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1.
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
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2173-2177, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018437

RESUMO

Tracking a liquid or food bolus in videofluoroscopic images during X-ray based diagnostic swallowing examinations is a dominant clinical approach to assess human swallowing function during oral, pharyngeal and esophageal stages of swallowing. This tracking represents a highly challenging problem for clinicians as swallowing is a rapid action. Therefore, we developed a computer-aided method to automate bolus detection and tracking in order to alleviate issues associated with human factors. Specifically, we applied a stateof-the-art deep learning model called Mask-RCNN to detect and segment the bolus in videofluoroscopic image sequences. We trained the algorithm with 450 swallow videos and evaluated with an independent dataset of 50 videos. The algorithm was able to detect and segment the bolus with a mean average precision of 0.49 and an intersection of union of 0.71. The proposed method indicated robust detection results that can help to improve the speed and accuracy of a clinical decisionmaking process.


Assuntos
Transtornos de Deglutição , Deglutição , Cinerradiografia , Transtornos de Deglutição/diagnóstico por imagem , Fluoroscopia , Humanos , Orofaringe
3.
PLoS One ; 15(9): e0237501, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877418

RESUMO

PURPOSE: The concept of dysphagia/aspiration-related structures (DARS) was developed against the background of severe late side effects of radiotherapy (RT) for head and neck cancer (HNC). DARS can be delineated on CT scans, but with a better morphological discrimination on magnetic resonance imaging (MRI). Swallowing function was analyzed by use of patient charts and prospective investigations and questionnaires. METHOD: Seventeen HNC patients treated with intensity-modulated radiotherapy (IMRT) ± chemotherapy between 5/2012 - 8/2015 were included. Planning CT (computed tomography) scans and MRIs (magnetic resonance imaging) prior, during 40 Gray (Gy) radiotherapy and posttreatment were available and co-registered to delineate DARS. The RT dose of each DARS was calculated. Five patients were investigated posttreatment for swallowing function and assessed by means of various questionnaires for quality of life (QoL), swallowing, and voice function. RESULTS: By retrospective comparison of DARS volume, a significant change in four of eight DARS was detected over time. Three increased and one diminished. The risk of posttreatment dysphagia rose by every 1Gy above the mean dose (D mean) of RT to DARS. 7.5 was the risk factor for dysphagia in the first 6 months, reducing to 4.7 for months 6-12 posttreatment. For all five patients of the prospective part of swallowing investigations, a function disturbance was detected. These results were in contrast to the self-assessment of patients by questionnaires. There was neither a dose dependency of D mean DARS volume changes over time nor of dysphonia and no correlation between volume changes, dysphagia or dysphonia. CONCLUSION: Delineation of DARS on MRI co-registered to planning CT gave the opportunity to differentiate morphology better than by CT alone. Due to the small number of patients with complete MRI scans over time, we failed to detect a dose dependency of DARS and swallowing and voice disorder posttreatment.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/radioterapia , Imagem por Ressonância Magnética , Sucção , Tomografia Computadorizada por Raios X , Adulto , Idoso , Deglutição , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Voz , Adulto Jovem
4.
Vasc Endovascular Surg ; 54(8): 747-751, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32748705

RESUMO

Dysphagia Lusoria is a condition when aberrant right subclavian artery (ARSA) causes esophageal compression. We report 2 cases of Dysphagia Lusoria treated by hybrid endovascular technique which included subclavian to carotid transposition and embolization of origin of ARSA. By using this technique, we avoided the need for thoracotomy. Both patients had complete symptom relief without any surgery related complication.


Assuntos
Anormalidades Cardiovasculares/cirurgia , Transtornos de Deglutição/etiologia , Embolização Terapêutica , Procedimentos Endovasculares , Estenose Esofágica/etiologia , Artéria Subclávia/anormalidades , Enxerto Vascular , Adulto , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico por imagem , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/fisiopatologia , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(31): e21526, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756197

RESUMO

RATIONALE: Dysphagia is a common presenting symptom in elderly people. Nevertheless, dysphagia resulting from diffuse idiopathic skeletal hyperostosis (DISH) of patients' cervical spine may be due to several factors. Despite computed tomography scan showing the size and shape of osteophytes, endoscopy may be necessary to exclude other intrinsic causes of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. Once perforation occurs, inappropriate treatments may finally lead to an irretrievable outcome. PATIENT CONCERNS: A 58-year-old male patient with a 20-day history of dysphagia initially visited an ear-nose-throat (ENT) doctor. He had no neck pain and no other history of cervical disease. DIAGNOSIS: This patient with dysphagia due to DISH of the cervical spine underwent laryngoscopy to exclude other causes. Pharyngeal perforation resulted as a complication of the procedure. INTERVENTIONS: The patient underwent laryngoscopy and biopsy by an ENT doctor to exclude intrinsic causes. After the procedure, a perforation was formed on the posterior wall of the pharynx. Conservative management, that is, 1 week of nothing per oral, and 1 month of antibiotics, was adopted. On the 30th day after the examination, the patient was voluntarily discharged from the hospital and recommended to take antibiotics orally. OUTCOMES: On the 56th day, the patient experienced fever and neck pain. Magnetic resonance imaging showed that the cervical vertebral bodies and spinal cord were infected. On the midday of the 60th day, the patient had a failed resuscitation and died. LESSONS: DISH involving the cervical spine is a complicated cause of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. If other intrinsic causes of dysphagia have to be excluded with the aid of endoscopy, plain films and computed tomography images should be read carefully first. To minimize the risk of perforation, it is necessary to perform endoscopy extremely carefully, especially biopsy. Once perforation occurs, operative treatment may be more appropriate and effective.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Hiperostose Esquelética Difusa Idiopática/complicações , Laringoscopia/efeitos adversos , Faringe/lesões , Humanos , Masculino , Pessoa de Meia-Idade
6.
Medicine (Baltimore) ; 99(34): e21795, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846813

RESUMO

The objective of this study was to investigate the quality of life in stroke patients using a swallowing quality of life (SWAL-QOL) questionnaire. The correlation between SWAL-QOL questionnaire outcome and videofluoroscopic dysphagia scale (VDS) scores in stroke patients was also determined.This cross-sectional study was retrospectively conducted with 75 stroke patients with dysphagia symptoms. Videofluoroscopic swallowing study (VFSS) and SWAL-QOL questionnaires were performed for all patients. These patients were divided into an oral feeding group and a tube feeding group. SWAL-QOL scores were compared between the 2 groups. The severity of dysphagia was estimated by VDS scores according to the videofluoroscopic swallowing study results. The relationships between SWAL-QOL scores and VDS scores were also investigated.The composite score was 48.82 ±â€Š19.51 for the tube feeding group and 53.17 ±â€Š25.42 for the oral feeding group. There were significant differences in burden and sleep subdomains of the SWAL-QOL between the 2 groups (P = .005 and P = .012, respectively). There was a significant negative correlation between the composite score of SWAL-QOL outcome and the total VDS score (r = -0.468, P = .012). The pharyngeal-phase score of the VDS had significant negative correlations with the SWAL-QOL subdomains of burden (r = -0.327, P = .013), mental health (r = -0.348, P = .008), and social functioning (r = -0.365, P = .029).To improve the quality of life of stroke patients, dysphagia rehabilitation should focus on the pharyngeal phase of dysphagia.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Qualidade de Vida , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Deglutição , Transtornos de Deglutição/fisiopatologia , Nutrição Enteral , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Estudos Retrospectivos , Inquéritos e Questionários
7.
J Oral Rehabil ; 47(12): 1489-1495, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32813891

RESUMO

BACKGROUND: Dysphagia is a growing health problem in aging societies. An observational cohort study targeting community-dwelling populations revealed that 16% of elderly subjects present with dysphagia. There is a need in elderly communities for systematic dysphagia assessment. OBJECTIVE: This study aimed to verify whether laryngeal elevation in the pharyngeal phase could be measured from the body surface using thin and flexible stretch sensors. METHODS: Thirty-two elderly subjects (17 males, 15 females; mean age ± SD: 89.2 ± 6.2 years) with suspected dysphagia underwent a swallowing contrast examination in which seven stretch sensors were attached to the front of the neck. The elongation of the sensors was measured and compared to the laryngeal elevation time values obtained using videofluorography. The sensor signal detected the laryngeal elevation start time, conclusion of the descent of the larynx, and the laryngeal elevation time. The respective laryngeal elevation times obtained using videofluorography and using the sensor were compared using the Bland-Altman method. RESULTS: The laryngeal elevation time was 1.34 ± 0.46 s with the stretch sensor and 1.49 ± 0.56 s with videofluorography. There was a significant positive correlation between the duration obtained by both methods (r = .69, P < .0001). A negative additional significant bias of -0.15 s (95% confidence interval -0.30 to -0.03, P = .046) was noted in the laryngeal elevation time from the videofluorography measurement. CONCLUSION: Laryngeal elevation time can be measured non-invasively from the neck surface using stretch sensors.


Assuntos
Transtornos de Deglutição , Laringe , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Humanos , Laringe/diagnóstico por imagem , Masculino , Faringe/diagnóstico por imagem
8.
Artigo em Inglês | MEDLINE | ID: mdl-32622798

RESUMO

OBJECTIVE: The aim of this study was to evaluate whether a new cine-magnetic resonance imaging (CMRI) technique might be useful for evaluating swallowing function in patients with different types of oral cancers by assessing 12 CMRI-related parameters. STUDY DESIGN: In total, 111 patients with oral cancers were evaluated. We examined whether visualization of fluid flow and determination of flow direction to the trachea or the esophagus were possible with CMRI. We evaluated the correlations between CMRI-related parameters and self-reported dysphagia scores as the status of dysphagia, T classification groups as tumor staging for preoperative patients, alterations in CMRI-related parameters between pre- and postoperative patients, and the degree of invasiveness of oral cancer surgery. RESULTS: We could judge the flow direction to the esophagus on CMRI in all 111 patients. Six CMRI-related parameters showed significant correlations with dysphagia status. Increases in CMRI-related parameters were significantly related to deterioration of swallowing status, as shown by a decrease in self-reported dysphagia scores, advances in the T classification, and degree of invasiveness of oral cancer surgery. CONCLUSIONS: The results of the present study suggest that CMRI can be used to directly visualize swallowing dynamics and objectively evaluate the swallowing complaints of patients with oral cancer.


Assuntos
Transtornos de Deglutição , Neoplasias Bucais , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Humanos , Imagem por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Neoplasias Bucais/diagnóstico por imagem , Estadiamento de Neoplasias
9.
J Smooth Muscle Res ; 56(0): 46-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32581185

RESUMO

Oropharyngeal dysphagia (OD) is a common symptom in the older people, and may cause fatal complications such as aspiration pneumonia. However, there is no established treatment for OD. The relationship between the transient receptor potential vanilloid 1 (TRPV1) and substance P released by activated TRPV1 was recently demonstrated. Further, there are several reports showing that capsaicin, a specific agonist of TRPV1, can improve OD. Currently, the evaluation of swallowing is mainly performed by videofluoroscopic examination. However, there are no reports on the clinical application of ultrasonography using tissue Doppler imaging. In this review, we describe the pathophysiology and treatments for OD, introduce our novel US method to evaluate cervical esophageal motility, and then outline our clinical study examining the effects of capsaicin, a specific TRPV1 agonist, in older patients with OD.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/terapia , Ultrassonografia Doppler/métodos , Capsaicina/farmacologia , Capsaicina/uso terapêutico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Motilidade Gastrointestinal , Humanos , Substância P , Canais de Cátion TRPV/agonistas , Canais de Cátion TRPV/metabolismo
10.
Rev. neurol. (Ed. impr.) ; 70(12): 444-452, 16 jun., 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195434

RESUMO

INTRODUCCIÓN: La disfagia orofaríngea tiene una elevada prevalencia tras un ictus. Se manifiesta clínicamente en alteraciones en la eficacia y la seguridad de la deglución, con la consiguiente morbimortalidad asociada a las alteraciones nutricionales y respiratorias. OBJETIVO: Efectuar una revisión actualizada de los aspectos diagnósticos y terapéuticos de la disfagia orofaríngea tras un ictus, con aplicabilidad en la clínica diaria, y de las técnicas de neuroestimulación no invasiva. DESARROLLO: El proceso de diagnóstico y tratamiento de la disfagia orofaríngea tiene como objetivos cribar, identificar y diagnosticar a los pacientes con riesgo de disfagia, e instaurar las medidas dietéticas y terapéuticas que aseguren la correcta nutrición e hidratación de los pacientes en condiciones de seguridad. El diagnóstico se basa en la exploración clínica de la deglución y en las exploraciones instrumentales, como la videofluoroscopia y la fibroendoscopia. Las medidas terapéuticas incluyen las estrategias compensadoras y rehabilitadoras (maniobras activas, ejercicios de control motor, electroestimulación neuromuscular y tratamiento con toxina botulínica). Las técnicas de neuroestimulación incluyen la estimulación central no invasiva y la estimulación eléctrica intrafaríngea. CONCLUSIÓN: La disfagia orofaríngea tiene una elevada prevalencia tras un ictus. El diagnóstico debe incluir una evaluación clínica y una exploración instrumental, y así indicar de forma objetiva el tratamiento, que incluirá medidas compensadoras y restauradoras con las que reducir la morbimortalidad asociada


INTRODUCTION. The prevalence of oropharyngeal dysphagia is high after a stroke. Clinically, it manifests as alterations affecting swallowing efficiency and safety, with the consequent morbidity and mortality associated with nutritional and respiratory alterations. AIM. To carry out an updated review of the diagnostic and therapeutic aspects of oropharyngeal dysphagia after a stroke that can be applied in daily clinical practice, and of the non-invasive neurostimulation techniques. DEVELOPMENT: The process of diagnosis and treatment of oropharyngeal dysphagia aims to screen, identify and diagnose patients at risk of dysphagia, and establish the dietary and therapeutic measures that ensure proper nutrition and hydration of patients under safe conditions. The diagnosis is based on the clinical examination of swallowing and on instrumental examinations such as videofluoroscopy and fibro-endoscopy. Therapeutic measures include compensatory and rehabilitative strategies (active manoeuvres, motor control exercises, neuromuscular electrostimulation and botulinum toxin treatment). Neurostimulation techniques include non-invasive central stimulation and intrapharyngeal electrical stimulation. CONCLUSION: The prevalence of oropharyngeal dysphagia is high after a stroke. Diagnosis should include a clinical evaluation and an instrumental examination, and thus objectively indicate the treatment, which will include compensatory and restorative measures with which to reduce the associated morbidity and mortality


Assuntos
Humanos , Transtornos de Deglutição/terapia , Acidente Vascular Cerebral/complicações , Estimulação Elétrica Nervosa Transcutânea/métodos , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Endoscopia/métodos , Fluoroscopia , Manometria
11.
Yonsei Med J ; 61(4): 341-348, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32233177

RESUMO

PURPOSE: This study aimed to predict the surgical outcomes of diffuse idiopathic skeletal hyperostosis (DISH)-related dysphagia (DISH-phagia) and to evaluate the importance of prevertebral soft tissue thickness (PVST). MATERIALS AND METHODS: In total, 21 surgeries (anterior osteophytectomy or anterior cervical decompression and fixation) were included in this study for DISH-phagia from 2003 to 2019. Clinical outcomes were assessed using the Dysphagia Outcome and Severity Scale (DOSS) preoperatively, at 1 month postoperatively, and last follow up (mean 29.5 months). PVST was measured using lateral plain radiographs. Paired t-test and Spearman's correlation test was used to identify relationships between various PVST indices and DOSS. RESULTS: Comparisons were made from 17 patients out of 21, in which the record had all of three measurements. The narrowest PVST preoperatively was 2.55±0.90 mm, with a DOSS score of 4.47±1.61, and that at 1 month after surgery was 5.02±2.33 mm, with a DOSS score of 6.12±1.32. At last follow up, PVST and DOSS values were 3.78±0.92 mm and 5.82±1.34, and three patients experienced symptom relapse. Significant relationships were found between PVST and DOSS at all time points: before surgery (R=0.702, p<0.001), 1 month after surgery (R=0.539, p=0.012), and last follow up (R=0.566, p=0.020). CONCLUSION: Surgical removal of anterior osteophytes is an effective treatment option for DISH-phagia, and PVST is a useful parameter in DISH-phagia. The goal of DISH surgery should be to remove DISH as much as possible to ensure sufficient PVST postoperatively.


Assuntos
Vértebras Cervicais/cirurgia , Transtornos de Deglutição/cirurgia , Hiperostose Esquelética Difusa Idiopática/cirurgia , Osteófito/complicações , Idoso , Vértebras Cervicais/diagnóstico por imagem , Estudos Transversais , Descompressão Cirúrgica , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Humanos , Hiperostose Esquelética Difusa Idiopática/complicações , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Procedimentos Neurocirúrgicos , Osteófito/diagnóstico por imagem , Osteófito/cirurgia , Período Pós-Operatório , Radiografia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
12.
Int J Comput Assist Radiol Surg ; 15(6): 901-908, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32306186

RESUMO

PURPOSE: Dysphagia has a large impact on the society because it is a risk factor of malnutrition and aspiration pneumonia, and therefore, it is necessary to elucidate the entire mechanism of dysphagia. In this study, we propose a segmentation method of cervical intervertebral disks (CIDs) in videofluorography (VF) by use of patch-based convolutional neural network (CNN), our multi-channelization (MC) method and image feature selection. METHODS: Twenty image filters are individually applied to a VF frame image to generate feature images. One color image, called a multi-channelized image, is generated by setting three selected feature images to its red, green and blue channels. Patch-based CNN is applied to the MC image, and the segmentation accuracy of CIDs is evaluated by the pixel-based F-measure. The combination of the three feature images is optimized by the simulated annealing method. RESULTS: The proposed method was applied to actual VF dataset consisting of 19 patients and 39 healthy participants. The segmentation accuracy was 59.3% in the F-measure when Sobel and morphological top-hat filters were selected in MC, whereas it was 56.2% when original frame images were used. CONCLUSION: The experimental results demonstrated that the proposed method was able to segment CIDs from actual VF and also that the MC method was able to increase the segmentation accuracy by approximately 3%. In this study, LeNet was used as CNN. One of our future tasks is to use other CNNs.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Disco Intervertebral/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Redes Neurais de Computação
13.
PLoS One ; 15(2): e0228652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32045464

RESUMO

PURPOSE: To automate the estimation of swallowing motion from 2D MR cine images using deformable registration for future applications of personalized margin reduction in head and neck radiotherapy and outcome assessment of radiation-associated dysphagia. METHODS: Twenty-one patients with serial 2D FSPGR-MR cine scans of the head and neck conducted through the course of definitive radiotherapy for oropharyngeal cancer. Included patients had at least one cine scan before, during, or after radiotherapy, with a total of 52 cine scans. Contours of 7 swallowing related regions-of-interest (ROIs), including pharyngeal constrictor, epiglottis, base of tongue, geniohyoid, hyoid, soft palate, and larynx, were manually delineated from consecutive frames of the cine scan covering at least one swallowing cycle. We applied a modified thin-plate-spline robust-point-matching algorithm to register the point sets of each ROI automatically over frames. The deformation vector fields from the registration were then used to estimate the motion during swallowing for each ROI. Registration errors were estimated by comparing the deformed contours with the manual contours. RESULTS: On average 22 frames of each cine scan were contoured. The registration for one cine scan (7 ROIs over 22 frames) on average took roughly 22 minutes. A number of 8018 registrations were successfully batch processed without human interaction after the contours were drawn. The average registration error for all ROIs and all patients was 0.36 mm (range: 0.06 mm- 2.06 mm). Larynx had the average largest motion in superior direction of all structures under consideration (range: 0.0 mm- 58.7 mm). Geniohyoid had the smallest overall motion of all ROIs under consideration and the superior-inferior motion was larger than the anterior-posterior motion for all ROIs. CONCLUSION: We developed and validated a deformable registration framework to automate the estimation of swallowing motion from 2D MR cine scans.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Deglutição , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Algoritmos , Humanos , Laringe/diagnóstico por imagem , Boca/diagnóstico por imagem , Faringe/diagnóstico por imagem
14.
Dig Dis Sci ; 65(4): 957-960, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32026277

RESUMO

We report a 39-year-old Native American female with an almost 20-year history of dysphagia that had increased in the 6 months prior to the initial evaluation. Investigation revealed a number of distinct esophageal disorders including Plummer-Vinson syndrome, gastroesophageal reflux disease with esophagitis, distal esophageal stricture, esophageal intramural pseudo-diverticulosis, and recurrent esophageal Candida infections. Although prolonged therapy with proton pump inhibitors, fluconazole, nystatin, and repeated esophageal balloon dilations relieved her symptoms, her prognosis remains uncertain.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Saúde Holística , Síndrome de Plummer-Vinson/complicações , Síndrome de Plummer-Vinson/terapia , Adulto , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico por imagem , Anemia Ferropriva/terapia , Transtornos de Deglutição/diagnóstico por imagem , Dilatação/métodos , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Síndrome de Plummer-Vinson/diagnóstico por imagem , Inibidores da Bomba de Prótons/uso terapêutico , Resultado do Tratamento
15.
Artigo em Chinês | MEDLINE | ID: mdl-32086923

RESUMO

Objective:The aim of this study is to investigate the effect of fibreoptic endoscopic of sallowing (FEES) in the assessment of pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma. Method:Fifty-three NPC patients with post-irradiated underwent FEES and video fluoroscopy(VF).The results were analyzed using the Bolus Residue Scale and Rosenbek's penetration aspiration scale. Result:The agreement in the detection of penetration and aspiration between FEES and VF of liquid(κ=0.56, 95%CI 0.38-0.73) and porridge(κ=0.64, 95%CI 0.43-0.81) was "fair". The detection rates of penetration on FEES with liquid and porridge were 60% and 51%, the detection rates of aspiration on VF with liquid and porridge were 70% and 53%. There were no statistical differences. The agreement in the detection of pharyngeal residue between FEES and VF of liquid (κ=0.38, 95%CI0.12-0.62) and porridge (κ=0.66, 95%CI 0.44-0.86) was "fair". The detection rates of pharyngeal residue on FEES and VF with porridge were 43% and 45%, the difference was not statistically significant. The detection rates of pharyngeal residue on FEES and VF with liquid were 44% and 24%, and the difference was statistically significant. Conclusion:FEES is an effective and valuable tool for evaluating pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Endoscópios , Carcinoma Nasofaríngeo/complicações , Neoplasias Nasofaríngeas/complicações , Deglutição , Transtornos de Deglutição/etiologia , Tecnologia de Fibra Óptica , Humanos , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia
16.
Codas ; 32(2): e20180248, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32074165

RESUMO

PURPOSE: The objective of the present study was to describe the total oral transit time (TOTT) of children with neurological impairment (CNI) and with an indication of gastrostomy. METHOD: A cross-sectional clinical study was conducted on 15 children (10 male and 5 female ranging in age from 1 to 14 years; mean 5.7 years) with CNI and gastrostomy indication. The patients were monitored by a Multidisciplinary Group of Pediatric Gastroenterology of Universidade de Marília - UNIMAR, which 13 of them with previous exclusive oral feeding and 2 fed by a nasogastric tube. Swallowing was analyzed by videofluoroscopy swallowing study and 19 images of TOTT were obtained using specific software, with analysis of pureed food (13 images) and liquid (six images). TTOT was categorized as short or long based on definitions already evidenced in the literature. RESULTS: The mean and standard deviation of TOTT values was 10.75 s and 11.76 s for pureed food and 4.22 s and 1.54 s for liquid food. CONCLUSION: The total oral transit time of pureed or liquid consistency was long in children with neurological involvement and with an indication of gastrostomy.


Assuntos
Transtornos de Deglutição/etiologia , Deglutição , Gastrostomia , Doenças do Sistema Nervoso/complicações , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/cirurgia , Nutrição Enteral/métodos , Feminino , Fluoroscopia/métodos , Humanos , Lactente , Masculino
18.
Laryngoscope ; 130(4): E190-E198, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31448826

RESUMO

PURPOSE: The timing of laryngeal vestibule closure (LVC) is important for airway protection during swallowing. However, it is unknown whether the extent of LVC contributes to airway protection. The goal of this study is to validate the extent of LVC via a measure called laryngeal constriction ratio (LCR). METHODS: A retrospective analysis of videofluoroscopic swallows was conducted on 38 stroke participants and 40 healthy controls. The LCR was calculated by deriving a size-normalized area of airspace from a 1) maximum closed laryngeal vestibule and a 2) maximum open laryngeal airspace (at rest). Airway invasion severity was derived via the Penetration-Aspiration Scale score. RESULTS: Six hundred forty-nine videofluoroscopic swallows were analyzed. A mixed model analysis revealed a statistically significant mean difference between the normalized laryngeal constriction ratios of healthy individuals (mean (m) = 0.003) versus older dysphagic patients (m = .026) (P = 0.001), quantifying less closure in older patients with dysphagia. Additionally, swallows with airway compromise had a statistically worse LCR when compared to swallows without airway compromise (P = 0.001). CONCLUSION: The normalized LCR might be a valid fluoroscopic surrogate measure for LVC and, furthermore, airway compromise during swallowing. By investigating spatial measurements in the laryngeal vestibule during safe and unsafe swallows, the LCR provides a direction for further research to allow for critical examination of the physiology relating to closure degree in order to precisely detect and treat abnormalities during swallowing. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E190-E198, 2020.


Assuntos
Transtornos de Deglutição/fisiopatologia , Laringoestenose/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfato de Bário , Estudos de Casos e Controles , Constrição Patológica , Meios de Contraste , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Laringoestenose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
Spine (Phila Pa 1976) ; 45(2): 103-108, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31415467

RESUMO

STUDY DESIGN: Videoflurographic swallowing study in asymptomatic volunteers. OBJECTIVE: The purpose of this study was to investigate the relationship between the severity of dysphagia and various parameters of the subjects. SUMMARY OF BACKGROUND DATA: Occipitocervical fixation is associated with several potential complications. Malalignment of craniovertebral junction and associated dysphagia have been well described in the literature. However, there has been little attention given to investigate the association between the degree of swallowing dysfunction and various patient's parameters. METHODS: Thirty-nine healthy asymptomatic volunteers, 18 males and 21 females, were enrolled in this study. Based on videofluorographic swallowing study (VFSS), two scoring systems of swallowing dysfunction (dysphagia rating scale [DRS], dysphagia outcome and severity scale [DOSS]) were measured in neutral and retraction position. Multiple linear regression analysis was performed to evaluate the relationship between the degree of swallowing dysfunction and various factors of the subjects such as radiological and clinical parameters. RESULTS: There was statistically significant correlation between DRS and DOSS (r = -0.354, P < 0.05). Multiple regression analysis showed that there was a significant association of the dysphagia severity (DRS and DOSS) with the percentile change of the narrowest oropharyngeal diameter (OD) (%dn OD) (r = 0.121, P < 0.01 and r = 0.020, P < 0.01, respectively). Percentile change of OD (neutral and retraction position) was positively associated with the difference of C0-2 angle (r = 1.676, P < 0.01). None of the other variables such as age, sex, C0-1 angle, C1-2 angle, and C2-7 angle were significantly associated with the degree of dysphagia or %dn OD. CONCLUSION: This study demonstrated that the severity of dysphagia is significantly associated with the percentile change of OD and the C0-2 angle has considerable effect on the OD after O-C fusion. Therefore, C0-2 angle could be the most critical radiological parameter not only for predicting the stricture of oropharyngeal space but also for preventing postoperative dysphagia. LEVEL OF EVIDENCE: 4.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Deglutição , Orofaringe/diagnóstico por imagem , Orofaringe/patologia , Índice de Gravidade de Doença , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Fluoroscopia , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Postura , Adulto Jovem
20.
Laryngoscope ; 130(2): 514-520, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30835858

RESUMO

OBJECTIVES/HYPOTHESIS: Timing and indication for surgical intervention is a major challenge in managing pediatric oropharyngeal dysphagia. No study has evaluated a natural course of swallowing dysfunction in otherwise healthy infants. Our objective was to review the outcomes and time to resolution of abnormal swallow in infants with aspiration. STUDY DESIGN: Retrospective case series at a tertiary children's hospital. METHODS: Fifty patients under 1 year old with aspiration on a modified barium swallow study were included. Patients born <34 weeks, with medical or genetic comorbidities, or who underwent surgical intervention for aspiration were excluded. Patients were followed until aspiration resolved on a swallow study. Kaplan-Meier survival analysis was performed. RESULTS: Forty patients (25 patients [50%] by 6 months, 10 [20%] by 1 year, three [6%] by 2 years, and two [4%] at the end of the follow-up interval) were recommended a normal diet, and 10 patients (20%) were still aspirating by the end of the follow-up interval. Median time to resolution was 202 ± 7 days (range, 19-842 days), probability 48% (95% confidence interval [CI]: 0.34-0.62). The probability of resolution at 6 months was 46% (95% CI: 0.4-0.68), at 1 year was 64% (95% CI: 0.51-0.77), at 2 years was 76% (95% CI: 0.64-0.88), and at the end of the follow-up interval 81.3% (95% CI: 0.7-0.92). CONCLUSIONS: The majority of infants with aspiration and without any other major comorbidities improved within 1 year. Future research should be directed toward better understanding swallowing dysfunction in neurologically normal infants. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:514-520, 2020.


Assuntos
Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/cirurgia , Aspiração Respiratória/prevenção & controle , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Estudos Retrospectivos
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