Hospital speech-language pathology approach in oropharyngeal dysphagia and its motor and etiological associations

Objective: To identify the profile of speech-language pathology in patients with oropharyngeal dysphagia at a University Hospital and the associations between health conditions and the etiology of swallowing disorders. Methods: A cross-sectional and descriptive study, with analysis of medical records of patients with oropharyngeal dysphagia treated at a University Hospital, of both sexes, attended from February to December 2018. A descriptive and association analysis of the evaluated variables was carried out, with a significance level of 0.05. Results: It was identified in the sample, consisting of 26 (51%) females and 25 (49%) males, with a mean of 57.1 years (± 18.6), presence of progressive neurogenic oropharyngeal dysphagia (39.2 %), idiopathic (31.4%) and non-progressive (29.4%), in which the most performed speech-language pathology procedures were assessment (100%), giving support to observational issues during the fiberoptic endoscopic evaluation of swallowing (96.1%), management of dysphagia (92.2%) and return and discharge conducts (49% and 25.5%, respectively). The multi-professional participation has conducted better decision-making for an adequate diagnosis and speech therapy approach that had aimed at the management of oropharyngeal dysphagia, as well the intervention approaches with techniques aimed at maneuvers, and neuromuscular conditioning in relation to disorders of the biomechanics of swallowing. There was a significant association between the presence of motor and balance changes with neurogenic oropharyngeal dysphagia and difficulty in swallowing and choking symptoms as a sign of oropharyngeal dysphagia.

Voluntary Cough Effectiveness and Airway Clearance in Neurodegenerative Disease

Purpose: Voluntary cough dysfunction is highly prevalent across multiple patient populations. Voluntary cough has been utilized as a screening tool for swallowing safety deficits and as a target for compensatory and exercise-based dysphagia management. However, it remains unclear whether voluntary cough dysfunction is associated with the ability to effectively clear the airway. Method: Individuals with neurodegenerative disorders performed same-day voluntary cough testing and flexible endoscopic evaluations of swallowing (FEES). Participants who were cued to cough after exhibiting penetration to the vocal folds and/or aspiration with thin liquids during FEES met inclusion criteria. One-hundred and twenty-three trials were blinded, and the amount of residue before and after a cued cough on FEES was measured with a visual analog scale. Linear and binomial mixed-effects models examined the relationship between cough airflow during voluntary cough testing and the proportion of residue expelled. Results: Peak expiratory flow rate ( p = .004) and cough expired volume from the entire epoch ( p = .029) were significantly associated with the proportion of aspiration expelled from the subglottis. Peak expiratory flow rate values of 3.00 L/s, 3.50 L/s, and 5.30 L/s provided high predicted probabilities that ≥ 25%, ≥ 50%, and ≥ 80% aspirate was expelled. Accounting for depth of aspiration significantly improved model fit ( p < .001). Conclusions: These findings suggest that voluntary cough airflow is associated with cough effectiveness to clear aspiration from the subglottis, although aspiration amount and depth may play an important role in this relationship. These findings provide further support for the clinical utility of voluntary cough in the management of dysphagia.

Association between Swallowing-Related Questionnaire Responses and Pathological Signs on Videofluoroscopy in Children

The aim of this study was to identify relationships in children between responses to specific questions of interest in a clinical questionnaire concerning swallowing-related difficulties and pathological signs on a videofluoroscopic swallowing study (VFSS). A prospective data analysis was made of children evaluated with swallowing disorder between January 2018 and April 2021 at a tertiary care centre. Each child enrolled in the study underwent a subjective evaluation (targeted questions) and instrumental examination (VFSS). In total, 51 children suffering from swallowing problems (32 with a neurological disorder and 19 without neurological disorder) were included into the study. Our results showed there was a correlation between the occurrence of specific symptoms (wet voice, wet breathing, recurrent respiratory infections, chronic mucus) and other pathological signs on a VFSS (laryngeal penetration, residua, nasal regurgitation). The evaluation of these specific questions is a reliable and useful method for the management of dysphagia in neonates and infants. It can help us in selecting those patients for which it is appropriate to perform a VFSS.

Successful treatment of dysphagia in a COVID-19 survivor

<p class="abstract">This study was aimed<strong> </strong>document a successful case of dysphagia management after coronavirus disease 2019 (COVID-19) infection. COVID-19 is highly infectious disease and causes 75 million infection and 1.66 million deaths worldwide. Clinical features of COVID-19 including respiratory compromise, microvascular thrombosis and neurologic dysfunction as well as well as prolonged intensive care unit (ICU) care in severe cases yield patients particularly susceptible to mild to severe swallowing impairment which can persist for months or years after ICU discharge. A 52 years old female was diagnosed with severe pharyngo-oesophageal dysphagia after COVID-19 infection and was advised for swallowing therapy. The swallowing therapy was given thrice a week for 45 minutes including Masako, Shaker’s and modified Shaker’s exercise along with effortful swallow, Mendelsohn maneuvers and super-supraglottic swallow. After 2 weeks of swallowing therapy patient started taking semisolid food orally and maintain normal SpO₂level during feeding. This study concluded early intervention is the key to boost faster recovery and helped to improve patient’s quality of life.<strong> </strong>Swallowing manuvers and exercises were very effective for the management of dysphagia secondary to COVID-19 infection. This can be generalized and efficacy can be determined with large group of patients having swallowing difficulty after COVID-19 infection.</p>

Parkinson‘s disease and GIT involvement

Involvement of the upper part of the gastrointestinal tract in patients with Parkinson disease is reported less frequently than the involvement of the lower part. Its clinical impact is, however, substantial because dysphagic symptoms considerably decrease the quality of life and may lead to life threatening complications. Even though the clinical symptoms related to esophageal motility disorders as a result of Parkinson disease are more common in the advanced stages of the disease, these could be dia­gnosed much earlier using high resolution manometry. The authors describe the basic principles of dia­gnostic management of dysphagia in patients with Parkinson disease and in the clinical part they present an analysis of their patient cohort. They found out that nonspecific and diverse motility disorders are present in most patients, even without dysphagic symptoms. In the experimental part, we outlined new possibilities for dia­gnostic procedures using the most up-to-date methods for the detection of pathological forms of alpha-synuclein and advanced microscopic methods. Key words: esophageal motility disorders – manometry – Parkinson disease – alpha-synuclein – FLIM analysis – immunohistochemistry

Emerging Role of Ultrasound in Dysphagia Assessment and Intervention: A Narrative Review

Ultrasonography has gained increasing attention as a non-invasive and radiation-free instrument for the assessment of swallowing function. In the past decades, an extensive repertoire of ultrasonographic techniques, such as, B-mode dynamic scanning, pixel analysis, M-mode, Doppler, 3D reconstruction, and sonoelastography, has been applied in the evaluation of oropharyngeal structures and movement. Yet, a universal consensus on the examination protocols and clinical implications remains to be established. This review aimed to provide a brief introduction of the application of ultrasound in dysphagia assessment and intervention, encompassing the ultrasonography of swallowing-related muscles, tongue movement, and hyolaryngeal excursion, as well as ultrasound-guided interventions in the management of dysphagia. In addition to non-invasiveness, ultrasonography, a portable, easy to use, and low-cost technique, could compliment videofluoroscopic swallowing study as a first-line screening and follow-up tool for the evaluation of swallowing function, although further study is warranted to provide quantitative diagnostic and prognostic values. Finally, ultrasonography aids in the precisely targeted injection of botulinum toxin in patients exhibiting oropharyngeal muscle spasticity.

Curriculum review : investigation and management of dysphagia

Dysphagia is a common presentation in gastroenterology practice and the diagnosis and management requires a comprehensive knowledge of diverse range of aetiologies, with a systematic approach for assessment of symptoms, selection of investigations and appropriate treatment to relieve symptoms. In this curriculum review, the suggested diagnostic approach highlights the importance of thorough clinical assessment in order to guide the selection of investigations. This article discusses the utility of endoscopic, histopathology, fluoroscopic and motility investigations for dysphagia, and their interpretation, in order to guide targeted treatments ranging from dietary, pharmacological, endoscopic and surgical interventions.

Dysphagia, dyspepsia, and hiccups

Dysphagia, or difficulty swallowing, is a complex problem. Although patients may present with dysphagia as an issue that requires palliation, other patients may develop dysphagia as a complication of progressive disease and increasing debilitation. The diagnosis of dyspepsia requires patients to be experiencing one or more of the following four problems: epigastric pain, epigastric burning, postprandial fullness, or early satiety. Dyspepsia may occur either as a functional disorder where the cause is not clear or as a secondary disorder. Hiccup, or more correctly, singultus, is a problem where patients experience a sharp and involuntary contraction of the muscles of inspiration which cause a sudden sharp inspiration and closure of the glottis. For most, this is a short-lived experience. This chapter discusses the definition, prevalence, pathophysiology, causes, presenting problems, investigations, and management of dysphagia, dyspepsia, and hiccups.