Diagnosis Of Oropharyngeal Dysphagia Research Articles

Effect of a texture-modified and controlled bolus volume diet on all-cause mortality in older persons with oropharyngeal dysphagia: Secondary analysis of a randomized controlled trial.

Oropharyngeal dysphagia (OD) is common among older adults. Some studies have evaluated the efficacy of a texture-modified diet on mortality but with short-term follow-up. We aimed to evaluate the effect of a texture-modified diet and controlled bolus volume on all-cause mortality after 12 months in older persons with OD. This secondary analysis of a randomized clinical trial included patients aged ≥60 years with a diagnosis of OD. They were concurrently and randomly assigned to receive either a texture-modified food diet and controlled bolus volume (intervention group) or standard treatment (control group) with 12 months of follow-up. Secondary outcomes were oral intake, weight, handgrip strength, phase angle, and aspiration pneumonia. Kaplan-Meier analysis and the Cox proportional hazards model were used for mortality analysis. A total of 127 participants (intervention group: 64 and control group: 63) were recruited, with a mean age of 76 years. The probability of all-cause mortality was significantly lower in the intervention group (n = 8, 12%) than in the control group (n = 18, 29%) (hazard ratio = 0.36 [95% CI = 0.16-0.86]; P = 0.01). There were 5 (7.9%) and 10 (16.1%) aspiration pneumonia events in the intervention and control groups, respectively (not significant) in 12 months of follow-up. Changes were observed in protein consumption (P = 0.01), body weight (P = 0.04), body mass index (P = 0.004), handgrip strength (P = 0.02), and phase angle (P = 0.04) between the treatment groups. Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all-cause mortality.

Spontaneous Swallowing Frequency in Post-Stroke Patients with and Without Oropharyngeal Dysphagia: An Observational Study

Oropharyngeal dysphagia (OD) is a frequent complication after stroke (PSOD) that increases morbidity and mortality. Early detection of PSOD is essential to reduce morbidity and mortality in patients with acute stroke. In recent years, an association between reduced spontaneous swallowing frequency (SSF) and OD has been described. Likewise, the reduction of saliva substance P (SP) concentration has been associated with an increased risk of aspiration and a decrease in SSF. In this study we aimed to compare SSF, salivary SP concentration, hydration and nutritional status in post-stroke (PS) patients with and without OD. We included 45 acute PS patients (4.98 ± 2.80 days from stroke onset, 62.22% men, 71.78 ± 13.46 year). The Volume-Viscosity Swallowing Test (V-VST) was performed for clinical diagnosis of OD. SSF/minute was assessed through 10-min neurophysiological surface recordings including suprahyoid-electromyography and cricothyroid-accelerometry. Saliva samples were collected with a Salivette® to determine SP by ELISA. Hydration status was assessed by bioimpedance. Nutritional status was evaluated by Mini Nutritional Assessment Short Form (MNA-sf) and blood analysis. Twenty-seven PS patients (60%) had OD; 19 (40%), impaired safety of swallow. SSF was significantly reduced in PSOD, 0.23 ± 0.18 and PSOD with impaired safety, 0.22 ± 0.18 vs 0.48 ± 0.29 swallows/minute in PS without OD (PSnOD); (both p < 0.005). Nutritional risk was observed in 62.92% PSOD vs 11.11% PSnOD (p = 0.007) and visceral protein markers were also significantly reduced in PSOD (p < 0.05). Bioimpedance showed intracellular dehydration in 37.50% PSOD vs none in PSnOD. There were no differences for saliva SP concentrations. SSF is significantly reduced in PSOD in comparison with PSnOD. Acute PSOD patients present poor nutritional status, hydropenia, and high risk for respiratory complications.

Factors associated with oropharyngeal dysphagia diagnosed by videofluoroscopy in children with cerebral palsy.

Oropharyngeal dysphagia (OD) occurs in children with cerebral palsy. It is important to investigate its relationship with some variables, and the objective of this study was to identify factors associated with OD. Case-control study in patients with cerebral palsy from 8months to 15years of age, from November 2018 to November 2019, approved by the Ethics Committee. The diagnosis of OD was made by videofluoroscopy when there was nasopharyngeal reflux, stagnation in the vallecular sinuses, in the piriformis sinuses, penetration, and aspiration. The independent variables were type of cerebral palsy, gross motor impairment classified into five levels, nutritional status and comorbidities. One case with OD was included and the next one without alterations in videofluoroscopy was control. The variables were compared with Chi square and Student's t. The association was measured with odds ratio. The confidence interval was 95%. Thirty patients with OD and 30without OD were studied. Sex, age, birth weight, and gestational age had a similar distribution in the two groups. From the data perceived by the mothers at the time of feeding, the greater frequency of the difficulty in the transfer of the food bolus in the group with OD showed a statistically significant difference (P<.001) and of the studied factors, the levelV of the gross motor involvement was associated with a higher frequency of OD. OD was associated with level V of gross motor involvement.

A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia.

(1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR–) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD’s prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.

A low phase angle determined by bioelectrical impedance analysis is associated with oropharyngeal dysphagia among institutionalized older adults.

The aim was to evaluate the prevalence of oropharyngeal dysphagia (OD) and its association with body composition by bioelectrical impedance analysis (BIA) and functionality among institutionalized older adults. A cross-sectional study was conducted. The swallowing function and diagnosis of OD were evaluated with a volume-viscosity swallow test. Activities of daily living were evaluated by the Barthel Index. Body composition was evaluated by BIA, and phase angle (PhA) was determined. Eighty institutionalized older adults were evaluated. The mean age of the study population was 82±9.5 years, and 65% were females. The OD prevalence was 30%, dependence was 30%, and sarcopenia was 16%. In the multivariate analysis, a low PhA (<3.5°) was independently associated with the presence of OD adjusted by sex and age (OR: 2.60, 95%CI 2.41-2.90, p=0.01). A higher prevalence of OD was found. Significant and independent associations were found between low PhA, dependence, and sarcopenia with the presence of OD among institutionalized older persons.

Rheological Issues on Oropharyngeal Dysphagia.

There is an increasing proof of the relevance of rheology on the design of fluids for the diagnosis and management of dysphagia. In this sense, different authors have reported clinical evidence that support the conclusion that an increase in bolus viscosity reduces the risks of airway penetration during swallowing. However, this clinical evidence has not been associated yet to the definition of objective viscosity levels that may help to predict a safe swallowing process. In addition, more recent reports highlight the potential contribution of bolus extensional viscosity, as elongational flows also develops during the swallowing process. Based on this background, the aim of this review paper is to introduce the lecturer (experts in Dysphagia) into the relevance of Rheology for the diagnosis and management of oropharyngeal dysphagia (OD). In this sense, this paper starts with the definition of some basic concepts on Rheology, complemented by a more extended vision on the concepts of shear viscosity and elongational viscosity. This is followed by a short overview of shear and elongational rheometrical techniques relevant for the characterization of dysphagia-oriented fluids, and, finally, an in-depth analysis of the current knowledge concerning the role of shear and elongational viscosities in the diagnosis and management of OD (shear and elongational behaviors of different categories of dysphagia-oriented products and contrast fluids for dysphagia assessment, as well as the relevance of saliva influence on bolus rheological behavior during the swallowing process).

DISTÚRBIO DE DEGLUTIÇÃO EM CRIANÇA COM COMPLEXO DE DOENÇAS PULMONARES INTERSTICIAIS: AVALIAÇÃO E PROPOSTA TERAPÊUTICA

Case report of a 7 month old baby with the disease studied, in which the evaluation and therapeutic proposal of the swallowing disorder was performed in home care. In the speech-language evaluation hypotonia of the musculature of the stomatognathic system was identified, and bite and GAG reflexes were present. It presented little tolerance to the intra-oral touch, with signs of stress during evaluation. A direct evaluation of swallowing was performed, offering 5ml of food in a homogeneous pasty consistency in which we observed respiratory incoordination and slow oral transit time, with food stasis in the oral cavity. Patient presented respiratory discomfort, crying, and irritability, with the presence of regurgitation of mucoid secretion and the refusal to a new attempt of supply. Patient with speech-language diagnosis of oropharyngeal dysphagia, with signs of eating difficulties. Speech-language intervention, global sensory stimulation, guidelines for those responsible and the nursing techniques team on posture, and therapeutic and stimulation activities were conducted. Patient presents a rare complex of pulmonary diseases and speech-language pathology is innovative in patients with this pathology.

Design and implementation of modified-texture diet in older adults with oropharyngeal dysphagia: a randomized controlled trial.

Oropharyngeal dysphagia (OD) is a common problem in elderly population that negatively affects the oral intake and body composition resulting in clinical complications as malnutrition and dehydration. The aim of this study was to design, implement, and evaluate the effect of texture-modified foods and thickened drinks diet, with nectar or pudding viscosity and controlled bolus volume in older adults with OD on body composition and oral intake. Randomized clinical trial, simple blind. Patients ≥ 65 years, admitted at a national institute, who had a confirmed diagnosis of OD were included. A texture-modified foods and thickened drinks diet, with nectar or pudding viscosity and controlled bolus volume, was compared to isocaloric standard treatment for 12 weeks. Body composition was evaluated by bioelectrical impedance, muscular functionality was evaluated by handgrip strength, and daily energy and protein intake by 24-h recall and evaluated by Food Processor Nutrition Analysis® software. Twenty participants were included per group, with mean age 76 years. After 12 weeks, the consumption of energy (29 ± 10 to 40 ± 15 kcal/kg, p = 0.009) and protein (1.3 ± 0.6 to 1.8 ± 0.7 g/kg, p = 0.03), as well as phase angle (4.4 ± 1.8 to 5.5 ± 2.5°, p = 0.05), body weight (56 ± 10 to 60 ± 10 kg, p < 0.001), and handgrip strength (18 ± 11 to 21 ± 13 kg, p = 0.004) increased in the intervention group. In control group there were no changes. The dietary intervention improved oral intake, weight, handgrip strength, and phase angle, which can prevent or limit the nutritional complications associated with the OD.

Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review.

BackgroundThis systematic review qualitatively summarizes the current literature on diagnosis and treatment of oropharyngeal dysphagia (OD) after total laryngectomy (TLE).MethodsElectronic databases PubMed, Embase, and the Cochrane Library were used. Two independent reviewers carried out the literature search and assessed the methodological quality of the included studies using a critical appraisal tool.ResultsForty‐four articles met the inclusion criteria. Of these, 35 studies were on diagnosis, four on therapy, and five on both diagnosis and treatment of OD following TLE. Study aims, swallowing‐assessment methods, and main findings of the included studies were summarized and presented.ConclusionsThe reviewers found heterogeneous outcomes and serious methodological limitations, which prevented us from pooling data to identify trends that would assist in designing best clinical practice protocols for OD following TLE. Further research should focus on several remaining gaps in our knowledge on diagnosis and treatment interventions for OD following TLE.

Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care.

The study evaluated the association of the sociodemographic, behavioural variables and the oral conditions with the presence of oropharyngeal dysphagia in long-term care older persons. Due to the influence of ageing, swallowing may be altered both in people with natural teeth and in those who have dentures or tooth loss. This cross-sectional study evaluated 115 individuals older than 60years, living in long-term care institutions of the State of Rio Grande do Sul in 2016. The diagnosis of dysphagia happen using a clinical speech evaluation, based on the research of signals and symptoms of alterations during deglutition, and on an oral sensory-motor evaluation. The dental clinical evaluation examined the oral cavity, teeth and dental prostheses, including a Xerostomia assessment. Poisson Regressions with robust variance was calculated were used to estimate crude and adjusted Prevalence Ratios(PR) and their IC95%. The sample was mostly comprised of older women (67.0%), with more than 81years of age (44.3%) and edentulous (54.3%). Diagnosis of oropharyngeal dysphagia was verified in 60.9% of the participants. In the final model, older persons who presented no pair (PR=1.52(CI95%=1.02-2.40)) had a highest prevalence of oropharyngeal dysphagia, when compared to older persons who presented 8 to 14 mixed pairs, as well as those older persons who had more complaints related to symptoms of Xerostomia (PR=2.86(CI95% 1.58-5.18)). Institutionalised older persons with a poor oral health condition are associated with a higher prevalence of oropharyngeal dysphagia, as well as with the presence of Xerostomia.

Relación entre dependencia funcional y severidad de la disfagia en pacientes mayores postrados

IntroductionDependency and dysphagia are conditions that often co-exist in frail elderly. The aim of this study was to determine the association between the level of function in activities of daily living and severity of dysphagia in bedridden older adults. MethodA functional and clinical assessment of swallowing was conducted on a purposive sample of 30 elderly bedridden Primary Health Care patients, with the intention of obtaining measurements of functional independence and severity of dysphagia. It was then determined if both variables were associated using a bivariate correlation analysis. ResultsOf the total participants, 6 (20%) had normal swallowing and 24 (80%) a diagnosis of oropharyngeal dysphagia. Among both groups, there were statistically significant differences (P<.05) between the groups in all domains of the assessment of the functionality and the total result. There was a positive and statistically significant correlation between the total result of the assessment of the functionality and degree of severity of oropharyngeal dysphagia. DiscussionThe results of this study showed that the level of dependence is associated with the severity of dysphagia, suggesting that as the functional compromise of bedridden patients increases the severity of the swallowing disorder is probably greater. Consequently, deterioration in functionality represents a major risk factor in the incidence and exacerbation of oropharyngeal dysphagia in the bedridden elderly.

Nutritional Aspects of Dysphagia Management.

This chapter describes the nutritional aspects of dysphagia management by starting with the definition of these two conditions (dysphagia and malnutrition) that share three main clinical characteristics: (a) their prevalence is very high, (b) they can lead to severe complications, and (c) they are frequently underrecognized and neglected conditions. From an anatomical standpoint, dysphagia can result from oropharyngeal and/or esophageal causes; from a pathophysiological perspective, dysphagia can be caused by organic or structural diseases (either benign or malignant) or diseases causing impaired physiology (mainly motility and/or perception disorders). This chapter gathers up-to-date information on the screening and diagnosis of oropharyngeal dysphagia, the consequences of dysphagia (aspiration pneumonia, malnutrition, and dehydration), and on the nutritional management of dysphagic patients. Concerning this last topic, this chapter reviews the rheological aspects of swallowing and dysphagia (including shear and elongational flows) and its influence on the characteristics of the enteral nutrition for dysphagia management (solid/semisolid foods and thickened liquids; ready-to-use oral nutritional supplements and thickening powders), with special focus on the real characteristics of the bolus after mixing with human saliva.

Avaliação clínica e objetiva da deglutição em crianças com paralisia cerebral

OBJETIVO: Investigar as principais manifestações disfágicas na avaliação clínica e objetiva da deglutição em crianças com paralisia cerebral. MÉTODOS: Estudo transversal com amostra de 50 crianças com paralisia cerebral. A coleta de dados consistiu na realização das avaliações clínica fonoaudiológica e videoendoscópica da deglutição para a detecção das principais manifestações disfágicas presentes nas fases preparatória oral, oral e faríngea da deglutição, em diferentes consistências alimentares e tipos de paralisia cerebral. RESULTADOS: Não houve influência significativa da idade e do tipo de paralisia cerebral sobre a maior presença de manifestações disfágicas. As principais manifestações disfágicas na avaliação clínica foram: escape anterior de líquidos (70%); tosse na deglutição de líquidos (60%); diminuição da formação do bolo alimentar sólido (57,9%); presença de resíduos alimentares na cavidade oral após a deglutição de sólidos (47,4%); aumento do trânsito oral de pastosos grossos (47,1%) e presença da voz molhada após a deglutição de líquidos (30%). As principais manifestações disfágicas na avaliação objetiva foram: aumento do trânsito faríngeo de pastosos grossos (79%); escape posterior de líquidos (77,5%); presença de resíduos alimentares nas estruturas faríngeas após a deglutição de pastosos grossos (58,8%); penetração laríngea de líquidos (37,5%) e aspiração traqueal de líquidos (20%). A sensibilidade laríngea esteve alterada em apenas 16% da amostra. CONCLUSÃO: As avaliações clínica e objetiva da deglutição são complementares e essenciais no diagnóstico das disfagias orofaríngeas em crianças com paralisia cerebral.