Videomanometry of the pharynx in dysphagic patients with laryngeal barium penetration during swallowing

1998 ◽  
Vol 39 (4) ◽  
pp. 405-409 ◽  
Author(s):  
R. Olsson ◽  
J. Castell ◽  
O. Ekberg ◽  
D. O. Castell
Keyword(s):  
Healthy Volunteers ◽  
Peak Pressure ◽  
Oropharyngeal Dysphagia ◽  
Barium Swallow ◽  
Mean Values ◽  
Contraction Duration ◽  
Laryngeal Penetration ◽  
Resting Pressure ◽  
Laryngeal Vestibule ◽  
Dysphagic Patients

Purpose: This study used simultaneous videomanometry to measure pressure characteristics in a group of patients with evidence of laryngeal and/or tracheal barium penetration, and to compare the results to those of one group of healthy volunteers and one group of patients with dysphagia but a normal barium swallow. Material and Methods: Videomanometry during barium swallowing was performed in 25 patients who showed penetration of barium into the laryngeal vestibule. Manometric abnormalities were determined by comparing these mean values with those of 25 healthy volunteers, and the frequency of manometric abnormalities was compared to that of 19 patients presenting with oropharyngeal dysphagia with a normal barium swallow. Results: The frequency of abnormalities for four parameters (pharyngo-eso-phageal segment (PES) resting pressure, PES relaxation duration, pharyngeal peak pressure, pharyngeal contraction duration) differed significantly between the patients with penetration and those with normal barium studies. There was, however, no association between manometric abnormalities and the degree of barium penetration. Conclusion: The differences in manometric abnormalities between patients with laryngeal penetration and patients with normal barium swallows may be useful in identifying the mechanisms of laryngeal penetration.

scholarly journals Pathophysiology of Swallowing Dysfunction in Parkinson Disease and Lack of Dopaminergic Impact on the Swallow Function and on the Effect of Thickening Agents

2020 ◽  
Vol 10 (9) ◽  
pp. 609
Author(s):  
Weslania Viviane Nascimento ◽  
Viridiana Arreola ◽  
Pilar Sanz ◽  
Ediz Necati ◽  
Mireia Bolivar-Prados ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Healthy Volunteers ◽  
Oropharyngeal Dysphagia ◽  
Yahr Stage ◽  
Disease Evolution ◽  
Swallowing Dysfunction ◽  
Bolus Viscosity ◽  
Laryngeal Vestibule ◽  
Thickening Agents ◽  
Swallow Function

(1) Background: The effect of dopaminergic treatment on swallowing response in patients with Parkinson’s disease (PD) suffering oropharyngeal dysphagia (OD) is not understood. Aim: To characterize OD pathophysiology in PD and to assess whether dopaminergic states affect swallow function and the effect of thickeners. (2) Methods: Fifty patients with PD (40 evaluated in OFF/ON states) and 12 healthy volunteers (HVs) were evaluated with videofluoroscopy (VFS) to assess the swallowing biomechanics and kinematics of the swallowing response at three different shear-viscosities (<50, 120, and 4000 mPa·s); (3) Results: Patients presented a mean age of 70.46 ± 10.03 years. Disease evolution was 5.09 ± 3.86 year and Hoehn-Yahr stage was 2.32 ± 0.81. For HVs, mean age was 40.20 ± 2.50 year. Penetrations were present in 37.50% of PD patients and were associated with delayed laryngeal vestibule closure (LVC = 293.33 ± 90.07 ms). In contrast, HVs presented a LVC = 164.00 ± 39.78 ms (p < 0.05). An LVC ≥ 260 ms cutoff predicted unsafe swallow (sensitivity ≥ 0.83, specificity ≥ 0.57, AUC = 0.80) in PD. Increasing bolus viscosity improved deglutition safety but increased oropharyngeal residue. There were no differences in swallowing between the OFF/ON states. (4) Conclusions: In initial PD stages, oropharyngeal swallow response is severely delayed, while mildly impaired swallow safety improves with increasing bolus viscosity, which increases residue. Dopaminergic treatment does not affect swallowing or the therapeutic effect of thickeners.

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 ◽  
...  
Keyword(s):  
Rating Scale ◽  
Pyriform Sinus ◽  
Endoscopic Evaluation ◽  
Pharyngeal Residue ◽  
Food Residue ◽  
Severity Rating ◽  
Vegetable Soup ◽  
Laryngeal Vestibule ◽  
Dysphagic Patients ◽  
Penetration Aspiration Scale

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.

Assessment of the reliability of ionization current measurement in estimating peak pressure angle in a spark ignition engine

2021 ◽  
pp. 146808742110399
Author(s):  
Veniero Giglio ◽  
Livia Della Ragione ◽  
Alessandro di Gaeta ◽  
Natale Rispoli
Keyword(s):  
Peak Pressure ◽  
Angular Position ◽  
Spark Ignition ◽  
Operating Conditions ◽  
Spark Ignition Engine ◽  
Mean Values ◽  
Pressure Angle ◽  
Ionization Current ◽  
Significant Difference ◽  
Second Peak

Ionization current measured at the spark plug during combustion in spark ignition engines has often been proposed to determine the crank-angle at combustion pressure peak, namely the peak pressure angle, for the purpose of regulating spark timing to attain maximum brake torque (MBT). The proposal is based on the assumption that agreement exists between peak pressure angle and the angular position of the ionization current second peak, although no one has ever proved it by an appropriate statistical analysis. The aim of this work, for the first time and by rigorous statistical methods, is to prove the agreement between Peak Pressure Angle and Ionization Current Second Peak Angle (ICSPA), without which a MBT control via ICSPA would be ineffective. Our experimental database consisted of about 9000 pairs of Peak Pressure Angle and Ionization Current Second Peak Angle values corresponding to 90 different operating conditions of a spark ignition engine. A two-sample comparison was first carried out between mean values of Peak Pressure Angle and Ionization Current Second Peak Angle, which showed a statistically significant difference between them. Then Bland-Altman analysis (Lancet, 1986), widely known and used for checking agreement between two different measurement methods, was conducted. It demonstrated that under almost all the experimental operating conditions, there was no agreement between the Ionization Current Second Peak Angle and the Peak Pressure Angle.

scholarly journals The use of a neck brace does not influence visual vertical perception

2011 ◽  
Vol 69 (3) ◽  
pp. 509-512 ◽  
Author(s):  
Martha Funabashi ◽  
Natya N.L. Silva ◽  
Luciana M. Watanabe ◽  
Taiza E.G Santos-Pontelli ◽  
José Fernando Colafêmina ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Healthy Subjects ◽  
Afferent Input ◽  
Subjective Visual Vertical ◽  
Sensory Receptors ◽  
Ocular Torsion ◽  
Vertical Orientation ◽  
Mean Values ◽  
Visual Vertical ◽  
The Mean

Subjective visual vertical (SVV) evaluates the individual's capacity to determine the vertical orientation. Using a neck brace (NB) allow volunteers' heads fixation to reduce cephalic tilt during the exam, preventing compensatory ocular torsion and erroneous influence on SVV result. OBJECTIVE: To analyze the influence of somatosensory inputs caused by a NB on the SVV. METHOD: Thirty healthy volunteers performed static and dynamic SVV: six measures with and six without the NB. RESULTS: The mean values for static SVV were -0.075º±1.15º without NB and -0.372º±1.21º with NB. For dynamic SVV in clockwise direction were 1.73º±2.31º without NB and 1.53º±1.80º with NB. For dynamic SVV in counterclockwise direction was -1.50º±2.44º without NB and -1.11º±2.46º with NB. Differences between measurements with and without the NB were not statistically significant. CONCLUSION: Although the neck has many sensory receptors, the use of a NB does not provide sufficient afferent input to change healthy subjects' perception of visual verticality.

scholarly journals Comparison of the CSF dynamics between patients with idiopathic normal pressure hydrocephalus and healthy volunteers

2019 ◽  
Vol 131 (4) ◽  
pp. 1018-1023 ◽  
Author(s):  
Johan Jacobsson ◽  
Sara Qvarlander ◽  
Anders Eklund ◽  
Jan Malm
Keyword(s):  
Healthy Volunteers ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Neurological Status ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Diagnostic Process ◽  
Clinical Trial Registration ◽  
Resting Pressure ◽  
The Relationship ◽  
Dynamic Investigation

OBJECTIVEIntracranial pressure (ICP), outflow resistance (Rout), and amplitude of cardiac-related ICP pulsations (AMPs) are established parameters to describe the CSF hydrodynamic system and are assumed, but not confirmed, to be disturbed in idiopathic normal pressure hydrocephalus (INPH). The aim of this study was to compare the CSF hydrodynamic profile between patients with INPH and healthy volunteers.METHODSSixty-two consecutive INPH patients (mean age 74 years) and 40 healthy volunteers (mean age 70 years) were included. Diagnosis was made by two independent neurologists who assessed patients’ history, neurological status, and MRI studies. A CSF dynamic investigation through the lumbar route was performed: ICP and other CSF dynamic variables were blinded to the neurologists during the diagnostic process and were not used for establishing the diagnosis of INPH.RESULTSRout was significantly higher in INPH (Rout 17.1 vs 11.1; p < 0.001), though a substantial number of INPH subjects had normal Rout. There were no differences between INPH patients and controls regarding ICP (mean 11.5 mm Hg). At resting pressure, there was a trend that AMP in INPH was increased (2.4 vs 2.0 mm Hg; p = 0.109). The relationship between AMP and ICP was that they shared the same slope, but the curve was significantly shifted to the left for INPH (reduced P0 [p < 0.05]; i.e., higher AMP for the same ICP).CONCLUSIONSThis study established that the CSF dynamic profile of INPH deviates from that of healthy volunteers and that INPH should thus be regarded as a disease in which intracranial hydrodynamics are part of the pathophysiology.Clinical trial registration no.: NCT01188382 (clinicaltrials.gov)

scholarly journals Clinical evaluation of oropharyngeal dysphagia in Machado-Joseph disease

2010 ◽  
Vol 47 (4) ◽  
pp. 334-338 ◽  
Author(s):  
Sabrina Mello Alves Corrêa ◽  
Valter Nilton Felix ◽  
Jonas Lírio Gurgel ◽  
Rubens A. A Sallum ◽  
Ivan Cecconello
Keyword(s):  
Clinical Evaluation ◽  
Clinical Characteristics ◽  
Oropharyngeal Dysphagia ◽  
Neurological Manifestations ◽  
Severity Scale ◽  
Pharyngeal Phase ◽  
History Of ◽  
Machado Joseph Disease ◽  
Dysphagic Patients

CONTEXT: In Machado-Joseph disease, poor posture, dystonia and peripheral neuropathy are extremely predisposing to oropharyngeal dysphagia, which is more commonly associated with muscular dystrophy. OBJECTIVE: To evaluate the clinical characteristics of oropharyngeal dysphagia in Machado-Joseph disease patients. METHOD: Forty individuals participated in this study, including 20 with no clinical complaints and 20 dysphagic patients with Machado-Joseph disease of clinical type 1, who were all similar in terms of gender distribution, average age, and cognitive function. The medical history of each patient was reviewed and each subject underwent a clinical evaluation of deglutition. At the end, the profile of dysphagia in patients with Machado-Joseph disease was classified according to the Severity Scale of Dysphagia, as described by O'Neil and collaborators. RESULTS: Comparison between dysphagic patients and controls did not reveal many significant differences with respect to the clinical evaluation of the oral phase of deglutition, since afflicted patients only demonstrated deficits related to the protrusion, retraction and tonus of the tongue. However, several significant differences were observed with respect to the pharyngeal phase. Dysphagic patients presented pharyngeal stasis during deglutition of liquids and solids, accompanied by coughing and/or choking as well as penetration and/or aspiration; these signs were absent in the controls. CONCLUSIONS: Oropharyngeal dysphagia is part of the Machado-Joseph disease since the first neurological manifestations. There is greater involvement of the pharyngeal phase, in relation to oral phase of the deglutition. The dysphagia of these patients is classified between mild and moderate.

scholarly journals The Occurrence of Laryngeal Penetration and Aspiration in Patients with Glottal Closure Insufficiency

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ali Rajaei ◽  
Ebrahim Barzegar Bafrooei ◽  
Fariba Mojiri ◽  
Mohammad Hussein Nilforoush
Keyword(s):  
Early Interventions ◽  
Glottal Closure ◽  
Pharyngeal Phase ◽  
Laryngeal Penetration ◽  
Swallowing Evaluation ◽  
Dysphagic Patients ◽  
Incomplete Closure

Glottal closure during the pharyngeal phase of swallowing is one of the important steps in protecting the airway. Generally, it is believed that any deficiency in this process can lead to laryngeal penetration and aspiration. This study investigated the incidence of laryngeal penetration and aspiration among 44 patients with glottal closure insufficiencies that were referred for voice and swallowing evaluation to our institution. The videostroboscopy and 3 oz water swallow test were performed for all of the patients and dysphagic patients were screened and referred for videofluoroscopy. Overall, 15.90% of patients demonstrated signs of laryngeal penetration (13.63%) and aspiration (2.27%). The patients with the pattern of incomplete closure illustrated the highest percentage of penetration-aspiration (21.73%, 4.34%) among other GCI patterns. Thus, early interventions for these patients’ swallowing condition seem necessary.

The Modified Barium Swallow Impairment Profile as a Predictor of Clinical Outcomes of Admission for Pneumonia or Choking in Dysphagic Patients with Parkinson’s Disease

Dysphagia ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 896-903 ◽  
Author(s):  
Amanda Hui-Juan Kooi ◽  
Jasmine Pei-Ling Boo ◽  
Samuel Yong-Ern Ng ◽  
Sanchalika Acharyya ◽  
Kwang-Hwee Goh ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Outcomes ◽  
Barium Swallow ◽  
Modified Barium Swallow ◽  
Dysphagic Patients

scholarly journals Percutaneous Endoscopic Gastrostomy versus Nasogastric Tube Feeding: Oropharyngeal Dysphagia Increases Risk for Pneumonia Requiring Hospital Admission

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2969 ◽  
Author(s):  
Wei-Kuo Chang ◽  
Hsin-Hung Huang ◽  
Hsuan-Hwai Lin ◽  
Chen-Liang Tsai
Keyword(s):  
Hospital Admission ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Nasogastric Tube ◽  
Oropharyngeal Dysphagia ◽  
Tube Feeding ◽  
Pyriform Sinus ◽  
Control Group ◽  
Endoscopic Gastrostomy ◽  
Endoscopic Observation ◽  
Laryngeal Vestibule

Background: Aspiration pneumonia is the most common cause of death in patients with percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding. This study aimed to compare PEG versus NGT feeding regarding the risk of pneumonia, according to the severity of pooling secretions in the pharyngolaryngeal region. Methods: Patients were stratified by endoscopic observation of the pooling secretions in the pharyngolaryngeal region: control group (<25% pooling secretions filling the pyriform sinus), pharyngeal group (25–100% pooling secretions filling the pyriform sinus), and laryngeal group (pooling secretions entering the laryngeal vestibule). Demographic data, swallowing level scale score, and pneumonia requiring hospital admission were recorded. Results: Patients with NGT (n = 97) had a significantly higher incidence of pneumonia (episodes/person-years) than those patients with PEG (n = 130) in the pharyngeal group (3.6 ± 1.0 vs. 2.3 ± 2.1, P < 0.001) and the laryngeal group (3.8 ± 0.5 vs. 2.3 ± 2.2 vs, P < 0.001). The risk of pneumonia was significantly higher in patients with NGT than in patients with PEG (adjusted hazard ratio = 2.85, 95% CI: 1.46–4.98, P < 0.001). Cumulative proportion of pneumonia was significantly higher in patients with NGT than with PEG for patients when combining the two groups (pharyngeal + laryngeal groups) (P = 0.035). Conclusion: PEG is a better choice than NGT feeding due to the decrease in risk of pneumonia requiring hospital admission, particularly in patients with abnormal amounts of pooling secretions accumulation in the pyriform sinus or leak into the laryngeal vestibule.

Epiglottic Position after Cricothyroidotomy: A Comparison with Tracheotomy

1997 ◽  
Vol 106 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Jessica W. Lim ◽  
Patricia Kerman Lerner ◽  
Stephen G. Rothstein
Keyword(s):  
New York ◽  
Medical Center ◽  
Upper Esophageal Sphincter ◽  
Barium Swallow ◽  
New York University ◽  
Laryngeal Elevation ◽  
Posterior Displacement ◽  
Tube Removal ◽  
Laryngeal Penetration ◽  
Swallowing Dysfunction

Dysphagia is a known problem in patients with tracheotomy, but its association with cricothyroidotomy is not well studied. The purpose of this study was to evaluate dysphagia in patients with cricothyroidotomy and to determine if there is a reliable indicator of swallowing dysfunction in these patients. A review of charts for patients with modified barium swallow studies conducted at the New York University Medical Center Swallowing Disorders Center yielded three groups of patients: patients with cricothyroidotomy, patients with tracheotomy, and normal patients. There were 8 patients in each group. In all patients in the cricothyroidotomy group, there was a greater impairment of epiglottic displacement, laryngeal elevation, and upper esophageal opening than in the tracheotomy group. This problem with epiglottic displacement produced susceptibility to laryngeal penetration and, in turn, increased the risk of aspiration in those patients with cricothyroidotomy. After cricothyroidotomy tube removal, a return to normal epiglottic movement was observed within 2 months. One mechanism of swallowing dysfunction is impaired posterior displacement of the epiglottis over the glottic aperture. This impaired epiglottic motion appears to be related to restricted laryngeal elevation secondary to tethering of the larynx anteriorly at the site of the cricothyroidotomy. Additionally, we noted a decrease in the opening of the upper esophageal sphincter.

Sign in / Sign up

Export Citation Format

Share Document