Outcomes of laryngohyoid suspension techniques in an ovine model of profound oropharyngeal dysphagia

2017 ◽  
Vol 127 (12) ◽  
pp. E422-E427 ◽  
Author(s):  
Christopher M. Johnson ◽  
Naren N. Venkatesan ◽  
M. Tausif Siddiqui ◽  
Daniel J. Cates ◽  
Maggie A. Kuhn ◽  
...  
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Ovine Model

Comparison of swallowing outcomes of laryngotracheal separation versus total laryngectomy in a validated ovine model of profound oropharyngeal dysphagia

2017 ◽  
Vol 131 (4) ◽  
pp. 350-356 ◽  
Author(s):  
N N Venkatesan ◽  
C M Johnson ◽  
M T Siddiqui ◽  
D J Cates ◽  
M A Kuhn ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Oropharyngeal Dysphagia ◽  
Aerodigestive Tract ◽  
National Institutes Of Health ◽  
Ovine Model ◽  
Laryngotracheal Separation ◽  
Scale Scores ◽  
Human Cadavers ◽  
Swallowing Outcomes ◽  
Penetration Aspiration Scale

AbstractObjectives:To validate the ovine model of profound oropharyngeal dysphagia and compare swallowing outcomes of laryngotracheal separation with those of total laryngectomy.Methods:Under real-time fluoroscopy, swallowing trials were conducted using the head and neck of two Dorper cross ewes and one human cadaver, secured in lateral fluoroscopic orientation. Barium trials were administered at baseline, pre- and post-laryngohyoid suspension, following laryngotracheal separation, and following laryngectomy in the ovine model.Results:Mean pre-intervention Penetration Aspiration Scale and National Institutes of Health Swallow Safety Scale scores were 8 ± 0 and 6 ± 0 respectively in sheep and human cadavers, with 100 per cent intra- and inter-species reproducibility. These scores improved to 1 ± 0 and 2 ± 0 post-laryngohyoid suspension (p < 0.01). Aerodigestive tract residue was 18.6 ± 2.4 ml at baseline, 15.4 ± 3.8 ml after laryngotracheal separation and 3.0 ± 0.7 ml after total laryngectomy (p < 0.001).Conclusion:The ovine model displayed perfect intra- and inter- species reliability for the Penetration Aspiration Scale and Swallow Safety Scale. Less aerodigestive tract residue after narrow-field laryngectomy suggests that swallowing outcomes after total laryngectomy are superior to those after laryngotracheal separation.

Lingual Strengthening: Success in an Outpatient Setting

2015 ◽  
Vol 24 (2) ◽  
pp. 71-74
Author(s):  
Ali Meier
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Patient Discharge ◽  
Outpatient Setting ◽  
Oral Performance ◽  
Exercise Protocol ◽  
Anterior Position ◽  
Tongue Position ◽  
Bolus Propulsion ◽  
Posterior Position

In the last decade or more, dysphagia research has investigated the effect of lingual strengthening on oropharyngeal dysphagia with promising results. Much of this research has utilized strengthening devices such as the Iowa Oral Performance Instrument (IOPI) or the Madison Oral Strengthening Therapeutic (MOST) Device. Patients are often given a device to use, and are able to complete an exercise protocol daily or multiple times per day. This case study was completed to determine the effectiveness of using the IOPI in an outpatient clinic where therapy was conducted two to three times per week. The patient was seen post tongue resection due to oropharyngeal cancer. From initiation of IOPI use to patient discharge, the patient demonstrated a 71% increase in lingual strength at the anterior position, a 61% increase at the posterior position, and a 314% increase at the base of tongue position. His diet advanced from NPO to general based on gains in lingual strength and bolus propulsion.

Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

2008 ◽  
Vol 17 (2) ◽  
pp. 43-49
Author(s):  
James L. Coyle
Keyword(s):  
Treatment Effectiveness ◽  
Code Of Ethics ◽  
Oropharyngeal Dysphagia ◽  
Clinical Importance ◽  
Professional Services ◽  
Adverse Outcomes ◽  
Professional Judgment ◽  
Evidence Based ◽  
Intervention Selection ◽  
Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

Hearing and Neurodevelopmental Outcomes of Young Infants with Parechovirus-A and Enterovirus Meningitis: Cohort Study in Singapore Children and Literature Review

2020 ◽  
Author(s):  
Elis Yuexian Lee ◽  
Jessica Hui Yin Tan ◽  
Chew Thye Choong ◽  
Nancy Wen Sim Tee ◽  
Chia Yin Chong ◽  
...  
Keyword(s):  
Developmental Delay ◽  
Oropharyngeal Dysphagia ◽  
Significant Risk ◽  
Developmental Outcomes ◽  
Autism Spectrum ◽  
Clinical Findings ◽  
Cortical Blindness ◽  
Speech Delay ◽  
Neurodevelopmental Outcomes ◽  
Young Infants

Abstract Parechovirus-A (PeV-A) and Enterovirus (EV) commonly cause childhood aseptic meningitis. Bacterial meningitis in children has been associated with devastating long-term sequelae. However, developmental outcomes are unclear in Parechovirus meningitis. This study aims to review the clinical findings and developmental outcomes of infants with PeV-A and EV meningitis. We performed a retrospective study of infants aged 90 days or younger being admitted to our hospital with PeV-A meningitis between November 2015 and July 2017, with positive cerebrospinal fluid (CSF) PeV-A PCR and negative blood and CSF bacterial cultures. Hearing and neurodevelopmental outcomes were compared with a previous cohort of infants aged 90 days or younger with EV meningitis admitted from January 2015 to December 2015. A total of 161 infants were included in our study, of which 68 infants (42.2%) had PeV-A meningitis and 93 infants (57.8%) had EV meningitis. We assessed their developmental outcome at 6 months, 1 year, and 2 years post-meningitis. At 2 years post-meningitis, three infants with PeV-A meningitis had developmental delay (5.5%), whereas none with EV meningitis had developmental delay. One patient had speech delay and autism spectrum disorder, while two had mild speech delay. When compared with our cohort of EV meningitis ≤90 days old, children with PeV-A meningitis ≤90 days old were more likely to have developmental delay 2 years post-meningitis (odds ratio 2.4, 95% confidence interval 2.0–3.0, p = 0.043). None of the patients with PeV-A or EV meningitis had sensorineural hearing loss or neurological sequelae, such as cortical blindness, oropharyngeal dysphagia, hydrocephalus, epilepsy, or cerebral palsy. Infants with PeV-A meningitis had a significant risk of developmental delay 2 years post-meningitis compared with those with EV meningitis. It is important to follow-up the developmental milestones of infants diagnosed with PeV-A meningitis for at least 2 years; and when they develop developmental delay, to ensure that they receive appropriate intervention.

Observation of the Pattern of Oral Reflux in Two Patients with Oropharyngeal Dysphagia.

2002 ◽  
Vol 53 (6) ◽  
pp. 445-452
Author(s):  
Sachiyo Hamakawa ◽  
Chieko Kouda ◽  
Hirohito Umeno ◽  
Yoshikazu Yoshida ◽  
Tadashi Nakashima
Keyword(s):  
Oropharyngeal Dysphagia

CONCEPTION AND VALIDATION OF A REFLUX LARYNGITIS MODEL INNEWBORN LAMBS

2008 ◽  
Vol 31 (4) ◽  
pp. 6
Author(s):  
A-M Carreau ◽  
H Patural ◽  
A Doueik ◽  
P-H Fortier ◽  
J P Praud
Keyword(s):  
Weight Gain ◽  
Gastric Juice ◽  
Histological Study ◽  
Ovine Model ◽  
Preliminary Results ◽  
Surgical Instrumentation ◽  
Clinical Observations ◽  
Study Results ◽  
Reflux Laryngitis ◽  
Histological Characteristics

Background: Daily clinical observations and a recent study (D Vermeylen et al., 2004) suggest that reflux laryngitis (RL) is involved in apneas/ bradycardias of the newborn. The aim of this study is to develop and tovalidate a unique RL model in newborn lambs to test the assumption that a RL provokesan increase in apneas/ bradycardias/ desaturations observed within thelaryngeal chemoreflexes induced by the contact of a liquid with the larynx. Methods: A surgical instrumentation was performed on the first day of life, which included the insertion of a transcutaneous esophageal catheter in order to allow instillation of a gastric juice surrogate (HCl +pepsin at pH 2) directly on the larynx. The 2 ml-instillations were made 3 times per day for 6 consecutive days. At day 9-10 laryngeal chemoreflexes were induced during sleep. The larynx was removed at the time of necropsy to grade inflammation by a histological study. Results: Lambs in which a RL was induced (n = 4) presented characteristic signs of RL: cough, weak bleat, reduction in weight gain. Preliminary histological analyses showed a characteristic laryngeal inflammation. Preliminary results showing that apneas and oxygen desaturations seem more prominent in RL lambs than controls provided further validation ofour RL model. Conclusion: The ovine model developed in this study presents theclinical and histological characteristics of RL observed in newborns. Preliminary results suggesting that a RL increases apneas/bradycardias/desaturations when a liquid is in contact with laryngealmucosa in the newborn must be confirmed. Supported by: CIHR, FRSQ, Foundation of stars.

The New Geriatric Syndromes

2019 ◽  
Vol 15 (1) ◽  
pp. 33-36
Author(s):  
Animesh Gupta ◽  
Soumya K. Inamadar ◽  
Ashish Goel
Keyword(s):  
Health Outcomes ◽  
Sleep Disorders ◽  
Elderly Population ◽  
Oropharyngeal Dysphagia ◽  
The Elderly ◽  
Present Review ◽  
Social Deficits ◽  
Geriatric Syndromes ◽  
Adverse Health Outcomes ◽  
Clinical Conditions

Geriatric syndromes consist of common clinical conditions affecting the elderly population. They lead to multiple, interacting medical and social deficits that increase the risk of adverse health outcomes, including dependence, institutionalization and also death. Research over the last few decades, in this area of medicine, has led to evolution of newer syndromes that pose a greater challenge to the physician. The present review aims to provide a synopsis of some of the newer syndromes like frailty, osteosarcopenia, sleep disorders and oropharyngeal dysphagia that have emerged in geriatric literature in recent times.

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