Predictors of Aspiration and Silent Aspiration in Patients With New Tracheostomy

Purpose Hospitalized, medically complex patients with new tracheostomy are at risk for aspiration. This study reports incidence of aspiration in these patients with new tracheostomy and investigates possible risk factors for aspiration and silent aspiration in this patient population. Method Retrospective review of instrumental swallowing evaluations from hospitalized inpatients with new tracheostomy tubes to determine frequency of aspiration and silent aspiration and patient factors associated with aspiration. Patient variables including sex, age, reason for hospital admission, reason for tracheostomy, duration of intubation, time since tracheostomy placement, and tracheostomy cuff and cap status were examined as possible risk factors for aspiration and silent aspiration. Results Of the 272 patients with new tracheostomies who underwent instrumental swallowing evaluation, 59% aspirated on at least one consistency. Odds of aspiration were twice as high in patients with uncapped tracheostomy compared to closed (i.e., cap or speaking valve in place). Odds of aspiration were 3.4 times greater with patients who underwent tracheostomy for an oropharyngeal etiology (oropharyngeal or laryngeal tumor, surgery, or infection). Of the patients who aspirated, 81% aspirated silently on at least one consistency. Odds of silent aspiration was 4.5 greater with an uncapped tracheostomy. Conclusions Medically complex patients with new tracheostomy are at risk for aspiration and benefit from instrumental swallowing evaluations. Future prospective research is warranted to determine contributing factors responsible for this risk. Lastly, speech pathologists play an important role in the patient’s recovery.

Swallowing Problems after Thyroidectomy

Background Dysphagia is the medical term that is used to describe the difficulty of swallowing and the feeling of difficulty in passage of solids or semisolids or liquids from the mouth to the stomach. Objectives The aim of this work is to evaluate swallowing after different types of thyroidectomy operations. Subjects and Methods This study is a prospective, randomized trial on evaluation of swallowing after different types of thyroidectomy operations. This thesis study was conducted on 100 patients underwent different types of thyroidectomy operations, recruited from otorhinolaryngology and general surgery outpatient clinic Ain Shams university hospital from April 2018 to September 2019. An informed consent was obtained from each patient or their legal guardians before enrolment in the study. Each patient assessed by A EAT-10 Questionnaire and FEES(functional endoscopic evaluation of swallowing) both (pre-operative, early post-operative(EPO) and late postoperative(LPO). Results The study include 100 patient and mean age of study cases was 37.4 ±10.1; females represented 94% of cases. Total thyroidectomy was performed in 94% of cases. Among our cases, we found that Dysphagia was scored 0% at pre-operative questionnaire, 82% at early post-operative questionnaire and 36% at late post-operative questionnaire. Two groups were compared by FEES: Group I with normal vocal fold mobility(NVFM) and Group II with abnormal vocal fold mobility(AVFM) (unilateral fixed vocal fold). Group I included 89 patients, Forty two percent of them had early Dysphagia, while only 22% of them had late dysphagia. As regard swallowing; we found that early post-operative delayed triggering, early post-operative aspiration; early postoperative penetration and early postoperative residue were 12.4%, 0%, 0% and 42.7% respectively. While late postoperative examination revealed that there was improvement of 6 patients and the number of patients of this group became 95 who had normal vocal fold mobility. And the swallowing evaluation revealed that as regard late post-operative delayed triggering, late post-operative aspiration; late post-operative penetration and late post-operative residue were 11.6%, 0%, 0% and 6.3% had respectively. Group II included 11patients at the early postoperative evaluation, all of them had early Dysphagia (100%). As regard the swallowing evaluation, we found that early post-operative delayed triggering, early post-operative aspiration early postoperative penetration and early postoperative residue were 100%, 54.5%, 100% and 45.5% respectively. But the late post-operative evaluation showed that 45% only of the cases of this group (5 cases) still had abnormal vocal fold mobility (unilateral fixed vocal fold). And as regard swallowing; we found late postoperative delayed triggering, late postoperative aspiration, late post-operative penetration and late post-residue were 100%, 100%, 80% and 0% respectively. Conclusion Dysphagia occurs in patients after thyroidectomy operations (regardless of larynx mobility alteration) and characterized by delayed triggering and stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.

How to manage problems with bodily functions

Although dementia can disrupt many bodily functions, there are ways you can help your loved one and yourself. Determine the cause of any falls and work proactively to prevent future ones. If their walking is impaired, work with a physical therapist to improve it. To reduce incontinence, use a toileting schedule, decrease fluid intake before bed, and plan ahead when you go on outings. Make meals more enticing by increasing the flavor and spice of food. Use heavy silverware and mugs to dampen tremors. Improve swallowing and reduce choking by altering the consistency of solid foods and liquids and consider a swallowing evaluation. Reduce the difficulties inherent in activities requiring skilled or complicated movements to the extent possible. Lessen scratching and picking by treating medical problems and dry skin; cover the arms if needed.

How Can Speech-Language Pathologists Think About Sensation During Swallowing Evaluation and Intervention?

Purpose Both the enjoyment of foods and safe swallowing revolve around incorporating multiple streams of sensory feedback to form a positive sensory experience; these include information about the taste, smell, texture, temperature, and even the sight of food. Traditional swallowing assessment and treatment paradigms have primarily focused on the motor aspects of swallowing. However, sensory information is vital for not only enjoying foods while eating but also coordinating safe and efficient swallow behaviors. The purpose of this clinical focus article is to discuss the clinical importance of sensation in swallowing evaluation and intervention. Conclusions During their clinical assessments of swallowing, speech-language pathologists are already documenting the functional results of oropharyngeal sensorimotor impairments (e.g., residue). A combination of sensory and motor aspects is already integrated within current behavioral treatment strategies for dysphagia. Focused attention to the salient sensory features of swallowing has the potential to improve swallowing evaluation and intervention efforts. A discussion of potential future research in improved measurement and documentation of altered sensation is provided.

Laryngeal Sarcoidosis and Swallowing: What Do We Know About Dysphagia Assessment and Management in this Population?

Introduction Sarcoidosis is a chronic granulomatous disease of unknown aetiology and laryngeal involvement is seen in a small percentage of cases. Dysphagia is a common but under-reported symptom. Little is known about how dysphagia typically presents or is managed in the context of this fluctuating disease. We present our case series using an SLT-led model of assessment and management. Methods A literature search was conducted for any articles that reported both laryngeal sarcoidosis and dysphagia. We then analysed a case series of laryngeal sarcoidosis patients treated at Charing Cross Hospital. We report on multidimensional swallowing evaluation and rehabilitative interventions. Results Seventeen papers report both laryngeal sarcoidosis and dysphagia, with only one paper giving details on the nature of the dysphagia and the treatment provided. In our case series (n = 7), patients presented with FOIS Scores ranging from 5 to 7 pre-operatively (median = 6). Aspiration (median PAS Score = 6 and Range = 3–8) and pharyngeal residue were common. Sensory issues were also prevalent with most unaware of the extent of their difficulties. Management interventions included safe swallowing advice, compensatory strategies, exercises and close surveillance given their potential for repeated surgical interventions. Conclusion Laryngeal sarcoidosis is a rare condition. Dysphagia is under-reported and our experience highlights the need for specialist dysphagia intervention. Further research is required to understand dysphagia management requirements in the context of this fluctuating disease process.

How to manage problems with bodily functions

Although dementia can disrupt many bodily functions, there are ways you can help your loved one and yourself. Determine the cause of any falls and work proactively to prevent future ones. If their walking is impaired, work with a physical therapist to improve it. To reduce incontinence, use a toileting schedule, decrease fluid intake before bed, and plan ahead when you go on outings. Make meals more enticing by increasing the flavor and spice of food. Use heavy silverware and mugs to dampen tremors. Improve swallowing and reduce choking by altering the consistency of solid foods and liquids and consider a swallowing evaluation. Reduce the difficulties inherent in activities requiring skilled or complicated movements to the extent possible. Lessen scratching and picking by treating medical problems and dry skin; cover the arms if needed.

Reassessment of Poststroke Dysphagia in Rehabilitation Facility Results in Reduction in Diet Restrictions

Background: Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings. Methods: This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018–2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES. Results: 19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA revealed significant differences (p < 0.001) between dietary prescriptions in an acute care setting and following clinical and endoscopic reassessment in the rehabilitation center. Diet recommendations changed in 41 of 63 (65%) enrolled patients (p < 0.001). Conclusion: Instrumental diagnostic by FEES during the early convalescence period of stroke patients leads to clinically relevant changes to diet restrictions and lower rates of pneumonia. Our findings underline the need for regular and qualitative dysphagia diagnostics in stroke patients participating in neurological rehabilitation.

Dysphagia Management in Military Service Members With Polytrauma: Overview and Case Report

Purpose At Walter Reed National Military Medical Center, service members (SMs) with polytraumatic injuries, usually resulting from blast explosions, are routinely referred to the Speech Pathology Clinic for evaluation of swallowing function. The purpose of this clinical focus article is to advance the speech-language pathologist's (SLP) knowledge of polytrauma and to improve the care of individuals with traumatic injuries, especially related to nutrition and swallowing within a larger multidisciplinary team approach. Case Report Previous research within our center identified common demographic and injury characteristics of SMs with combat-related injuries that led to referrals for swallowing evaluation. An SM with polytraumatic injuries was selected for this case report to illustrate the relevance of the research findings and also the importance of multidisciplinary team support to appropriately manage such complex cases. Evaluations and relevant treatments are described across a 3-month acute care hospitalization, including swallowing and nutritional recommendations at the time of each swallowing evaluation. Discussion Comparisons of polytrauma cases at Walter Reed National Military Medical Center with literature from civilian trauma centers revealed somewhat longer hospitalizations and the particular influence of maxillofacial trauma on dysphagia outcomes. The complex case reported in this article illustrates the importance of multidisciplinary care and coordination, with particular emphasis on the intersecting roles of the SLP and registered dietitian. This report can serve as a guide for SLPs working in trauma settings for developing prognostic statements, treatment plans, and multidisciplinary interaction.