Change in Spontaneous Swallowing Frequency in HNC Patients Undergoing C/RT

2021 ◽  
pp. 019459982110207
Author(s):  
Giselle D. Carnaby ◽  
Aarthi Madhavan ◽  
Ali Barikroo ◽  
Michael Crary
Keyword(s):  
Repeated Measures ◽  
Prospective Cohort ◽  
Area Under The Curve ◽  
Objective Measure ◽  
Oral Intake ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Swallowing Function ◽  
Function Change ◽  
Functional Oral Intake Scale

Objective This study sought to evaluate the role and trajectory of spontaneous swallowing frequency (SFA) in patients with head and neck cancer (HNC) undergoing chemoradiotherapy (C/RT). Study Design. Prospective cohort. Setting University comprehensive cancer center. Methods A prospective cohort of 80 patients with HNC was followed from baseline to 3 months post-C/RT. Subjects were evaluated for performance on swallowing function, functional diet consumed, weight, swallowing frequency rate, perceived xerostomia, perceived pain, and mucositis. Relationships were evaluated using univariate correlations, t tests, and repeated-measures analysis of variance. The diagnostic accuracy of SFA to express dysphagia was calculated by area under the curve (AUROC) and displayed using receiver operator characteristic curves. Results In general, patients with HNC demonstrated a parabolic decline in most measures over the C/RT trajectory. SFA and perceived xerostomia did not show improved recovery by 3 months. SFA was related to swallow function, xerostomia, and functional diet consumed posttreatment and pain at 3 months. The ability of SFA to correctly identify clinical dysphagia (Mann Assessment of Swallowing–Cancer version [MASA-C]) and reduced oral intake (Functional Oral Intake Scale [FOIS]) at posttreatment was strong (AUROC MASA-C: 0.824 [95% CI, 0.63-1.00], P < .0018; AUROC FOIS: 0.96 [95% CI, 0.87-0.96], P < .0001). Conclusion This exploratory study suggests SFA may provide a useful method to identify dysphagia after HNC treatment. Furthermore, SFA may offer a simple, objective measure of swallowing function change in HNC over the C/RT trajectory.

Transoral Tubed Supraglottoplasty: A New Minimally Invasive Procedure for Aspiration

2019 ◽  
Vol 128 (12) ◽  
pp. 1122-1128 ◽  
Author(s):  
Yue Ma ◽  
Matthew R. Naunheim ◽  
Jill Gregory ◽  
Peak Woo
Keyword(s):  
Minimally Invasive ◽  
Oral Intake ◽  
Invasive Procedure ◽  
Posterior Wall ◽  
Advancement Flap ◽  
Minimally Invasive Procedure ◽  
Posterior Commissure ◽  
Swallowing Function ◽  
Mucosal Flap ◽  
Functional Oral Intake Scale

Objectives: We describe a new procedure for aspiration called tubed supraglottoplasty (TS). TS is a transoral procedure that approximates the aryepiglottic (AE) folds and arytenoids. This narrows the laryngeal inlet. This procedure has been used to improve swallowing and reduce aspiration in patients with vocal fold paralysis. We describe the technical aspects of TS and report on 11 patients. Methods: TS is done by oral intubation followed by suspension laryngoscopy. An incision is made along the AE fold into the posterior commissure and then continued to the opposite AE fold. Dissection within this incision creates two mucosal flaps, one based on the laryngeal surface and the other on the pharyngeal surface. Two 1-cm releasing incisions are made at each end of the AE fold. The laryngeal mucosal flap is approximated using a 3-0 self-locking running suture. The pharyngeal mucosal flap is approximated as a second layer. This double-layered mucosal V-Y advancement flap builds up the posterior laryngeal height. It narrows and “tubes” the supraglottis. Results: All patients tolerated TS without airway complications. Ten of the 11 patients reported improved swallowing function with less aspiration. Six of the 8 patients with prior G-tubes had their gastrostomy tube removed. Postoperative laryngoscopy showed a narrowed “tubed” supraglottis with a higher posterior wall preventing spillover and aspiration. An improved Functional Oral Intake Scale was recorded in ten of eleven patients. Conclusion: TS is a minimally invasive procedure that can improve swallowing and reduce aspiration.

scholarly journals Decreased Maximal Tongue Protrusion Length May Predict the Presence of Dysphagia in Stroke Patients

2021 ◽  
Vol 45 (6) ◽  
pp. 440-449
Author(s):  
Hyunchul Cho ◽  
Jeong Se Noh ◽  
Junwon Park ◽  
Changwook Park ◽  
No Dam Park ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Oral Intake ◽  
Stroke Patients ◽  
Tongue Protrusion ◽  
Swallowing Function ◽  
Transparent Plastic ◽  
Post Stroke ◽  
Tongue Length ◽  
Functional Oral Intake Scale ◽  
The Relationship

Objective To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients.Methods Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS).Results The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%.Conclusion There is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.

scholarly journals Impact of Osteophytectomy on Swallowing Function in a Patient with Chronic Dysphagia

2020 ◽  
Vol 05 (03) ◽  
pp. 1-1
Author(s):  
Melissa M Howard ◽  
◽  
Justin Phillips ◽  
Stefan Henley ◽  
Sarah E. Green ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Treatment Options ◽  
Oral Intake ◽  
Barium Swallow ◽  
Inpatient Stay ◽  
Swallowing Function ◽  
Geriatric Population ◽  
Surgical Interventions ◽  
Functional Oral Intake Scale

Anterior cervical osteophytes are common in the geriatric population. Dysphagia can occur in individuals suffering from these spinal abnormalities. Surgical intervention is an uncommon course of treatment for these patients, but is often utilized as a last resort with the hope of swallow recovery. The purpose of this article is to highlight a unique case study documenting the required treatment course for dysphagia associated with osteophytes and subsequent osteophytectomy. We review current literature of both conservative and surgical interventions, as well as discuss the rehabilitation course for a complex patient with persistent dysphagia. Various outcome measures were utilized during the patient’s inpatient stay to track progress including the Functional Oral Intake Scale (FOIS), the Bolus Residue Scale (BRS), Penetration Aspiration Scale (PenAsp), Dysphagia Outcome Severity Scale (DOSS), and a Modified Barium Swallow Study (MBSS). The patient received rehabilitative training including oral motor and pharyngeal strengthening exercises, respiratory strengthening, speech instruction, cognitive retraining, and instrumental assessment. Following osteophytectomy and dysphagia rehabilitation the patient did not show any change based on a repeat MBSS which revealed the necessity for the patient to remain nothing per oral (NPO). The patient demonstrated an inability to manage his secretions, requiring continual suctioning. Upon discharge the patient remained NPO with the exception of ice chips, utilized a PEG for nutrition, and had a red capped tracheostomy. He was on room air and independently utilized oral suction as needed for secretion management. Our patient’s clinical course was not aligned with typical osteophytectomy recovery as progress after his 25-day inpatient stay was limited. The goal of this case study is to contribute information to the limited and variable data available regarding treatment options, outcome measures and timelines for recovery as it pertains to patients who undergo an osteophytectomy.

Palliative medical management of inoperable malignant bowel obstruction with “triple therapy”: Dexamethasone, octreotide, and metoclopramide at a comprehensive cancer center.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 125-125
Author(s):  
Winston Wey ◽  
Moeena Mian ◽  
Rebecca Calabrese ◽  
Eric Hansen ◽  
Michelle Walter ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Triple Therapy ◽  
Bowel Obstruction ◽  
Medical Management ◽  
Oral Intake ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Malignant Bowel Obstruction ◽  
Advanced Malignancy ◽  
Endoscopic Gastrostomy

125 Background: Malignant bowel obstruction (MBO) is a complication of advanced malignancy. For inoperable patients, symptoms are often treated using analgesics, anticholinergics, and anti-emetics. There are, however, few published guidelines or algorithms for the medical management of MBO. Therefore, the objective was to measure the effect of the combination of dexamethasone, octreotide, and metoclopramide (“triple therapy”) in patients with MBO, compared to patients who received none of the three medications (“no drug therapy”). Methods: A retrospective cohort study was done of patients with malignant bowel obstruction admitted between 1/1/2015 to 12/31/2018. The outcome measures were a patient having de-obstruction (defined as toleration of oral intake and resolution of nausea and vomiting), as well as time to de-obstruction. Results: Medical staff identified 34 patients who received triple therapy and 34 patients who received no drug therapy. Patients who received triple therapy were more likely to reach de-obstruction, compared to patients who had no drug therapy (OR: 9.02 [1.43, 56.99], p=0.0194), after adjusting for related covariates (i.e. length of stay and percutaneous endoscopic gastrostomy [PEG] placement). Patients who reached de-obstruction in the triple therapy arm, however, took longer to reach de-obstruction than those in the no drug therapy arm (5.4 days versus 3.4 days, p=0.045). Conclusions: Triple drug therapy with dexamethasone, octreotide, and metoclopramide leads to higher rates of de-obstruction in patients with inoperable MBO, compared to patients who received none of the three drugs, though time to de-obstruction is longer.

scholarly journals Prevalence of oropharyngeal dysphagia in hereditary spastic paraplegias

2019 ◽  
Vol 77 (12) ◽  
pp. 843-847 ◽  
Author(s):  
Laís Alves Jacinto-Scudeiro ◽  
Gustavo Dariva Machado ◽  
Annelise Ayres ◽  
Daniela Burguêz ◽  
Marcia Polese-Bonatto ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Genetic Diseases ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Hereditary Spastic Paraplegias ◽  
Swallowing Dysfunction ◽  
Clinically Significant ◽  
Functional Oral Intake Scale

ABSTRACT Hereditary spastic paraplegias (HSP) are a group of genetic diseases characterized by lower limb spasticity with or without additional neurological features. Swallowing dysfunction is poorly studied in HSP and its presence can lead to significant respiratory and nutritional complications. Objectives: The aim of this study was to evaluate the frequency and clinical characteristics of dysphagia in different types of HSP. Methods: A two-center cross-sectional prevalence study was performed. Genetically confirmed HSP patients were evaluated using the Northwestern Dysphagia Patient Check Sheet and the Functional Oral Intake Scale. In addition, self-perception of dysphagia was assessed by the Eat Assessment Tool-10 and the Swallowing Disturbance Questionnaire. Results: Thirty-six patients with spastic paraplegia type 4 (SPG4), five with SPG11, four with SPG5, four with cerebrotendinous xanthomatosis (CTX), three with SPG7, and two with SPG3A were evaluated. Mild to moderate oropharyngeal dysphagia was present in 3/5 (60%) of SPG11 and 2/4 (50%) of CTX patients. A single SPG4 (2%) and a single SPG7 (33%) patient had mild oropharyngeal dysphagia. All other evaluated patients presented with normal or functional swallowing. Conclusions: Clinically significant oropharyngeal dysphagia was only present in complicated forms of HSP Patients with SPG11 and CTX had the highest risks for dysphagia, suggesting that surveillance of swallowing function should be part of the management of patients with these disorders.

Effect of Pretreatment Dysphagia on Postchemoradiation Swallowing Function in Head and Neck Cancer

2021 ◽  
pp. 019459982110098
Author(s):  
Daniel J. Cates ◽  
Lisa M. Evangelista ◽  
Peter C. Belafsky
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Odds Ratio ◽  
Independent Predictor ◽  
Oral Intake ◽  
Swallowing Function ◽  
Swallowing Dysfunction ◽  
The Mean ◽  
Functional Oral Intake Scale

Objectives Chemoradiation therapy (CRT) for head and neck cancer can have profound effects on swallowing function. Identification of risk factors for development of swallowing dysfunction after CRT may improve allocation of preventive strategies. The purpose of this study is to determine the association between pre-CRT dysphagia and post-CRT swallowing dysfunction. Study Design Retrospective cohort study. Setting Academic medical center. Methods Patients with head and neck cancer were evaluated before and 3 months after CRT. Dysphagia was assessed with the Eating Assessment Tool (EAT-10). Swallowing dysfunction was evaluated by a videofluoroscopic swallow study and the Penetration-Aspiration Scale and swallowing safety was evaluated by the Functional Oral Intake Scale. The association between pre-CRT EAT-10 scores and post-CRT swallowing dysfunction was evaluated. Results The mean ± SD post-CRT Functional Oral Intake Scale score was 6.5 ± 1.2 for individuals with a pre-CRT EAT-10 score <3 and 5.3 ± 1.9 for those with a pre-CRT EAT-10 score ≥3 ( P < .001). The mean post-CRT Penetration-Aspiration Scale score was 2.2 ± 1.5 for individuals with a pre-CRT EAT-10 score <3 and 3.8 ± 2.6 for those with a pre-CRT EAT-10 score ≥3 ( P < .001). After multivariate analysis adjusting for age, tumor subsite, T classification, and primary surgery, pre-CRT dysphagia (EAT-10 ≥3) was an independent predictor of post-CRT aspiration (odds ratio, 4.19 [95% CI, 1.08-16.20]; P = .04) and feeding tube dependence (odds ratio, 3.54 [95% CI, 1.01-12.33]; P = .04). Conclusion The presence of dysphagia before chemoradiation for head and neck cancer is an independent predictor of swallowing dysfunction after completion of therapy. These results may help target intervention toward preventing swallowing dysfunction in high-risk individuals.

ASCO-GU 2019: Fortgeschrittenes Nierenzellkarzinom

2019 ◽  
Vol 10 (02) ◽  
pp. 75-76
Author(s):  
Ine Schmale
Keyword(s):  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Washington Dc

Das Armamentarium zur Behandlung des Nierenzellkarzinoms (RCC) hat sich um effektive Therapien erweitert, durch die der Therapiealgorithmus komplett umgestellt werden musste. Prof. Michael B. Atkins vom Georgetown-Lombardi Comprehensive Cancer Center, Washington DC/USA, und Prof. Daniel Y. C. Heng vom Tom Baker Cancer Center, Calgary/Kanada, teilten beim ASCO-GU ihre Einschätzung zur optimalen Behandlung des Nierenzellkarzinoms in der Erst- und Zweitlinientherapie für das Jahr 2019.

Sign in / Sign up

Export Citation Format

Share Document