CONCLUSION: Clinical and instrumental evaluations of swallowing are complementary and essential in the diagnosis of oropharyngeal dysphagia in children with cerebral palsy.
CONCLUSION: Chagasic patients might present oropharyngeal swallowing alterations, and patients with more significant esophageal involvement present more weight loss than patients with less esophageal involvement.
Frontal cortical activation is elicited when subjects have been instructed not to initiate a sensorimotor task. The goal of this preliminary fMRI study was to examine BOLD response to a “Do Not Swallow” instruction (an intentional “off-state”) in the context of other swallowing tasks in 3 groups of participants (healthy young, healthy old, and early Alzheimer’s disease (AD)). Overall, the older group had larger, bilaterally active clusters in the cortex, including the dorsomedial prefrontal cortex during the intentional swallowing off-state; this region is commonly active in response inhibition studies. Disease-related differences were evident where the AD group had significantly greater BOLD response in the insula/operculum than the old. These findings have significant clinical implications for control of swallowing across the age span and in neurodegenerative disease. Greater activation in the insula/operculum for the AD group supports previous studies where this region is associated with initiating swallowing. The AD group may have required more effort to “turn off” swallowing centers to reach the intentional swallowing off-state.
from the Journal of Alzheimer’s Disease
Conclusions: Results show that as the physiologic demands of swallowing deviate from single, small bolus swallows, the integration of the swallowing and respiratory systems change. This may reflect obligate differences in airway protection strategy and prolonged competition for respiratory resources.
This exploratory study confirms that dual-axis accelerometry and nasal airflow signals can be used to discriminate healthy and abnormal swallows from patients with dysphagia. The fact that features from all signal channels contributed discriminatory information suggests that multi-sensor fusion is promising in abnormal swallow detection.
The purpose of this study was to assess displacement of oropharyngeal structures, particularly the hyoid bone and velum, and variations in timing of the pharyngeal stage of swallowing in the upright versus the supine position. Twelve Caucasian adult subjects between 19 and 27 years of age participated. Subjects were recorded swallowing 7 cc of liquid barium in the upright and supine positions. The hyoid bone had a significantly greater amount of anterior displacement while in the supine position compared to that of the upright position (p < 0.01). While in the upright position, the velum comes to a fully elevated position at nearly the same time as the initiation of the pharyngeal swallow (within an average of 27 ms of each other), whereas in the supine position the velum continues to elevate on average 115 ms after the initiation of the pharyngeal swallow. Results indicated a significant difference (p < 0.05) in the amount of velar movement from rest to the fully elevated position between the upright and supine positions for female subjects. The results from the study demonstrate variations in hyoid displacement, velar movement, and bolus movement through the pharynx with respect to the two body positions and the subjects’ gender.
Foreign body sensation of the pharynx is a common complaint in otolaryngologic practice. The definite cause of this symptom is seldom precisely diagnosed, leading to chronic pharyngitis. The purpose of the present study was to evaluate the relationship between lump in throat and cervical degenerative disease by their clinical symptoms and the associated image characteristics. All patients with or without the complaint of lump in throat who attended the otolaryngologic clinics of Chang Gung Memorial Hospital—Kaohsiung Medical Center from January 2009 to May 2010 were prospectively eligible for this study. A total of 225 patients who met the inclusion criteria were assigned to either the study group (150 patients with symptoms of lump in the throat) or the control group (75 individuals without symptoms). All patients received plain views of the cervical lateral neck. The study group underwent further diagnostic examinations, including esophagography to exclude other diseases. Symptom scores (range, 0–3) and imaging characteristics such as the number (total spurs) and location (C level) of cervical osteophytes, interspace narrowing, spondylolisthesis, and retrolisthesis were compared between the two groups. It was found that the study group had a significantly greater number of total spurs (P < 0.001), and C45, C56, and C67 were the predominant sites, with significant odds ratios of more than 2 at all these levels. Only C67 revealed a difference in interspace narrowing, and only C45 showed a difference in spondylolisthesis between groups. Hence, a high correlation was found between the lump-in-throat sensation and total number of spurs, especially at the levels of C45, C56, and C67. This result implied that cervical osteophytes might be associated with foreign body sensations of the pharynx.
Reports in the literature suggest that clinicians demonstrate poor reliability in rating videofluoroscopic swallow (VFS) variables. Contemporary perception theories suggest that the methods used in VFS reliability studies constrain subjects to make judgments in an abnormal way. The purpose of this study was to determine whether a directed search or a free search approach to rating swallow studies results in better interjudge reliability. Ten speech pathologists served as judges. Five clinical judges were assigned to the directed search group (use checklist) and five to the free search group (unguided observations). Clinical judges interpreted 20 VFS examinations of swallowing. Interjudge reliability of ratings of dysphagia severity, affected stage of swallow, dysphagia symptoms, and attributes identified by clinical judges using a directed search was compared with that using a free search approach. Interjudge reliability for rating the presence of aspiration and penetration was significantly better using a free search (“substantial” to “almost perfect” agreement) compared to a directed search (“moderate” agreement). Reliability of dysphagia severity ratings ranged from “moderate” to “almost perfect” agreement for both methods of search. Reliability for reporting all other symptoms and attributes of dysphagia was variable and was not significantly different between the groups.
Racial Disparities in the Development of Dysphagia After Stroke: Further Evidence From the Medicare Database
Our findings confirm previous research suggesting an association between Asian race and dysphagia after stroke while adding evidence for increased odds in other racial/ethnic minority groups.
Comparing the Effects of Rehabilitation Swallowing Therapy vs. Functional Neuromuscular Electrical Stimulation Therapy in an Encephalitis Patient: A Case Study
A 49-year-old man with pharyngeal dysphagia after encephalitis is presented in this case study. Sixteen months earlier the patient experienced a sudden severe fever which resulted in encephalitis, leading to liquid dysphagia. Despite receiving an initial treatment of swallowing therapy, the patient’s liquid dysphagia did not improve. Functional neuromuscular electrical stimulation, which is a new treatment method, was then applied to the patient. The patient showed improvement in the pharyngeal phase of swallowing. Clinical and treatment observations are reported.
The purpose of this study was to investigate the mechanisms of aspiration with respect to the viscosity of ingested material in patients with dysphagia. Seventy patients with dysphagia underwent videofluoroscopic swallow studies (VFSS) between May 1, 2009 and September 30, 2009. Based on the findings of the VFSS, patients were divided into three groups: a thick-fluid aspiration group, a thin-fluid aspiration group, and a no-aspiration group. Kinematic analyses were performed during thick-fluid swallowing. Among our 70 patients, 23 had thick-fluid aspiration, 20 had thin-fluid aspiration, and 27 had no aspiration. A shortened duration of upper esophageal sphincter (UES) opening, a shorter interval between UES opening and peak pharyngeal constriction, and a diminished extent of laryngeal elevation were all significant risk factors for thick-fluid aspiration. A prolonged latency of the swallowing reflex, pharyngeal transit time, and the interval between bolus arrival at the vallecula and laryngeal elevation were all significant risk factors for thin-fluid aspiration. Our kinematic analysis of dysphagia employing the VFSS indicated that the mechanisms relevant to aspiration differed with respect to food viscosity.
We present an algorithm developed in MATLAB that can be applied to both normal and disordered swallowing to automatically extract a wide array of measurements from the spatiotemporal plots produced by high-resolution manometry (HRM) of the pharyngeal swallow. The algorithm was developed from data from 12 normal and 3 disordered subjects swallowing 5-ml water boluses. Automated extraction was compared to manual extraction for a subset of seven normal and the three disordered subjects to evaluate algorithm accuracy. Area and line integrals, pressure wave velocity, and pressure gradients during upper esophageal sphincter opening were also measured. Automated extraction showed strong correlations with manual extraction, producing high correlation coefficients in both normal and disordered subjects for maximum velopharyngeal pressure and maximum tongue base pressure. Timing data were also strongly correlated for all variables, including velopharyngeal pressure duration, tongue base pressure duration, and total swallow duration. Preliminary descriptive data on area and line integrals are presented. Our results indicate that the algorithm can effectively extract data automatically from HRM spatiotemporal plots. The efficiency of the algorithm makes it a valuable tool to supplement clinical and research use of HRM.
Assessment of the swallowing function in older individuals referred to myocardial revascularization surgery
CONCLUSION: older individuals with heart disease presented differences in the swallowing function when compared to healthy older individuals. Older individuals with heart disease presented alterations in the temporal coordination between breathing and swallowing, thus indicating risk for dysphagia.
Cervical auscultation has been proposed as an augmentative procedure for the subjective clinical swallowing examination due to the tangible differences between normal and dysphagic swallowing sounds. However, the research is incomplete regarding cervical auscultation and swallowing acoustics in that the differences between the sounds of normal versus dysphagic swallowing have yet to be fully understood or quantified. The swallows of 96 reportedly healthy adults, balanced for gender and divided into younger, middle, and older age groups, were audio-recorded while ingesting several boluses of varying viscosity and volume. The audio signals were then analyzed to determine their temporal and acoustic characteristics. Results indicated increasing pharyngeal swallowing duration with increasing age, bolus viscosity, and bolus volume. In addition, an increased duration to peak intensity with increasing age was found in one of our two analyses, as well as with some of the more viscous versus less viscous boluses. Men and older persons produced higher peak intensities and peak frequencies than women and younger persons. Thin liquids were produced with more intensity than honey or more viscous boluses, and with greater frequency than mechanical soft solids. Larger volumes resulted in greater peak frequency values. Some of the acoustic measurements appear to be more useful than others, including the duration of the acoustic swallowing signal and the within-subjects peak intensity variable. We noted that differences in swallowing acoustics were more related to changes in viscosity rather than volume. Finally, within-participant observations were more useful than between-participant observations.
Pharyngeal Pressures During Swallowing Within and Across Three Sessions: Within-Subject Variance and Order Effects
No studies have investigated within-subject variation in measures of pharyngeal pressures during swallowing across sessions. This study aimed to document the variation in pharyngeal pressures both within and across three sessions. Twenty healthy participants were recruited for three sessions. For each session, peak or nadir pressures were recorded from the upper pharynx (sensor 1), mid-pharynx (sensor 2), and upper esophageal sphincter (sensor 3) during saliva and 10-ml water bolus swallows. Variance was larger across sessions than within sessions for sensors 1 and 2 but comparable for sensor 3. For all sensors there was a high correlation between the variance across sessions and within session (r = 0.92, p < 0.0001). There were no significant order effects of session or of trial at any sensor with estimated order effects less than 2% and the estimated maximum possible change no larger than 5% for trial and no larger than 12% for session. These data offer direction for longitudinal treatment studies in which pharyngeal pressures are an outcome measurement by (1) providing a basis for power calculations, (2) estimating the likely values of any confounding order effects, and (3) providing suggestions for more reliable data analysis.