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.

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 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.

scholarly journals ECOG-ACRIN 2399: analysis of patient related outcomes after Chemoradiation for locally advanced head and neck Cancer

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Anthony Cmelak ◽  
Mary S. Dietrich ◽  
Shuli Li ◽  
Sheila Ridner ◽  
Arlene Forastiere ◽  
...  
Keyword(s):  
Head And Neck ◽  
Performance Status ◽  
Locally Advanced ◽  
Surrogate Marker ◽  
Post Treatment ◽  
Self Report ◽  
Barium Swallow ◽  
Functional Communication ◽  
Swallowing Function ◽  
Modified Barium Swallow

Abstract Background We conducted a correlative study for E2399, a function preservation trial for resectable locally advanced oropharynx and larynx cancer, to prospectively assess effects of chemoradiation (CCR) on quality of life (QOL), swallowing and voice. We correlated the results of swallow assessments done via questionnaires and objective assessments by modified barium swallow (MBS). Methods The Functional Assessment of Cancer-HN (FACT-HN), the Performance Status Scale – Head and Neck (PSS-HN), swallow assessments (including modified barium swallow studies), and voice assessments: Voice Handicap Index (VHI), the Voice Disability Assessment (VDA), and American Speech-Language Hearing Association’s Functional Communication Measure (FCM) were conducted at baseline and periodically post-treatment for 2 years. Results Baseline QOL and swallowing function predicted overall survival. Patients experienced a marked decrease in QOL, swallowing, and speech post CCR although the decrease in vocal function was modest. Function and QOL returned towards baseline in the majority of patients by 12 months post treatment. Less than 10% of patients had severe dysphagia and were PEG dependent at 12 months post treatment. There was a high degree of correlation between the FACT-HN and PSS-HN swallow items. Statistically significant correlations were found between subjective and objective measures of swallow function. Conclusions Patients experience marked loss in swallowing function post CCR which returned to baseline in the majority of patients. The correlations between the FCM and self-report swallow items on the PSS and FACT-HN appear to be sufficiently strong to justify their use as a surrogate marker for swallowing disability in large therapeutic trials.

scholarly journals In Pursuit of an Effective Treatment: the Past, Present and Future of Clinical Trials in Inclusion Body Myositis

2021 ◽  
Author(s):  
A. M. Snedden ◽  
J. B. Lilleker ◽  
H. Chinoy
Keyword(s):  
Clinical Practice ◽  
Effective Treatment ◽  
Inclusion Body ◽  
Therapeutic Effect ◽  
Outcome Measures ◽  
Inclusion Body Myositis ◽  
Cytotoxic T Cells ◽  
Treatment Options ◽  
Trial Methodology ◽  
Short Treatment

Abstract Purpose of review No clinical trial in sporadic inclusion body myositis (IBM) thus far has shown a clear and sustained therapeutic effect. We review previous trial methodology, explore why results have not translated into clinical practice, and suggest improvements for future IBM trials. Recent findings Early trials primarily assessed immunosuppressive medications, with no significant clinical responses observed. Many of these studies had methodological issues, including small participant numbers, nonspecific diagnostic criteria, short treatment and/or assessment periods and insensitive outcome measures. Most recent IBM trials have instead focused on nonimmunosuppressive therapies, but there is mounting evidence supporting a primary autoimmune aetiology, including the discovery of immunosuppression-resistant clones of cytotoxic T cells and anti-CN-1A autoantibodies which could potentially be used to stratify patients into different cohorts. The latest trials have had mixed results. For example, bimagrumab, a myostatin blocker, did not affect the 6-min timed walk distance, whereas sirolimus, a promotor of autophagy, did. Larger studies are planned to evaluate the efficacy of sirolimus and arimoclomol. Summary Thus far, no treatment for IBM has demonstrated a definite therapeutic effect, and effective treatment options in clinical practice are lacking. Trial design and ineffective therapies are likely to have contributed to these failures. Identification of potential therapeutic targets should be followed by future studies using a stratified approach and sensitive and relevant outcome measures.

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 A Wearable Sensor-Based Platform for Surgeon Posture Monitoring: A Tool to Prevent Musculoskeletal Disorders

2021 ◽  
Vol 18 (7) ◽  
pp. 3734
Author(s):  
Nicola Carbonaro ◽  
Gabriele Mascherini ◽  
Ilenia Bartolini ◽  
Maria Ringressi ◽  
Antonio Taddei ◽  
...  
Keyword(s):  
Musculoskeletal Disorders ◽  
Risk Index ◽  
Dynamical Analysis ◽  
Surgical Interventions ◽  
Posture Monitoring ◽  
Measurement Units ◽  
Mini Laparotomy ◽  
Surgical Operations ◽  
Ergonomic Risk

Surgeons are workers that are particularly prone to the development of musculoskeletal disorders. Recent advances in surgical interventions, such as laparoscopic procedures, have caused a worsening of the scenario, given the harmful static postures that have to be kept for long periods. In this paper, we present a sensor-based platform specifically aimed at monitoring the posture during actual surgical operations. The proposed system adopts a limited number of Inertial Measurement Units (IMUs) to obtain information about spine and neck angles across time. Such a system merges the reliability of sensor-based approaches and the validity of state-of-the-art scoring procedure, such as RULA. Specifically, three IMUs are used to estimate the flexion, lateral bending, and twisting angles of spine and neck. An ergonomic risk index is thus estimated in a time varying fashion borrowing relevant features from the RULA scoring system. The detailed functioning of the proposed systems is introduced, and the assessment results related to a real surgical procedure, consisting of a laparoscopy and mini-laparotomy sections, are shown and discussed. In the exemplary case study introduced, the surgeon kept a high score, indicating the need for an intervention on the working procedures, for a large time fraction. The system allows separately analyzing the contribution of spine and neck, also specifying the angle configuration. It is shown how the proposed approach can provide further information, as related to dynamical analysis, which could be used to enlarge the features taken into account by currently available approaches for ergonomic risk assessment. The proposed system could be adopted both for training purposes, as well as for alerting surgeons during actual surgical operations.

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