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

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.

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Progression of swallowing dysfunction and associated complications of dysphagia in a cohort of patients with serial videofluoroscopic swallow examinations

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001298 ◽

2021 ◽

pp. 1-6

Author(s):

R Hanna ◽

D R Randall

Keyword(s):

Univariate Analysis ◽

Oropharyngeal Dysphagia ◽

Risk Groups ◽

Common Symptom ◽

Swallowing Dysfunction ◽

Scale Scores ◽

Patients At Risk ◽

Life Threatening ◽

Over Time ◽

Penetration Aspiration Scale

Abstract Objective Dysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time. Method This was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities. Results This study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time (p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time (p = 0.57) or severity of dysphagia (p = 0.88). Conclusion Our dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.

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Delayed Upper Aerodigestive Tract Perforation from Anterior Cervical Spine Hardware: Treatment and Swallowing Outcomes

Dysphagia ◽

10.1007/s00455-021-10361-w ◽

2021 ◽

Author(s):

Hannah G. Kay ◽

Benjamin Campbell ◽

Jean-Nicolas Gallant ◽

Catherine Carlile ◽

Patty Wright ◽

...

Keyword(s):

Cervical Spine ◽

Aerodigestive Tract ◽

Upper Aerodigestive Tract ◽

Tract Perforation ◽

Swallowing Outcomes

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Underdosed Direct Oral Anticoagulants in Atrial Fibrillation Patients Reduce Stroke Severity and Improve Outcome

Cerebrovascular Diseases ◽

10.1159/000520857 ◽

2021 ◽

pp. 1-8

Author(s):

Masaki Naganuma ◽

Yuichiro Inatomi ◽

Toshiro Yonehara ◽

Makoto Nakajima ◽

Mitsuharu Ueda

Keyword(s):

Atrial Fibrillation ◽

Functional Outcomes ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

National Institutes Of Health ◽

Stroke Severity ◽

Anticoagulant Drugs ◽

Scale Scores ◽

Anticoagulant Drug ◽

Ischemic Attack

Background and Purpose: Anticoagulant drugs, including vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs), can reduce stroke severity and are associated with good functional outcomes. Some patients are prescribed lower-than-recommended doses of DOACs; whether these have similar effects has not been clarified. Methods: We retrospectively evaluated 1,139 consecutive ischemic stroke and transient ischemic attack patients with atrial fibrillation. Patients were divided into 5 groups according to their preceding anticoagulant drug therapies: no anticoagulant therapy (ACn), undercontrolling VKA doses (VKAuc), recommended, controlling VKA doses (VKArec), prescribed underdoses of DOAC (DOACud), and recommended doses of DOAC (DOACrec). We investigated the associations between these anticoagulant drug therapies and patients’ initial stroke severity and 3-month outcomes. Results: Median National Institutes of Health Stroke Scale scores at admission were as follows: ACn: 16, VKAuc: 15, VKArec: 9, DOACud: 5, and DOACrec: 7. When the ACn group was used as a reference, regression analysis showed that VKArec (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.01–2.21), DOACud (OR 2.84, 95% CI: 1.47–5.66), and DOACrec (OR 1.83, 95% CI: 1.23–2.74) were associated with milder stroke severity, while VKAuc was not. Median 3-month modified Rankin Scale scores were 2 in the DOACud and DOACrec groups and 4 in all other groups. After adjusting for confounding factors, DOACud (OR 3.14, 95% CI: 1.50–6.57) and DOACrec (OR 1.67, 95% CI: 1.05–2.64) were associated with good 3-month outcomes while VKAuc and VKArec were not. Conclusions: In patients with atrial fibrillation, recommended doses and underdoses of DOACs reduced stroke severity on admission and were associated with good 3-month outcomes.

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Reliability and Construct Validity of the Penetration-Aspiration Scale for Quantifying Pediatric Outcomes after Interarytenoid Augmentation

Otolaryngology ◽

10.1177/0194599819856299 ◽

2019 ◽

Vol 161 (5) ◽

pp. 862-869 ◽

Cited By ~ 1

Author(s):

Elizabeth H. Wick ◽

Kaalan Johnson ◽

Kim Demarre ◽

Amy Faherty ◽

Sanjay Parikh ◽

...

Keyword(s):

Construct Validity ◽

Mixed Model ◽

Mixed Linear Model ◽

Barium Swallow ◽

Time Interval ◽

Modified Barium Swallow ◽

Outcome Group ◽

Scale Scores ◽

Postoperative Time ◽

Penetration Aspiration Scale

Objective To assess the reliability and construct validity of the Penetration-Aspiration Scale in children. Study Design This was a retrospective cohort study of pre- and postoperative video modified barium swallow studies from children who underwent interarytenoid injection augmentation for unexplained persistent pharyngeal dysphagia. Two pediatric speech and language pathologists reviewed each study twice in a blinded and randomized fashion. Setting Tertiary academic pediatric hospital. Subjects and Methods Thirty children were identified with adequate pre- and postoperative modified barium swallow studies within 4 weeks of intervention. Children were separated into clinical outcome groups based on ability to advance to thinner diet consistencies postoperatively. Construct validity was assessed with a mixed linear model to test the hypothesis that only the clinically improved group would receive better Penetration-Aspiration Scale scores after surgery. Reliability was assessed by calculating chance-corrected agreement between raters (interrater) and raters’ repeat evaluations (intrarater). Results Inter- and intrarater reliabilities (Cohen’s κ) were both excellent. Results of the mixed model revealed a significant interaction between outcome group and pre- and postoperative time interval. As hypothesized, this involved a significant improvement in Penetration-Aspiration Scale score only in the improved group. Conclusions These findings suggest that the Penetration-Aspiration Scale is a reliable and valid measure of clinical response to interarytenoid injection augmentation in children.

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Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents

Interventional Neurology ◽

10.1159/000486457 ◽

2018 ◽

Vol 7 (3-4) ◽

pp. 189-195 ◽

Cited By ~ 1

Author(s):

Benjamin M. Zussman ◽

Bradley A. Gross ◽

William J. Ares ◽

Cynthia L. Kenmuir ◽

Gregory M. Weiner ◽

...

Keyword(s):

Internal Carotid ◽

Treatment Options ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Endovascular Techniques ◽

Aspiration Thrombectomy ◽

Patient Demographics ◽

Clinical Presentations ◽

Scale Scores

Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections. Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents. Patient demographics, clinical presentations, endovascular techniques, and clinical outcomes were reviewed. Results: In both cases, MAT achieved modified Treatment in Cerebral Ischemia scale 2B reperfusion, and complete endovascular reconstruction of the dissected extracranial loop was performed. Both patients had improved pre- to postintervention National Institutes of Health Stroke Scale scores (16 to 0 and 14 to 0), and both had modified Rankin scale scores of 1 at 3-month follow-up. Conclusions: Stent reconstruction of complex cerebrovascular anatomy is increasingly feasible with advancements in stent technology and catheter support system design. This technique may be of use to neuroendovascular surgeons who encounter variant ICA anatomy.

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Is the Association of National Institutes of Health Stroke Scale Scores and Acute Magnetic Resonance Imaging Stroke Volume Equal for Patients With Right- and Left-Hemisphere Ischemic Stroke?

Stroke ◽

10.1161/01.str.0000013069.24300.1d ◽

2002 ◽

Vol 33 (4) ◽

pp. 954-958 ◽

Cited By ~ 95

Author(s):

John N. Fink ◽

Magdy H. Selim ◽

Sandeep Kumar ◽

Brian Silver ◽

Italo Linfante ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Stroke Volume ◽

Left Hemisphere ◽

National Institutes Of Health ◽

Resonance Imaging ◽

Scale Scores

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Acute Ischemic Stroke in Patients With COVID-19

Stroke ◽

10.1161/strokeaha.121.034301 ◽

2021 ◽

Vol 52 (5) ◽

pp. 1826-1829

Author(s):

Pratyaksh K. Srivastava ◽

Shuaiqi Zhang ◽

Ying Xian ◽

Hanzhang Xu ◽

Christine Rutan ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Adverse Outcomes ◽

National Institutes Of Health ◽

Stroke Severity ◽

Younger Age ◽

Increased Risk ◽

Scale Scores ◽

Get With The Guidelines

Background and Purpose: Studies suggest an increased risk of adverse outcomes among patients with acute ischemic stroke (AIS) and coronavirus disease 2019 (COVID-19). Methods: Using Get With The Guidelines–Stroke, we identified 41 971 patients (AIS/COVID-19: 1143; AIS/no COVID-19: 40 828) with AIS hospitalized between February 4, 2020 and June 29, 2020, from 458 Get With The Guidelines–Stroke hospitals with at least one COVID-19 case and evaluated clinical characteristics, treatment patterns, and outcomes. Results: Compared with patients with AIS/no COVID-19, those with AIS/COVID-19 were younger, more likely to be non-Hispanic Black, Hispanic, or Asian, more likely to present with higher National Institutes of Health Stroke Scale scores, and had greater proportions of large vessel occlusions. Rates of thrombolysis and thrombectomy were similar between the groups. Door to computed tomography (median 55 [18–207] versus 35 [14–99] minutes, P <0.001), door to needle (59 [40–82] versus 46 [33–64] minutes, P <0.001), and door to endovascular therapy (114 [74–169] versus 90 [54–133] minutes, P =0.002) times were longer in the AIS/COVID-19 cohort. In adjusted models, patients with AIS/COVID-19 had decreased odds of discharge with modified Rankin Scale score of ≤2 (odds ratio, 0.65 [95% CI, 0.52–0.81], P <0.001) and increased odds of in-hospital mortality (odds ratio, 4.34 [95% CI, 3.48–5.40], P <0.001). ConclusionS: This analysis demonstrates younger age, greater stroke severity, longer times to evaluation and treatment, and worse morbidity and mortality in patients with AIS/COVID-19 compared with those with AIS/no COVID-19.

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