Oropharyngeal Dysphagia and Swallowing Dysfunction

2014 ◽  
pp. 1-13 ◽  
Author(s):  
Daniel Sifrim ◽  
Natàlia Vilardell ◽  
Pere Clavé
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Swallowing Dysfunction

scholarly journals Pathophysiology of Swallowing Dysfunction in Parkinson Disease and Lack of Dopaminergic Impact on the Swallow Function and on the Effect of Thickening Agents

2020 ◽  
Vol 10 (9) ◽  
pp. 609
Author(s):  
Weslania Viviane Nascimento ◽  
Viridiana Arreola ◽  
Pilar Sanz ◽  
Ediz Necati ◽  
Mireia Bolivar-Prados ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Healthy Volunteers ◽  
Oropharyngeal Dysphagia ◽  
Yahr Stage ◽  
Disease Evolution ◽  
Swallowing Dysfunction ◽  
Bolus Viscosity ◽  
Laryngeal Vestibule ◽  
Thickening Agents ◽  
Swallow Function

(1) Background: The effect of dopaminergic treatment on swallowing response in patients with Parkinson’s disease (PD) suffering oropharyngeal dysphagia (OD) is not understood. Aim: To characterize OD pathophysiology in PD and to assess whether dopaminergic states affect swallow function and the effect of thickeners. (2) Methods: Fifty patients with PD (40 evaluated in OFF/ON states) and 12 healthy volunteers (HVs) were evaluated with videofluoroscopy (VFS) to assess the swallowing biomechanics and kinematics of the swallowing response at three different shear-viscosities (<50, 120, and 4000 mPa·s); (3) Results: Patients presented a mean age of 70.46 ± 10.03 years. Disease evolution was 5.09 ± 3.86 year and Hoehn-Yahr stage was 2.32 ± 0.81. For HVs, mean age was 40.20 ± 2.50 year. Penetrations were present in 37.50% of PD patients and were associated with delayed laryngeal vestibule closure (LVC = 293.33 ± 90.07 ms). In contrast, HVs presented a LVC = 164.00 ± 39.78 ms (p < 0.05). An LVC ≥ 260 ms cutoff predicted unsafe swallow (sensitivity ≥ 0.83, specificity ≥ 0.57, AUC = 0.80) in PD. Increasing bolus viscosity improved deglutition safety but increased oropharyngeal residue. There were no differences in swallowing between the OFF/ON states. (4) Conclusions: In initial PD stages, oropharyngeal swallow response is severely delayed, while mildly impaired swallow safety improves with increasing bolus viscosity, which increases residue. Dopaminergic treatment does not affect swallowing or the therapeutic effect of thickeners.

Progression of swallowing dysfunction and associated complications of dysphagia in a cohort of patients with serial videofluoroscopic swallow examinations

2021 ◽  
pp. 1-6
Author(s):  
R Hanna ◽  
D R Randall
Keyword(s):  
Univariate Analysis ◽  
Oropharyngeal Dysphagia ◽  
Risk Groups ◽  
Common Symptom ◽  
Swallowing Dysfunction ◽  
Scale Scores ◽  
Patients At Risk ◽  
Life Threatening ◽  
Over Time ◽  
Penetration Aspiration Scale

Abstract Objective Dysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time. Method This was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities. Results This study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time (p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time (p = 0.57) or severity of dysphagia (p = 0.88). Conclusion Our dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.

scholarly journals Prevalence of oropharyngeal dysphagia in hereditary spastic paraplegias

2019 ◽  
Vol 77 (12) ◽  
pp. 843-847 ◽  
Author(s):  
Laís Alves Jacinto-Scudeiro ◽  
Gustavo Dariva Machado ◽  
Annelise Ayres ◽  
Daniela Burguêz ◽  
Marcia Polese-Bonatto ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Genetic Diseases ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Hereditary Spastic Paraplegias ◽  
Swallowing Dysfunction ◽  
Clinically Significant ◽  
Functional Oral Intake Scale

ABSTRACT Hereditary spastic paraplegias (HSP) are a group of genetic diseases characterized by lower limb spasticity with or without additional neurological features. Swallowing dysfunction is poorly studied in HSP and its presence can lead to significant respiratory and nutritional complications. Objectives: The aim of this study was to evaluate the frequency and clinical characteristics of dysphagia in different types of HSP. Methods: A two-center cross-sectional prevalence study was performed. Genetically confirmed HSP patients were evaluated using the Northwestern Dysphagia Patient Check Sheet and the Functional Oral Intake Scale. In addition, self-perception of dysphagia was assessed by the Eat Assessment Tool-10 and the Swallowing Disturbance Questionnaire. Results: Thirty-six patients with spastic paraplegia type 4 (SPG4), five with SPG11, four with SPG5, four with cerebrotendinous xanthomatosis (CTX), three with SPG7, and two with SPG3A were evaluated. Mild to moderate oropharyngeal dysphagia was present in 3/5 (60%) of SPG11 and 2/4 (50%) of CTX patients. A single SPG4 (2%) and a single SPG7 (33%) patient had mild oropharyngeal dysphagia. All other evaluated patients presented with normal or functional swallowing. Conclusions: Clinically significant oropharyngeal dysphagia was only present in complicated forms of HSP Patients with SPG11 and CTX had the highest risks for dysphagia, suggesting that surveillance of swallowing function should be part of the management of patients with these disorders.

scholarly journals Radiologic examination of pharynx for oropharyngeal dysphagia in a patient with dermatomyositis (clinical observation)

2021 ◽  
Vol 25 (2) ◽  
pp. 116-123
Author(s):  
N. V. Kovaleva ◽  
A. N. Khelkovskaya-Sergeeva ◽  
M. A. Ushakova
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Clinical Signs ◽  
Radiological Examination ◽  
Respiratory Protection ◽  
Inflammatory Myopathies ◽  
Swallowing Function ◽  
Progressive Muscle Weakness ◽  
Radiologic Examination ◽  
Swallowing Dysfunction ◽  
Residual Amount

Dermatomyositis – a systemic connective tissue disease, from the group of idiopathic inflammatory myopathies. Affection of the skeletal muscle tissue in inflammatory myopathies causes progressive muscle weakness. In dermatomyositis reduction in contraction ability of the muscles involved in the act of swallowing, leads to violation of the mechanism of respiratory protection from getting food masses inside and from development of dysphagia.The purpose of the study was to evaluate the changes detected in the process of radiologic examination of the dermatomyositis patient’s throat.Materials and methods. Patient K. 61 years old, he has dermatomyositis and clinical signs of oropharyngeal dysphagia. The patient underwent a pharyngeal radiologic examination, which allowed to confirm the disturbance of swallowing function and to establish the fact of aspiration.Results and discussion. Radiological examination of the pharynx showed signs of pharynx hypotony, pharyngeal ectasia, stasis, residual amount of radiocontrast agent in caudal section of larynx, penetration, aspiration.Conclusion. Radiological examination of the pharynx in patients with dermatomyositis is important method examination of studying swallowing disorders and predicting risk of serve complications.The peculiarity of this case is the demonstration of swallowing dysfunction dynamics in a patient with dermatomyositis at admission to the clinic and after treatment.

Functional Anatomy Underlying Pharyngeal Swallowing Mechanics and Swallowing Performance Goals

2019 ◽  
Vol 4 (4) ◽  
pp. 648-655
Author(s):  
William G. Pearson ◽  
Jacline V. Griffeth ◽  
Alexis M. Ennis
Keyword(s):  
Functional Anatomy ◽  
Neuromuscular Control ◽  
Upper Esophageal Sphincter ◽  
Performance Goals ◽  
Laryngeal Elevation ◽  
Port Closure ◽  
Swallowing Dysfunction ◽  
Hyoid Movement ◽  
Pharyngeal Swallowing ◽  
Pharyngeal Constriction

Purpose Rehabilitation of pharyngeal swallowing dysfunction requires a thorough understanding of the functional anatomy underlying the performance goals of pharyngeal swallowing. These goals include the safe and efficient transfer of a bolus through the hypopharynx into the esophagus. Penetration or aspiration of a bolus threatens swallowing safety. Bolus residue indicates swallowing inefficiency. Several primary mechanics, or elements of the swallowing mechanism, underlie these performance goals, with some elements contributing to both goals. These primary mechanics include velopharyngeal port closure, hyoid movement, laryngeal elevation, pharyngeal shortening, tongue base retraction, and pharyngeal constriction. Each element of the swallowing mechanism is under neuromuscular control and is therefore, in principle, a potential target for rehabilitation. Secondary mechanics of pharyngeal swallowing, those movements dependent on primary mechanics, include opening the upper esophageal sphincter and epiglottic inversion. Conclusion Understanding the functional anatomy of pharyngeal swallowing underlying swallowing performance goals will facilitate anatomically informed critical thinking in the rehabilitation of pharyngeal swallowing dysfunction.

Lingual Strengthening: Success in an Outpatient Setting

2015 ◽  
Vol 24 (2) ◽  
pp. 71-74
Author(s):  
Ali Meier
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Patient Discharge ◽  
Outpatient Setting ◽  
Oral Performance ◽  
Exercise Protocol ◽  
Anterior Position ◽  
Tongue Position ◽  
Bolus Propulsion ◽  
Posterior Position

In the last decade or more, dysphagia research has investigated the effect of lingual strengthening on oropharyngeal dysphagia with promising results. Much of this research has utilized strengthening devices such as the Iowa Oral Performance Instrument (IOPI) or the Madison Oral Strengthening Therapeutic (MOST) Device. Patients are often given a device to use, and are able to complete an exercise protocol daily or multiple times per day. This case study was completed to determine the effectiveness of using the IOPI in an outpatient clinic where therapy was conducted two to three times per week. The patient was seen post tongue resection due to oropharyngeal cancer. From initiation of IOPI use to patient discharge, the patient demonstrated a 71% increase in lingual strength at the anterior position, a 61% increase at the posterior position, and a 314% increase at the base of tongue position. His diet advanced from NPO to general based on gains in lingual strength and bolus propulsion.

Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

2008 ◽  
Vol 17 (2) ◽  
pp. 43-49
Author(s):  
James L. Coyle
Keyword(s):  
Treatment Effectiveness ◽  
Code Of Ethics ◽  
Oropharyngeal Dysphagia ◽  
Clinical Importance ◽  
Professional Services ◽  
Adverse Outcomes ◽  
Professional Judgment ◽  
Evidence Based ◽  
Intervention Selection ◽  
Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

Hearing and Neurodevelopmental Outcomes of Young Infants with Parechovirus-A and Enterovirus Meningitis: Cohort Study in Singapore Children and Literature Review

2020 ◽  
Author(s):  
Elis Yuexian Lee ◽  
Jessica Hui Yin Tan ◽  
Chew Thye Choong ◽  
Nancy Wen Sim Tee ◽  
Chia Yin Chong ◽  
...  
Keyword(s):  
Developmental Delay ◽  
Oropharyngeal Dysphagia ◽  
Significant Risk ◽  
Developmental Outcomes ◽  
Autism Spectrum ◽  
Clinical Findings ◽  
Cortical Blindness ◽  
Speech Delay ◽  
Neurodevelopmental Outcomes ◽  
Young Infants

Abstract Parechovirus-A (PeV-A) and Enterovirus (EV) commonly cause childhood aseptic meningitis. Bacterial meningitis in children has been associated with devastating long-term sequelae. However, developmental outcomes are unclear in Parechovirus meningitis. This study aims to review the clinical findings and developmental outcomes of infants with PeV-A and EV meningitis. We performed a retrospective study of infants aged 90 days or younger being admitted to our hospital with PeV-A meningitis between November 2015 and July 2017, with positive cerebrospinal fluid (CSF) PeV-A PCR and negative blood and CSF bacterial cultures. Hearing and neurodevelopmental outcomes were compared with a previous cohort of infants aged 90 days or younger with EV meningitis admitted from January 2015 to December 2015. A total of 161 infants were included in our study, of which 68 infants (42.2%) had PeV-A meningitis and 93 infants (57.8%) had EV meningitis. We assessed their developmental outcome at 6 months, 1 year, and 2 years post-meningitis. At 2 years post-meningitis, three infants with PeV-A meningitis had developmental delay (5.5%), whereas none with EV meningitis had developmental delay. One patient had speech delay and autism spectrum disorder, while two had mild speech delay. When compared with our cohort of EV meningitis ≤90 days old, children with PeV-A meningitis ≤90 days old were more likely to have developmental delay 2 years post-meningitis (odds ratio 2.4, 95% confidence interval 2.0–3.0, p = 0.043). None of the patients with PeV-A or EV meningitis had sensorineural hearing loss or neurological sequelae, such as cortical blindness, oropharyngeal dysphagia, hydrocephalus, epilepsy, or cerebral palsy. Infants with PeV-A meningitis had a significant risk of developmental delay 2 years post-meningitis compared with those with EV meningitis. It is important to follow-up the developmental milestones of infants diagnosed with PeV-A meningitis for at least 2 years; and when they develop developmental delay, to ensure that they receive appropriate intervention.

Observation of the Pattern of Oral Reflux in Two Patients with Oropharyngeal Dysphagia.

2002 ◽  
Vol 53 (6) ◽  
pp. 445-452
Author(s):  
Sachiyo Hamakawa ◽  
Chieko Kouda ◽  
Hirohito Umeno ◽  
Yoshikazu Yoshida ◽  
Tadashi Nakashima
Keyword(s):  
Oropharyngeal Dysphagia
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