Frequent Swallowing Research Articles

Masks, Empathy, and a Pediatric Cancer Diagnosis During COVID-19.

Masks, Empathy, and a Pediatric Cancer Diagnosis During COVID-19.

Swallowing patterns after adenotonsillectomy in children.

ImportanceHypertrophy of the pharyngeal and palatine tonsils can interfere with breathing, physical and cognitive development, and quality of life, including sleep quality. There are important relationships between the muscles of the airways, the anatomy, and the pattern of breathing and swallowing.ObjectiveThe aims of the present study were to evaluate the swallowing process in children after adenotonsillectomy undertaken to treat obstructive breathing disorders.MethodsSubjects were 85 children or adolescents who underwent adenotonsillectomy in a reference hospital between 2003 and 2007. For the clinical evaluation of swallowing, the protocol of orofacial myofunctional evaluation with scores (OMES) was used, videofluoroscopy of deglutition was performed, and the Dysphagia Outcome and Severity Scale (DOSS) and Classification for Severity of Dysphagia to Videofluoroscopy Scale were applied for analysis.ResultsOut of the 85 evaluated children, 43 were male (50.59%), the average age at evaluation was 12.11 years, the average age at the time of surgery was 6.73 years, and post‐surgery time was 3.00–8.00 years. In the clinical evaluation of swallowing, half the sample (50.59%) recorded the poorest score for lip and tongue behavior. A score of 1 was observed in 67.06% of subjects for other behaviors, and in 15.30% of subjects for efficiency of swallowing. Videofluoroscopic analysis demonstrated that the most frequent swallowing alterations were labial sealing (50.59%), residue in vallecula (51.76%), and use of compensatory maneuvers (61.18%). Analysis of DOSS showed that normal swallowing was attributed to 48.31% of subjects at level 7, 44.95% at level 6, and 6.74% at level 5. For the Classification for Severity of Dysphagia to Videofluoroscopy, 75.28% were classified as having mild dysphagia.InterpretationAlterations in the dynamics of swallowing are common in children who have undergone surgery of the tonsils, even at late follow‐up.

Esophageal Acid Clearance During Random Swallowing Is Faster in Patients with Barrett's Esophagus Than in Healthy Controls.

Background/AimsImpaired esophageal acid clearance may be a contributing factor in the pathogenesis of Barrett’s esophagus. However, few studies have measured acid clearance as such in these patients. In this explorative, cross-sectional study, we aimed to compare esophageal acid clearance and swallowing rate in patients with Barrett’s esophagus to that in healthy controls.MethodsA total of 26 patients with histology-confirmed Barrett’s esophagus and 12 healthy controls underwent (1) upper endoscopy, (2) an acid clearance test using a pH-impedance probe under controlled conditions including controlled and random swallowing, and (3) an ambulatory pH-impedance measurement.ResultsCompared with controls and when swallowing randomly, patients cleared acid 46% faster (P = 0.008). Furthermore, patients swallowed 60% more frequently (mean swallows/minute: 1.90 ± 0.74 vs 1.19 ± 0.58; P = 0.005), and acid clearance time decreased with greater random swallowing rate (P < 0.001). Swallowing rate increased with lower distal esophageal baseline impedance (P = 0.014). Ambulatory acid exposure was greater in patients (P = 0.033), but clearance times assessed from the ambulatory pH-measurement and acid clearance test were not correlated (all P > 0.3).ConclusionsMore frequent swallowing and thus faster acid clearance in Barrett’s esophagus may constitute a protective reflex due to impaired mucosal integrity and possibly acid hypersensitivity. Despite these reinforced mechanisms, acid clearance ability seems to be overthrown by repeated, retrograde acid reflux, thus resulting in increased esophageal acid exposure and consequently mucosal changes.

Eucoleus contortus Parasitism in Captive-Bred Valley Quail Callipepla californica (Shaw, 1798): Disease and Control

After the introduction of an infected valley quail into a colony, Eucoleus contortus became a severe problem. Despite previous treatment with anthelmintics, four out of nine quails were affected and died due to disease complications. Major clinical signs were profuse oral mucous secretion, frequent swallowing movements, and whitish diarrhea. Main pathological findings included thickened and wrinkled crop walls, parasites deeply embedded in the stratified squamous epithelium, and diffuse mucosa hyperplasia. Keeping the remaining quails in a wire mesh-floored aviary under treatment with levamisole and applying management practices to the dirt floor aviaries (temporary depopulation, bedding exchange and liming) promoted the health and growth of the quail colony. Apparently, the anthelmintics given to these birds had little effect on the control of the disease. Regularly treatments decreased temporarily the egg counts, which increased again during periods (breeding season) in dirt floor aviaries, even after applying the aforementioned environmental measures. This paper highlights the importance of adopting appropriate health management practices to both prevent and control E. contortus infection in susceptible avian flocks housed in outdoor aviaries with dirt floor, often a necessary condition in bird conservation programs.

Deglutition-Induced Dose Deformations in Head-and-Neck Cancer IMRT Treatments: Volume Shuttle Imaging Analysis

The 4D respiration-correlated imaging using external metric system is ideal way to capture range of motion for moving targets. However momentary apneic phase during swallowing leads to sorting errors and image artifacts thus deterring this modality from being used to track motion displacements in head and neck region. A special Imaging tool used for CT-Angio/joint motion study called Dynamic helical Volume shuttle (DHVS) fills this void. DVHS is continuous bidirectional scan with extended 'z' coverage and improved temporal sampling. Present study aims to assess the deglutition induced displacement and dose deformations in patients with head and neck cancer using DHVS imaging. Twenty patients of treatment naive oropharyngeal cancers following rigid immobilization were setup in treatment position on a 128 slice multidetector CT Scanner and underwent DHVS imaging (2 mts scan). Image data for single patient was acquired during voluntary effortful swallowing act (once in 20 seconds) at 2 alternating table positions with the table shuttling back and forth. Around 3000 images/per pt. were reformatted using Dynamic Pitch Cone Beam Reconstruction (RetroRecon) for 12 phases @ 1.25 mm thickness and cine looped to quantify the range of motion during swallowing. Deglutition-induced GTV and Spinal cord displacements were quantified based on position change during deglutition relative to pre-swallow structure location for anterior (A), posterior (P), superior (S), and inferior (I) directions. The image datasets in extreme bins (peak expiratory and peak inspiratory bins) were backprojected on to the original plan in QA mode (to preserve the plan integrity) and dose deformations happening consequent to swallowing were analyzed. Deglutition-induced maximal GTV displacements ranged from 3 mm to 18 mm with mean and standard deviation of 3.5 +/- 2, 2.50 +/- 1.51, 1.75 +/- 4.0, and 9.60 +/- 7.7 mm in the A, P, I, and S directions respectively. The SC displacement ranged from 2.8 mm of the prescribed dose would still be delivered to the tumor even if the tumor partly vacated the PTV during the entire swallowing event for 15 of the 20 patients during the VHS scan. However, for the other 5 patients’ cohort, which had frequent swallowing, the target coverage failed to reach 80%. This is the first study reported in literature using DHVS for deglutition displacements quantification. Asymmetric IMs and PRV margins, derived from directional displacement, using DVS imaging should be employed to account for tumor motion for high precision treatments in HNC.

Late dysphagia after IMRT for head and neck cancer and correlation with dose–volume parameters

Background and purposeMany head and neck cancer (HNC) survivors experience diminished quality of life due to radiation-induced dysphagia. The aim of this study was to investigate frequency, intensity and dose–volume dependency for late dysphagia in HNC patients treated with curative IMRT. Materials and methodsCandidates for the study were 294 patients treated with primary IMRT from 2006 to 2010; a total of 259 patients accepted to participate by answering the EORTC QLQ-C30 and H&N35 questionnaires. A total of 65 patients were further examined with modified barium swallow (MBS) and saliva collection. Data on patient, tumor and treatment characteristics were prospectively recorded in the DAHANCA database. Dose–volume histograms (DVH) of swallowing-related structures were retrospectively analyzed. ResultsQoL data showed low degree of dysphagia (QoL subscales scores of 17 and below) compared to objective measures. The most frequent swallowing dysfunction was retention; penetration and aspiration was less common. In general, objective measurements and observer-assessed late dysphagia correlated with dose to pharyngeal constrictor muscles (PCM), whereas QoL endpoints correlated with DVH parameters in the glottis/supraglottic larynx. Both xerostomia and dysphagia has been reduced after introduction of IMRT. ConclusionsRadiation-induced dysphagia is still important, with a high degree of retention and penetration. Introduction of parotid-sparing IMRT has reduced the severity of dysphagia, primarily through a major reduction in xerostomia. Dose–response relationships were found for specific dysphagia endpoints.

Gelatinous nutritional supplements: a useful alternative in dysphagia

The oropharingeal dysphagia is a very prevalent syndrome among the elderly, and even more among institutionalized individuals. Dysphagia is frequently caused by neurodegenerative and cerebrovascular conditions, the dementia syndrome being the most common of them, where the latest stages of the process are often accompanied by frequent swallowing problems requiring to incorporate thick foodstuffs in the diet of the elderly, such as the pudding. Nutritional supplements with a puddinglike consistency are not financed by the National Health System. Therefore, when they are needed, patients must either pay their full price for them or thicken the liquid supplements financed by the National Health System. This is normally done in an individualized way, through the powder thickeners in the market. It is a very laborious and highly changeable process regarding the resulting consistency, with a poor homogeneous aspect; thus, it is complicated to implement this method in big community dwelling. We hereby present a different way to use these financed supplements, this is: mixing them up with commercial jelly resulting in a refined product with a homogeneous texture. These supplements will remain stable in their composition and safe to be used within 5 days.

Suplementos nutricionales gelatinizados: una alternativa válida para la disfagia

The oropharingeal dysphagia is a very prevalent syn- drome among the elderly, and even more among institu- tionalized individuals. Dysphagia is frequently caused by neurodegenerative and cerebrovascular conditions, the dementia syndrome being the most common of them, where the latest stages of the process are often accompa- nied by frequent swallowing problems requiring to incor- porate thick foodstuffs in the diet of the elderly, such as the pudding. Nutritional supplements with a pudding- like consistency are not financed by the National Health System. Therefore, when they are needed, patients must either pay their full price for them or thicken the liquid supplements financed by the National Health System. This is normally done in an individualized way, through the powder thickeners in the market. It is a very laborious and highly changeable process regarding the resulting consistency, with a poor homogeneous aspect; thus, it is complicated to implement this method in big community dwelling. We hereby present a different way to use these financed supplements, this is: mixing them up with com- mercial jelly resulting in a refined product with a homo- geneous texture. These supplements will remain stable in their composition and safe to be used within 5 days.

Soft palate cyst in a cat

A 17-month-old cat presented for frequent swallowing, occasional cough and stertor. Radiographic evaluation revealed a soft tissue mass at the level of the soft palate. Oral examination revealed a soft tissue mass within the soft palate. Surgical resection was performed. Histopathology was consistent with a large developmental cyst. Following surgical management the cat has remained clinically free of signs for 2 months.

Oral Feeding in the Preterm Infant

After completing this article, readers should be able to: 1. Describe the sequential development of sucking, swallowing, and respiration. 2. Delineate the limitation of an infant’s oral feeding skills at specific times of development to provide realistic expectations for oral feeding performance. 3. Define oral feeding success in preterm infants. 4. Use the current knowledge of preterm infants’ oral motor skills to facilitate and enhance their performance. 5. Enumerate the potential short- and long-term consequences of an infant’s oral feeding aversion for the patient, family, and health professional. Oral feeding issues in preterm infants are a growing concern for neonatologists because attainment of independent oral feeding is one of the prerequisites for hospital discharge. With the increase in survival of infants born continuously more preterm, understanding such issues has a certain urgency. Concerns do not pertain only to difficulties encountered by neonatologists during the birthstay hospitalization, but also by pediatricians and pediatric gastroenterologists who attend to long-term feeding difficulties/disorders, such as oral feeding aversion. Indeed, greater than 40% of patients followed in feeding disorder clinics are former preterm infants. Research over the last decade has begun to shed light on the development of oral feeding skills in these infants as they mature, which has increased understanding of their limited skills at varying postmenstrual ages. Such knowledge is crucial in clinical practice insofar as expectations of these infants’ oral feeding performance must take into account the ever-changing level of maturity of their skills. This article focuses on the development of sucking, swallowing, and respiration (as it pertains to oral feeding) and the coordination of these three functions. Additional factors, separate from infant feeding skills, also are discussed because they can affect oral feeding performance. This review examines information gathered from bottle feeding because more extensive research has been conducted on bottle feeding than on breastfeeding. However, …

Physical and physiological consequences of passive intra-oral shimming

Imaging the human orbitofrontal cortex (OFC) with fMRI is problematic due to the proximity of this region to the air-filled sinuses, which causes susceptibility artifacts. Placing a strongly diamagnetic material into the mouth (‘mouthshim’) of a human volunteer can significantly reduce the artifacts in this region. Using the same combined olfactory and visual fMRI paradigm, we compared brain activation and static B 0 field maps of participants being scanned both with and without the ‘mouthshim’. Results demonstrate that the device improves the B 0 field homogeneity within OFC, resulting in significantly stronger BOLD activation in this region. However, the device also caused both increased head motion and reduced activation in insular cortices due to more frequent swallowing and tactile stimulation of the tongue. The ‘mouthshim’ should only, therefore, be used where sensitivity in OFC regions is paramount.

Influence of sleep states on laryngeal and abdominal muscle response to upper airway occlusion in lambs.

This study was aimed at describing abdominal and laryngeal muscle responses to upper airway occlusion (UAO) in early life and the effect of sleep states on these responses. Twelve nonsedated, 9-26-d-old lambs were studied. We simultaneously recorded 1) airflow (pneumotachograph + face mask); 2) sleep states (electrocorticogram and electrooculogram); 3) abdominal muscle (external obliquus) electromyogram (EMG); and 4) glottic constrictor (thyroarytenoid) and dilator (posterior cricoarytenoid and cricothyroid) muscle EMGs. The pneumotachograph was repeatedly occluded for 15-30 s in wakefulness and natural sleep. We analyzed 90 occlusions during wakefulness (11 lambs), 28 during non-rapid eye movement (nREM) sleep (six lambs), and 23 during rapid eye movement (REM) sleep (five lambs). A phasic expiratory external obliquus EMG was present during baseline and progressively increased throughout UAO in wakefulness and nREM sleep, but not in REM sleep. Phasic thyroarytenoid EMG progressively increased during inspiratory efforts throughout UAO in wakefulness and nREM sleep, paralleling the increase in glottic dilator (posterior cricoarytenoid and cricothyroid) EMG. In contrast, glottic muscle response to UAO in REM sleep was severely blunted or disorganized by frequent swallowing movements. We conclude that UAO triggers complex and coordinated laryngeal and abdominal muscle responses during wakefulness and nREM sleep in lambs; these responses are largely absent, however, in REM sleep. These unique results, together with the defective arousal response in REM sleep, suggest that vulnerability to airway occlusion could be increased during REM sleep in early life. Possible implications for understanding severe postnatal apneas are discussed.

Facial pain from elongated styloid process.

BIZARRE symptoms are often lightly cast aside as a diagnosis of psychoneurosis is placed on the patient's chart. Globus hystericus is a prime example. The Plummer-Vinson syndrome, neoplasms of the hypopharynx or of the cervical esophagus, paralysis of the pharyngeal and palatal muscles, stenoses, or strictures of the inferior pharyngeal constrictor region, and foreign bodies in this area are often missed because adequate histories are not taken and physical examinations and studies are not made. Largely through the efforts of Dr. W. W. Eagle 1 the symptomatic styloid process has become recognized as an entity to be sought in routine examinations. Dr. Eagle and Dr. Fritz 2 have presented the usual symptoms of an elongated styloid process as dysphagia, frequent swallowing, increased salivation, fulness in the throat or a sore throat, a feeling that food has lodged in the throat, and sharp, lancinating pains in the ear. They describe the