Prevalence of oropharyngeal dysphagia in hereditary spastic paraplegias

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.

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

Annals of Rehabilitation Medicine ◽

10.5535/arm.21126 ◽

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.

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

Otolaryngology ◽

10.1177/01945998211009853 ◽

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.

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

Otolaryngology ◽

10.1177/01945998211020744 ◽

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.

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Dysphagia in Perry Syndrome: Pharyngeal Pressure in Two Cases

Case Reports in Neurology ◽

10.1159/000457900 ◽

2017 ◽

Vol 9 (2) ◽

pp. 161-167 ◽

Cited By ~ 1

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.

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Relationship between the Functional Oral Intake Scale (FOIS) and the Self-Efficacy Scale among Cancer Patients: A Cross-Sectional Study

Healthcare ◽

10.3390/healthcare8030269 ◽

2020 ◽

Vol 8 (3) ◽

pp. 269

Author(s):

Yuhei Matsuda ◽

Masaaki Karino ◽

Takahiro Kanno

Keyword(s):

Oral Health ◽

Self Efficacy ◽

Odds Ratio ◽

Oral Intake ◽

Cross Sectional Study ◽

The Self ◽

Sectional Study ◽

Cross Sectional ◽

Health Related ◽

Functional Oral Intake Scale

A few studies have provided detailed reports suggesting that subjective swallowing disorders may be related to dysphagia. Therefore, we verified the relationship between oral health-related self-efficacy and dysphagia severity in cancer treatment using a cross-sectional study. Participants included patients undergoing treatment for cancer at Shimane University Hospital in Shimane, Japan, and those receiving outpatient treatment at the hospital’s Oral Care Center between August 2018 and April 2019. In all, 203 participants enrolled in the study and completed the Functional Oral Intake Scale (FOIS), the Self-efficacy Scale for Advanced Cancer (SEAC), and the Oral Health-related Self-Efficacy Scale for Patients with Cancer (OSEC). Multivariate analysis showed a statistically significant correlation between the low FOIS score and the SEAC subscales of Activities of Daily Living Self-efficacy (ADE) (odds ratio 1.04, 95% [CI] 1.00–1.07) and Symptom Coping Self-efficacy (SCE) (odds ratio 0.61, 95% [CI] 0.42–0.88). Based on the Jonckheere-Terpstra test, the SEAC and the OSEC tended to increase as the category of the FOIS progressed. To conclude, self-efficacy played an important role in dysphagia and may affect the severity of dysphagia in cancer patients.

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Long-Term Voice and Swallowing Outcomes for Oral and Oropharyngeal Cancer Following Primary or Adjuvant Chemoradiation

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419842256 ◽

2019 ◽

Vol 128 (9) ◽

pp. 802-810 ◽

Cited By ~ 3

Author(s):

Liuba Soldatova ◽

Natasha Mirza

Keyword(s):

Assessment Tool ◽

Patient Survey ◽

Swallowing Function ◽

Swallowing Dysfunction ◽

Related Quality ◽

Oral And Oropharyngeal Cancer ◽

Calculated Probability ◽

Fair Poor ◽

The Voice

Objective: Chemoradiation (CRT) for nonlaryngeal head and neck cancer (HNC) can lead to voice and swallowing dysfunction. The purpose of this study was to examine voice and swallowing from the patient’s perspective at least 5 years after treatment. Design: Patient survey. Methods: Twenty-eight patients treated with primary or adjuvant CRT at least 5 years ago (mean = 10.7 years, SD = 5.5, range, 5-28) completed a survey created based on previously validated questionnaires (the Patient Perception of Swallowing Function Questionnaire, PPSFQ; the Eating Assessment Tool, EAT-10; the Voice Handicap Index, VHI-10; the Voice Related Quality of Life, V-RQOL). Results: Patients reported some voice and swallowing dysfunction (39% of V-RQOL scores in categories of fair, poor, or worst possible and 32% of VHI-10 scores ≥20 or greater than 50% of the maximum; 39% of PPSFQ scores greater than 50% of the maximum and 32% of EAT-10 scores ≥20 or 50% of the maximum). There was a correlation between V-RQOL and VHI-10 scores (Pearson product moment correlation coefficient r = .96, calculated probability value p = 0), PPSFQ and EAT-10 scores (r = 0.87, p = 0.8 × 10−8), as well as between V-RQOL and PPSFQ/EAT-10 scores (r = .94, p = 0), VHI-10 and PPSFQ/EAT-10 scores (r = .97, p = 0). Conclusions: Perceived voice and swallowing dysfunction following CRT for nonlaryngeal HNC can persist or worsen beyond 5 years.

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A Retrospective Cross-Sectional Analyses of Swallowing and Tongue Functions in Maxillectomy Patients

10.21203/rs.3.rs-159878/v1 ◽

2021 ◽

Author(s):

Yoichiro Ogino ◽

Natsue Fujikawa ◽

Sayuri Koga ◽

Ryoji Moroi ◽

Kiyoshi Koyano

Keyword(s):

Soft Palate ◽

Assessment Tool ◽

Correlation Coefficients ◽

Tongue Pressure ◽

Continuous Variables ◽

Swallowing Function ◽

Cross Sectional ◽

Oral Dryness ◽

History Of ◽

Oral Diadochokinesis

Abstract Purpose To investigate the profiles of swallowing and tongue functions, and to identify factors influencing swallowing in maxillectomy patients. Methods Maxillectomy patients whose swallowing function defined by Eating Assessment Tool (EAT-10) score and tongue functions (oral diadochokinesis: ODK, maximum tongue pressure: MTP) with or without maxillofacial prostheses had been evaluated were enrolled in this study. The effects of the history of radiotherapy or soft palate resection on swallowing function were evaluated. The effect of radiotherapy on oral dryness was also evaluated. To examine correlations of swallowing function with continuous variables, Spearman correlation coefficients were calculated. Results A total of 47 maxillectomy patients (23 males and 24 females, median age:71 [IQR: 63–76]) were registered. The median value of EAT-10 scores was 3 [IQR: 0–14]. Patients with the history of radiotherapy, but not with soft palate resection, showed significantly declined swallowing function. ODK and MTP of patients wearing maxillofacial prostheses were significantly improved. No significant effect of radiotherapy on oral dryness was found. A significant correlation was found between EAT-10 score and MTP (P = 0.04). Conclusions Swallowing function in maxillectomy patients was relatively impaired and the patients with the history of radiotherapy showed lower swallowing function. Maxillofacial prostheses could contribute to the improvement of MTP and ODK (/ta/). MTP may play a crucial role in swallowing in maxillectomy patients.

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Decreased swallowing function in the sarcopenic elderly without clinical dysphagia: a cross-sectional study

BMC Geriatrics ◽

10.1186/s12877-020-01832-0 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Yen-Chih Chen ◽

Pei-Yun Chen ◽

Yu-Chen Wang ◽

Tyng-Guey Wang ◽

Der-Sheng Han

Keyword(s):

Assessment Tool ◽

Clinical Symptoms ◽

Handgrip Strength ◽

The Elderly ◽

Cross Sectional Study ◽

Tongue Pressure ◽

Sectional Study ◽

Swallowing Function ◽

Cross Sectional ◽

Swallowing Assessment

Abstract Background Sarcopenia and dysphagia are prevalent health issues as the elderly population continues to grow. However, whether sarcopenia, defined by either reduced handgrip strength or gait speed, would lead to pathological effects on swallowing function is still a matter of debate. Studies focusing on subclinical changes in the swallowing function in the sarcopenic elderly are lacking. This study evaluates the swallowing function in the sarcopenic elderly without dysphagia. Methods: A cross-sectional study was conducted including subjects recruited from the community. Ninety-four individuals aged 65 and older without dysphagia were divided into two groups: sarcopenia and nonsarcopenia. The swallowing assessment included tongue pressure measurement, hyoid displacement (HD), hyoid velocity (HV) measurement with submental ultrasonography, 100-ml water-swallowing test, and the 10-item Eating Assessment Tool (EAT-10). Results The average tongue pressure was 47.0 ± 13.7 and 48.6 ± 11.5 kPa in the sarcopenia and nonsarcopenia groups, respectively (p = 0.55), whereas the average HD during swallowing was 15.3 ± 4.4 and 13.0 ± 4.2 mm in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of HV during swallowing was 19.5 (6.41–45.86) and 15.9 (3.7–39.7) mm/s in the sarcopenia and nonsarcopenia group (p < 0.05). The median of time needed for consuming 100 ml water was 12.43 (3.56–49.34) and 5.66 (2.07–19.13) seconds in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of the EAT-10 score was 0 (0–2) and 0 (0–1) in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). Conclusions In elderly individuals, swallowing function was significantly impaired with sarcopenia before clinical symptoms become clear. However, tongue muscles exhibited resistance to sarcopenia. We observed compensative strategies in patients with sarcopenia, such as reduced swallowing speed and increased hyoid bone movement.

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Transoral Tubed Supraglottoplasty: A New Minimally Invasive Procedure for Aspiration

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419862581 ◽

2019 ◽

Vol 128 (12) ◽

pp. 1122-1128 ◽

Cited By ~ 2

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.

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Improved Swallow Outcomes after Injection Laryngoplasty in Unilateral Vocal Fold Immobility

Ear Nose & Throat Journal ◽

10.1177/014556131809700822 ◽

2018 ◽

Vol 97 (8) ◽

pp. 250-256 ◽

Cited By ~ 4

Author(s):

Steven Zuniga ◽

Barbara Ebersole ◽

Nausheen Jamal

Keyword(s):

Vocal Fold ◽

Assessment Tool ◽

Oral Intake ◽

Injection Laryngoplasty ◽

Percutaneous Injection ◽

Scale Scores ◽

Vocal Fold Immobility ◽

Functional Oral Intake Scale ◽

The Impact ◽

Swallow Function

While the impact of injection laryngoplasty on voice outcomes in unilateral vocal fold immobility has been well characterized, there is a relative paucity of literature investigating its influence on swallow function and outcomes. We performed a retrospective chart review of patients presenting to an academic cancer center between January 2014 and January 2016 to evaluate the clinical impact of percutaneous injection laryngoplasty on reduction of aspiration risk, patient perception of swallowing, and recommended safe diet in patients with vocal fold immobility after head and neck and thoracic surgery. A consecutive sample of patients diagnosed with unilateral vocal fold immobility with patient- or clinician-identified abnormal swallow function who underwent bedside or in-office vocal fold injection was included in the study. Fiberoptic endoscopic evaluation of swallowing, Eating Assessment Tool-10 scores, Functional Oral Intake Scale scores, and patient perceptual assessment of swallow were evaluated pre- and postinjection. Twenty-one patients with new-onset unilateral vocal fold immobility who underwent injection laryngoplasty were evaluated. Median Eating Assessment Tool-10 and Functional Oral Intake Scale scores postinjection were significantly improved from preinjection. Patients who initially required restricted oral diets, or were nil per os, were able to advance their diet after injection laryngoplasty. Injection laryngoplasty is a safe and effective intervention for improvement of dysphagia in patients with unilateral vocal fold immobility. A single treatment may markedly reduce or eliminate risk of aspiration and potential sequelae.

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