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.

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.

Dysphagia following Various Degrees of Surgical Resection for Oral Cancer

1992 ◽  
Vol 101 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Minoru Hirano ◽  
Hidetaka Matsuoka ◽  
Yasunao Kuroiwa ◽  
Kiminori Sato ◽  
Shinzo Tanaka ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Surgical Resection ◽  
Tongue Cancer ◽  
Tube Feeding ◽  
The Other ◽  
Surgical Removal ◽  
Swallowing Function ◽  
Pharyngeal Wall ◽  
Swallowing Problems ◽  
Nasogastric Tube Feeding

Postoperative swallowing problems were investigated in 20 patients who had undergone various degrees of surgical resection for oral cancer. The swallowing problems were evaluated on the basis of type of food, degree of aspiration, and duration of postoperative nasogastric tube feeding. Two patients with tongue cancer who had had hemiglossectomy without reconstruction ate normal food without aspiration within a week after operation. Eight patients who had undergone two- to three-quarter glossectomy for tongue cancer ate gruel with no or occasional liquid aspiration. Among 4 patients who had had near-total or total glossectomy for tongue cancer, 3 ate thin gruel or liquid with occasional aspiration. The other could not eat orally because of consistent severe aspiration. One patient with mouth floor cancer underwent resection of the mouth floor in combination with hemiglossectomy and she ate gruel without aspiration. Among 5 patients with mouth floor cancer who had had surgical removal accompanied by near-total or total glossectomy, 3 ate gruel with no or occasional liquid aspiration, 1 ate thin gruel with no aspiration, and the other could not eat orally. A diagnosis of T4 lesions, extensive removal of the tongue base, removal of the geniohyoid and mylohyoid muscles, and removal of the lateral pharyngeal wall were significantly related to poor swallowing function.

Oropharyngeal dysphagia in multiple sclerosis

2010 ◽  
Vol 16 (3) ◽  
pp. 362-365 ◽  
Author(s):  
Marziyeh Poorjavad ◽  
Fatemeh Derakhshandeh ◽  
Masoud Etemadifar ◽  
Bahram Soleymani ◽  
Alireza Minagar ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Oropharyngeal Dysphagia ◽  
Neurological Impairment ◽  
Functional System ◽  
Swallowing Disorders ◽  
Limited Attention ◽  
Swallowing Function ◽  
Oral Stage ◽  
Dysphagic Patients

Swallowing disorders are commonly observed in multiple sclerosis (MS) patients. The complications of dysphagia are common causes of morbidity and death in late stages of MS. However, dysphagia in MS usually receives limited attention. The purpose of this study was to determine the prevalence of different kinds of swallowing disorders in MS patients with mild to moderate disability; and to identify possible associations between clinical and demographic features of patients and the presence of dysphagia. The swallowing functions of 101 consecutive MS patients were screened by the Northwestern Dysphagia Patient Check Sheet. This is a screening test which identifies patients with pharyngeal stage disorders, aspiration, oral stage disorders and/or pharyngeal delay. ‘Dysphagia’ was defined as having at least one of the above mentioned four disorders. Among 101 MS patients, 32 (31.7%) were classified as having dysphagia. Pharyngeal stage disorders were the most common observed impairment (28.7%) and aspiration, oral stage disorders, and pharyngeal delay were observed in 6.9%, 5%, and 1% of patients, respectively. Dysphagic patients had a significantly longer disease duration ( p = 0.031) and more neurological impairment in cerebellar functional system ( p = 0.04) when compared with non-dysphagic patients. Moreover, dysphagia was significantly more prevalent in patients with more neurological disability as measured by Expanded Disability Status Scale (EDSS) scores ( p = 0.04). These results emphasize the importance of assessment and management of swallowing function in MS patients, particularly in patients with a high EDSS score; more sever cerebellar dysfunction, and long disease duration.

Do dysphagic patients with an absent pharyngeal swallow have a shorter survival than dysphagic patients with pharyngeal swallow? prognostic importance of a therapeutic videoradiographic swallowing study (TVSS)

2005 ◽  
Vol 46 (2) ◽  
pp. 126-131 ◽  
Author(s):  
M. Bülow ◽  
R. Olsson ◽  
O. Ekberg
Keyword(s):  
Survival Time ◽  
Tactile Stimulation ◽  
Tube Feeding ◽  
Oral Intake ◽  
Therapeutic Strategies ◽  
Diet Modification ◽  
Head Positioning ◽  
Swallowing Rehabilitation ◽  
Pharyngeal Swallow ◽  
Dysphagic Patients

Purpose:To study survival in two groups of dysphagic patients – one group unable to elicit the pharyngeal stage of swallow (APS) and another group with pharyngeal swallow (WPS) – and to compare recommendations regarding nutrition and therapeutic strategies based on the therapeutic swallowing study. Material and Methods: In this retrospective study, the records of dysphagic patients who have undergone a therapeutic videoradiographic swallowing study (TVSS) were reviewed. Forty patients without pharyngeal swallow were matched for age and gender with 40 patients with pharyngeal swallow; altogether 80 patients were included in the study. Survival was registered at 3, 12, and 72 months after the TVSS. Results: In this study, the APS group had a significantly shorter survival time ( P = 0.0030) compared to the WPS group when followed‐up at 12 months. In the APS group, most patients (37.5% (15/40)) died within the 3 months after TVSS. At 72 months, 62.5% (25/40) of the patients in the APS group had died. In the WPS group, 5% (2/40) had died within 3 months and 47.4% (19/40) after 12 months. At 72 months, 52.5% (21/40) of the patients in the WPS group had died. Regarding nutritional and therapeutic recommendations based on TVSS, 34/40 in the APS group were recommended no oral intake. Eighteen naso‐gastric tubes were placed directly after TVSS. The therapeutic strategies recommended were head‐positioning, thermal tactile stimulation, and tongue exercises (in 8 patients). In the WPS group, all patients were recommended oral intake. Diet modification was recommended in 29 patients. The therapeutic strategies recommended were head‐positioning, thermal tactile stimulation, tongue exercises, supraglottic swallow, and effortful swallow (in 24 patients). Conclusion: Patients unable to elicit the pharyngeal stage of swallow had a shorter survival time than patients with pharyngeal swallow, probably due to a more severe underlying disease. Tube feeding was more frequent in the APS group. Fewer therapeutic strategies were recommended compared to the WPS group. In the WPS group, diet modification was frequent. Several patients had different therapeutic strategies. At the end of the study, 8/40 patients (20%) in the APS group had recovered and regained the ability to elicit the pharyngeal stage of swallow. All eight had achieved active swallowing rehabilitation.

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.

Posterior Fossa Syndrome After Surgical Removal of a Pineal Gland Tumor

2011 ◽  
Vol 45 (6) ◽  
pp. 417-419 ◽  
Author(s):  
Dana L. Ellis ◽  
Julie Kanter ◽  
John W. Walsh ◽  
Stacy S. Drury
Keyword(s):  
Pineal Gland ◽  
Posterior Fossa ◽  
Surgical Removal ◽  
Posterior Fossa Syndrome ◽  
Gland Tumor

Abstract 2903: Nutritional Access of Dysphagic Patients 3 Months after Onset of Acute Stroke -From Database of 5,000 Patients in a Single Stroke Center-

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Makoto Nakajima ◽  
Yuichiro Inatomi ◽  
Toshiro Yonehara ◽  
Yoichiro Hashimoto ◽  
Teruyuki Hirano
Keyword(s):  
Acute Stroke ◽  
Chronic Phase ◽  
Oral Intake ◽  
Continuous Variables ◽  
Operating Characteristics ◽  
Stroke Patients ◽  
Nihss Score ◽  
Swallowing Dysfunction ◽  
Stroke Center ◽  
Dysphagic Patients

Background and purpose: Prediction of swallowing function in dysphagic patients with acute stroke is indispensable for discussing percutaneous endoscopic gastrostomy (PEG) placement. We performed a retrospective study using database of a large number of acute ischemic stroke patients to clarify predictors for acquisition of oral intake in chronic phase. Methods: A total 4,972 consecutive acute stroke patients were admitted to our stroke center during 8.5 years; a questionnaire was sent to all the survivors after 3 months of onset. We investigated nutritional access after 3 months of onset in 588 patients who could not eat orally 10 days after admission, and analyzed predictive factors for their acquisition of oral intake. Continuous variables were dichotomized to identify the most sensitive predictors; the cutoff values were investigated by receiver operating characteristics curve analysis. Results: Out of 588 dysphagic patients, 75 died during the 3 months, and 143 (28%) of the residual 513 achieved oral intake after 3 months. In logistic-regression models, age ≤80 years, absence of hyperlipidemia, absence of atrial fibrillation, modified Rankin Scale score 0 before onset, and low National Institutes of Health Stroke Scale (NIHSS) score independently predicted oral intake 3 months after onset. From two different model analyses, NIHSS score ≤17 on day 10 (OR 3.63, 95% CI 2.37-5.56) was found to be a stronger predictor for oral intake than NIHSS score ≤17 on admission (OR 2.34, 95% CI 1.52-3.59). At 3 months, 17/143 (12%) patients with oral intake were living at home, while only 1/370 (0.3%) patients without oral intake were. Conclusion: A quarter of dysphagic patients with acute stroke obtained oral intake 3 months after onset. Clinicians should be cautious about PEG placement for stroke patients with severe dysphagia who were independent prior to the stroke, aged ≤80 years, and show NIHSS score ≤17 on day 10, because their swallowing dysfunction may improve in a few months.

scholarly journals Dysphagia bedside evaluatation in adults with nasogastric tube

2021 ◽  
Vol 2 (5 (293)) ◽  
pp. 1-7
Author(s):  
Saulė Grigaliūnaitė ◽  
Rita Kantanavičiūtė-Petružė
Keyword(s):  
Theoretical Analysis ◽  
Nasogastric Tube ◽  
Scientific Literature ◽  
Early Stage ◽  
Voice Quality ◽  
Swallowing Disorders ◽  
Assessment Tools ◽  
Swallowing Function ◽  
Oral Control ◽  
Adult Swallowing

The theoretical analysis of scientific literature sources and practice show that standardized adult assessment tools for the evaluation of adult swallowing disorders and readiness for withdrawal of the nasogastric tube (NGZ) are not uniformly used in Lithuanian health care institutions. The theoretical analysis of the assessment of swallowing disorders in adults fed by NGZ in the article showed that in the early stage of the disorder, examinations that are performed in the patient's ward and do not require radiological evaluation are sufficiently accurate. The aim of the study is to reveal the tools and methodologies for the evaluation of swallowing disorders in adults fed by NGZ in the patient's ward during the acute period of the disease. After the theoretical analysis of scientific literature sources, it can be stated that: enteral feeding improves feeding quality, but it restricts patient's movements, complicates communication, induces isolation; accurate assessment of dysphagia can be made by performing a swallowing sample in the patient’s ward; assessment of swallowing function takes into account masticatory muscle function, movements of lips, tongue and soft palate, swallowing, cough and gag reflex, oral control, oral residue, voice quality after swallowing and aspiration risk.

Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

2018 ◽  
pp. 204-208
Author(s):  
Peter J. Fagenholz
Keyword(s):  
Acute Pancreatitis ◽  
Tube Feeding ◽  
Oral Intake ◽  
Adequate Nutrition ◽  
On Demand ◽  
Major Complications ◽  
Nasojejunal Tube ◽  
Poor Oral Intake ◽  
Oral Diet

This study evaluated whether starting nasojejunal tube feeding within 24 hours of presentation would reduce the rate of death or major complications in patients with acute pancreatitis. This strategy was compared to allowing patients to take an “on demand” oral diet and only initiating nasojejunal tube feeding if there was poor oral intake by 96 hours after presentation. There was no difference between the two groups in any of the measured outcomes, though the study may have been underpowered. We conclude it is acceptable to allow an on-demand oral diet and reserve nasoenteric feeding for patients who have not achieved adequate nutrition by 96 hours after presentation. It is not necessary or beneficial to start nasojejunal tube feeds in the first 24 hours.

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