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.

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 The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review

Dysphagia ◽  
2019 ◽  
Vol 35 (5) ◽  
pp. 745-761 ◽  
Author(s):  
Sana Smaoui ◽  
Amy Langridge ◽  
Catriona M. Steele
Keyword(s):  
Systematic Review ◽  
Resistance Training ◽  
Data Extraction ◽  
Meta Analysis ◽  
Quality Data ◽  
Tongue Pressure ◽  
Swallowing Function ◽  
Temporal Measures ◽  
The Impact ◽  
Training Protocols

Abstract Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions. Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.

The impact of different medical complications on the feasibility of removing the feeding tube from infants with dysphagia

2021 ◽  
Vol 14 (3) ◽  
pp. 371-377
Author(s):  
Hikari Fukatsu ◽  
Kanji Nohara ◽  
Nobukazu Tanaka ◽  
Nami Fujii ◽  
Takayoshi Sakai
Keyword(s):  
Tube Feeding ◽  
Feeding Tube ◽  
Cardiovascular Complications ◽  
Oral Feeding ◽  
Medical Complications ◽  
Cardiac Complications ◽  
Medical Complication ◽  
Feeding Tubes ◽  
Tube Removal ◽  
The Impact

PURPOSE: This study examined whether certain medical complications influence the feasibility of tube removal. METHODS: 42 subjects with dysphagia who were under the age of 2.5 years were nourished entirely through feeding tubes. Additionally, they were judged to have no aspiration. The following data about the infants were collected through a retroactive survey: age at which oral feeding training commenced, gender, and whether certain medical complications (cardiovascular, respiratory, digestive, neurological, or oral) had been present at birth. The data were analyzed to determine which type of medical complication affected the likelihood of removing the feeding tube from the infant at 3 years of age. RESULTS: Of the five medical complications examined, cardiovascular complications significantly affected the feasibility of tube removal (p = 0.049). CONCLUSION: Pediatric dysphagia patients with cardiac complications, compared to those with other complications, may take longer to transition off tube feeding.

scholarly journals Swallowing function and the incidence of fever in older residents with special care needs: a one-year longitudinal prospective study

2020 ◽  
Author(s):  
Maya Izumi ◽  
Kazuo Sonoki ◽  
Yuko Ohta ◽  
Masayo Fukuhara ◽  
Masaharu Nagata ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Prospective Study ◽  
Proportional Hazards ◽  
The Body ◽  
Tongue Pressure ◽  
Care Needs ◽  
Swallowing Function ◽  
Kaplan Meier ◽  
Swallowing Dysfunction

Abstract Background Infectious diseases including aspiration pneumonia are the most frequent causes of fever, common in older residents of nursing homes. We investigated whether swallowing dysfunction was related to fever in such residents. Methods Older residents aged ≥ 65 years from three nursing homes were included in this prospective study conducted from July 2017 to May 2019. The follow-up period was 13 months. The outcome was fever incidence in relation to swallowing function. Baseline data on the activities of daily living, cognitive function, swallowing function, respiratory function, tongue pressure, and comorbidity conditions were collected. Dates on which the body temperature of participants was more than 37.5 °C during the follow-up period were also recorded. For statistical analysis, swallowing function assessed by the modified water swallow test (MWST) scores were used to divide the participants into three groups; scores ≤ 3, 4, and 5. Results A total of 52 participants [median age, 89.5 (67–104)] were enrolled. Kaplan-Meier analysis showed that the average periods until onset of fever in participants with MWST scores of ≤ 3, 4, and 5 were 8.0 (6.0–11.0), 10.0 (7.0–12.0), and 12.0 (10.0–13.0) months, respectively. Cox’s proportional hazards regression model revealed that participants with an MWST score ≤ 3 were at a higher risk of fever compared to those with an MWST score of 5 (hazards ratio 13.0, 95% confidence interval 1.9–87.6), adjusted with possible confounders. Conclusions Swallowing dysfunction correlated with the risk of fever in older residents of nursing homes.

scholarly journals Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia

2020 ◽  
Vol 44 (1) ◽  
pp. 1-10
Author(s):  
Ji Soo Choi ◽  
Hyun Bang ◽  
Goo Joo Lee ◽  
Han Gil Seo ◽  
Byung-Mo Oh ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Oral Feeding ◽  
Stroke Patients ◽  
Swallowing Function ◽  
Follow Up Study ◽  
Key Indicator ◽  
Subacute Stroke ◽  
Function Recovery ◽  
Multiple Structures

Objective To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake.Methods Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs.Results At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function.Conclusion This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.

scholarly journals Impact of nasogastric tube feeding on swallowing function in patients with dysphagia: a pilot study

2021 ◽  
Vol 26 (4) ◽  
pp. 809-815
Author(s):  
Yu Sang Jung ◽  
MinYoung Kim ◽  
Kyunghoon Min ◽  
Jong Moon Kim ◽  
Eun Young Han ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Tube Feeding ◽  
University Hospital ◽  
Diagnostic Significance ◽  
Swallowing Function ◽  
Videofluoroscopic Swallowing Study ◽  
Swallowing Therapy ◽  
Swallowing Dysfunction ◽  
Nasogastric Tube Feeding

During dysphagia treatment, direct oral swallowing therapy is applied to some patients temporarily fed via nasogastric tube. However, the risk of aspiration in oral swallowing while nasogastric tube in situ may be disregarded in a standard videofluoroscopic swallowing study performed without a nasogastric tube. To evaluate the diagnostic significance of nasogastric tube in situ videofluoroscopic swallowing study of nectar and pureed diet compared to the standard videofluoroscopic swallowing study without nasogastric tube. Videofluoroscopic swallowing study records of dysphagia patients conducted between June and August 2017 in a university hospital were collected for review. Rosenbek’s penetration-aspiration scale, diagnostic criteria of aspiration were used to define aspiration. videofluoroscopic dysphagia scale for videofluoroscopic swallowing study with or without nasogastric tube were compared for nectar and pureed diet swallowing. Patients had various duration of nasogastric tube feeding. Paired T-test comparing the videofluoroscopic dysphagia scales for videofluoroscopic swallowing study with or without nasogastric tube revealed significant aggravation of swallowing dysfunction in nectar drinking while nasogastric tube in situ. This aggravation was noted in 19% (n=4) of patients who suffered from stroke regardless of nasogastric tube duration. Nasogastric tube in situ videofluoroscopic swallowing study, at least of nectar drinking could be beneficial in selecting a safe candidate for direct oral swallowing therapy in conjunction with the conventional nasogastric tube removed videofluoroscopic swallowing study.

Abstract TP157: Functional Oral Intake Scale is Associated With Poorer Outcomes Following Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Juli T De Souza ◽  
Sérgio Paiva ◽  
Priscila Ribeiro ◽  
Suzana Tanni ◽  
Marcos Minicucci ◽  
...  
Keyword(s):  
Protective Factor ◽  
Oropharyngeal Dysphagia ◽  
Tube Feeding ◽  
Adult Life ◽  
Oral Intake ◽  
Oral Feeding ◽  
Early Evaluation ◽  
Food Consistency ◽  
Specific Protocol ◽  
Functional Oral Intake Scale

Background: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65-90% of patients, and its identification in the acute phase of stroke can prevent complications. Objective: Verify whether Functional Oral Intake Scale (FOIS) score during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. Methods: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and FOIS, in which FOIS 1-3 - tube feeding, 4-5 - oral feeding requiring food consistency changes, and 6-7 - oral feeding with no changes in food consistency. mRs≥3 90 days after discharge was considered disability. The data were adjusted for the NIHSS score, sex, age, type of stroke, and presence of thrombolysis. Significance level of 5%. Results: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate . A FOIS score of 6-7 may be a protective factor against disability (mRs≥3) (OR:0.17; CI:0.005-0.56; p=0.004), and FOIS 1-3 at hospital discharge increased the risk of mRs≥3 (OR:14.97; CI: 2.68-83.65; p=0.002) and mortality (OR:9.79; CI:2.21-43.4; p=0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and FOIS 1-3 at discharge were associated with death from any cause. Important to highlight that the interaction of FOIS 1-3 at discharge and pneumonia further enhanced mortality chance (OR:113; CI:1.40-9.097; p=0.035). Conclusion: Dysphagia or FOIS 1-3 at discharge are markers of poor prognosis after stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke.

Evaluation of pharyngeal swallowing pressure using high-resolution manometry during transoral surgery for oropharyngeal cancer

2021 ◽  
Vol 135 (2) ◽  
pp. 153-158
Author(s):  
K Fujiwara ◽  
S Koyama ◽  
K Taira ◽  
K Kawamoto ◽  
T Fukuhara ◽  
...  
Keyword(s):  
High Resolution ◽  
Oropharyngeal Cancer ◽  
Objective Evaluation ◽  
Transoral Surgery ◽  
Swallowing Function ◽  
High Resolution Manometry ◽  
Pharyngeal Pressure ◽  
Significant Difference ◽  
Upper Oesophageal Sphincter ◽  
The Impact

AbstractBackgroundTransoral robotic surgery is frequently described, driven by the desire to offer a less morbid alternative to chemoradiation. However, the objective evaluation of post-operative function has rarely been reported. Therefore, high-resolution manometry was used in this study to evaluate the impact of changes in peri-operative swallowing function on pharyngeal pressure events.MethodsTen patients with various stages of oropharyngeal cancer underwent transoral surgery. High-resolution manometry and videofluoroscopic swallow studies were performed before surgery and two months afterwards. The following parameters were obtained: velopharyngeal and mesopharyngeal post-deglutitive upper oesophageal sphincter pressures, velo-meso-hypopharyngeal contractile integral, upper oesophageal sphincter relaxation pressure, and pharyngeal velocity.ResultsThere was no significant difference in pharyngeal pressure or contractile integral pre- versus post-operatively. However, pharyngeal velocity was significantly higher post-operatively than pre-operatively.ConclusionHigh-resolution manometry showed that transoral surgery in patients without pre-operative dysphagia preserved pharyngeal constriction. However, transoral surgery might produce scar formation in the pharynx, which could lead to narrowing of the pharynx.

scholarly journals Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2561
Author(s):  
Sriramya Lapa ◽  
Johanna Quick-Weller ◽  
Christiane Nasari ◽  
Rainer Dziewas ◽  
Florian Gessler ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Tube Feeding ◽  
Oral Intake ◽  
Swallowing Disorders ◽  
Full Recovery ◽  
Surgical Removal ◽  
Imaging Data ◽  
Clinical Predictors ◽  
Swallowing Function ◽  
Dysphagic Patients

Background: While swallowing disorders are frequent sequela following posterior fossa tumor (PFT) surgery in children, data on dysphagia frequency, severity, and outcome in adults are lacking. The aim of this study was to investigate dysphagia before and after surgical removal of PFT. Additionally, we tried to identify clinical predictors for postsurgical swallowing disorders. Furthermore, this study explored the three-month outcome of dysphagic patients. Methods: In a cohort of patients undergoing PFT surgery, dysphagia was prospectively assessed pre- and postoperatively using fiberoptic endoscopic evaluation of swallowing. Patients with severe dysphagia at discharge were re-evaluated after three months. Additionally, clinical and imaging data were collected to identify predictors for post-surgical dysphagia. Results: We included 26 patients of whom 15 had pre-operative swallowing disorders. After surgery, worsening of pre-existing dysphagia could be noticed in 7 patients whereas improvement was observed in 2 and full recovery in 3 subjects. New-onset dysphagia after surgery occurred in a minority of 3 cases. Postoperatively, 47% of dysphagic patients required nasogastric tube feeding. Re-evaluation after three months of follow-up revealed that all dysphagic patients had returned to full oral intake. Conclusion: Dysphagia is a frequent finding in patients with PFT already before surgery. Surgical intervention can infer a deterioration of impaired swallowing function placing affected patients at temporary risk for aspiration. In contrast, surgery can also accomplish beneficial results resulting in both improvement and full recovery. Overall, our findings show the need of early dysphagia assessment to define the safest feeding route for the patient.

Noninvasive Respiratory Support and Feeding in the Neonate

2017 ◽  
Vol 2 (13) ◽  
pp. 82-92 ◽  
Author(s):  
Keith Hirst ◽  
Pamela Dodrill ◽  
Memorie Gosa
Keyword(s):  
Neonatal Intensive Care ◽  
Respiratory Illness ◽  
Original Data ◽  
Oral Feeding ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Limited Evidence ◽  
Swallowing Function ◽  
Adverse Respiratory Events ◽  
The Impact

Background Preterm neonates are at risk for respiratory illness including respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). Recent advancements in neonatal medicine have introduced less invasive forms of respiratory support for neonates with RDS and BPD, including continuous positive airway pressure (CPAP) and humidified “high-flow” therapy via nasal cannula (HFNC). There is limited evidence documenting the impact of these respiratory supports on neonatal swallowing function. Objective This article presents the results of a structured literature review that sought to determine the evidence to support the practice of feeding neonates in the neonatal intensive care unit (NICU) by mouth while on CPAP or HFNC. Methods A systematic search of PubMed was completed to identify relevant, peer-reviewed literature reporting original data that addressed the identified objective. Results Five studies were identified that related to oral feeding and/or swallowing while on CPAP or HFNC in neonates. Conclusions Given the limited evidence available to support the practice of feeding neonates in the NICU by mouth while on CPAP or HFNC, and the potential for adverse respiratory events related to the underlying respiratory disease, the authors urge caution with this practice, and highlight the urgent need for further research in this area.

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