Fiberoptic Evaluation Of Swallowing Research Articles

Research report: Management of dysphagia using pharyngeal electrical stimulation in the general intensive care population – A service development

Background: Dysphagia places a substantial burden on the critically ill, affecting 12%–84% of this cohort, and is independently associated with worse outcomes. Pharyngeal electrical stimulation (PES-treatment) is a novel dysphagia therapy with an emerging evidence base. This retrospective observational study describes our dysphagia service and reports the use of PES-treatment as a standard of care in recovering critically ill patients at a single-site tertiary UK hospital. Methods: Patients admitted to Acute or Cardio-Thoracic adult intensive care units between 1st July 2017 and 30th June 2022 were routinely referred to Speech and Language Therapy (SLT) following tracheostomy, or suspected dysphonia/dysphagia. Clinical assessments and direct laryngeal visualisation using Fibreoptic Evaluation of Swallowing (FEES) were performed. Severe dysphagia was defined as Penetration-Aspiration Score of ⩾6 and patients were offered PES-treatment when staffing allowed. Results: Of 289 patients with severe dysphagia, 19 underwent a course of PES-treatment with the remaining patients receiving standard care. PES-treatment patients were significantly less likely to remain nil-by-mouth (11.1% vs 62.5%, Chi2 p < 0.001) or to have an enteral feeding tube in situ at discharge from critical care (27.8% vs 62.5%, p = 0.006) than those receiving standard dysphagia care. Both groups demonstrated an improvement in Penetration-Aspiration Score at repeat FEES: PES-treatment mean difference −2.0 ( p = 0.003); non-PES-treatment −1.68 ( p < 0.001); (61% PES-treatment improved vs 40% non-PES-treatment, p = 0.09). Conclusion: Our observations suggest that PES may be effective in the general critical care population. PES may offer new treatment options for patients and healthcare staff managing severe dysphagia and its significant consequences.

Dysphagia in people with dementia

AbstractBackgroundDysphagia is a common complication in multiple neurodegenerative disorders, influencing quality of life and long term prognosis. In dementia, data regarding prevalence of dysphagia and secondary complications such as aspiration pneumonia is not well understood.Aim of the study: to assess the prevalence of dysphagia and aspiration pneumonia in patients with dementia.MethodCross‐sectional study that included patients previously diagnosed with dementia, evaluated in the outpatient clinic or admitted in the Department of Neurology, County Clinic Hospital Brasov. We evaluated the patients using a standardized protocol that included the MMSE, MoCA scale, Gugging Swallowing Screen, fiberoptic evaluation of swallowing and FEDSS scale.Resultthere were 42 patients with dementia included in the study (57,14% females) with a mean age of 69.7 ±9,1 years. The mean MMSE score was 16.8 ± 4.4. Dysphagia was present in 9 patients (21.42%). Pneumonia was encountered in 33.3% of the dysphagic patients, and it was associated with high mortality. The major secondary risk factors for pneumonia were older age, obesity, smoking and diabetes. Patients with a lower score on the MMSE/MoCA scale had a higher risk of developing dysphagia and aspiration pneumonia. Mortality in the dysphagic group was higher when compared with the non‐dysphagic group (44.2% vs. 21.2%).ConclusionDysphagia has an important impact on the clinical outcome of the patients with dementia, increasing the risk of institutionalization and mortality and being associated with dependency and poor quality of life.

Transformer Models and Convolutional Networks with Different Activation Functions for Swallow Classification Using Depth Video Data

Dysphagia is a common geriatric syndrome that might induce serious complications and death. Standard diagnostics using the Videofluoroscopic Swallowing Study (VFSS) or Fiberoptic Evaluation of Swallowing (FEES) are expensive and expose patients to risks, while bedside screening is subjective and might lack reliability. An affordable and accessible instrumented screening is necessary. This study aimed to evaluate the classification performance of Transformer models and convolutional networks in identifying swallowing and non-swallowing tasks through depth video data. Different activation functions (ReLU, LeakyReLU, GELU, ELU, SiLU, and GLU) were then evaluated on the best-performing model. Sixty-five healthy participants (n = 65) were invited to perform swallowing (eating a cracker and drinking water) and non-swallowing tasks (a deep breath and pronouncing vowels: “/eɪ/”, “/iː/”, “/aɪ/”, “/oʊ/”, “/u:/”). Swallowing and non-swallowing were classified by Transformer models (TimeSFormer, Video Vision Transformer (ViViT)), and convolutional neural networks (SlowFast, X3D, and R(2+1)D), respectively. In general, convolutional neural networks outperformed the Transformer models. X3D was the best model with good-to-excellent performance (F1-score: 0.920; adjusted F1-score: 0.885) in classifying swallowing and non-swallowing conditions. Moreover, X3D with its default activation function (ReLU) produced the best results, although LeakyReLU performed better in deep breathing and pronouncing “/aɪ/” tasks. Future studies shall consider collecting more data for pretraining and developing a hyperparameter tuning strategy for activation functions and the high dimensionality video data for Transformer models.

Pharyngeal transit time in different consistency of food using Fiberoptic Evaluation of Swallowing

ABSTRACTBackground: In Indonesia, no research has been carried out or reported on pharyngeal transit time and a view of the swallowing process in a sample without complaints of dysphagia using the Flexible Endoscopic Evaluation of Swallowing (FEES) method and using five food consistencies. Purpose: To obtain the value of pharyngeal transit time and a view of the swallowing process in subjects without dysphagia problems. Method: Twenty-eight subjects without dysphagia (based on Ohkuma’s Dysphagia Screening) underwent FEES to determine pharyngeal transit time and dysphagia profile based on leakage, standing secretion, residue, penetration, and aspiration. Result: The median value of pharyngeal transit time on puree consistency was 0.799(0.499-5.666), gastric rice 0.966(0.433-5.733), oatmeal 0.849(0.533- 4.399), thick liquid 0.982(0.399-4.633), thin liquid 0.566(0.366-1.366). The pharyngeal delay time on the puree consistency was 0.566(0.199-5.333), gastric rice 0.799(0.233-2.799), oatmeal 0.899(0.099-3.633), thick liquid 0.833(0.033-3.733), and thin liquid mean was 0.294 (± 0.232). The pharyngeal response time on the puree consistency was 0.566(0.167-1.300), gastric rice 0.583(0.300-2.934), oatmeal 0.583(0.367- 1.233), thick liquid 0.549(0.333-1.533), thin liquid 0.549(0.366-1.399). There was no standing secretion, pre-swallowing leakage, penetration, and aspiration found in FEES. A grade 1 residue was found in 3(10.7%) subjects of puree, in 2(7.2%) subjects of gastric rice, in 3(10.7%) subjects of oatmeal, and in 9(32.2%) subjects of thick liquid. Conclusion: There was no prolonged pharyngeal transit time, pre-swallowing leakage, standing secretion, penetration, and aspiration in all subjects without dysphagia complaints at all food consistencies. There was minimal residue within normal limits in some subjects. ABSTRAKLatar belakang: Di Indonesia, belum pernah dilaporkan penelitian mengenai waktu transit faring dan gambaran proses menelan pada sampel tanpa keluhan disfagia dengan menggunakan metode Flexible Endoscopic Evaluation of Swallowing (FEES) dan menggunakan lima konsistensi makanan. Tujuan: Penelitian ini bertujuan untuk memperoleh nilai waktu transit faring dan gambaran proses menelan pada subjek tanpa masalah disfagia. Metode: Dua puluh delapan subjek tanpa disfagia (berdasarkan Skrining Disfagia Ohkuma) menjalani FEES untuk menentukan waktu transit faring dan profil disfagia berdasarkan leakage, standing secretion, residue, penetration, dan aspiration. Hasil: Nilai median waktu transit faring pada konsistensi puree adalah 0,799(0,499-5,633), gastric rice 0,966(0,433-5,733), oatmeal 0,849(0,533-4,399), thick liquid 0.982(0.399-4.633), thin liquid 0.566(0.366- 1.366). Waktu tunda faring pada konsistensi puree adalah 0,566 (0,199-5.333), gastric rice 0,799 (0,233-2,799), oatmeal 0,899 (0,099-3,633), thick liquid 0,833 (0,033-3,733), dan rerata thin liquid 0,294 (± 0,232). Waktu respon faring terhadap konsistensi puree adalah 0,566 (0,167-1,300), gastric rice 0,583 (0,300-2,934), oatmeal 0,583 (0,367-1,233), thick liquid 0,549 (0,333-1,533), thin liquid 0,549 (0,366-1,399). Tidak didapati adanya leakage, standing secretion, penetration, dan aspiration pada pemeriksaan FEES. Residu grade 1 ditemukan pada 3 (10,7%) subjek puree, pada 2 (7,2%) subjek gastric rice, pada 3 (10,7%) subjek oatmeal, dan pada 9 (32,2%) subjek thick liquid. Kesimpulan: Tidak terdapat perpanjangan waktu transit faring, leakage, standing secretion, penetration, dan aspiration pada semua subjek tanpa keluhan disfagia dengan semua konsistensi makanan. Terdapat residu minimal dalam batas normal pada beberapa subjek.

Aspiration in Children and Adolescents with Neurogenic Dysphagia: A Comparison of Clinical Assessment with Fiberoptic Evaluation of Swallowing

Introduction: For the therapy of dysphagia, it is of utmost importance to determine swallowing quality so that one may plan therapy and recommend adequate foods. Circumstances in a hospital do not always allow for early on swallowing endoscopy because of lacking resources (staff and material) or compliance. Then, therapy will have to be based on hypotheses. In this study, we asked whether clinical assessment regarding the quality of swallowing is confirmed by fiberoptic evaluation of swallowing (FEES).

Dysphagie-Management im Akut- und Langzeitverlauf bei kritisch kranken intensivpflichtigen Patienten

Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors.

Letter by Daniels Regarding Article "Silent Aspiration Risk is Volume-Dependent"

Leder and Suiter [1] have proposed the 3-oz. water swallowchallenge as a screening tool for dysphagia in all patientpopulations. Their study was of a retrospective referral-based cohort, i.e., consecutive admissions were not tested.Studies on referral-based patients have the potential forbias. In addition, blinding was not part of this study as thesame investigator interpreted both the fiber-optic evalua-tion of swallowing (FEES) and the 3-oz water swallowchallenge. In their article it was stated that FEES wasperformed prior to the administration of the 3-oz. waterswallow challenge. In a most recent article [2], the sameauthors again studied a large cohort of referred patients,primarily the same patients in the previous study. As in theearlier study, FEES was conducted prior to the 3-oz. waterswallow challenge with the same examiner completingboth. This time, however, the authors reported that over400 patients were excluded from the 3-oz water swallowchallenge due to safety issues, e.g., aspiration of largeamounts of various consistencies on FEES. This detail callsinto question the authors entire body of work and raisesstrong safety concerns about the validity of the 3-oz. waterswallow challenge. When screening a patient, the potentialfor dysphagia and aspiration is unknown; this is the entirereason to screen. Given the information about the exclusionof patients from the 3-oz. water swallow challenge, howare clinicians to decide who is and is not a safety risk priorto actual screening? This methodological informationregarding patient exclusion begs the question: Werepatients excluded in initial study but not reported? Theauthors have not reported any negative consequences ofadministering the 3-oz. water swallow challenge. Theremay have been a lack of negative consequences due to thepreferential selection of patients who underwent thescreening. In order to clarify these issues, the authorsshould undertake a well-designed prospective study inwhich all patients, or a particular subpopulation of patients,are studied, not just referrals. Blinding must be in place;otherwise, the potential for bias will always exist. Lastly,the 3-oz. water swallow challenge MUST be administeredto all patients. In addition, morbidity of patients should bereported. Only after such a study is undertaken can health-care personnel be confident in using the 3-oz. water swal-low challenge as a screening tool.References

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

The study aim was to document the acute physiological characteristics of swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and fiberoptic evaluation of swallowing (FEES). FEES confirmed six individuals (32%) had no aspiration risk and were excluded from further analyses. Of the remaining 13, CSE confirmed that two had specific oral-phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal-phase deficits, with the major findings evident in greater than 50% being impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n=10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 50% (n=6/12 penetration aspiration events) of the cases. Most events occurred post swallow. Findings support the fact that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral-stage swallow function. This study has identified a range of factors that may contribute to both oral- and pharyngeal-stage dysfunction in this clinical population and has highlighted the importance of using a combination of clinical and instrumental assessments to fully understand the influence of burn injury on oral intake and swallowing.