Sensory-Motor-Oral Stimulation Combined with Early Sucking During the Mandibular Distraction Osteogenesis Process in Children with Robin Sequence.

OBJECTIVE: To describe the findings of children with Robin Sequence (RS) who received sensory-motor-oral stimulation combined with early sucking during mandibular distraction osteogenesis (MDO), compared with children who did not receive the intervention. DESIGN: A quasi-experimental study. Setting: A tertiary public hospital. Patients: Children with RS referred to MDO. A historical group from the same population but managed according to the institution's standard protocol (no sucking) served as a control group. Interventions: Sensory-motor-oral stimulation, including sucking, starting 24 h after MDO (intervention group). Main Outcome Measure: Our hypothesis is that sensory-motor-oral stimulation, including sucking during the DOM process, do not negatively affect surgical outcomes. RESULTS: Twenty-nine children were included. Eight (72.7%) of the 11 patients in the intervention group and 13 (72.2%) of the 18 controls had MDO complications, with no significant difference between the groups (p = 1.000). The most common surgical outcome was antibiotic therapy for surgical site infection (76.2%). Six months after MDO, 22 (75.9%) children attained full oral feeding or associated with alternative feeding methods. CONCLUSION: The intervention group did not have higher complication rates, from a surgical point of view, than control group. The protocol adopted by some centers that contraindicates sucking during MDO should be revised to consider the benefits of such stimulation. Keywords: Pierre Robin Syndrome, deglutition, therapeutics, child development.

Aspiration in the First Year of Life and Later Tube Feeding: A Retrospective Cohort from a Low-Income Country.

The objective of this study is to investigate in infants submitted to videofluoroscopic swallowing study (VFSS) during the first year of life, the association between aspiration and later tube feeding, and to identify potential risk factors related to feeding route outcome. Retrospective cohort study with data from electronic health records was performed. Data were collected from infants < 12 months of age who underwent VFSS during inpatient hospital stay in the period between 2013 and 2018. Patient charts after 24 months of age were reviewed to ascertain the outcome and study factors, including VFSS findings, neonatal data, clinical comorbidities, nutritional status, ICU admissions, and hospital readmissions. Relative risk (RR) for tube feeding was calculated, and a Poisson regression with robust variance was used to identify potential risk factors. VFSS data from 164 patients < 1 year old were retrieved, of whom 112 (68%) contributed with data about feeding route after 2 years of age. Most infants were preterm < 37 weeks (66%), with a median age of 9.28 weeks at the time of the exam. Aspiration occurred in 33% of the patients, with no statistically significant difference between full-term or premature infants (p = 0.173). The relative risk of tube feeding after the age of 2 among infants who aspirated in VFSS was 0.74 (CI 0.25-2.16, p = 0.573). Poisson regression analysis showed that number of hospital readmissions (RR 1.04, 95%CI 1.01-1.07, p = 0.005) and gestational age < 34 weeks (RR 0.26, 95%CI 0.07-0.089, p = 0.032) were associated with later tube feeding. Early VFSS findings have low predictive value regarding later feeding route. Aspiration events should be considered as complementary information for clinical decision.

Therapeutic Management with Airway Clearance in Children with Robin Sequence and Association with Swallowing Outcomes: A Systematic Review and Meta-analysis.

Dysphagia in Robin Sequence can be present in varying degrees, requiring multidisciplinary management and specific swallowing assessment by a specialist. Most studies published to date have evaluated only respiratory outcomes, and the available evidence on the improvement of swallowing is questionable. To conduct a systematic review and meta-analysis of studies evaluating swallowing in children with Robin Sequence before and after airway clearance procedures. The research question was developed based on the PICO strategy. The literature search was performed in electronic databases and gray literature. Studies were selected by 3 independent reviewers. The risk of bias and level of evidence of the studies were assessed. A proportion meta-analysis was performed to calculate the prevalence of dysphagia after airway clearance procedures. The search identified 4938 studies, 5 of which were included. All studies had limitations in terms of design and sample size. The prevalence of dysphagia after airway clearance was obtained by analyzing treatment subgroups: mandibular distraction osteogenesis, mandibular distraction osteogenesis + tracheostomy tube, and nasopharyngeal tube. Clinical and/or instrumental assessment was assessed by a swallowing specialist. The meta-analysis was precluded by the limitations of the studies, especially regarding sample size, which affected the accuracy of the findings. Dysphagia remained unresolved in 55% of children (95% CI 1-99%). The methodological quality of the studies indicated a high risk of bias and very low level of evidence. It was not possible to confirm that airway clearance techniques used in Robin Sequence improve dysphagia.

Clinical outcomes before and after videofluoroscopic swallow study in children 24 months of age or younger.

OBJECTIVE: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD). METHODS: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS. RESULTS: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002). CONCLUSIONS: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

Impact of a pre-feeding oral stimulation program on first feed attempt in preterm infants: Double-blind controlled clinical trial.

OBJECTIVE: To evaluate the effect of an oral stimulation program in preterm on the performance in the first oral feeding, oral feeding skills and transition time from tube to total oral intake. STUDY DESIGNER: Double-blind randomized clinical trial including very preterm newborns. Congenital malformations, intracranial hemorrhage grade III or IV, bronchopulmonary dysplasia, and necrotizing enterocolitis were excluded. Intervention group (GI) received an oral stimulation program of tactile extra-, peri-, and intraoral tactile manipulation once a day for 15 minutes, during a 10-day period. Control group (GII) received sham procedure with same duration of time. Feeding ability was assessed by a speech-language pathologist blinded to group assignment. The classification of infants' oral performance was determined by Oral Feeding Skills (OFS). Neonates were monitored until hospital discharge. RESULTS: Seventy-four (37 in each group) were randomized. Mean gestational ages and birth weights were 30±1.4 and 30±1.5 weeks, and 1,452±330g and 1,457±353g for intervention and control groups, respectively. Infants in the intervention group had significantly better rates than infants in the control group on: mean proficiency (PRO) (41.5%±18.3 vs. 19.9%±11.6 (p<0.001)), transfer rate (RT) (2.3 mL/min and 1.1 mL/min (p<0.001)) and overall transfer (OT) (57.2%±19.7 and 35.0%±15.7 (p<0.001)). Median transition time from tube to oral feeding was 4 (3-11) and 8 (7-13) days in intervention and control groups, respectively (p = 0.003). Intake of breast milk was found to reduce transition time from tube feeds to exclusive oral feeding (p<0.001, HR 1.01, 95%CI 1.005-1.019), but the impact of the study intervention remained significant (p = 0.007, HR 1.97, 95%CI 1.2-3.2). CONCLUSION: Infants who were breast-fed and an oral stimulation program proved beneficial in reducing transition time from tube feeding to oral feeding. TRIAL REGISTRATION: ClinicalTrials.gov number NCT03025815.

Clinical outcomes before and after videofluoroscopic swallow study in children 24 months of age or younger / Desfechos clínicos antes e depois da videofluoroscopia da deglutição em crianças com 24 meses de idade ou menos

ABSTRACT Objective: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD). Methods: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS. Results: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002). Conclusions: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

RESUMO Objetivo: Avaliar o impacto conjunto da videofluoroscopia da deglutição (VFD) e intervenções terapêuticas de alimentação e deglutição nos desfechos clínicos em crianças com disfagia orofaríngea (DOF). Métodos: Trata-se de um estudo analítico longitudinal não controlado em que pacientes com DOF foram avaliados antes e depois da VFD. Foram incluídas no estudo crianças com idade ≤ 24 meses e diagnóstico clínico de DOF, submetidas à VFD para a investigação e manejo da DOF. Os participantes do estudo receberam intervenções terapêuticas de alimentação e deglutição após terem sido submetidos à VFD, sendo então acompanhados em um ambulatório de disfagia pediátrica para o monitoramento das dificuldades de alimentação e deglutição. Os desfechos respiratórios e alimentares foram comparados antes e depois da VFD. Resultados: Eventos de penetração/aspiração foram observados em 61% das VFD (n = 72), e intervenções terapêuticas de alimentação e deglutição foram recomendadas a 97% dos participantes do estudo. Após a VFD, houve uma redução das chances de receber antibioticoterapia (OR = 0,007) e da duração da antibioticoterapia (p = 0,014), bem como das chances de internação hospitalar (p = 0,024) e do tempo de internação (p = 0,025). A alimentação por via oral e enteral em conjunto tornou-se mais comum do que a alimentação exclusivamente por via oral ou enteral (p = 0,002). Conclusões: Houve alta proporção de crianças que apresentaram penetração/aspiração na VFD. As intervenções terapêuticas de alimentação e deglutição após a VFD parecem estar associadas à redução da morbidade respiratória nessa população.

Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis.

OBJECTIVE: To investigate the accuracy of clinical evaluation of swallowing in a sample of children with laryngomalacia or glossoptosis and describe the prevalence of dysphagia in each of these diseases, as well as characterize the swallow response to speech and language therapy interventions. STUDY DESIGN: Children aged 1 month to 11 years receiving care at the Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Brazil, were evaluated in a cross-sectional design. Evaluation of swallowing was performed at two time points by two blinded speech-language pathologists, one responsible for clinical evaluation and the other for videofluoroscopic study. The protocols employed were based on the instruments proposed by DeMatteo et al. (DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol 2005;47:149-157.). RESULTS: The study sample consisted of 29 patients: 10 patients with laryngomalacia and 19 patients with glossoptosis. The sensitivity of clinical evaluation did not exceed 50% in any of the evaluations, but specificity reached 100% in some cases, using thickened liquids. The prevalence of dysphagia was 100%, and the use of thickened liquids significantly reduced tracheal aspiration. CONCLUSIONS: Dysphagia was highly prevalent in this sample. The sensitivity of clinical evaluation to detect laryngeal penetration and tracheal aspiration was low, as the majority of aspiration events were silent. The videofluoroscopic study is important in order to determine a safest method to feed the patient. Pediatr Pulmonol. 2017;52:41-47. © 2016 Wiley Periodicals, Inc.

Desfechos de deglutição e alimentação associados à intubação orotraqueal e à traqueostomia em pediatria / Swallowing and feeding outcomes associated with orotracheal intubation and tracheostomy in pediatrics

RESUMO Objetivo verificar os desfechos de deglutição e alimentação de pacientes pediátricos submetidos à intubação orotraqueal (IOT) prolongada, considerando aqueles que evoluíram para traqueostomia após. Métodos estudo de coorte retrospectivo, realizado por meio da análise de prontuários de pacientes admitidos em Unidade de Terapia Intensiva Pediátrica e acompanhados até a alta hospitalar, entre março de 2017 e dezembro de 2018. Resultados dos 51 pacientes incluídos, 64,7% eram do gênero masculino e a mediana de idade foi de 6,7 meses. Pacientes submetidos à IOT por mediana de sete dias apresentaram disfagia orofaríngea (DOF) leve e, quando submetidos a mais de 14 dias, apresentaram DOF moderada/grave, distúrbio alimentar pediátrico (DAP) com características de recusa alimentar e contraindicação de alimentação por via oral na alta hospitalar. Dentre os pacientes, 74,5% foram submetidos apenas à IOT e 25,5% evoluíram para traqueostomia, após. Pacientes traqueostomizados apresentaram maior ocorrência de alta hospitalar com DOF moderada/grave, DAP com características de recusa alimentar e uso de via alternativa de alimentação, em comparação a pacientes sem traqueostomia (p=0,001). Comparado ao diagnóstico inicial, pacientes não traqueostomizados tiveram diagnóstico final com graus mais leves de disfagia (p<0,001). Conclusão o tempo de IOT e a presença de traqueostomia são fatores associados ao diagnóstico fonoaudiológico de DOF moderada/grave, à presença de sinais de DAP com características de recusa alimentar e à necessidade de via alternativa de alimentação, persistentes até a alta hospitalar, sendo achados fonoaudiológicos frequentes entre os desfechos de deglutição/alimentação em pediatria.

ABSTRACT Purpose To verify the swallowing and feeding outcomes of pediatric patients undergoing prolonged OTI, considering those who progressed to tracheostomy afterward. Methods Retrospective cohort study, carried out by analyzing the medical records of patients admitted to the Pediatric ICU and followed up until hospital discharge, between 03/2017 and 12/2018. Results Of the 51 patients included, 64.7% were male and the median age 6.7 months. Patients undergoing OTI for a median of 7 days had mild dysphagia and when submitted for more than 14 days had moderate/severe dysphagia and PFD with characteristics of food refusal, with contraindication to oral feeding at hospital discharge. 74.5% of the patients underwent OTI only and 25.5% progressed to tracheostomy afterward. Tracheostomized patients had a higher occurrence of hospital discharge with moderate/ severe oropharyngeal dysphagia, pediatric feeding disorder (PFD) with characteristics of food refusal and alternative method of feeding compared to patients without tracheostomy (p=0.001). Non-tracheostomized patients had a final diagnosis with milder degrees of dysphagia when compared to the initial diagnosis (p<0.001). Conclusion The time of OTI and the presence of tracheostomy are factors associated with the speech-language pathology diagnosis of moderate/severe oropharyngeal dysphagia, presence of signs of PFD with characteristics of food refusal and the need for an alternative method of feeding that persists until hospital discharge, being frequent findings among the swallowing/feeding outcomes in pediatrics.

Severity of clinical manifestations and laryngeal exposure difficulty predicted by glossoptosis endoscopic grades in Robin sequence patients.

OBJECTIVE: To evaluate the performance of two glossoptosis airway obstruction classifications in predicting symptom severity and laryngeal exposure difficulty in Robin Sequence (RS) patients. SETTING: Public tertiary hospital otolaryngology section (Hospital de Clínicas de Porto Alegre - HCPA). PATIENTS: All RS patients diagnosed at HCPA from October 2012 to February 2015 were enrolled, a total of 58 individuals. They were classified in isolated RS, RS-Plus and syndromic RS. INTERVENTION: Patients were submitted to sleep endoscopy and a score was attributed according to Yellon and de Sousa by a blinded researcher. Symptom severity evaluation was performed as defined by Cole classification. MAIN OUTCOME MEASURE: Association between endoscopic findings and clinical symptoms severity and laryngeal exposure difficulty. RESULTS: Twenty four patients were identified as isolated RS (41.4%), 19 patients presented as RS-Plus (32.7%) and 15 patients had well defined diagnosed syndromes (25.9%). Concomitant airway anomalies were found in 18 patients (31%). Specifically 17.4% in isolated RS, 55.6% in RS- Plus and 28.6% in the syndromic group had such anomalies (P = 0,03). Probability of presenting severe clinical symptoms as graded by Cole was higher in grade 3 Yellon classification (68.4%, P = 0.012) and in moderate and severe de Sousa classification (61.5% and 62.5%, respectively, P = 0.015) than in milder grades of obstruction. This findings were considered significant even after controlling for patient age. Laryngeal exposure difficulty was correlated with de Sousa and Yellon (Rho = 0,41 and Rho = 0,43, respectively; P < 0,05). CONCLUSION: Patients with higher degrees of obstruction in sleep endoscopy had a higher probability of presenting a more severe clinical manifestation and a more difficult laryngeal exposure. Since the number of patients included in this study was small for subgroup analyses, it is not clear if this association is restricted to a specific group of RS.

Evaluation of swallowing in infants with congenital heart defect.

Introduction Surgical repair of congenital heart disease in the first years of life compromises the coordination of the suction, breathing, and swallowing functions. Objective To describe the alterations in swallowing found in infants with congenital heart defect during their hospitalization. Methods Prospective, cross-sectional study in a reference hospital for heart disease. The sample consisted of 19 postsurgical patients who underwent an evaluation of swallowing. The infants included were younger than 7 months and had a diagnosis of congenital heart defect and suspected swallowing difficulties. Results Of the 19 infants with congenital heart defect, the median age was 3.2 months. A significant association was found between suction rhythm and dysphagia (p = 0.036) and between oral-motor oral feeding readiness and dysphagia (p = 0.014). Conclusions The data suggest that dysphagia often occurs after surgery in infants with congenital heart defect. Infants with congenital heart defect had very similar behavior to preterm infants in terms of oral feeding readiness.

Cryostimulation improves recovery from oropharyngeal dysphagia after stroke.

INTRODUCTION: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. AIM: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. METHODS: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue) 3 times a day (for a total of 30 daily applications per structure) for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test. RESULTS: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. CONCLUSION: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

Evaluation of Swallowing in Infants with Congenital Heart Defect

Introduction Surgical repair of congenital heart disease in the first years of life compromises the coordination of the suction, breathing, and swallowing functions. Objective To describe the alterations in swallowing found in infants with congenital heart defect during their hospitalization. Methods Prospective, cross-sectional study in a reference hospital for heart disease. The sample consisted of 19 postsurgical patients who underwent an evaluation of swallowing. The infants included were younger than 7 months and had a diagnosis of congenital heart defect and suspected swallowing difficulties. Results Of the 19 infants with congenital heart defect, the median age was 3.2 months. A significant association was found between suction rhythm and dysphagia (p = 0.036) and between oral-motor oral feeding readiness and dysphagia (p = 0.014). Conclusions The data suggest that dysphagia often occurs after surgery in infants with congenital heart defect. Infants with congenital heart defect had very similar behavior to preterm infants in terms of oral feeding readiness. .

Avaliação da deglutição em lactentes com cardiopatia congênita e síndrome de Down: estudo de casos / Swallowing evaluation in infants with congenital heart disease and Down syndrome : clinical study cases

O presente estudo teve por objetivo realizar avaliação fonoaudiológica da deglutição em lactentes com diagnóstico de síndrome de Down e cardiopatia congênita (DSAV tipo A de Rastelli) internados na unidade 2A e Unidade de Tratamento Intensivo Pediátrica da instituição de origem, com suspeita de dificuldade de deglutição, encaminhados ao serviço de fonoaudiologia. Trata-se de uma pesquisa de caráter descritivo-qualitativo, nessa foi possível avaliar dois lactentes durante o período de janeiro a outubro de 2012. Utilizou-se um protocolo de perfil da amostra para a coleta de dados sobre histórico clínico e diagnósticos dos prontuários dos pacientes, além do instrumento de avaliação para prontidão do prematuro para alimentação oral proposto por Fujinaga (2002) para avaliação clínica da deglutição. Os pacientes apresentaram como resultados a presença de disfagia orofaríngea e escores baixos inviabilizando a alimentação exclusivamente por via oral. A conduta terapêutica foi de estimulação oral e volume de alimentação controlado para alimentação oral. Os achados corroboram a literatura no que diz respeito à relação entre disfagia, cardiopatia congênita, síndromes genéticas e alterações miofuncionais orofaciais. Conclui-se que a disfagia apresentou-se como um sintoma dificultante para a alimentação por via oral de forma segura e eficaz para todos os lactentes estudados. Estudos prospectivos com um número maior de sujeitos são necessários para contribuir com a série de casos e, desta forma, identificar outros fatores de risco para disfagia bem como condutas terapêuticas específicas para crianças com síndrome de Down e distúrbios da deglutição associados.

This study had the aim to perform clinical swallowing evaluation in infants diagnosed with Down syndrome and congenital heart disease (complete atrioventricular canal) suspected to have swallowing disorders hospitalized in unit 2A and Pediatric ICU of instituition.It is a descriptive and qualitative study in which was possible to assess two infants during the proposed period. It was used a sample profile protocol to collect data about clinical history and diagnoses from patients records and the Instrumento de avaliação para prontidão do prematuro para alimentação oral by Fujinaga (2002) for clinical swallowing evaluation. The pacients presented results of oropharyngeal dysphagia and low scores invalidating exclusively oral feed. The treatment was oral stimulation and oral feeding volume controlled. The findings contribute to the literature regarding the correlation between dysphagia, congenital heart defects, genetic syndromes and myofunctional disorders. It is concluded that dysphagia was presented as a difficulty symptom to safe and effective oral feed for all infants studied. Prospective larger researches are needed to contribute with this clinical cases study and thus identify other risk factors for dysphagia and specific treatment for children with Down syndrome and swallowing disorders associated.

Cryostimulation improves recovery from oropharyngeal dysphagia after stroke

Introduction: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. Aim: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. Methods: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue) 3 times a day (for a total of 30 daily applications per structure) for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test. Results: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. Conclusion: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation...

Alterações miofuncionais em adultos e idosos usuários de prótese dentária / Changes myofunctional in adults and elderly users dental prosthesis

Objective: To describe the myofunctional oral aspects of adults and elders users of dental prosthesis. Materials and methods: The subjects were divided into six groups according to the type of dental prosthesis. The instruments for data collection were an interview with sociodemographic data and clinical speech pathology assessment through the Miofunctional Oral Assessment protocol. Results: 41 prosthesis users participated. Regarding the changes in the stomatognathic system, it was perceived the cut of food changed in 42% of users and 20% of non users. With relation to type of mastication, it was found unilateral mastication in 41% of dental prosthesis users and for 36,36% of non users of dental prosthesis. The swallowing changed was found in 70% of prosthesis users and 66.6% of non-users. Only the five group composed by users of upper and lower prosthesis presented a mastication time of 9 sec. greater than that found in the literature and the other study groups. Among prosthesis users 17.07% had abnormal speech and among non users nobody had abnormal speech. Conclusion: there are structural and functional modifications of the stomatognathic system arising from the use of removable prosthesis, which demonstrates the importance of interdisciplinary work between speech therapy and dentistry in the adaptation of dental prosthesis, allowing faster adaptation and effectively, minimizing the losses of stomatognathic functions and quality of life.

Objetivo: Descrever os aspectos miofuncionais orais dos indivíduos adultos e idosos usuários de próteses dentárias. Materiais e métodos: Os sujeitos foram divididos em seis grupos de acordo com o tipo de prótese dentária. Os instrumentos para a coleta dos dados foram anamnese com dados sociodemográficos e avaliação fonoaudiológica através do protocolo de Avaliação Miofuncional Oral. Resultados: Participaram 41 usuários de prótese dentária. Com relação às alterações do sistema estomatognático foi percebido corte do alimento alterado em 42% dos usuários e em 20% dos não usuários de prótese. Quanto ao tipo de mastigação encontramos mastigação unilateral em 41% dos usuários de prótese dentária e em 36,36% dos não usuários de prótese dentária. A alteração de deglutição foi encontrada em 70% dos usuários de prótese dentária e em 66,6% dos não usuários. Apenas o grupo cinco composto por usuários de prótese superior e inferior apresentou um tempo mastigatório de 9 seg. maior do que o encontrado na literatura e do que os demais grupos do estudo. Dentre os usuários de prótese dentária 17,07% apresentaram alteração de fala e dentre os não usuários de prótese dentária ninguém apresentou alteração de fala. Conclusão: existem modificações estruturais e funcionais do sistema estomatognático decorrentes do uso da prótese dentária removível, o que demonstra a importância de um trabalho interdisciplinar entre a fonoaudiologia e a odontologia na adaptação das próteses dentárias, propiciando uma adaptação mais rápida e eficaz, minimizando os prejuízos das funções estomatognáticas e da qualidade de vida.

Influência do zumbido no bem-estar de idosos / The influence of tinnitus in the welfare of the elderly

O objetivo deste estudo foi verificar a opinião de idosos sobre a influência do zumbido no bem-estar. Foram entrevistados 11 idosos, sendo 7 institucionalizados e 4, não institucionalizados. As idadesvariaram entre 60 e 95 anos. Eles responderam a uma entrevista semiestruturada elaborada para este estudo. A avaliação qualitativa dos dados foi feita de acordo com os pressupostos de Giorgi (1978). Verificou-se que os idosos institucionalizados e não institucionalizados consideraram que o zumbido interfere no bem-estar.(AU)

The aim of this study was to assess the opinion of the elderly on the influence of tinnitus in the welfare. Eleven elderly were interviewed, 7 were institutionalized and 4 were not. Their ages ranged from 60to 95 years old. The elderly answered to a semistrutured interview. Qualitative evaluation of the data was done according to the assumptions of Giorgi (1978). It was found that the majority of the elderly considered that tinnitus has a negative influence on welfare.(AU)

Influência do zumbido no bem-estar de idosos / The influence of tinnitus in the welfare of the elderly

O objetivo deste estudo foi verificar a opinião de idosos sobre a influência do zumbido no bem-estar. Foram entrevistados 11 idosos, sendo 7 institucionalizados e 4, não institucionalizados. As idadesvariaram entre 60 e 95 anos. Eles responderam a uma entrevista semiestruturada elaborada para este estudo. A avaliação qualitativa dos dados foi feita de acordo com os pressupostos de Giorgi (1978). Verificou-se que os idosos institucionalizados e não institucionalizados consideraram que o zumbido interfere no bem-estar.

The aim of this study was to assess the opinion of the elderly on the influence of tinnitus in the welfare. Eleven elderly were interviewed, 7 were institutionalized and 4 were not. Their ages ranged from 60to 95 years old. The elderly answered to a semistrutured interview. Qualitative evaluation of the data was done according to the assumptions of Giorgi (1978). It was found that the majority of the elderly considered that tinnitus has a negative influence on welfare.

Associação entre tonturas, quedas e teste do alcance funcional em idosos da comunidade / Dizziness, falls and functional reach test: results obtained in non-institutionalized elderly

Este estudo teve como objetivo verificar a associação entre a tontura,o teste do alcance funcional e o histórico de quedas. Foramavaliados 50 idosos, utilizando-se entrevista elaborada para esteestudo e o teste de alcance funcional. Os resultados evidenciaramque 52% dos idosos apresentavam tontura e 24% relataramqueda nos últimos 6 meses. No teste do alcance funcional 38%dos idosos atingiram índices superiores a 25 cm. A análise estatísticafoi feita utilizando-se os testes Qui-Quadrado, Mann-Whitney eKruskal-Wallis e demonstrou que não houve associação entre asvariáveis pesquisadas.(AU)

This study aimed to investigate the association among dizziness,functional reach test and history of falls. Fifty patients were evaluated,using interviews prepared for this study and the functional reachtest. Results showed that 52% of elderly had dizziness and 24% reporteda fall in the last 6 months. In the functional reach test, resultspointed that 38% of the elderly reached values higher than 25 cm. Statistical analysis was performed using the Qui-Quadrado, Mann-Whitney and Kruskal-Wallis tests and demonstrated that there wasno association between the variables studied.(AU)