RESUMO
OBJECTIVE: Many reports on inpatient dysphagia rehabilitation in acute and convalescent rehabilitation hospitals exist, but there are a few reports on outpatient treatments. Otolaryngologists still take a trial-and-error approach when treating dysphagia. Here, we explore the effectiveness and limitations of outpatient treatment in ear-nose-and-throat (ENT) clinics. METHODS: Sixty-four patients (41 males and 23 females) aged 27-101 years (mean 78 years) visited an outpatient clinic specialising in feeding and swallowing conditions (the Fukuyo ENT Clinic). All were able to perform the activities of daily living (ADL) to the extent that outpatient visits were possible; no home visits were made. The weekly outpatient day was staffed by an otolaryngologist and a speech-language-hearing therapist (SLHT). All patients were subjected to fibreoptic endoscopic evaluation of swallowing (FEES), followed by appropriate training as revealed by the examinations. RESULTS: Salivary retention in the glottis valley and piriform sinuses improved (both p < 0.05) in 30 patients who underwent repeat FEES; we compared the initial and final figures. In 14 cases in whom maximal tongue pressure (TP) was measured, this was higher at the final than at the first examination (p < 0.01). CONCLUSION: Outpatient treatment at ENT clinics for patients who are able to maintain their ADLs to the extent that they are able to walk to a hospital is an option for the treatment of age-related dysphagia. For severe cases, however, house calls and collaboration with the home and nursing care sector will be necessary and should be considered in the future.
RESUMO
OBJECTIVE: In Japan, many otolaryngologists provide primary care for patients with coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the characteristics of otorhinolaryngological findings in order to improve COVID-19 diagnostic systems in a primary care setting. METHODS: A total of 351 patients (mean age, 36.0 ± 15.4 years) diagnosed with COVID-19 by otolaryngologists who belong to the Japan Otorhinolaryngologists Association were included in the study. A web-based questionnaire was used to collect information regarding the timing of positive identification of COVID-19, the route of infection, symptoms, and findings in the tonsils, nasal cavity, pharynx, ear, and neck. A modified Centor score was calculated for cases in which age, symptoms, and tonsil and neck findings were described. RESULTS: Symptoms included fever (56%), olfactory disturbance (46%), and a sore throat (56%). Of the individuals considered, 63% had ordinary rhinoscopic findings, 21% experienced watery rhinorrhea, and 12% had observable mucosal redness. Further, 87% had ordinary tonsillar findings, 13% displayed tonsillar redness, with enlargement and white mucus observe in 2% and 1% of participants, respectively. A total of 193 patients had a calculated Centor score of 3 points in 2%, and scores of the remaining participants were ≤2 points. CONCLUSION: Of all patients considered, 40% had nasal findings and 4% had purulent nasal discharge. In contrast, only 13% of the patients had tonsillar findings, and no patients had Centor scores ≥4 points. Symptom differentiation from that of bacterial infections is difficult. In areas where COVID-19 is prevalent, the disease should be considered in patients presenting with fever, olfactory disturbances, and sore throat with minimal or no clinical findings in the nasal cavity and pharynx.