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1.
Medicine (Baltimore) ; 100(13): e25349, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787636

RESUMO

RATIONALE: Videofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet. PATIENT CONCERNS: A 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since. DIAGNOSIS: VFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia. INTERVENTION: VFSS was performed in this case. OUTCOMES: In the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery. LESSONS: This case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.


Assuntos
Deglutição/fisiologia , Fístula Traqueoesofágica/diagnóstico , Traqueostomia/efeitos adversos , Broncoscopia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/fisiologia , Fluoroscopia/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Traqueia/fisiologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/fisiopatologia
2.
Medicine (Baltimore) ; 100(11): e25108, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725989

RESUMO

BACKGROUND: Swallowing dysfunction is a common dysfunction after stroke, and its incidence exceeds 50%. Aspiration pneumonia and malnutrition induced by dysphagia not only cause psychological shock to patients after stroke, but also burden the medical payment. Neuromuscular electrical stimulation, which stimulates the cortex and cortical bulb pathways to improve swallowing function, has been one of the emerging treatments for the post-stroke deglutition disorder. These therapy operators require the proficiency in professional knowledge, limiting clinical large sample studies, so there is an absence of evidence-based medicine. The research is to evaluate the effectiveness of neuromuscular electrical stimulations combined with swallowing-related muscle training to treat swallowing dysfunction after stroke. METHODS: Computer retrieval performed in the 9 databases, including PubMed, Embase, Web of science, Cochrane Library, ClinicalTrials, China Biomedical Literature Database (CBM), China Knowledge Network Database (CNKI), Wanfang Database (WanFang), and China VIP Database (VIP). Taking the published literature from the establishment of the database until December 20, 2020. Literature searching is related to neuromuscular electrical stimulation randomized controlled trials on the effect of swallowing in stroke. In addition, we will do the manual search in Baidu Academic and Google Academic database as a supplementary search. The correlative randomized controlled clinical studies retrieval time range from the establishment of the database to December 20, 2020. Two investigators will screen the literature according to the inclusion and exclusion criteria independently, during that period they will evaluate the quality of the included studies and extract data from studies. The extracted data are dichotomous data will be represented by relative risk, continuous data will be represented by mean difference or standard mean deviation. If there exists heterogeneity and the final data summary analysis select random effect model. On the contrary, the fixed effect model is selected. Then, RevMan5.3 software was used when analyzing included literature. Meanwhile, the analysis results were illustrated by drawing. RESULTS: This review will summarize available trials aimed at providing a comprehensive estimation of effectiveness of neuromuscular electrical stimulation associated with swallowing muscle training for post-stroke dysphagia. CONCLUSION: This review based on a comprehensive analysis of currently published randomized controlled trials on post-stroke dysphagia, that provide reliable evidence-based medicine evidence for the efficacy of neuromuscular electrical stimulation associated with swallowing rehabilitation training. REGISTRATION NUMBER: INPLASY202110009.


Assuntos
Transtornos de Deglutição/terapia , Terapia por Estimulação Elétrica/métodos , Terapia Miofuncional/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Deglutição/fisiologia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Músculos Faríngeos/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Acidente Vascular Cerebral/fisiopatologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Adulto Jovem
3.
Am J Speech Lang Pathol ; 30(2): 598-608, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33555954

RESUMO

Purpose The COVID-19 pandemic has drastically increased the use of telehealth. Prior studies of telehealth clinical swallowing evaluations provide positive evidence for telemanagement of swallowing. However, the reliability of these measures in clinical practice, as opposed to well-controlled research conditions, remains unknown. This study aimed to investigate the reliability of outcome measures derived from clinical swallowing tele-evaluations in real-world clinical practice (e.g., variability in devices and Internet connectivity, lack of in-person clinician assistance, or remote patient/caregiver training). Method Seven raters asynchronously judged clinical swallowing tele-evaluations of 12 movement disorders patients. Outcomes included the Timed Water Swallow Test (TWST), Test of Masticating and Swallowing Solids (TOMASS), and common observations of oral intake. Statistical analyses were performed to examine inter- and intrarater reliability, as well as qualitative analyses exploring patient and clinician-specific factors impacting reliability. Results Forty-four trials were included for reliability analyses. All rater dyads demonstrated "good" to "excellent" interrater reliability for measures of the TWST (intraclass correlation coefficients [ICCs] ≥ .93) and observations of oral intake (≥ 77% agreement). The majority of TOMASS outcomes demonstrated "good" to "excellent" interrater reliability (ICCs ≥ .84), with the exception of the number of bites (ICCs = .43-.99) and swallows (ICCs = .21-.85). Immediate and delayed intrarater reliability were "excellent" for most raters across all tasks, ranging between ICCs of .63 and 1.00. Exploratory factors potentially impacting reliability included infrequent instances of suboptimal video quality, reduced camera stability, camera distance, and obstruction of the patient's mouth during tasks. Conclusions Subjective observations of oral intake and objective measures taken from the TWST and the TOMASS can be reliably measured via telehealth in clinical practice. Our results provide support for the feasibility and reliability of telehealth for outpatient clinical swallowing evaluations during COVID-19 and beyond. Supplemental Material https://doi.org/10.23641/asha.13661378.


Assuntos
Transtornos de Deglutição/terapia , Deglutição/fisiologia , Patologia da Fala e Linguagem/métodos , Telemedicina/métodos , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Feminino , Humanos , Doença por Corpos de Lewy/complicações , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/complicações , Pandemias , Doença de Parkinson/complicações , Estudos Prospectivos , Telemedicina/normas
4.
J Laryngol Otol ; 135(2): 153-158, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33551000

RESUMO

BACKGROUND: Transoral robotic surgery is frequently described, driven by the desire to offer a less morbid alternative to chemoradiation. However, the objective evaluation of post-operative function has rarely been reported. Therefore, high-resolution manometry was used in this study to evaluate the impact of changes in peri-operative swallowing function on pharyngeal pressure events. METHODS: Ten patients with various stages of oropharyngeal cancer underwent transoral surgery. High-resolution manometry and videofluoroscopic swallow studies were performed before surgery and two months afterwards. The following parameters were obtained: velopharyngeal and mesopharyngeal post-deglutitive upper oesophageal sphincter pressures, velo-meso-hypopharyngeal contractile integral, upper oesophageal sphincter relaxation pressure, and pharyngeal velocity. RESULTS: There was no significant difference in pharyngeal pressure or contractile integral pre- versus post-operatively. However, pharyngeal velocity was significantly higher post-operatively than pre-operatively. CONCLUSION: High-resolution manometry showed that transoral surgery in patients without pre-operative dysphagia preserved pharyngeal constriction. However, transoral surgery might produce scar formation in the pharynx, which could lead to narrowing of the pharynx.


Assuntos
Deglutição/fisiologia , Neoplasias Orofaríngeas/cirurgia , Faringe/fisiopatologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/fisiopatologia , Esfíncter Esofágico Superior/fisiologia , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Período Pós-Operatório , Pressão , Procedimentos Cirúrgicos Robóticos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
5.
Am Fam Physician ; 103(2): 97-106, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33448766

RESUMO

Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent; esophageal biopsies should be performed to make the diagnosis. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Opioid-induced esophageal dysfunction is becoming more common. Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Esophageal cancer and other serious conditions have a low prevalence, and testing in low-risk patients may be deferred while a four-week trial of acid-suppressing therapy is undertaken. Many frail older adults with progressive neurologic disease have significant but unrecognized dysphagia, which significantly increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care before potentially harmful interventions are considered. Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.


Assuntos
Transtornos de Deglutição/etiologia , Deglutição/fisiologia , Medicina de Família e Comunidade/métodos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Esôfago/patologia , Feminino , Humanos , Masculino , Faringe/anatomia & histologia , Exame Físico/métodos
6.
Acta odontol. Colomb. (En linea) ; 11(1): 42-58, 2021. tab, ilus, ilus, ilus, ilus, ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1128590

RESUMO

Objetivo: desarrollar y aplicar un manual para evaluar los procesos de deglución y rendimiento masticatorio, dirigido a estudiantes y profesionales de odontología. Método: se realizó un estudio con enfoque cuali-cuantitativo, a partir de dos técnicas de recolección de información: documental para reunir información de los procedimientos y observacional para la aplicación del manual. Los métodos seleccionados fueron el rendimiento masticatorio (Albert T) y de deglución (Técnica Payne); el diseño se esbozó según la metodología para mejorar la calidad de los procesos y una guía técnica de elaboración de manuales de procedimientos en salud. Así, el manual cuenta con introducción, antecedentes históricos, alcance y objetivo, flujograma, descripción de procedimientos de evaluación de la deglución, del rendimiento masticatorio y bibliografía. Este fue aplicado en 27 pacientes de la clínica de ortodoncia, a quienes se les diagnosticó deglución atípica, y se midió el rendimiento masticatorio para conocer la mediana de tamaño de partícula (MTP) de cada individuo. Resultados: el manual se realizó basándose en dos procedimientos, uno con el diagnóstico de deglución y otro con rendimiento masticatorio. Este último fue aplicado por dos estudiantes investigadores a una muestra de 27 pacientes, cuyo resultado fue una mediana de tamaño total de partícula de MTP = 5.35 mm2. Hubo una diferencia estadísticamente significativa entre sexos (MTP en hombres: 6,0 mm2 y mujeres 5.1 mm2) siendo las mujeres quienes presentaron mejor desempeño masticatorio. Conclusión: al aplicar el manual, los estudiantes evaluaron el rendimiento masticatorio y la deglución, con lo cual lograron resultados medibles, aplicables y reproducibles.


Objective: To apply a manual to evaluate swallowing and chewing performance aimed at dental students and professionals. Method: A study was carried out with a qualitative-quantitative approach developing two information gathering techniques: documentary to gather information on procedures and observational in the application of the manual. The methods of chewing performance (Albert T) and swallowing (Payne Technique) were selected; the design was outlined according to the methodology to improve the quality of the processes and a technical guide for the elaboration of manuals of health procedures; in the development phase, the thematic units were created and the manual was prepared with: cover, back cover, authors, introduction, historical background, scope and objective, flow chart, description of swallowing evaluation procedures, chewing performance and bibliography; this was applied to 27 patients from the orthodontic clinic, who were diagnosed with atypical swallowing, and the masticatory performance was measured to determine the median particle size (MTP) of each individual evaluated. Results: The manual was made based on two procedures, one with swallowing diagnosis and the other with masticatory performance, which was applied by two student researchers to a sample of 27 patients, yielding a median total particle size of MTP = 5.35 mm2. There was a statistically significant difference between the sexes (MTP in men: 6.0 mm2 and women 5.1 mm2), with women presenting the best masticatory performance Conclusion: when applying the manual, the students evaluated the chewing performance and swallowing, achieving measurable, applicable and reproducible.


Assuntos
Humanos , Deglutição/fisiologia , Mastigação/fisiologia , Padrões de Referência , Estudantes de Odontologia , Metodologia , Má Oclusão , Mastigação
7.
Medicine (Baltimore) ; 99(46): e23177, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181693

RESUMO

Prediction of aspiration pneumonia development in at-risk patients is vital for implementation of appropriate interventions to reduce morbidity and mortality. Unfortunately, studies utilizing a comprehensive approach to risk assessment are still lacking. The objective of this study was to analyze the clinical features and videofluoroscopic swallowing study (VFSS) findings that predict aspiration pneumonia in patients with suspected dysphagia.Medical records of 916 patients who underwent VFSS between September 2014 and June 2018 were retrospectively analyzed. Patients were divided into either a pneumonia group or a non-pneumonia group based on diagnosis of aspiration pneumonia. Clinical information and VFSS findings were evaluated.One hundred seven patients (11.7%) were classified as having pneumonia. Multivariate analysis indicated that aspiration during the 2- cubic centimeter thick-liquid trial of VFSS (odds ratio [OR] = 3.23, 95% confidence interval [CI]: 1.93-5.41), smoking history (OR = 2.63, 95% CI: 1.53-4.53), underweight status (OR = 2.27, 95% CI: 1.31-3.94), abnormal pharyngeal delay time (OR = 1.60, 95% CI: 1.01-2.53), and a Penetration-Aspiration Scale level of 8 (OR = 3.73, 95% CI: 2.11-6.59) were significantly associated with aspiration pneumonia development. Integrated together, these factors were used to develop a predictive model for development of aspiration pneumonia (DAP), with a sensitivity of 82%, specificity of 56%, and an area under the receiver operating characteristic curve of 0.73.The best predictors for DAP included videofluoroscopic findings of aspiration during a 2-cubic centimeter thick-liquid trial, prolonged pharyngeal delay time, a Penetration-Aspiration Scale level of 8, history of smoking, and underweight status. These 5 proposed determinants and the associated DAP score are relatively simple to assess and may constitute a clinical screening tool that can readily identify and improve the management of patients at risk for aspiration pneumonia.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Deglutição/fisiologia , Fluoroscopia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Transtornos de Deglutição/complicações , Feminino , Fluoroscopia/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/fisiopatologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Reino Unido , Gravação em Vídeo/instrumentação
8.
Codas ; 32(4): e20200222, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33053075

RESUMO

PURPOSE: to describe de functional development of swallowing in Intensive Care Unit (ICU) patients with COVID-19, who were submitted to a swallowing intervention. METHODS: participants of the study were 77 patients (both gender, mean age 53.4±15.9; score on the Glasgow Coma Scale ≥14 and stable respiratory condition). The functional scale of swallowing used for assessment was the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS). RESULTS: the results indicate that there was a significant recovery of the functional swallowing patterns when comparing the measurements pre and post swallowing intervention. CONCLUSION: 83% of the patients needed up to 3 swallowing interventions to recover a safe swallowing pattern.


Assuntos
Infecções por Coronavirus/prevenção & controle , Deglutição/fisiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Adulto , Idoso , Betacoronavirus , Coronavirus , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia
9.
J Speech Lang Hear Res ; 63(10): 3293-3310, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-32910735

RESUMO

Purpose Surface electromyography (sEMG) is often used for biofeedback during swallowing rehabilitation. However, commercially available sEMG electrodes are not optimized for the head and neck area, have rigid form, and are mostly available in large medical centers. We developed an ultrathin, soft, and flexible sEMG patch, specifically designed to conform to the submental anatomy and which will be ultimately incorporated into a telehealth system. To validate this first-generation sEMG patch, we compared its safety, efficiency, and signal quality in monitoring submental muscle activity with that of widely used conventional sEMG electrodes. Method A randomized crossover design was used to compare the experimental sEMG patch with conventional (snap-on) sEMG electrodes. Participants completed the same experimental protocol with both electrodes in counterbalanced order. Swallow trials included five trials of 5- and 10-ml water. Comparisons were made on (a) signal-related factors: signal-to-noise ratio (SNR), baseline amplitude, normalized mean amplitude, and sEMG burst duration and (b) safety/preclinical factors: safety/adverse effects, efficiency of electrode placement, and satisfaction/comfort. Noninferiority and equivalence tests were used to examine signal-related factors. Paired t tests and descriptive statistics were used to examine safety/preclinical factors. Results Forty healthy adults participated (24 women, M age = 67.5 years). Signal-related factors: SNR of the experimental patch was not inferior to the SNR of the conventional electrodes (p < .0056). Similarly, baseline amplitude obtained with the experimental patch was not inferior to that obtained with conventional electrodes (p < .0001). Finally, normalized amplitude values were equivalent across swallows (5 ml: p < .025; 10 ml: p < .0012), and sEMG burst duration was also equivalent (5 ml: p < .0001; 10 ml: p < .0001). Safety/preclinical factors: The experimental patch resulted in fewer mild adverse effects. Participant satisfaction was higher with the experimental patch (p = .0476, d = 0.226). Conclusions Our new wearable sEMG patch is equivalent with widely used conventional sEMG electrodes in terms of technical performance. In addition, our patch is safe, and healthy older adults are satisfied with it. With lessons learned from the current COVID-19 pandemic, efforts to develop optimal swallowing telerehabilitation devices are more urgent than ever. Upon further validation, this new technology has the potential to improve rehabilitation and telerehabilitation efforts for patients with dysphagia. Supplemental Material https://doi.org/10.23641/asha.12915509.


Assuntos
Transtornos de Deglutição/reabilitação , Eletrodos , Eletromiografia/instrumentação , Telerreabilitação/instrumentação , Dispositivos Eletrônicos Vestíveis , Idoso , Betacoronavirus , Infecções por Coronavirus , Estudos Cross-Over , Deglutição/fisiologia , Eletromiografia/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral
10.
PLoS One ; 15(9): e0239590, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991632

RESUMO

We investigated the association between the results of a simplified cough test and pneumonia onset in 226 patients with acute stroke admitted to Suiseikai Kajikawa Hospital from April to December, 2018. For the simplified cough test, performed on admission, patients orally inhaled a mist of 1% citric acid-physiological saline using a portable mesh nebulizer. When the first cough was evoked or if it remained absent for 30 seconds (indicating an abnormal result), the test was ended. Patients also completed the repetitive saliva swallowing test (RSST) and modified water swallowing test. We monitored patients for pneumonia signs for 30 days post-admission. Eighteen patients exhibited an abnormal simplified cough test result. On multivariate analysis, an abnormal RSST result was independently associated with an abnormal simplified cough test result. Seventeen patients developed pneumonia. The adjusted Cox proportional hazard model for pneumonia onset revealed that the simplified cough test had predictive power for pneumonia onset (hazard ratio, 10.52; 95% confidence interval, 3.72-29.72). The simplified cough test is a strong indicator for predicting the pneumonia development in patients with acute stroke; it should be added to existing bedside screening tests for predicting pneumonia risk, allowing appropriate and timely intervention.


Assuntos
Tosse/diagnóstico , Pneumonia/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Idoso , Deglutição/fisiologia , Feminino , Humanos , Masculino , Admissão do Paciente
11.
PLoS One ; 15(8): e0236804, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790801

RESUMO

OBJECTIVE: The ALS Functional Rating Scale-Revised (ALSFRS-R) is the most commonly utilized instrument to index bulbar function in both clinical and research settings. We therefore aimed to evaluate the diagnostic utility of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed impairments in swallowing safety (penetration or aspiration) and global pharyngeal swallowing function in individuals with ALS. METHODS: Two-hundred and one individuals with ALS completed the ALSFRS-R and the gold standard videofluoroscopic swallowing exam (VFSE). Validated outcomes including the Penetration-Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) were assessed in duplicate by independent and blinded raters. Receiver operator characteristic curve analyses were performed to assess accuracy of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed unsafe swallowing (PAS > 3) and global pharyngeal dysphagia (DIGEST >1). RESULTS: Although below acceptable screening tool criterion, a score of ≤ 3 on the ALSFRS-R swallowing item optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 64%, AUC: 0.68) and penetration/aspiration (sensitivity: 79%, specificity: 60%, AUC: 0.72). Depending on score selection, sensitivity and specificity of the ALSFRS-R bulbar subscale ranged between 34-94%. A score of < 9 optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 68%, AUC: 0.76) and unsafe swallowing (sensitivity:78%, specificity:62%, AUC: 0.73). CONCLUSIONS: The ALSFRS-R bulbar subscale or swallowing item did not demonstrate adequate diagnostic accuracy to detect radiographically confirmed swallowing impairment. These results suggest the need for alternate screens for dysphagia in ALS.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico , Transtornos de Deglutição/diagnóstico , Idoso , Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/patologia , Área Sob a Curva , Deglutição/fisiologia , Transtornos de Deglutição/etiologia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença
12.
PLoS One ; 15(8): e0230224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764766

RESUMO

The term "oral frailty" reflects the fact that oral health is associated with physical frailty and mortality. The gold standard methods for evaluating the swallowing function have several problems, including the need for specialized equipment, the risk of radiation exposure and aspiration, and general physicians not possessing the requisite training to perform the examination. Hence, several simple and non-invasive techniques have been developed for evaluating swallowing function, such as those for measuring tongue pressure and tongue thickness. The aim of this study was to investigate the relationship between tongue thickness ultrasonography and tongue pressure in the Japanese elderly. We evaluated 254 elderly patients, who underwent tongue ultrasonography and tongue pressure measurement. To determine tongue thickness, we measured the vertical distance from the surface of the mylohyoid muscle to the tongue dorsum using ultrasonography. The results of the analyses revealed that tongue thickness was linearly associated with tongue pressure in both sexes. In male participants, dyslipidemia, lower leg circumference, and tongue pressure were independently and significantly associated with tongue thickness. In female participants, body mass index and tongue pressure were independently and significantly associated with tongue thickness. The optimal cutoff for tongue thickness to predict the tongue pressure of < 20 kPa was 41.3 mm in males, and 39.3 mm in females. In the Japanese elderly, tongue thickness using ultrasonography is associated with tongue pressure. Tongue thickness and tongue pressure, which are sensitive markers for oral frailty, decrease with age. We conclude that tongue ultrasonography provides a less invasive technique for determining tongue thickness and predicts oral frailty for elderly patients.


Assuntos
Deglutição/fisiologia , Língua/fisiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Fragilidade , Humanos , Japão , Masculino , Força Muscular/fisiologia , Saúde Bucal , Pressão , Ultrassonografia/métodos
13.
Medicine (Baltimore) ; 99(34): e21778, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846806

RESUMO

BACKGROUND: There are some clinical reports on dysphagia in patients with chronic obstructive pulmonary disease (COPD); however, its pathophysiology remains largely unknown.Changes in respiratory function occur in patients with COPD causing a decrease in tidal volume and an increase in respiratory rate (tachypnea). In addition, it leads to lack of coordination between respiration and swallowing.A new treatment called nasal high flow (NHF) has been introduced for patients with COPD, replacing the traditional non-invasive ventilation (NIV) procedure. The NHF therapy involves inhalation of high flow of humidified air, which reduces respiratory effort in patients with COPD. Furthermore, NHF therapy facilitates swallowing of saliva even during respiratory management. A recent clinical study reported that high-flow nasal cannula oxygen therapy for 6 weeks improved the health-related quality of life and reduced hypercapnia in patients with stable COPD. Taken together, NHF therapy is gaining attention in the clinical management of patients with COPD.Therefore, in this study, we aim to examine the efficacy of NHF therapy on the coordination between breathing and swallowing of saliva during daytime nap in patients with COPD. METHODS/DESIGN: This open-label, investigator-initiated, single center study will evaluate the efficacy of NHF therapy on the coordination between breathing and swallowing of saliva during the daytime nap in COPD patients with forced expiratory volume in 1 second (FEV1%) of <70% during treatment at the Nagasaki University Hospital Respiratory Rehabilitation Center. Evaluations will be performed during the 90 to 180 minute "daytime nap" in the measurement room of the hospital. The primary endpoint will be the rate of appearance of the expiratory phase after swallowing of saliva and the frequency of swallowing during the measurement period. DISCUSSION: The purpose of this study is to obtain evidence regarding the utility of NHF as a potential therapeutic device for COPD patients to prevent aspiration of saliva during the sleep stage of daytime nap. The utility will be assessed by comparing the decrease in incidence rates of the expiratory phase after swallowing of saliva in the NHF device group and the control group, wherein this device was not used.


Assuntos
Deglutição/fisiologia , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Mecânica Respiratória/fisiologia , Cânula , Humanos , Ventilação não Invasiva/efeitos adversos , Projetos de Pesquisa , Saliva
14.
Ann Otol Rhinol Laryngol ; 129(11): 1101-1109, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32500729

RESUMO

OBJECTIVES: To evaluate the precise objective fluoroscopic abnormalities in persons with dysphagia following anterior cervical spine surgery (ACSS). METHODS: 129 patients with dysphagia after ACSS were age and sex matched to 129 healthy controls. All individuals underwent videofluoroscopic swallow study (VFSS). VFSS parameters abstracted included upper esophageal sphincter (UES) opening, penetration aspiration scale (PAS), and pharyngeal constriction ratio (PCR). Other data collected included patient-reported outcome measures of voice and swallowing, number of levels fused, type of plate, vocal fold immobility, time from surgery to VFSS, and revision surgery status. RESULTS: The mean age of the entire cohort was 63 (SD ± 11) years. The mean number of levels fused was 2.2 (±0.9). 11.6% (15/129) were revision surgeries. The mean time from ACSS to VFSS was 58.3 months (±63.2). The majority of patients (72.9%) had anterior cervical discectomy and fusion (ACDF). For persons with dysphagia after ACSS, 7.8% (10/129) had endoscopic evidence of vocal fold immobility. The mean UES opening was 0.84 (±0.23) cm for patients after ACSS and 0.86 (±0.22) cm for controls (P > .0125). Mean PCR was 0.12 (±0.12) for persons after ACSS and 0.08 (±0.08) for controls, indicating significant post-surgical pharyngeal weakness (P < .0125). The median PAS was 1 (IQR 1) for persons after ACSS as well as for controls. For ACSS patients, PCR had a weak correlation with EAT-10 (P < .0125). CONCLUSION: Chronic swallowing dysfunction after ACSS appears to be secondary to pharyngeal weakness and not diminished UES opening, the presence of aspiration, vocal fold immobility, or ACSS instrumentation factors.Level of Evidence: 3b.


Assuntos
Transtornos de Deglutição/diagnóstico , Deglutição/fisiologia , Esfíncter Esofágico Inferior/diagnóstico por imagem , Fluoroscopia/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Doenças da Coluna Vertebral/cirurgia , Estudos de Casos e Controles , Vértebras Cervicais , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Esfíncter Esofágico Inferior/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos
15.
Geriatr Gerontol Int ; 20(7): 697-703, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32489001

RESUMO

AIM: The present study investigated the effects of two types of lingual exercise (tongue-hold swallowing and tongue-pressure resistance training) on oral muscle strength, salivary flow rate and subjective oral health of the elderly. METHODS: We randomly assigned 74 elderly adults (≥65 years) to three groups (tongue-hold swallowing, tongue-pressure resistance training and control groups). Each group participated in 8 weeks of their appropriately prescribed intervention. We measured anterior tongue strength, posterior tongue strength, lip strength, salivary flow rate and Oral Health Impact Profile-14 score before and after 8 weeks. Differences before and after intervention were observed with a paired sample t-test. Moreover, analyses of covariance and variance were performed to determine the differences in the measured values between the groups. RESULTS: The tongue-hold swallowing group showed improvement in both anterior and posterior tongue strength, while the tongue-pressure resistance training group showed a significant increase in only anterior tongue strength. Both the tongue-hold swallowing and tongue-pressure resistance training groups showed increased salivary secretion, with the tongue-pressure resistance training group showing a higher level of salivary secretion. However, the difference in the subjective oral health scores before and after the intervention was not significant. CONCLUSIONS: The two lingual exercises strengthened some aspects of tongue muscles and increased the salivary flow rate, with more salivary secretion in the tongue-pressure resistance training group than in the tongue-hold swallowing group. Any evidence of the lingual exercises being able to enhance subjective oral health could not be found. Geriatr Gerontol Int 2020; ••: ••-••.


Assuntos
Deglutição/fisiologia , Terapia por Exercício/métodos , Saúde Bucal , Salivação/fisiologia , Língua/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Força Muscular/fisiologia , República da Coreia
16.
Braz Oral Res ; 34: e059, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578802

RESUMO

The aim of this study was to evaluate the association of malocclusion, nutritive and non-nutritive sucking habits and dental caries in the masticatory function of preschool children. A cross-sectional study was conducted with a sample of 384 children aged 3-5 years. A single examiner calibrated for oral clinical examinations performed all the evaluations (kappa > 0.82). Presence of malocclusion was recorded using Foster and Hamilton criteria. The number of masticatory units and of posterior teeth cavitated by dental caries was also recorded. The parents answered a questionnaire in the form of an interview, addressing questions about the child's nutritive and non-nutritive sucking habits. The masticatory function was evaluated using Optocal test material, and was based on the median particle size in the masticatory performance, on the swallowing threshold, and on the number of masticatory cycles during the swallowing threshold. Data analysis involved simple and multiple linear regression analyses, and the confidence level adopted was 95%. The sample consisted of 206 children in the malocclusion group and 178 in the non-malocclusion group. In the multiple regression analysis, the masticatory performance was associated with age (p = 0.025), bottle feeding (p = 0.004), presence of malocclusion (p = 0.048) and number of cavitated posterior teeth (p = 0.030). The swallowing threshold was associated with age (p = 0.025), bottle feeding (p = 0.001) and posterior malocclusion (p = 0.017). The number of masticatory cycles during the swallowing threshold was associated with the number of cavitated posterior teeth (p = 0.001). In conclusion, posterior malocclusion, bottle feeding and dental caries may interfere in the masticatory function of preschool children.


Assuntos
Deglutição/fisiologia , Cárie Dentária/fisiopatologia , Má Oclusão/fisiopatologia , Mastigação/fisiologia , Comportamento de Sucção/fisiologia , Alimentação Artificial , Aleitamento Materno , Pré-Escolar , Estudos Transversais , Feminino , Sucção de Dedo , Humanos , Modelos Lineares , Masculino , Tamanho da Partícula , Valores de Referência , Fatores Sexuais , Estatísticas não Paramétricas
17.
PLoS One ; 15(6): e0234194, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525920

RESUMO

Swallow-breathing coordination is influenced by changes in lung volume, which is modulated by feedback from both vagal and spinal sensory afferents. The purpose of this study was to manipulate feedback from these afferents, with and without a simultaneous mechanical challenge (chest compression), in order to assess the influence of each sensory pathway on swallow in rats. We hypothesized that manipulation of afferent feedback would shift the occurrence of swallow toward the inspiratory phase of breathing. Afferent feedback was perturbed by lidocaine nebulization, extra-thoracic vagotomy, or lidocaine administration to the pleural space in sodium pentobarbital anesthetized rats (N = 43). These different afferent perturbations were performed both in control conditions (no chest compression), and with chest compression. Manipulating pulmonary stretch receptor-mediated volume feedback in male animals decreased swallow occurrence. Female rats appear to rely more on spinal afferent feedback, as swallow occurrence shifted to late expiration with chest compression and vagotomy or lidocaine injections. Results suggest that sex-specific mechanisms modulate swallow-breathing coordination, and that vagal feedback is inhibitory to swallow-related muscles, while spinal feedback from pleural afferents has excitatory effects. This study supports the theory that a balance of vagal and spinal afferent feedback is necessary to maintain an optimal swallow pattern and swallow-breathing coordination.


Assuntos
Deglutição/fisiologia , Respiração , Caracteres Sexuais , Medula Espinal/fisiologia , Nervo Vago/fisiologia , Animais , Feminino , Masculino , Ratos , Ratos Sprague-Dawley
18.
Einstein (Sao Paulo) ; 18: eAO5390, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32428067

RESUMO

Objective To describe functional and quality of life results after extended supratracheal laryngectomy. Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing. Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects. Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.


Assuntos
Deglutição/fisiologia , Laringectomia/métodos , Qualidade de Vida , Voz/fisiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
19.
Sci Rep ; 10(1): 8704, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32457331

RESUMO

High resolution cervical auscultation is a very promising noninvasive method for dysphagia screening and aspiration detection, as it does not involve the use of harmful ionizing radiation approaches. Automatic extraction of swallowing events in cervical auscultation is a key step for swallowing analysis to be clinically effective. Using time-varying spectral estimation of swallowing signals and deep feed forward neural networks, we propose an automatic segmentation algorithm for swallowing accelerometry and sounds that works directly on the raw swallowing signals in an online fashion. The algorithm was validated qualitatively and quantitatively using the swallowing data collected from 248 patients, yielding over 3000 swallows manually labeled by experienced speech language pathologists. With a detection accuracy that exceeded 95%, the algorithm has shown superior performance in comparison to the existing algorithms and demonstrated its generalizability when tested over 76 completely unseen swallows from a different population. The proposed method is not only of great importance to any subsequent swallowing signal analysis steps, but also provides an evidence that such signals can capture the physiological signature of the swallowing process.


Assuntos
Auscultação/métodos , Aprendizado Profundo , Transtornos de Deglutição/diagnóstico , Deglutição/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador
20.
Brain Stimul ; 13(3): 891-899, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32289722

RESUMO

BACKGROUND: Brain mapping is fundamental to understanding brain organization and function. However, a major drawback to the traditional Brodmann parcellation technique is the reliance on the use of postmortem specimens. It has therefore historically been difficult to make any comparison regarding functional data from different regions or hemispheres within the same individual. Moreover, this method has been significant limited by subjective boundaries and classification criteria and therefore suffer from reproducibility issues. The development of transcranial magnetic stimulation (TMS) offers an alternative approach to brain mapping, specifically the motor cortical regions by eliciting quantifiable functional reactions. OBJECTIVE: To precisely describe the motor cortical topographic representation of pharyngeal constrictor musculature using TMS and to further map the brain for use as a tool to study brain plasticity. METHODS: 51 healthy subjects (20 male/31 female, 19-26 years old) were tested using single-pulse TMS combined with intraluminal catheter-guided high-resolution manometry and a standardized grid cap. We investigated various parameters of the motor-evoked potential (MEP) that include the motor map area, amplitude, latency, center of gravity (CoG) and asymmetry index. RESULTS: Cortically evoked response latencies were similar for the left and right hemispheres at 6.79 ± 0.22 and 7.24 ± 0.27 ms, respectively. The average scalp positions (relative to the vertex) of the pharyngeal motor cortical representation were 10.40 ± 0.19 (SE) cm medio-lateral and 3.20 ± 0.20 (SE) cm antero-posterior in the left hemisphere and 9.65 ± 0.24 (SE) cm medio-lateral and 3.18 ± 0.23 (SE) cm antero-posterior in the right hemisphere. The mean motor map area of the pharynx in the left and right hemispheres were 9.22 ± 0.85(SE) cm2and 10.12 ± 1.24(SE) cm2, respectively. The amplitudes of the MEPs were 35.94 ± 1.81(SE)uV in the left hemisphere and 34.49 ± 1.95(SE)uV in the right hemisphere. By comparison, subtle but consistent differences in the degree of the bilateral hemispheric representation were also apparent both between and within individuals. CONCLUSION: The swallowing musculature has a bilateral motor cortical representation across individuals, but is largely asymmetric within single subjects. These results suggest that TMS mapping using a guided intra-pharyngeal EMG catheter combined with a standardized gridded cap might be a useful tool to localize brain function/dysfunction by linking brain activation to the corresponding physical reaction.


Assuntos
Mapeamento Encefálico/métodos , Córtex Motor/fisiologia , Faringe/fisiologia , Estimulação Magnética Transcraniana/métodos , Adulto , Deglutição/fisiologia , Eletromiografia/métodos , Potencial Evocado Motor/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manometria/métodos , Faringe/inervação , Tempo de Reação/fisiologia , Reprodutibilidade dos Testes , Adulto Jovem
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