S189 – Tracheotomy Tube Occlusion Status and Swallowing Function

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P139-P139
Author(s):  
Joseph J Donzelli ◽  
Susan L Brady ◽  
Scott M Kaszuba ◽  
Michele W Wesling
Keyword(s):  
Repeated Measure ◽  
Tracheotomy Tube ◽  
Swallowing Function ◽  
Laryngeal Penetration ◽  
Swallowing Dysfunction ◽  
Airway Invasion ◽  
Measure Design ◽  
Swallow Study ◽  
Videofluoroscopic Swallow Study ◽  
Swallow Function

Objectives To compare the effects, if any, various types of tracheotomy occlusion conditions may have upon swallowing during either the videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic exam of the swallow (FEES). Methods Prospective, repeated measure design. Patients underwent randomized order of tracheotomy occlusion conditions (open, finger, one-way valve, capped) during selected swallows. Main outcome measures were the presence or absence of aspiration/laryngeal penetration. Results 39 participants have completed the protocol, 19 males/20 females, mean age of 59.41 years (SD=19.31). 20 underwent the VFSS and 19 underwent FEES. The majority of participants (58.9%, 28/39) were able to safely swallow without any airway invasion under all occlusion conditions. Change in swallow function under 1 or more of the occlusion conditions was present in 25.6% (10/39) of the participants. 4 subjects had increased airway invasion with no occlusion (open), 4 with finger occlusion, and 2 while capped. One subject had less airway invasion with the 1-way valve as compared to the other conditions. One subject aspirated under all occlusion conditions. Conclusions No clear patterns for optimal occlusion condition for swallowing were identified. Results of this study suggest that swallowing disorders in patients with a tracheotomy tube is a multifactiorial problem and several factors may be associated with the swallowing dysfunction. Therefore, patients should be evaluated under various occlusion conditions to determine their specific optimal swallowing condition.

scholarly journals Pilot Date on Swallow Function in Nondysphagic Patients Requiring a Tracheotomy Tube

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Susan L. Brady ◽  
Michele Wesling ◽  
Joseph Donzelli
Keyword(s):  
Study Design ◽  
Repeated Measure ◽  
Common Finding ◽  
Single Subject ◽  
Repeated Measure Design ◽  
Tracheotomy Tube ◽  
Laryngeal Penetration ◽  
Swallowing Dysfunction ◽  
Measure Design ◽  
Swallow Function

Objective. To evaluate the effects of occlusion status (i.e., open, finger, capped) of the tracheotomy tube and removal of the tracheotomy tube that may have upon bolus flow and durational measurements in nondysphagic persons requiring a tracheotomy tube.Study Design. Prospective, single subject, repeated measure design.Methods. Participants had their swallow evaluated with 5 mL pureed boluses using nasal endoscopy with the tracheotomy tube in place, removed, and under the following occlusion conditions: open, finger, and capped. The order of occlusion condition was randomized.Results. Aspiration was never observed but laryngeal penetration was a common finding. Durational measurements for swallow initiation and duration of white out were not significantly different by occlusion status or after removal of the tracheotomy tube.Conclusion. This study provides corroborating evidence demonstrating the lack of a relationship between a tracheotomy tube and swallowing dysfunction.

Videofluoroscopic Swallow Study Findings and Correlations in Infancy of Children with Cerebral Palsy

2021 ◽  
pp. 000348942110267
Author(s):  
Amit Narawane ◽  
Christina Rappazzo ◽  
Jean Hawney ◽  
James Eng ◽  
Julina Ongkasuwan
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Demographic Data ◽  
Early Infancy ◽  
Gross Motor ◽  
Laryngeal Penetration ◽  
Swallowing Dysfunction ◽  
Swallow Study ◽  
Pharyngeal Swallowing ◽  
Tracheal Aspiration

Objectives: Cerebral palsy (CP) in infants can affect global motor function and lead to swallowing difficulties. This study aims to characterize oral and pharyngeal swallowing dynamics in infancy of patients later diagnosed with CP and to determine if swallow study performance in early infancy is associated with later CP severity and characteristics. Methods: This is a retrospective chart review of infants who underwent videofluoroscopic swallow studies (VFSS) between 6/2008 and 10/2018 at a tertiary children’s hospital, and were later diagnosed with CP. Demographic data, CP characteristics and metrics, and VFSS findings were collected and analyzed. Results: There were 66 patients included in this study. The average age at the time of VFSS was 4 months (range: 0.3-12 months), 42% of patients were female, and 50% of patients were born premature. In our sample, 86% of patients presented with oral dysphagia, and 76% with pharyngeal dysphagia. Laryngeal penetration in isolation was seen in 39% of patients, and tracheal aspiration was seen in 38% of patients. Of these tracheal aspiration events, 64% were silent. At the time of VFSS, 58% of patients had a nasogastric tube, 12% had a gastrostomy tube, and 3% had a prior hospitalization for pneumonia. Rates of penetration and aspiration in early infancy did not consistently correlate with prematurity, type of CP (spastic, non-spastic, or mixed), degree of paralysis (quadriplegic, hemiplegic, or diplegic), or severity of Gross Motor Function Classification System (GMFCS) score. Conclusion: While there was not a consistent correlation of swallowing dynamics in infancy with later gross motor categorizations of CP, the results of this retrospective review highlight the essential role of early clinical and videofluoroscopic swallowing evaluations to identify oral and pharyngeal swallowing dysfunction in this patient population.

Videofluoroscopic Swallow Studies and Diagnostic Outcomes in Otherwise Healthy Infants With Dysphagia

2021 ◽  
pp. 000348942110477
Author(s):  
Michael C. Shih ◽  
Christina Rappazzo ◽  
Caroline Hudson ◽  
Julina Ongkasuwan
Keyword(s):  
Chart Review ◽  
Future Research ◽  
Silent Aspiration ◽  
Healthy Infants ◽  
Laryngeal Penetration ◽  
Swallow Study ◽  
Videofluoroscopic Swallow Study ◽  
Diagnostic Outcomes ◽  
Tracheal Aspiration

Objectives: To evaluate videofluoroscopic swallow study (VFSS) findings in infants with dysphagia and without prior diagnoses, and to characterize the outcomes and any diagnoses that follow. Methods: A chart review of all pediatric patients who received a VFSS at a tertiary children’s hospital from November 2008 to March 2017 was performed. Results: There were 106 infants (57 males and 49 females) with 108 VFSS. VFSS was normal in 18 (16.98%) infants. Regarding airway protection, 50 (47.17%) infants had laryngeal penetration, and 8 (7.55%) had tracheal aspiration; 3 (2.83%, 37.5% of all aspirators) exhibited silent aspiration. Of the 75 infants with minimum 2-year follow-up, 35 (46.67%) had no sequelae of disease and received no diagnoses. The most common diagnoses and pathologic sequelae were gastroesophageal reflux (n = 18, 24.00%), asthma (n = 8, 10.67%), laryngomalacia (n = 6, 8.00%), and tracheomalacia (n = 4, 5.33%), all consistent with United States pediatric data on prevalence. All infants (n = 51) with follow-up for dysphagia had resolution of symptoms within 9 months from VFSS order date. Conclusions: Otherwise healthy infants may show signs of dysphagia and not develop later illness. Parents can thus be counseled on the implications of dysphagia in a previously healthy infant. Our findings provide comparative statistics for future research in pediatric dysphagia.

scholarly journals Bolus Airway Invasion Observed During Videofluoroscopy in Healthy, Non-dysphagic Community-Dwelling Adults

2019 ◽  
Vol 128 (5) ◽  
pp. 426-432 ◽  
Author(s):  
Kendrea L. (Focht) Garand ◽  
Elizabeth G. Hill ◽  
Elaine Amella ◽  
Kent Armeson ◽  
Alonna Brown ◽  
...  
Keyword(s):  
Community Dwelling ◽  
Age Related ◽  
Eligible Participant ◽  
Increased Risk ◽  
Airway Invasion ◽  
Swallow Study ◽  
Rising Incidence ◽  
Videofluoroscopic Swallow Study ◽  
Risk Of Aspiration ◽  
The Relationship

Objectives: Typical aging may result in subclinical swallowing alterations (presbyphagia), which can place an individual at risk for dysphagia-related conditions, such as aspiration pneumonia, secondary to loss of functional reserve and rising incidence of age-related diseases associated with dysphagia. The purpose of this study was to investigate occurrence of airway invasion among healthy, nondysphagic community-dwelling adults. Further, we tested for differences of airway invasion across age categories and between sexes. Methods: Each eligible participant underwent a videofluoroscopic swallow study using a standardized approach of various volumes and viscosities. Ten swallows observed in the lateral viewing plane was assessed for observation of bolus airway invasion using the Penetration-Aspiration Scale (PAS) scoring system. Eligible participants (N = 195) were categorized according to 1 of 3 age categories (21-39 years, 40-59 years, 60 years and older) and sex (male, female) for analyses. Results: Out of 1936 swallows analyzed, we observed penetration in 113 swallows (5.8%) and aspiration in 6 swallows (0.3%). Majority (98%) of bolus airway invasion events occurred during the swallow. Mean or worst PAS scores did not significantly differ across age categories or between sexes. The odds ratios of PAS impairment between age categories did not reveal any significant differences. Males were more likely to have impaired PAS scores relative to females (odds ratio [OR] = 3.5; P = .01). Conclusions: Entrance of ingested material into the airway observed during videofluoroscopy is uncommon in healthy adults, which helps support the notion that aging may not directly correlate with increased risk of aspiration. Rather, the increased risk of aspiration observed in the aging population may result from the increased incidence of neurological and other diseases with dysphagia as common sequelae with advancing age. Future investigations should compare age-matched healthy controls with a diseased population (eg, cerebral vascular accident) to further explore the relationship between aspiration risk as a function of age compared to consequence of disease/injury.

scholarly journals Longitudinal Changes of Tongue Thickness and Tongue Pressure in Neuromuscular Disorders

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
George Umemoto ◽  
Shinsuke Fujioka ◽  
Hajime Arahata ◽  
Nobutaka Sakae ◽  
Naokazu Sasagasako ◽  
...  
Keyword(s):  
Neuromuscular Disorders ◽  
The Other ◽  
Tongue Pressure ◽  
Swallowing Function ◽  
Longitudinal Changes ◽  
Swallowing Dysfunction ◽  
The Relationship ◽  
Lateral Sclerosis

Abstract Background Swallowing dysfunction is related to major cause of adverse events and an indicator of shorter survival among patients with neuromuscular disorders (NMD). It is critical to assess the swallowing function during disease progression, however, there are limited tools that can easily evaluate swallowing function without using videofluoroscopic or videoendoscopic examination. Here, we evaluated the longitudinal changes in tongue thickness (TT) and maximum tongue pressure (MTP) among patients with amyotrophic lateral sclerosis (ALS), myotonic dystrophy type 1 (DM1), and Duchenne muscular dystrophy (DMD). Methods Between 2010 and 2020, TT and MTP were measured from 21 ALS, 30 DM1, and 14 DMD patients (mean ages of 66.9, 44.5, and 21.4 years, respectively) at intervals of more than half a year. TT was measured, by ultrasonography, as the distance from the mylohyoid muscle raphe to the tongue dorsum, and MTP was determined by measuring the maximum compression on a small balloon when pressing the tongue against the palate. Then we examined the relationship between these evaluations and patient background and swallowing function. Results Mean follow-up periods were 24.0 months in the ALS group, 47.2 months in the DM1group, and 61.1 months in the DMD group. The DMD group demonstrated larger first TT than the other groups, while the DM1 group had lower first MTP than the ALS group. The ALS group showed a greater average monthly reduction in mean TT than the DM1 group and greater monthly reductions in mean body weight (BW) and MTP than the other groups. Significant differences between the first and last BW, TT, and MTP measures were found only in the ALS group. Conclusions This study suggests that ALS is associated with more rapid degeneration of tongue function over several years compared to DMD and DM1.

scholarly journals Model-Based Patterns of Lymphedema Symptomatology: Phenotypic and Biomarker Characterization

2020 ◽  
Author(s):  
Mei R. Fu ◽  
Bradley E Aouizerat ◽  
Gary Yu ◽  
Yvette Conley ◽  
Deborah Axelrod ◽  
...  
Keyword(s):  
Breast Cancer Survivors ◽  
Latent Class ◽  
Severe Symptom ◽  
Repeated Measure ◽  
Phenotypic Characteristics ◽  
Post Surgery ◽  
Lower Education Level ◽  
Measure Design ◽  
Lower Education ◽  
Symptom Patterns

Abstract Purpose of the Study More than 50% of breast cancer survivors without a diagnosis of lymphedema suffer daily from numerous and co-occurring lymphedema symptoms. This study aimed to identify lymphedema symptom patterns and the association of such patterns with phenotypic characteristics and biomarkers using latent class analysis (LCA). A prospective, descriptive, and repeated-measure design was used to enroll 140 women and collect data. Recent Findings LCA identified three distinct lymphedema symptom classes at 8 weeks and 12 months post-surgery: low, moderate, and severe symptom classes and associated phenotypic characteristics. Participants were more likely to be in the severe symptom classes at 12 months post-surgery if they had lower education level, cording, an axillary syndrome at 8 weeks post-surgery, neoadjuvant chemotherapy, and radiation. Summary Pre-surgery level of IL1-a, IL-6, IL-8, and VEGF was associated with the severe symptom class at 8 weeks post-surgery, suggesting that such biomarkers may be used to predict risk for lymphedema symptoms.

scholarly journals Dysphagia in Perry Syndrome: Pharyngeal Pressure in Two Cases

2017 ◽  
Vol 9 (2) ◽  
pp. 161-167 ◽  
Author(s):  
George Umemoto ◽  
Yoshio Tsuboi ◽  
Hirokazu Furuya ◽  
Takayasu Mishima ◽  
Shinsuke Fujioka ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Oral Intake ◽  
Normal Diet ◽  
Oral Feeding ◽  
Tongue Pressure ◽  
Normal Range ◽  
Swallowing Function ◽  
Pharyngeal Pressure ◽  
Swallowing Dysfunction ◽  
The Impact

Background: To investigate the impact of dysphagia in Perry syndrome (PS), an autosomal dominant parkinsonism caused by mutation of DCTN1, which is associated with hypoventilation, depression, and weight loss. Case Presentation: We used tongue pressure measurements and manofluorography to investigate swallowing function in 2 patients with PS. Case 1, a 60-year-old male showing parkinsonism, and case 2, a 49-year-old male admitted with pneumonia, were diagnosed as having PS based on the DCTN1 gene analysis. Case 1 showed a pharyngeal retention of the bolus on videofluorography (VF) and a few swallows were required for its passage into the esophagus. However, tongue pressure and manometry were within the normal range. This patient could eat a normal diet under supervision. Case 2 required artificial ventilation and tube feeding on admission. The VF image showed a slow transfer of the bolus, delayed swallow reflex, and pharyngeal retention of the bolus that required several swallows for its passage into the esophagus. The tongue pressure was within the normal range, but manometry showed a significant decrease in pressure at the hypopharynx and upper esophageal sphincter. The oral intake of the patients was limited to 2 cups of jelly per day. Conclusions: The investigation of swallowing dysfunction of 2 cases of PS showed that maintaining pharyngeal pressure within the normal range was very important for oral feeding success and prognosis.

Mechanism of Sequential Swallowing During Straw Drinking in Healthy Young and Older Adults

2004 ◽  
Vol 47 (1) ◽  
pp. 33-45 ◽  
Author(s):  
Stephanie K. Daniels ◽  
David M. Corey ◽  
Leslie D. Hadskey ◽  
Calli Legendre ◽  
Daniel H. Priestly ◽  
...  
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Movement Patterns ◽  
Leading Edge ◽  
Normal Aging ◽  
Significant Relation ◽  
Age Related ◽  
Laryngeal Penetration ◽  
Airway Invasion ◽  
Edge Location

Recent research has revealed differences between isolated and sequential swallowing in healthy young adults; however, the influence of normal aging on sequential swallowing has not been studied. Thus, the purpose of this investigation was to examine the effects of normal aging on deglutition during sequential straw drinking. Videofluoroscopic samples of two 10-s straw drinking trials were obtained for 20 healthy young men (age 29±3 years) and 18 healthy older men (age 69±7 years). Hyolaryngeal complex (HLC) movement patterns, leading edge of the bolus location at swallow onset, and occurrences of airway invasion were determined. Two HLC patterns were identified: (a) HLC lowering with the epiglottis returned to upright between swallows and (b) partially maintained HLC elevation with the epiglottis inverted between swallows. The bolus was frequently in the hypopharynx at swallow onset. Strong associations were identified between age and HLC pattern, age and leading edge of the bolus location, and HLC pattern and leading edge location. Laryngeal penetration was uncommon overall; however, it occurred more frequently in the older adults than in the young adults. A significant relation was identified between age and the average Penetration-Aspiration Scale score. Laryngeal penetration was associated with both HLC movement patterns and hypopharyngeal bolus location, particularly in older adults. Results indicate that subtle age-related differences are evident in healthy young and older adults with sequential straw drinking. These data suggest that specific inherent swallowing patterns may increase the risk of laryngeal penetration with normal aging.

scholarly journals PERBEDAAN TUJUAN AUDITOR ATAS TINGKAT OVERCONFIDENCE PERTIMBANGAN AUDITOR (STUDI EKSPERIMENTAL)

2017 ◽  
Vol 17 (2) ◽  
pp. 234
Author(s):  
Nungki Kartikasari ◽  
Bambang Subroto ◽  
Aulia Fuad Rahman
Keyword(s):  
Empirical Finding ◽  
Motivated Reasoning ◽  
Calibration Method ◽  
Repeated Measure ◽  
Business Faculty ◽  
Legal Risks ◽  
Measure Design ◽  
Auditor Judgments ◽  
Cochran Test ◽  
Client Relations

The purpose of this study is to investigate and provide empirical finding about the effect of accuracy, directional and combined goals on overconfidence level in auditors judgments. This study tested the motivated reasoning theory in audit context. Overconfidence level in auditor judgments was measured by calibration method. Calibration method is used by measures the level of accuracy and confidence in auditor judgments in the obsolescence inventory case. This experiment used repeated measure design. The design of this experiment was conducted by given the treatment of accuracy (a condition to avoid the legal risks and sanctions), directional (a condition to emphasizing the importance of good client relations) and combination (a condition to combining get along and accuracy goals) goal to the participants and measuring the overconfidence level in every goal. The hypothesis testing in this study used cochran test. This study used laboratory experiment with participants auditor from join program students of Economics and Business  Faculty,  University  of  Brawijaya. The result of this study shows that auditors judgments are overconfidence in all goals (accuracy, directional and combined). The result of this study was inconsistent  with  motivated reasoning theory.

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