Acoustic analysis of swallowing as an auxiliary method for assessing dysphagia in Parkinson's disease

Objective: To measure the accuracy of DeglutiSom as an auxiliary method to assess swallowing in patients with Parkinson's disease (PD). Methodology: Accuracy study. Among 248 individuals, 91 participants met the inclusion criteria, with a mean age of 64.9 years (SD 7.7), 53.8% male and 46.2% female, with a mean disease duration of 12.6 years (SD 3.8 years). Two instrumental studies were performed: An acoustic analysis with Sonar Doppler via the DeglutiSom Software, and a videofluoroscopic swallow study. Three judges analyzed the swallowing sounds in the DeglutiSom software and the instrumental examination findings. Results: The inter-rater reliability was 90.1%, with 4.4% degree of partial agreement and 5.5% disagreement. Sensitivity resulted in 90.0% and specificity in 90.0%. A sensitivity of 97.0% and specificity of 91.0% are indicators of a high validity for the dysphagia screening method, with predictive value (+) of 97.0% and predictive value (-) of 91.0%, with an accuracy method of 96.0%. The validity indicator values for screening aspiration were also high, with a sensitivity of 90.0%, specificity of 90.0%, predictive value (+) of 82.0%, predictive value (-) of 95% , 0% and 90.0% accuracy. Conclusion: The method proposed is considered appropriate for oropharyngeal dysphagia and tracheal aspiration screening in patients with Parkinson's Disease.

Videofluoroscopic Swallow Studies and Diagnostic Outcomes in Otherwise Healthy Infants With Dysphagia

Objectives: To evaluate videofluoroscopic swallow study (VFSS) findings in infants with dysphagia and without prior diagnoses, and to characterize the outcomes and any diagnoses that follow. Methods: A chart review of all pediatric patients who received a VFSS at a tertiary children’s hospital from November 2008 to March 2017 was performed. Results: There were 106 infants (57 males and 49 females) with 108 VFSS. VFSS was normal in 18 (16.98%) infants. Regarding airway protection, 50 (47.17%) infants had laryngeal penetration, and 8 (7.55%) had tracheal aspiration; 3 (2.83%, 37.5% of all aspirators) exhibited silent aspiration. Of the 75 infants with minimum 2-year follow-up, 35 (46.67%) had no sequelae of disease and received no diagnoses. The most common diagnoses and pathologic sequelae were gastroesophageal reflux (n = 18, 24.00%), asthma (n = 8, 10.67%), laryngomalacia (n = 6, 8.00%), and tracheomalacia (n = 4, 5.33%), all consistent with United States pediatric data on prevalence. All infants (n = 51) with follow-up for dysphagia had resolution of symptoms within 9 months from VFSS order date. Conclusions: Otherwise healthy infants may show signs of dysphagia and not develop later illness. Parents can thus be counseled on the implications of dysphagia in a previously healthy infant. Our findings provide comparative statistics for future research in pediatric dysphagia.

Swallowing Kinematic Analysis Might Be Helpful In Predicting Aspiration And Pyriform Sinus Stasis

Aspiration and pyriform sinus stasis resulting from compromised swallowing might cause aspiration pneumonia, which can have a negative impact on the patient’s prognosis. Clinically, videofluoroscopic swallow study (VFSS) is considered the standard instrument that is able to provide clues that contribute to the physiological impairment of swallowing. In addition, according to previously published literature, the parameters of kinematic analyses of VFSS might provide further information for aspiration detection. In this study, 449 files of VFSS studies from 232 patients were divided into three groups: normal, aspiration, and pyriform sinus stasis. Kinematic analyses and between-group comparison were conducted. Significant between-group differences were noted among parameters, including anterior hyoid displacement, maximal hyoid displacement, and average velocity of hyoid movement. No significant difference was detected in superior hyoid displacement. Furthermore, receiver-operating characteristic (ROC) analyses using anterior hyoid displacement, velocity of anterior hyoid displacement, and average velocity of maximal hyoid displacement showed acceptable predictability for detecting aspiration. Using 33.0 mm/s as a cutoff value of average velocity of maximal hyoid displacement, the sensitivity of detecting the presence of aspiration could be about 90%. Therefore, we assumed that the average velocity of maximal hyoid displacement could be a potential screening tool to detect aspiration.

Videofluoroscopic Swallow Study in Diagnostics of H-Type Tracheoesophageal Fistula in Children

Esophageal atresia remains one of the most challenging congenital anomalies of the newborn. It can occur with or without tracheoesophageal fistula (TEF), and to date, there are still no universally recommended diagnostic procedures. The so-called H-type TEF is that without esophageal atresia, and its prevalence is lower than 5% of all TEFs. We present a case report of a newborn with regurgitation, vomiting, feeding problems, dyspnea, and repeated aspiration bronchopneumonia. A wide range of diagnostics procedures had been performed with negative results until we used videofluoroscopy, which revealed the H-type TEF and allowed appropriate treatment of the patient.

Pharyngeal Manometry in Pediatric Dysphagia Assessment

Purpose Reliable measures to capture swallowing pathophysiology and outcomes from therapeutic interventions are needed in the pediatric setting. Therefore, this review presents the current best evidence for manometry investigation and its application in pediatric dysphagia. For oropharyngeal dysphagia assessment, videofluoroscopic swallow study is considered the gold standard, and fiberoptic endoscopic examination of swallowing is also employed in some settings. In clinical practice, both tests mostly rely on qualitative interpretation of image data and have variable reliability to detect pathophysiology. Conclusion Acknowledging that swallowing is a pressure-driven event, the role of manometry is now being considered as an objective, nonradiological technique that can be performed as an adjunct to other clinical swallow evaluations. The latest high-resolution manometry catheter technologies are miniaturized and simple to use, enhancing their potential application in pediatric clinical and research contexts.