Effects of Carbonated Thickened Drinks on Pharyngeal Swallowing with a Flexible Endoscopic Evaluation of Swallowing in Older Patients with Oropharyngeal Dysphagia.

This study aimed to determine the efficacy of carbonated and sweetened drinks added to thickened liquids, which are routinely used for patients with dysphagia to improve dysphagia. Patients swallowed thin liquid (Thin), thickened liquid (Thick), carbonated thin drink (C-Thin), and carbonated thickened drink (C-Thick) in random order. Penetration and/or aspiration were scored using the Penetration−Aspiration Scale (PAS). The residue was scored using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). Swallowing reflex initiation was scored using the Hyodo score. The subjective difficulty of swallowing was scored on a face scale. We analyzed 13 patients with a mean age of 79.6 ± 9.6 years. PAS was significantly lower in the C-Thick group than the Thin group (p < 0.05). Swallowing reflex initiation was significantly different between the Thin and Thick (p < 0.01) groups; moreover, post hoc analysis revealed that it was significantly lower in the C-Thick group than the Thin group (p < 0.01). The subjective difficulty of swallowing in the C-Thick was significantly lower than the Thick group (p < 0.05). C-Thick was easier to swallow than Thick and may improve penetration and/or aspiration in older patients with dysphagia with complex diseases.

Congenital Membranous Stapes Footplate Producing Episodic Pressure-Induced Perilymphatic Fistula Symptoms.

Introduction: Recent third window syndrome studies have revealed that the intact bony labyrinth and differences in the stiffness of the oval and round windows are essential for proper cochlear and vestibular function. Herein we report a patient with a congenital dehiscence of the right stapes footplate. This dehiscence caused long-standing episodic pressure-induced vertigo (Hennebert sign). At the time of presentation, her increased thoracic pressure changes induced the rupture of the membranous stapes footplate. Perilymph leakage was confirmed by imaging and a biochemical test [perilymph-specific protein Cochlin-tomoprotein (CTP) detection test]. Case Report: A 32-year-old woman presented with a sudden onset of right-sided hearing loss and severe true rotational vertigo, which occurred immediately after nose-blowing. CT scan showed a vestibule pneumolabyrinth. Perilymphatic fistula (PLF) repair surgery was performed. During the operation, a bony defect of 0.5 mm at the center of the right stapes footplate, which was covered by a membranous tissue, and a tear was found in this anomalous membrane. A perilymph-specific protein CTP detection test was positive. The fistula in the footplate was sealed. Postoperatively, the vestibular symptoms resolved, and her hearing improved. A more detailed history revealed that, for 15 years, she experienced true rotational vertigo when she would blow her nose. After she stopped blowing her nose, she would again feel normal. Discussion: There is a spectrum of anomalies that can occur in the middle ear, including the ossicles. The present case had a dehiscence of the stapes, with a small membranous layer of tissue covering a bony defect in the center of the footplate. Before her acute presentation to the hospital, this abnormal footplate with dehiscence induced pathological pressure-evoked fluid-mechanical waves in the inner ear, which resulted in Hennebert sign. When patients have susceptibility (e.g., weak structure) to rupture, such as that identified in this case, PLF can be caused by seemingly insignificant events such as nose-blowing, coughing, or straining. Conclusion: This case demonstrates that PLF is a real clinical entity. Appropriate recognition and treatment of PLF can improve a patient's condition and, hence, the quality of life.