Abstract P820: Fast Prediction of the Dysphagia Severity Using Clinical Signs in Acute Ischemic Stroke Patients

Objective: The purpose of this study was to compare the clinical signs in patients with acute ischemic stroke(AIS) and identify which of them was associated with the severity of dysphagia. Methods: This was a prospective observational study enrolled AIS within 14 onset days. All patients had swallowing evaluations by the modified Volume Viscosity Swallowing Test (the modified V-VST). Five clinical signs suggestive of swallow function impaired were directly observed in the patients who failed the test. We compared the performance of clinical signs between different completing volumes at three viscosity series. The area under curves (AUCs) were made to show the ability of specific clinical signs in predicting the dysphagia severity in patients with AIS. Results: 184 hospital-based AIS patients who failed the modified V-VST were enrolled from June 2017 to December 2019. 123 patients were identified as moderate swallow function impaired and 61 patients were identified as serious. Larynx movement and tongue movement were significant different clinical signs at all of three viscosities (p≤0.001). The AUC of larynx movement in predicting severity of dysphagia was 0.733( 95% CI 0.658-0.808,P<0.001). Conclusions: Larynx movement and tongue movement were easy clinical signs for medical staffs to assess the dysphagia severity quickly. Additionally, larynx movement showed stronger ability to predict the severity of dysphagia in AIS patients.

The Safety, Tolerability, and Impact of Respiratory–Swallow Coordination Training and Expiratory Muscle Strength Training on Pulmonary, Cough, and Swallow Function Surrogates in Amyotrophic Lateral Sclerosis

Purpose This feasibility study examined the safety, tolerability, and impact of expiratory muscle strength training (EMST) combined with respiratory–swallow coordination training (RST) in comparison to EMST alone, and no treatment on pulmonary function, cough function, surrogates of swallow function, and diaphragm thickness in a pre–post small case series of people with amyotrophic lateral sclerosis (ALS). Method This prospective, nonrandomized, delayed intervention case series consisted of six people with ALS: three patients assigned to EMST + RST, two patients assigned to EMST only, and one patient who received no intervention. Patients undergoing treatment underwent a 5-week no-treatment lead-in period before undergoing their respective 5 weeks of treatment with an optional maintenance period for an additional 5 weeks ( n = 4). Primary outcome measures included pulmonary function measurements, scores on the Eating Assessment Tool-10 and Swallowing Related Quality of Life, and diaphragm thickness. Results Descriptive statistics were used to describe outcome measures and individual patient performance. Results revealed that EMST + RST was a safe and well-tolerated intervention, and that both respiratory interventions led to maintenance and improvement of some outcome measures in most patients within this small case series. Conclusion This exploratory study provides preliminary support regarding the tolerability and efficacy of a combined respiratory intervention in a small case series of people with ALS.

Uric Acid and Clinical Outcomes Among Intracerebral Hemorrhage Patients: Results From the China Stroke Center Alliance

Background and Purpose: The effect of uric acid (UA) levels on severity and prognosis of spontaneous intracerebral hemorrhage (ICH) remains controversial. We aimed to explore the association of admission UA levels with stroke severity and outcomes in ICH patients.Materials and Methods: The patients enrolled in this study were from the China Stroke Center Alliance study (CSCA). Patients were divided into four groups (Q1–Q4) according to the quartiles of UA levels at admission. The primary outcome was in-hospital mortality. The secondary outcomes included stroke severity, in-hospital complications, and discharge disposition. Multivariate logistic regression was adopted to explore the association of UA levels with outcomes after ICH.Results: Patients (84,304) with acute ICH were included in the final analysis; the median (interquartile range) of UA was 277 (210, 354) μmol/L. The four groups were defined as follows: Q1 ≤ 210 μmol/L, 210 μmol/L &lt; Q2 ≤ 277 μmol/L, 277 μmol/L &lt; Q3 ≤ 354 μmol/L, Q4 &gt; 354 μmol/L. There was no significant evidence indicating that UA levels were correlated with the discharge disposition and in-hospital mortality after ICH. However, compared to Q1, the patients with higher UA levels had decreased odds of severe stroke (NIHSS ≥ 16) at admission (OR 0.89, 95% CI 0.86–0.92). An L-shaped association was found between UA and severe stroke. Among in-hospital complications, decrease in pneumonia, poor swallow function, gastrointestinal bleeding, and deep vein thrombosis (DVT) were significantly associated with higher UA levels compared to Q1 (P for trend &lt; 0.0001).Conclusions: UA was a protective factor for stroke severity and in-hospital complications such as pneumonia, poor swallow function, gastrointestinal bleeding, and DVT. However, no significant evidence indicated that UA levels were predictive of the discharge disposition and in-hospital mortality after ICH.

Oligometastatic renal cell carcinoma in the palatine tonsil: successful resection using trans-oral robotic surgery

A man in his mid 70s was referred to head and neck outpatients with bulky tissue in the left tonsillar fossa. He had previously been treated for oligometastatic renal clear cell carcinoma (diagnosed over 15 years prior to disease recurrence) by tonsillectomy and adjuvant radiotherapy (years from primary treatment), followed by trans-oral laser surgery to his oropharyngeal recurrence 3 years later. Examination under anaesthetic and biopsy confirmed further recurrence of disease in the left tonsillar fossa, with parapharyngeal extension, which has not been previously reported in the literature. After discussion in the head and neck and urology multi-disciplinary teams meeting, the patient was offered trans-oral robotic-assisted surgery (TORS) for local control and prevention of progression of a fungating oropharyngeal mass. TORS partial pharyngectomy and left buccal artery myomucosal flap reconstruction were successfully carried out, with preservation of some swallow function.

Pharyngoesophageal Segment Distention Across Volumes and Pathology

Purpose Patients receive multiple bolus trials during a videofluoroscopic swallowing study (VFSS) to assess swallow function, inclusive of narrowing within the pharyngoesophageal segment (PES). While differences in the narrowest and widest segments are visualized, the ratio of distention across boluses is not well understood. Method A retrospective review of 50 consecutive VFSSs with five boluses of varied viscosity and volume was performed. Still images at maximal PES distention were captured and scaled using a 19-mm disk. Measurements of the narrowest and widest segments were obtained, and a distention ratio was calculated. Studies were categorized by PES phenotype as normal, esophageal web, cricopharyngeal bar, or narrow PES. PES distention ratios were evaluated across bolus trials and within PES phenotypes using a mixed-methods repeated-measures analysis of variance. Results Of the 50 studies, there were 11 normal, 16 web, 10 bar, and 13 narrow PES. Quantitative differences were present for the narrowest ( p = .01) and widest ( p = .002) points across bolus volumes. No difference was present in distention ratio ( p = .2) across volumes. Evaluating the PES phenotype, web, normal, bar, and narrow PES distention ratios differed ( p = .03). Bar and PES narrow distention ratios were lower compared to that of the normal group ( p = .01 for normal vs. bar and p = .02 for normal vs. PES narrow). Conclusions PES distention ratio stability across varying bolus volumes and phenotypes suggests that a reduction in trials during a VFSS may permit an equivalent PES evaluation to traditional exams. Ultimately, this could improve our understanding and accurate diagnosis of PES dysfunction.

Dysphagia presentation and management following COVID-19: an acute care tertiary centre experience

Objectives As the pathophysiology of COVID-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital. Results During the first wave of the COVID-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status. Conclusion Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.