%) had their tracheotomy. In contrast, 17 (85%) patients in the PMMF group and 11 (39%) patients in the FF group required enteral tube feedings (P = .002). Also, 18 (64%) patients in the FF group were eating at least a soft diet compared with 6 (30%) patients in the PMMF group (P = .02). CONCLUSIONS: Comparison of direct costs reveals only a modest difference in reconstruction costs that is outweighed by the intangible costs of PMMF reconstruction. The functional benefits of FF reconstruction appear to justify its slight increased expense and its use rather than PMMF reconstruction after extirpation in the posterior oral cavity and oropharynx.
Assuntos
Boca/cirurgia , Orofaringe/cirurgia , Retalhos Cirúrgicos/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/economia , Carcinoma de Células Escamosas/fisiopatologia , Carcinoma de Células Escamosas/cirurgia , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca/fisiopatologia , Neoplasias Bucais/economia , Neoplasias Bucais/fisiopatologia , Neoplasias Bucais/cirurgia , Neoplasias Orofaríngeas/economia , Neoplasias Orofaríngeas/fisiopatologia , Neoplasias Orofaríngeas/cirurgia , Orofaringe/fisiopatologia , Complicações Pós-Operatórias/economia , Estudos Retrospectivos , Retalhos Cirúrgicos/métodos , WashingtonRESUMO
Breathing and swallowing are two of the most important basic functions that must be established at or soon after birth. Although each function serves a different purpose, they are intimately related by virtue of their sharing the same anatomic conduit for air and food. Thus, problems associated with swallowing and feeding can present with airway symptoms, and conversely, an airway problem may be made worse by feeding. This article discusses functional anatomy in relation to the clinical manifestations of airway problems in children with feeding problems. Evaluation and treatment of the most common problems by anatomic location is described, and the special complications of tracheotomy, chronic aspiration, and chronic sialorrhea (drooling) are considered in detail.
Assuntos
Transtornos de Deglutição/complicações , Transtornos de Deglutição/reabilitação , Pulmão/fisiopatologia , Ventilação Pulmonar , Transtornos Respiratórios/complicações , Transtornos Respiratórios/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Esôfago/fisiopatologia , Humanos , Laringe/fisiopatologia , Obstrução Nasal/complicações , Orofaringe/fisiopatologia , Pediatria , TraqueotomiaRESUMO
Taste disorders can a rise from lesions of peripheral receptors, taste control pathways or cortical area involvement. Among peripheral lesions, trauma of the tongue and oropharynx are the most common. Iatrogenic lesions of facial and glossopharingeal nerves are very important in Forensic Medicine, while there are different opinions about taste alterations due to head injuries; hypogeusia associated to smell disorders are found in 0.4-0.5% of patient after head trauma with good prognosis (90% healing) while qualitative disorders are more common (30%). The Authors describe clinical methodologies for taste evaluation and their application in Forensic Medicine. Forensic estimation of taste disorders con be classified by two main groups: study of cause relation between the occurrence and damage and quantitative valuation of the damage in three different juridical ambits: Penal, Civil, Insurance and foresight. In Penal Right taste damages could be classified among personal lesion crimes and can be classified as serious (permanent injury of taste) ore very serious (complete lost of taste function). Italian Legislation equipare the 5 sense organs. In Civil Right evaluation the so-called "biologic damage" and working ability are considered; this means very different evaluations. In the most recent baremes, generic damage is estimated by different Authors from 0 to 10% while with regard to specific working capacity, common evaluation criteria does not exist. In Insurance taste disorders evaluation is based only on working ability and not on biologic damage. In the previdenzial ambit, taste disorders are not even included in the most recent tables of permanent invalidity estimation. The Authors propose new and more efficacious valutation criteria for taste disorders in all ambits, hoping for more interest in the Forensic aspects of taste, a too often forgotten sensory function.
Assuntos
Medicina Legal/legislação & jurisprudência , Transtornos da Percepção/diagnóstico , Paladar , Adulto , Avaliação da Deficiência , Estimulação Elétrica , Nervo Facial/fisiopatologia , Nervo Glossofaríngeo/fisiopatologia , Humanos , Itália , Legislação como Assunto , Masculino , Orofaringe/lesões , Orofaringe/fisiopatologia , Transtornos da Percepção/fisiopatologia , Língua/lesões , Língua/fisiopatologia , Indenização aos TrabalhadoresRESUMO
Twenty patients with the diagnosis of Zenker's diverticulum were studied clinically and manometrically. In 8 patients oropharyngeal clearance of liquid isotopic markers was done. In three, esophageal emptying of a marked meal was also studied. Clinically, sixteen patients had oropharyngeal dysphagia, while for remained asymptomatic. Dysphagia was severe in only five patients. In half of the patients there were signs of hiatus hernia and/or reflux. Pharyngo-sphincteric incoordination was present in 70% of cases with a mean resting pressure of the LES significantly lower than in controls. There were no differences among patients with or without reflux. Isotopic esophageal clearance was not useful as a test, as there were no significant differences with the control group. On the other hand, esophageal emptying of solid isotopic meals may show the persistence of food in the diverticular sac long time after the meal.
Assuntos
Orofaringe/fisiopatologia , Divertículo de Zenker/fisiopatologia , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/fisiopatologia , Humanos , Manometria/métodos , Orofaringe/diagnóstico por imagem , Cintilografia , Divertículo de Zenker/diagnóstico por imagemRESUMO
It appears that uvulopalatopharyngoplasty (UVPP) is a reliable procedure for reducing snoring, but much less reliable when used as a treatment for OSAS. This is thought to be because of poor patient selection in that the site of the problem is not always the site of the operation. We present the technique of sleep nasendoscopy which allows direct visualization of the site or sites of obstruction in a sleeping patient. Our study has shown that there are patients with obstructive sleep apnoea syndrome (OSAS) in whom the only site of pharyngeal obstruction is at the velopharynx. These patients should do well with the relatively simple procedure of UVPP. This is not true for many other OSAS patients in whom we found that obstruction was multisegmental. This helps to explain the frequently poor results of UVPP in OSAS patients. We feel that this form of preoperative assessment will avoid unnecessary surgery.
Assuntos
Endoscopia , Síndromes da Apneia do Sono/fisiopatologia , Sono/fisiologia , Ronco/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Orofaringe/fisiopatologia , Palato Mole/fisiologiaRESUMO
Our goal in this paper is to evaluate the motor function of the oropharinx using esophageal manometry and isotopic study, in patients that underwent total laryngectomy (TL) with phonatory prosthesis (PP), and with or without cricopharyngeal myotomy (CM). 50 por 100 of the laryngectomized patients showed oropharyngeal dysphagia, more frequent and stronger in patients without CM. Voice quality was considered good or medium in 12/20. With manometry we achieve that after TL there is an intense pressure reduction of the UES, higher in patients with CM, there aren't differences for other manometrics parameters. The oropharyngeal isotopic clearance is clearly disturbed in all patients, there aren't differences due to the type of surgery, neither the degree of dysphagia nor the CM. The association of a CM to PL plus PP is a surgical procedure that improves markedly the manometric and clinic results in these patients.
Assuntos
Transtornos de Deglutição/fisiopatologia , Laringectomia/métodos , Laringe Artificial , Orofaringe/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Adulto , Idoso , Transtornos de Deglutição/diagnóstico por imagem , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , CintilografiaRESUMO
Reliable measurements are needed to document the natural history of ALS and to determine therapeutic efficacy. We have devised a standardized protocol that generates interval data sensitive to change-the Tufts Quantitative Neuromuscular Exam (TQNE). The TQNE consists of the following four major categories: pulmonary function, oropharyngeal function, timed functional activities, and isometric strength using an electronic strain gauge. The 29-item exam takes about 1 hour to administer and has excellent test-retest reliability.