scholarly journals Mixed Consistencies in Dysphagic Patients: A Myth to Dispel

Dysphagia ◽  
2021 ◽  
Author(s):  
Mozzanica Francesco ◽  
Pizzorni Nicole ◽  
Scarponi Letizia ◽  
Bazzotti Claudia ◽  
Ginocchio Daniela ◽  
...  

AbstractOnly limited and inconsistent information about the effect of mixed consistencies on swallowing are available. The aim of this study was to evaluate the location of the head of the bolus at the swallow onset, the risk of penetration/aspiration, and the severity of post-swallow pharyngeal residue in patients with dysphagia when consuming mixed consistencies. 20 dysphagic patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) testing five different textures: liquid, semisolid, solid, biscuits-with-milk and vegetable-soup. The location of the head of the bolus at the onset of swallowing was rated using a five-points scale ranging from zero (the bolus is behind the tongue) to four (the bolus falls into the laryngeal vestibule), the severity of penetration/aspiration was rated using the Penetration Aspiration Scale (PAS), the amount of pharyngeal residue after the swallow was rated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in the vallecula and pyriform sinus. When consuming biscuits-with-milk and liquid the swallow onset occurred more often when the boluses were located in the laryngeal vestibule. Penetration was more frequent with biscuits-with-milk, while aspiration was more frequent with Liquid, followed by biscuits-with-milk and vegetable-soup, Semisolid and Solid. In particular, no differences in penetration and aspiration between liquids and biscuits-with-milk were found as well as among vegetable-soup, semisolid and solid. No significant differences in the amount of food residue after swallowing were demonstrated. The risk of penetration-aspiration for biscuits-with-milk and liquid is similar, while the risk of penetration-aspiration is lower for vegetable-soup than for liquid.

2019 ◽  
Vol 24 ◽  
Author(s):  
Giovana Aparecida Dias de Souza ◽  
Marina Mendes Gozzer ◽  
Paula Cristina Cola ◽  
Suely Mayumi Motonaga Onofri ◽  
Roberta Gonçalves da Silva

RESUMO Este estudo teve por objetivo descrever o desempenho longitudinal da deglutição orofaríngea em indivíduo com distrofia miotônica tipo 1. Estudo de caso único de indivíduo de 66 anos, sexo masculino, com diagnóstico neurológico em 2010. Realizou a primeira avaliação clínica e objetiva da deglutição após quatro anos do diagnóstico neurológico. Foram realizadas sete avaliações objetivas da deglutição, por meio de videoendoscopia de deglutição, nas consistências pastosa, líquida espessada e líquida, com 3, 5, 10 ml, durante o processo de diagnóstico e gerenciamento da deglutição, por um ano e dois meses. Foram analisados sensibilidade laríngea, escape oral posterior, resíduos faríngeos, por meio da Yale Pharyngeal Residue Severity Rating Scale, penetração laríngea e/ou aspiração laringotraqueal, com aplicação da Penetration-Aspiration Scale (PAS). Constatou-se, durante o período de estudo, que não houve alteração na sensibilidade laríngea. Escape oral posterior, resíduos faríngeos e penetração laríngea estiveram presentes desde o início das avaliações objetivas. Após quatro meses da primeira avaliação, na consistência pastosa, o nível de resíduos faríngeos passou de vestígio residual para moderado, em recessos piriformes, já em valéculas, e o aumento no índice da gravidade evidenciou-se no último mês. Houve aumento na PAS em todas as consistências de alimento testadas. A presença de aspiração laringotraqueal ocorreu com líquido ralo, no último mês. Durante o período de acompanhamento da deglutição orofaríngea na distrofia miotônica tipo 1, os resíduos faríngeos e a penetração laríngea estiveram presentes desde o início das avaliações, porém, a aspiração laringotraqueal somente ocorreu no último mês do acompanhamento, com líquido ralo.


Author(s):  
Steven B. Leder ◽  
Paul D. Neubauer

Dysphagia ◽  
2018 ◽  
Vol 34 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Marco Gerschke ◽  
Thomas Schöttker-Königer ◽  
Annette Förster ◽  
Jonka Friederike Netzebandt ◽  
Ulla Marie Beushausen

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 13 ◽  
Author(s):  
Ashwini Namasivayam-MacDonald ◽  
Luis Riquelme

Previous research has begun to elucidate the physiological impairments associated with dysphagia in patients with dementia, but in order to select the most appropriate targets of intervention we need to better understand consequences of dysphagia. The purpose of this study was to quantify penetration, aspiration, and residue in people with dementia, and confirm if residue was associated with airway invasion on subsequent swallows. Videofluoroscopy clips of sips of thin and extremely thick liquid barium from 58 patients with dementia were retrospectively analyzed. Ratings of swallowing safety, using the Penetration–Aspiration Scale (PAS), and efficiency, using Normalized Residue Ratio Scale in the valleculae (NRRSv) and pyriform sinuses (NRRSp), were made on all swallows. Over 70% of both thin and extremely thick liquid swallows were found to be safe (PAS < 3). Results also revealed that residue was generally more common in the valleculae. However, the proportion of thin liquid swallows with significant NRRSp that were unsafe on the subsequent swallow was significantly greater than the proportion of swallows with significant NRRSp that were safe on the subsequent swallow. As such, there was a 2.83 times greater relative risk of penetration–aspiration in the presence of thin liquid pyriform sinus residue. Future research should determine the impaired physiology causing aspiration and residue in this population.


2020 ◽  
pp. 1-13
Author(s):  
Aliaa Sabry ◽  
James L. Coyle ◽  
Tamer Abou-Elsaad

<b><i>Objective:</i></b> The aim of this work was to design an anatomically based scale for judging post-swallow residue in the pharyngeal cavities, for use during the fiberoptic endoscopic evaluation of swallowing (FEES) in patients with dysphagia, and to assess its feasibility. <b><i>Methods:</i></b> Two 7-point ordinal scales (one for vallecular residue and one for pyriform sinus residue), were developed using detailed anatomic landmarks to denote residue levels. Hard copy color images of a specified frame, from 210 videos of 30 adult FEES evaluations demonstrating the range of all possible residue patterns, were selected (<i>n</i> = 56 valleculae, 62 pyriform sinuses). Half of these images were used to train 4 raters. The remaining half of the images were randomly ordered and rated by the trained raters. Two weeks later the same images were randomized again, and each rater re-analyzed them. The inter- and intra-rater reliability and criterion validity were determined using the kappa statistics and their standard errors. The internal consistency of the items in MFRRS was examined. <b><i>Results:</i></b> MFRRS showed strong inter-rater reliability (valleculae, κ = 0.832 ± 0.038; pyriform sinus, κ = 0.855 ± 0.034), almost perfect intra-rater reliability (valleculae, κ = 0.964 ± 0.018; pyriform sinus, κ = 0.962 ± 0.02), almost perfect concurrent validity (valleculae, κ = 0.968 ± 0.020; pyriform sinus, κ = 0.0971 ± 0.017), and excellent internal consistency (valleculae, Cronbach’s α = 0.990; pyriform sinus, Cronbach’s α = 0.985). <b><i>Conclusion:</i></b> MFRRS is a feasible and reliable, anatomically based tool that can provide more accurate pharyngeal residue judgments. The optimized description of residue accumulation patterns can contribute to a better overall description of the functional problem and future description of dysphagia phenotypes.


Dysphagia ◽  
2021 ◽  
Author(s):  
Yavuz Atar ◽  
Sevgi Atar ◽  
Can Ilgin ◽  
Melis Ece Arkan Anarat ◽  
Ugur Uygan ◽  
...  

CoDAS ◽  
2019 ◽  
Vol 31 (6) ◽  
Author(s):  
Giovana Aparecida Dias de Souza ◽  
Roberta Gonçalves da Silva ◽  
Paula Cristina Cola ◽  
Suely Mayumi Motonaga Onofri

RESUMO Objetivo Comparar os resíduos faríngeos por consistência de alimento entre indivíduos com disfagia orofaríngea neurogênica. Método Estudo clínico transversal. Realizada análise de 30 exames de videoendoscopia de deglutição de indivíduos com diagnóstico de doenças neurológicas e disfagia orofaríngea, independentemente do tempo ou estágio das doenças. Os indivíduos foram divididos em três grupos: o grupo I composto por 10 indivíduos pós-Acidente Vascular Cerebral, 8 homens e 2 mulheres, faixa etária entre 51 e 80 anos (média 67 anos); o grupo II por 10 indivíduos com Esclerose Lateral Amiotrófica, 5 homens e 5 mulheres, faixa etária entre 39 e 78 anos (média 57 anos), e o grupo III por 10 indivíduos com Doença de Parkinson (DP), 5 homens e 5 mulheres, faixa etária entre 65 e 88 anos (média 74 anos). Para análise dos resíduos faríngeos em valéculas e seios piriformes, foi aplicada a Yale Pharyngeal Residue Severity Rating Scale, considerando a primeira deglutição de 5 mL nas consistências pastosa e líquida espessada, por dois juízes independentes e de forma cega. Resultados Não houve diferença estatística significativa nos resíduos faríngeos, em valéculas (p= 0,25/ p= 0,18) e seios piriformes (p= 1,41/ 0,49), respectivamente nas consistências pastosa e líquida espessada, nas diferentes doenças estudadas. Conclusão Os níveis de resíduos faríngeos na consistência pastosa ou líquida espessada na população estudada foram semelhantes e mais frequentes nos níveis menos grave.


Dysphagia ◽  
2021 ◽  
Author(s):  
Aurora Ninfa ◽  
Nicole Pizzorni ◽  
Angelo Eplite ◽  
Claudia Moltisanti ◽  
Antonio Schindler

AbstractThe Functional Oral Intake Scale (FOIS) is a reliable and valid tool to assess functional oral intake of food and liquids in patients with oropharyngeal dysphagia (OD). Its validity was established for stroke patients against Videofluoroscopic Swallowing Study in English and Chinese and against Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in German. FOIS was cross-culturally validated into Italian (FOIS-It), but construct validity against instrumental assessment and nutritional status was not investigated. The study aims at contributing to the validation of the FOIS-It, by performing convergent and known-group validity against FEES and nutritional status in patients with OD of different etiologies. Overall, 220 adult patients with OD of etiological heterogeneity were recruited. FOIS-It score and Body Mass Index (BMI) were collected. FEES was performed to assess swallowing safety and efficiency based on the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Moderate to weak associations with PAS (ρ = − .37, p < .01), YPRSRS in the pyriform sinuses (ρ = − .20, p < .01), and BMI (ρ = .24, p < .01) were detected with Spearman’s correlation. FOIS-It distribution was compared with the Mann–Whitney U and Kruskal–Wallis tests. Significantly lower FOIS-It scores were detected among patients with penetration/aspiration (PAS > 2) and penetration (PAS > 2 ≤ 5) for all consistencies (p < .01), aspiration (PAS > 5) of liquids and semisolids (p < .001), residue in the pyriform sinuses (YPRSRS > 3) with semisolids (p < .001) and solids (p = .02), and malnutrition (BMI ≤ 18.5; p = .019). FOIS-It appears as a valid tool to assess functional oral intake against FEES’ measures of swallowing safety and efficiency and nutritional status in patients with OD of etiological heterogeneity.


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