Fiberoptic Endoscopic Examination Research Articles

Profile of oropharyngeal swallowing in healthy Brazilian adults and older adults

ObjectivesTo describe the findings of Fiberoptic Endoscopic Examination of Swallowing (FEES) in asymptomatic young and older adults, comparing results across different age groups. Additionally, this study aims to test the Eating Assessment Tool (EAT-10) as an instrument to identify dysphagia risk. MethodsA prospective cross-sectional observational analysis was conducted on a sample of individuals aged 20 and above, asymptomatic for dysphagia, stratified by age groups. The EAT-10 questionnaire was completed, and the FEES was employed to assess oropharyngeal swallowing function. Various parameters, including salivary stasis, swallowing reflex trigger, swallowing sequence, residue, penetration, and aspiration were blindly analyzed by two otolaryngologists. ResultsA total of 184 participants were included, with a mean age of 44.7 ± 18.5 years. There was good to excellent agreement between examiners for FEES parameters. The EAT-10 score ≥3 suggested dysphagia risk in 7.6% (n = 14) of the sample, with no association with age or any FEES parameter. Individuals aged ≥80 years presented more residue (50%; n = 5/10) compared to younger individuals (11.5%; n = 20/174; p = 0.039). Salivary stasis was found exclusively in individuals aged ≥60 years (n = 5/39; 12.8%; p = 0.027). Age did not influence on the swallowing reflex trigger, swallowing sequence, penetration, and aspiration. Penetration was observed in 4.9% (n = 9) of subjects and aspiration occurred in 0.5% (n = 1) of subjects, with no statistical significance in age groups. ConclusionAge does not have a linear influence on swallowing in healthy adults and elderly people. However, individuals aged ≥80 years showed a higher prevalence of residue, and individuals aged ≥60 years showed a higher prevalence of salivary stasis, suggesting an increased risk or presence of dysphagia. Other FEES parameters were not influenced by age. These findings provide valuable insights into the nuanced dynamics of swallowing across different age groups, emphasizing the importance of age-specific considerations in dysphagia assessment. Level of evidence4.

A Tool for the Assessment of Swallowing Safety and Efficiency in Adults: Turkish Adaptation of Boston Residue and Clearance Scale.

The objective of this study was to create a Turkish language adaptation of the Boston Residue and Clearance Scale (BRACS), a validated and reliable tool. The BRACS scale was first translated into Turkish and a Turkish version was subsequently developed. Fiberoptic endoscopic examination of swallowing (FEES) was administered to collect data from 25 dysphagic patients who were hospitalized after a stroke. The recorded films were subjected to editing procedures to ensure their appropriateness for the assessment of swallowing disorders and were then dispatched to a panel of five speech and language therapists for evaluation using the adaptation of the BRACS instrument. The scoring by the experts was evaluated using both explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity, item reliability, and construct (composite) reliability were measured by calculating the average variance extracted (AVE) values. For the 12 location items, EFA revealed 3 main latent factors: the laryngeal vestibule and the oropharynx and hypopharynx. The Turkish BRACS had excellent inter-rater reliability (Krippendorff's alpha coefficient values ranged from 0.93 to 0.95) and high internal consistency (Cronbach's alpha values ranged from 0.88 to 0.93). Inter-rater ICCs for the first and second sessions were 0.83 and 0.85, respectively. CFA showed that all fitted criteria reached acceptable or perfect fit levels. The findings indicated that the proposed factor structure was validated. The AVE values are between 0.61 and 0.73 which was taken as evidence of convergent validity. The Turkish adaptation of the BRACS tool demonstrates both reliablity and validity, rendering it a useful and credible tool for assessing residual severity, particularly in clinical settings.

Objective and Subjective Dysphagia Assessment in Inflammatory Bowel Diseases

Introduction: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease that is separated into two types: ulcerative colitis (UC) and Crohn’s disease (CD). Although dysphagia is a well-studied and important topic in head and neck cancers and neurological disorders, research on the relationship between IBD and swallowing problems is not yet elucidated. The aim of this study was to compare swallowing function in the UC and CD using objective and patient-reported evaluation modalities. Methods: This was a prospective cross-sectional research with 86 patients (50 UC and 36 CD) treated at the gastroenterology department. The assessment includes flexible fiberoptic endoscopic examination (FEES). The penetration-aspiration scale, the functional oral intake scale (FOIS), the functional outcome swallowing scale (FOSS), the Eating Assessment Tool-10 (EAT-10) test, the Yale Pharyngeal Residue Severity Scale for vallecula (Yale PRSS-vallecula) and pyriform sinus (Yale PRSS-PS) were all used to determine extent of dysphagia. Results: The CD group had higher EAT-10 scores than UC group (p = 0.014). In terms of PAS scores, there was no significant difference between the two groups in all three food types (water, yogurt, and crackers) (p > 0.05). There was not a statistically significant variance between the groups in terms of vallecular residue (p > 0.05) according to the Yale PRSS-vallecula. Based on the Yale PRSS-PS, the CD group had significantly more residue than the UC group with yogurt and cracker (p = 0.014 and 0.030, respectively). FOSS and FOIS scores did not vary significantly between the two groups (p > 0.05). Conclusion: CD impairs subjective and pharyngeal swallowing functions more than UC. It is obvious that swallowing should be assessed in patients with IBD.

Preserving vocal cord function: Continuous intraoperative vagus nerve monitoring in total thyroidectomy

A 42-year-old female patient who underwent left hemithyroidectomy for a benign thyroid nodule, was referred for further management, as histology revealed a minimally invasive follicular carcinoma requiring completion thyroidectomy as recommended by Oncologists. She had developed unilateral vocal card palsy following the initial hemithyroidectomy. Pre operatively vocal cord function was evaluated by fibre optic laryngoscopy, which confirmed a left vocal cord palsy. During the completion thyroidectomy, continuous intraoperative nerve monitoring was done using an electrode attached to endotracheal tube. A delta electrode was attached to the Vagus nerve and continuous monitoring of the Vagus nerve was done while performing intermittent monitoring of the Recurrent Laryngeal nerve. Stimulation was performed using a current of 1–2 mA. According to the International Nerve monitoring Study Group (INMSG) guidelines initial amplitude value of at least 500 μV was considered as the normal value.According to INMSG guide lines, change of EMG signal curve amplitude below 100 μV was considered as loss of signal during the operation. Post-operative period of the patient was uneventful and the right vocal cord function was confirmed as normal by fibre optic endoscopic examination. Even though intraoperative nerve monitoring is a useful procedure for all the thyroidectomy surgeries it is documented to be more beneficial during revision surgeries, thyroid malignancies and pre-operative unilateral nerve palsy patients.

Analysis of swallowing and voice-related quality of life in patients after supracricoid partial laryngectomy

ObjectiveThis study evaluated the swallowing and voice function of laryngeal cancer patients after Supracricoid Partial Laryngectomy(SCPL), and its influence on quality of life to provide a reference for the selection of surgical methods for laryngeal cancer patients.MethodsTwenty-one patients who received SCPL between April 2015 and November 2021 were included. Each patient’s swallowing function and quality of life were assessed through fiberoptic endoscopic examination of swallowing (FEES) and the M.D. Anderson Dysphagia Inventory (MDADI). Fundamental, jitter, shimmer, maximum phonation time (MPT), and voice handicap index-10 (VHI-10) were performed to assess voice function and voice-related quality of life.ResultsThe results of the FEES of the 21 patients were as follows: the rates of pharyngeal residue after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 38.09%, respectively; the rates of laryngeal infiltration after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 4.76%, respectively; and aspiration did not occur in any of the patients. In the evaluation of swallowing quality of life, the mean total MDADI score was 92.6 ± 6.32. The voice function evaluation showed that the mean F0, jitter, shimmer, and MPT values were 156.01 ± 120.87 (HZ), 11.57 ± 6.21 (%), 35.37 ± 14.16 (%) and 7.85 ± 6.08 (s), respectively. The mean total VHI-10 score was 7.14 ± 4.84.ConclusionSCPL provides patients with satisfactory swallowing and voice function. The patients in this study were satisfied with their quality of life in terms of swallowing and voice. SCPL can be used as a surgical method to preserve laryngeal function in patients with laryngeal cancer.

Assessment of diabetes as a risk factor for neurogenic dysphagia confirmed by FEES examination in post-CVA patients

IntroductionDiabetes mellitus (DM) is an independent factor for the occurrence of neurogenic dysphagia following an acute cerebrovascular accident in the form of a stroke. This study assesses the role of DM as a risk factor for post-stroke dysphagia (PSD), confirmed by the fiberoptic endoscopic examination of swallowing (FEES) with particular emphasis on silent aspiration (SA) as a high risk factor of aspiration pneumonia (AP).AimThe aim of the study is to assess the role of DM as a risk factor for PSD.Material and methodsStatistical analysis was performed on the cohort of 81 post-cerebrovascular-accident patients hospitalized in the neurological rehabilitation department. DM was diagnosed in more than one third of the cohort (35.8%). After the FEES examination, which was assessed in the penetration–aspiration scale (PAS), an analysis of DM incidence was performed in patients with diagnosed pharyngeal dysphagia of moderate degree (PAS 3–6) and severe degree (PAS 7–8).Results and discussionThe incidence of DM in patients with moderate dysphagia was lower than in the cohort. The incidence of DM in patients with severe dysphagia (aspiration) was comparable to the percentage in the cohort. Although diabetes was twice as frequent among patients with aspiration than among those with mild dysphagia (24% vs. 12%), the odds ratio (OR) of the diabetes incidence in these groups was not statistically significant.ConclusionsAlthough DM is an independent factor for PSD occurrence after cerebrovascular accident in the form of a stroke and a potential factor for lower cranial nerve neuropathy, no correlation between DM and PSD was found.

Lung ultrasound supports clinical evaluation of feeding competence development in preterm neonates.

The achievement of alimentary competencies is a milestone in the development of preterm neonates. Ten percent of neonates <37 weeks of gestational age and 25% of those VLBW experience swallowing disorders, with an increased risk of problems in the early phase of life (failure to thrive, growth retardation, inhalation, and consequent risk of pulmonary infection) and later in life due to delayed development of oromotor skills.The main diagnostic tools for swallowing disorders are endoscopic (fiber-optic endoscopic examination of swallowing, FEES) or radiographic (videofluoroscopic swallowing study, VFSS) exams. Given the invasiveness of these methods and the bias due to rheologic differences between bolus and contrast medium, FEES and VFSS are poorly reproducible. Moreover, neither of the technique is capable of detecting post-meal inhalations, especially microinhalations or those consequent to a whole meal rather than to a single swallowing.Lung ultrasound (LUS) is a widespread, repeatable, safe, fast point-of-care tool and we reported previous encouraging results in detecting silent and overt inhalation related to the meal in children with dysphagia/gastroesophageal reflux disease (GERD) risk factors. We report a pilot study, that investigated LUS approach (performing imaging before and after meals) to assess feeding competence development in a cohort of n. 19 newborns <32 weeks of age. Meal monitoring by LUS did not show any significant difference in scoring before/after eating. The achievement of full enteral feeding correlates with GA at birth (p < 0.001) but not with LUS scoring. The introduction of the first meal by bottle correlates both with gestational age (p < 0.001) and ultrasound scores (p = 0.004). LUS score at 7 days of life resulted predictive for length of invasive/non-invasive respiratory support (p = 0.002) and length of oxygen supply (p = 0.001), while LUS score at 48 h of life did not (p n.s.). Our study suggests that the development of oral feeding skills is not strictly dependent on gestational age. Moreover, our research suggests the predominant role of LUS in predicting the time of readiness to oral feeding, as the LUS score can be a marker of respiratory and lung wellness, and consequently a predictor of neonate stability during deglutitory apnea.

Dysphagia handicap index and fibre-optic endoscopic examination of swallowing in assessment of dysphagia

Oropharyngeal dysphagia is a swallowing disorder characterized by difficulty in transferring foods and/or liquids from the oral cavity to the stomach, affecting safe oral feeding. The main complications caused by dysphagia are tracheobronchial aspiration, pneumonia, malnutrition, and dehydration. Fibre-optic endoscopic evaluation of swallowing (FEES) is the first choice for studying swallowing disorders, it is easy to use, very well tolerated, allows bedside examination, and is economic. The dysphagia handicap index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool measuring the handicapping effect of dysphagia in three aspects: the physical, functional, and emotional aspects of life, so a patient can rate the impact of his swallowing problem. The aim of this study is to test the correlation between DHI scores and fibre-optic endoscopic examination of swallowing and the ability of DHI to predict penetration and aspiration. For all patients, FEES examination was done as an assessment tool for dysphagia and DHI. Testing the correlation between DHI scores and penetration and aspiration on FEES results in a positive significant correlation, so we can apply DHI as a predictor of aspiration and penetration at medical centres where FEES examination is not accessible.

An intensive neurorehabilitation programme with sEMG biofeedback to improve swallowing in idiopathic Parkinson's disease (IPD): A feasibility study.

Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non-instrumental assessment, including quality-of-life measures carried out at four different time points (two pre-treatment and two post-treatment). The final assessment was at 3 months post-intervention. Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70-5.50) and in pharyngeal residue from saliva (95% CI = 2.14-3.15) and solids (95% CI = 2.4-3.5) post-intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial. What is already known on the subject Biofeedback has positive effects on increasing swallowing function and quality of life in people with IPD and dysphagia. sEMG is the most common method used to deliver swallowing biofeedback in this population. The quality of the evidence on the intervention, based on findings from a recent systematic review, is low. Included studies in this review were heterogeneous in terms of type and frequency of biofeedback, study design and outcome measures. The majority of outcome measures were subjective and higher quality studies to examine the efficacy of biofeedback using sEMG are needed. What this study adds Recognizing the limitations of earlier studies, this within-subject feasibility study examined the efficacy and effectiveness of an intensive biofeedback intervention using sEMG in a sample of people with dysphagia and IPD. Valid and reliable outcome measures were used and repeated after a 3-month period. The feasibility of the methodological approach was also tested and a qualitative component was included in the study. Positive findings were evident. Qualitative information added new perspectives and provided direction for new outcomes to be included in future studies. This study helps to inform further research trials as well as clinical practice. Clinical implications of this study This intensive intervention using principles of neuroplasticity and motor programming with sEMG biofeedback led not only to positive swallowing outcomes but also to unexpected benefits such as improved voice production and general attention skills. No adverse events were reported. Improvement in function was retained at 3 months post-intervention. Despite the small sample size, participants described the benefits of the treatment, and enjoyed sEMG biofeedback tasks, especially using an sEMG game mode. This suggests that intensive biofeedback not only improved swallowing but also was acceptable to these participants. This intensive protocol has merit and is worth considering further in clinical practice.

The Complete Lateral Position Method Reduced the Mortality Rate among Elderly Patients with Severe Dysphagia.

Objective This study aimed to validate the efficacy of the complete lateral position method among elderly patients with severe dysphagia. Methods We enrolled 103 patients >65 years old who were diagnosed with severe dysphagia via the fiberoptic endoscopic examination of swallowing and were treated with the complete lateral position method at Hida Municipal Hospital between February 1, 2015, and October 31, 2020. Patients treated with the complete lateral position method were included in the lateral position group, and patients treated with conventional methods were included in the control group. The mortality rates were then compared between the lateral position and control groups. Results All patients had severe dysphagia. However, the complete lateral position method significantly decreased the mortality rate in the lateral position group compared with the control group (64.7% vs. 38.8%; p<0.01). In the lateral position group, approximately 55.6% of patients who were discharged from the hospital were able to safely take food orally again in the sitting position. Furthermore, the complete lateral position method significantly shortened the fasting period and improved the prognosis in patients whose condition had progressed due to senility in the lateral position group compared with the control group (17.3 vs. 8.8 days, p<0.05; 28.4 vs. 67.5 days, p<0.05) Conclusion The complete lateral position method facilitated safe oral ingestion among elderly patients with severe dysphagia. Furthermore, safe oral ingestion decreased the mortality rate and shortened the fasting period at the end of life. The method is easy to implement and does not require the use of special devices or techniques. It can therefore be a useful approach in the care of elderly patients with severe dysphagia.

Cross-Cultural Adaptation and Validation of the European Portuguese Dysphagia Handicap Index.

The Dysphagia Handicap Index (DHI) is a valid Health-related Quality of Life (HRQoL) 25-item questionnaire assessing the physical, functional, and emotional aspects of patients with oropharyngeal dysphagia (OD), of heterogeneous etiologies. The purpose of this study is to translate and validate the European Portuguese-DHI (EP-DHI). This is a prospective study that was carried out at Centro Hospitalar Universitário do Porto (CHUPorto). The generated EP-DHI was administered to 132 patients with OD and 112 healthy control subjects. 132 patients undergoing fiberoptic endoscopic examination of swallowing (FEES). 15 patients were contacted by phone, 2 or 3weeks later after the first interview to repeat the questionnaire. The validity of concurrent criteria was evaluated by comparing the results of the EP-DHI score with the score attributed to the pathological findings found in FEES and, consequently, Functional Oral Intake Scale (FOIS). The internal consistency of EP-DHI was successful: Cronbach's alpha coefficient for total EP-DHI was 0.874. The test-retest reliability for the total and the three EP-DHI subscales obtained a Pearson's correlation coefficient ranged from 0.990 to 0.712. This study demonstrates that EP-DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on physical, functional, and emotional aspects of patient's quality of life, among an European Portuguese sample.

Comparison of fiberoptic endoscopic examination of swallowing findings between neurogenic and non-neurogenic dysphagia patients

ABSTRACTBackground: Dysphagia is the difficulty or discomfort on swallowing which can affects a person’s quality of life. Based on pathophysiology, dysphagia can be classified as neurogenic and non-neurogenic. One method of diagnosis is to use a flexible endoscope called the Fiberoptic Endoscopic Examination of Swallowing (FEES). The basic findings obtained from the FEES examination were standing secretion, silent aspiration, hypopharyngeal sensitivity, leakage, residue, penetration and aspiration. Objective: To compare the findings of the FEES examination between patients with neurogenic and non-neurogenic dysphagia. Method: Observational research using cross sectional design. Data collection was carried out using medical record data on 94 subjects with dysphagia who underwent FEES examination at Dr. Mohammad Hoesin Hospital Palembang from January 2019 to January 2021. Result: The most common FEES finding in neurogenic dysphagia were filtered purée residue, milk residue, and biscuit residue. In the non-neurogenic dysphagia group, the most common FEES finding was filtered purée residue. There were significant differences in FEES findings between neurogenic dysphagia and non-neurogenic dysphagia in filtered purée residue (p=0.014), rice purée residue (p=0.017), flour purée residue (p=0.007), and biscuit puree penetration (p=0.017). Conclusion: There were significant differences in FEES findings between neurogenic dysphagia and non-neurogenic dysphagia concerning residue of filtered purée, residue of rice purée, residue of flour purée, and biscuit penetration. From regression analysis, the dominant factors found in neurogenic dysphagia were filtered purée penetration, flour purée residue, biscuit penetration, and found in non-neurogenic dysphagia were flour purée penetration and biscuit puree leakage.ABSTRAKLatar belakang: Disfagia adalah kesulitan atau gangguan proses menelan, yang dapat memengaruhi kualitas hidup seseorang. Berdasarkan patofisiologinya, disfagia dapat diklasifikasikan menjadi neurogenik dan non-neurogenik. Salah satu metode diagnosis adalah dengan menggunakan Fiberoptic Endoscopic Examination of Swallowing (FEES). Temuan dasar yang diperoleh dari pemeriksaan FEES adalah standing secretion, silent aspiration, sensitivitas hipofaring, leakage, residu, penetrasi dan aspirasi. Tujuan: Membandingkan hasil pemeriksaan FEES antara pasien disfagia neurogenik dan non-neurogenik. Metode: Penelitian observasional dengan desain potong lintang. Pengumpulan data dilakukan dengan menggunakan data rekam medis pada 94 subjek disfagia yang menjalani pemeriksaan FEES di Rumah Sakit Dr. Mohammad Hoesin Palembang dari Januari 2019 hingga Januari 2021. Hasil: Temuan FEES yang paling umum pada disfagia neurogenik adalah residu bubur saring, residu susu, dan residu biskuit. Pada kelompok disfagia non-neurogenik, temuan FEES yang paling umum adalah residu bubur saring. Terdapat perbedaan yang signifikan dalam temuan FEES antara disfagia neurogenik dan disfagia non-neurogenik pada residu bubur saring (p=0,014), residu bubur nasi (p=0,017), residu bubur tepung (p=0,007), dan penetrasi bubur biskuit (p=0,017). Kesimpulan: Terdapat perbedaan yang signifikan dalam temuan FEES antara disfagia neurogenik dan disfagia non-neurogenik pada residu bubur saring, residu bubur beras, residu bubur tepung, serta penetrasi bubur biskuit. Dari analisis regresi ditemukan faktor dominan di disfagia neurogenik adalah penetrasi bubur saring, residu bubur tepung, penetrasi bubur biskuit, dan di disfagia non-neurogenik adalah penetrasi bubur tepung dan kebocoran bubur biskuit.

LUNCH—Lung Ultrasound for early detection of silent and apparent aspiratioN in infants and young CHildren with cerebral palsy and other developmental disabilities: study protocol of a randomized controlled trial

BackgroundChildren with neurological impairment may have dysphagia and/or gastro-esophageal reflux disease (GERD), which predispose to complications affecting the airways, increasing risk for aspiration-induced acute and chronic lung disease, or secondarily malnutrition, further neurodevelopmental disturbances, stressful interactions with their caregivers and chronic pain. Only multidisciplinary clinical feeding evaluation and empirical trials are applied to provide support to the management of feeding difficulties related to dysphagia or GERD, but no standardized feeding or behavioral measure exists at any age to assess aspiration risk and support the indication to perform a videofluoroscopic swallowing study (VFSS) or a fibre-optic endoscopic examination of swallowing (FEES), in particular in newborns and infants with neurological impairments. Lung ultrasound (LUS) has been proposed as a non-invasive, radiation-free tool for the diagnosis of pulmonary conditions in infants, with high sensitivity and specificity.MethodsA RCT will be conducted in infants aged between 0 and 6 years having, or being at risk for, cerebral palsy, or other neurodevelopmental disease that determines abnormal muscular tone or motor developmental delay assessed by a quantitative scale for infants or if there is the suspicion of GERD or dysphagia based on clinical symptoms. Infants will be allocated in one of 2 groups: 1) LUS-monitored management (LUS-m); 2) Standard care management (SC-m) and after baseline assessment (T0), both groups will undergo an experimental 6-months follow-up. In the first 3 months, infants will be evaluated a minimum of 1 time per month, in-hospital, for a total of 3 LUS-monitored meal evaluations. Primary and secondary endpoint measures will be collected at 3 and 6 months.DiscussionThis paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the benefits of the use of LUS for monitoring silent and apparent aspiration in the management of dysphagia and its impact on pulmonary illness and growth and (2) to investigate the impact of the LUS management on blood sample and bone metabolism, pain and interaction with caregivers.Trial registrationTrial registration date 02/05/2020; ClinicalTrials.gov Identifier: NCT04253951.

Evaluation of Oropharyngeal Dysphagia in Elderly Patients with Pharyngeal Aberrant Internal Carotid Artery Using the Eating Assessment Tool-10 (EAT-10).

Pharyngeal aberrant internal carotid artery (PAICA) has been reported to be a cause of oropharyngeal dysphagia (OD) in case reports. However, as there have been no clinical studies, the relationship between PAICA and OD is not clear. The aim of this study was to investigate the perception of OD in elderly PAICA patients using the Eating Assessment Tool-10 (EAT-10). A study group (Group 1) was formed of patients diagnosed with PAICA from the visualization of a pulsatile mass in the pharynx in flexible fiberoptic endoscopic examination and carotid magnetic resonance angiography tests, and a control group (Group 2) was formed of age-matched healthy volunteers. The study group was subdivided as patients with unilateral PAICA (Group 1a) and patients with bilateral PAICA (Group 1b). The Turkish version of the EAT-10 was applied to all the participants. Total EAT-10 points of ≥ 3 were accepted as abnormal. Normal (< 3) and abnormal (≥ 3) total EAT-10 points were determined in 88.9% (24/27) and 11.1% (3/27), respectively, of the control group, in 55.2% (16/29) and 44.8% (13/29) of Group 1, in 70.6% (12/17) and 29.4% (5/17) of Group 1a, and in 33.3% (4/12) and 66.7% (8/12) of Group 1b. A statistically significant difference was determined between the control group and Group 1 and Group 1b in respect of abnormal (≥ 3) EAT-10 total points (p = 0.007, p = 0.001, respectively). No statistically significant difference was determined between the control group and Group 1a (p = 0.227). Problems (EAT point ≥ 1) in item 4 (swallowing solids takes extra effort) were experienced by 13 (44.8%) patients in Group 1, 9 (75%) patients in Group 1b, and 5 (18.5%) subjects in the control group (p < 0.05). These results demonstrated that unilateral PAICA does not significantly affect swallowing, whereas bilateral PAICA created a significant negative effect. These patients experience more problems when swallowing solid food.

Long-term swallowing outcomes of radiotherapy and transoral laser microsurgery for T1 glottic cancer treatment.

Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post-treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma. Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool-10 test (EAT-10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed. CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20mL water according to the Penetration and Aspiration Scale (P<.05). The mean EAT-10 Score was found 0 in the CO2 TOLMS group, and 3.20±3.24 in the RT group (P<.05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P>.05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5mL and 10mL water, 5mL and 20mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P<.05). It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.

Fiberoptic Endoscopic Examination of Swallowing (FEES) Evaluation in Post Stroke Patients

Introduction. Complications caused by post-stroke dysphagia increase the morbidity and mortality of patients. Although it has a significant effect on the functional abilities and worsening of the patient's prognosis, post-stroke dysphagia is still under-noticed and often undiagnosed. The importance of knowing the incidence of post-stroke dysphagia, not only to determine its relationship to the pathology of the disease but also to determine treatment plans or follow-up interventions. This study aims to determine the incidence of FEES findings in post-stroke dysphagia both hemorrhagic and non-hemorrhagic stroke.&#x0D; Methods. Forty post-stroke patients in the Inpatient and Outpatient Installation of the THTKL Section and the Neurology Section of Dr. Hospital. Mohammad Hoesin Palembang conducted a FEES examination to see leakage, residue, penetration, and aspiration after being given six different types of food boluses ranging from filter porridge, rice porridge, oatmeal, water, milk, and biscuits. The results of the assessment are recorded and analyzed descriptively.&#x0D; Results. From 40 research subjects found 25 people experiencing dysphagia, where subjects with non-hemorrhagic stroke types were 21 people (52.5%), while hemorrhagic stroke types were four people (10%). The occurrence of leakage of filter porridge was 5 findings, leakage of rice porridge was eight findings, oatmeal leakage, water, and milk were seven findings each, and biscuit leakage was two findings. The incidence of filtered pulp residues was 12 findings, rice porridge residues were 14 findings, oatmeal residues were 15 findings, water and milk residues were five findings each, and biscuit residues were eight findings. The incidence of penetration of filter porridge, rice porridge, and biscuits was one finding each, oatmeal penetration was not found, while water and milk penetration were six events each. The aspirations of filter porridge, rice porridge, oatmeal, and biscuits were not found, while water and milk aspirations were seven findings.&#x0D; Conclusion. The incidence of dysphagia in post-stroke patients both hemorrhagic and non-hemorrhagic in the Inpatient and Outpatient Installation of the THTKL Section and the Neurology Section of the Mohammad Hoesin Hospital Palembang Palembang is quite high at 62.5%. The occurrence of food residues is the most FEES findings. While aspirations are the fewest findings.

A prospective study for evaluation of structural and clinical validity of the Eating Assessment Tool

BackgroundThe Eating Assessment Tool is a self-rating questionnaire developed to assess symptom severity and treatment efficacy in swallowing disorders. The aim of this study was to investigate the structural validity of the Eating Assessment Tool and whether individual item scores differed between dysphagia secondary to neurological and structural/esophageal disorders, respectively.MethodsThis is a prospective cross-sectional questionnaire study. In total, 200 community-dwelling adults with suspected dysphagia referred for fiberoptic endoscopic examination of swallowing at Karolinska University Hospital, Stockholm, Sweden, completed the S-EAT-10. Patients’ medical charts were reviewed in order to establish the type of dysphagia. Principal axis factoring was conducted to examine structural validity, and Mann-Whitney U tests were used to study differences in the S-EAT-10 score patterns between different types of dysphagia.ResultsOne single factor explained 54% of the total variance in EAT-10 item scores. All ten items loaded substantially or strongly on this factor, supporting the single-factor solution (Cronbach’s alpha = 0.90). Structural/esophageal dysphagia was associated with higher scores on six items and with a higher total EAT-10 score.ConclusionsThe EAT-10 yields a unidimensional index of symptom severity in patients with dysphagia. Individual item scores reflect typical symptoms in neurogenic and structural/esophageal dysphagia, supporting its clinical relevance.

The Dysphagia in Multiple Sclerosis Questionnaire Correlates with Fiber-Optic Endoscopic Examination for Detecting Swallowing Deficits in MS.

Multiple sclerosis (MS) refers to chronic inflammation of the central nervous system including the brain and spinal cord. Assessing for the presence of dysphagia in subjects with MS represents a challenge for neurologists in clinical practice. The aim of the present study was to verify the relationship between DYMUS scores, a patient-reported scale, and objective symptoms using the Dysphagia Outcome Severity Score (DOSS), based on fiber-optic endoscopy. Data were collected in a multicenter study. Two hundred and fifteen MS patients were enrolled, irrespective of self-reported dysphagia. DOSS revealed dysphagia in 122 subjects (56.7%). Compared with non-dysphagic subjects, the presence of dysphagia was related to more severe disability, longer disease duration, and a progressive form of the disease. A DYMUS score of 0 strongly correlated with a DOSS of 6 (sensitivity 100%) while DYMUS score of > 2 correlated with a DOSS < 7 (specificity 82%) of the self-reported scale. The DYMUS questionnaire can be a useful clinical tool for red-flagging patients who should undergo objective testing and referral to a otorhinolaryngologist.

Extubation Readiness in Critically Ill Stroke Patients.

Background and Purpose- Predicting safe extubation represents a clinical challenge in acute stroke patients. Classical respiratory weaning criteria have not proven reliable. Concerning the paramount relevance of postextubation dysphagia in this population, criteria related to airway safety seem to perform better, but diagnostic standards are lacking. We compare clinical and instrumental swallowing examination tools to assess extubation readiness and propose a simple Determine Extubation Failure in Severe Stroke score for decision making. Methods- Data of 133 orally intubated acute stroke patients were prospectively collected in this observational study. Classical extubation criteria, a modified semiquantitative airway score, and an oral motor function score were assessed before extubation. A 3-ounce water swallow test and validated 6-point fiberoptic endoscopic dysphagia severity scoring were performed thereafter. Association of demographic and clinical parameters with extubation failure (EF) was investigated. Independent predictors of EF were translated into a point scoring system. Ideal cutoff values were determined by receiver operator characteristics analyses. Results- Patients with EF (24.1% after 24±43 hours) performed worse in all swallowing assessments (P<0.001). Fiberoptic endoscopic dysphagia severity scoring was the only independent predictor of EF (adjusted odds ratio, 4.2; P<0.007) with optimal cutoff ≥5 (sensitivity 84.6% and specificity 76.5%). Restricting regression analysis to parameters collected before extubation, a 4-item Determine Extubation Failure in Severe Stroke score (duration of ventilation, the examination of oral motor function, infratentorial lesion, and stroke severity) was derived. The score demonstrated excellent discrimination (area under the curve 0.89; 95% CI, 0.83-0.95) and calibration (Nagelkerkes R2=0.54) with an ideal cutoff ≥4 (sensitivity: 81.3% and specificity: 78.2%). Conclusions- Risk of EF is strongly correlated with postextubation dysphagia severity in stroke. Fiberoptic endoscopic examination of swallowing best predicts necessity of reintubation but requires a trial of extubation. The Determine Extubation Failure In Severe Stroke score is based on easy to collect clinical data and may guide extubation decision making in critically ill stroke patients.

Pharyngeal Manometry in Pediatric Dysphagia Assessment

PurposeReliable 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.ConclusionAcknowledging 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.