Improvement In Swallowing Function Research Articles

Beyond Laryngeal Clefts: Interarytenoid Injection Augmentation to Predict Success of Suture Augmentation in Children.

To assess the efficacy of interarytenoid injection augmentation (IAIA) and the ability of IAIA to predict response to interarytenoid suture augmentation (IASA) based on diet advancement on video fluoroscopic swallow studies (VFSS). Retrospective cohort analysis of patients with persistent pharyngeal dysphagia at a tertiary children's hospital with VFSS pre- and post-IAIA were included between March 2011 and June 2019. Median age of the 229 patients was 2.2 years (5.8 months-19 years). Interarytenoid mucosal height (IAMH) was found to be above the false vocal folds in 112 patients (53.4%) and at true vocal folds in 10 (4.9%) patients. On VFSS post-IAIA, 95 (41.5%) patients were successfully advanced in recommended diet consistency, 115 (50.2%) were stable, and 19 (8.3%) needed thicker consistency. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% confidence interval (CI; 0.50-0.85). Poisson regression found no covariates with significant association with improvement on IAIA. For IASA patients, 35/60 (58.3%) improved on post-op VFSS. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% CI (0.63-1.33). Positive predictive value for IAIA predicting response to IASA was 77% with positive likelihood ratio of 2.3. The response to IAIA versus no response to IAIA likelihood ratios were found to have a statistically significant difference (p< 0.05). Our study suggests IAIA yields objective improvement in swallow function on VFSS in nearly half of our patients and may be a reliable diagnostic tool to predict response to IASA in patients with persistent pharyngeal dysphagia with or without a laryngeal cleft. 3 Laryngoscope, 133:1749-1756, 2023.

Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson's disease.

Background and study aims Oropharyngeal dysphagia (OPD) is prevalent in patients with Parkinson’s disease (PD). Upper esophageal sphincter (UES) dysfunction is an important pathophysiological factor for OPD in PD. The cricopharyngeus (CP) is the main component of UES. We assessed the preliminary efficacy of cricopharyngeal peroral endoscopic myotomy (C-POEM) as a treatment for dysphagia due to UES dysfunction in PD. Patients and methods Consecutive dysphagic PD patients with UES dysfunction underwent C-POEM. Swallow metrics derived using high-resolution pharyngeal impedance manometry (HRPIM) including raised UES integrated relaxation pressure (IRP), raised hypopharyngeal intrabolus pressure (IBP), reduced UES opening caliber and relaxation time defined UES dysfunction. Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Questionnaire (SWAL-QOL) at before and 1 month after C-POEM measured symptomatic improvement in swallow function. HRPIM was repeated at 1-month follow-up. Results C-POEM was performed without complications in all (n = 8) patients. At 1 month, there was an improvement in both the mean SSQ (from 621.5 to 341.8, mean difference –277.3, 95 %CI [–497.8, –56.7], P = 0.02) and SWAL-QOL (from 54.9 to 68.3, mean difference 9.1, 95 %CI [0.7, 17.5], P = 0.037) scores. Repeat HRPIM confirmed a decrease in both the mean UES IRP (13.7 mm Hg to 3.6 mm Hg, mean difference –10.1 mm Hg, 95 %CI [–16.3, –3.9], P = 0.007) and the mean hypopharyngeal IBP (23.5 mm Hg to 10.4 mm Hg, mean difference –11.3 mm Hg, 95 %CI [–17.2, –5.4], P = 0.003). Conclusions In dysphagic PD patients with UES dysfunction, C-POEM is feasible and enhances UES relaxation and reduces sphincteric resistance to flow during the swallow, thereby improving dysphagia symptoms.

Outcomes of Combined Antegrade-Retrograde Dilations for Radiation-Induced Esophageal Strictures in Head and Neck Cancer Patients.

The purpose of this study is to analyze outcomes of combined antegrade-retrograde dilations (CARD). This retrospective study was conducted on 14 patients with a history of head and neck cancer, treated with radiation therapy that was complicated by either complete or near-complete esophageal stenosis. All patients had minimal oral intake and depended on a gastrostomy tube for nutrition. Swallow function before and after CARD was assessed using the Functional Oral Intake Scale, originally developed for stroke patients and applied to head and neck cancer patients. Patients undergoing CARD demonstrated a quantifiable improvement in swallow function (p = 0.007) that persisted at last known follow-up (p = 0.015) but only a minority (23.1%) achieved oral intake sufficient to obviate the need for tube feeds. Complication rates were 24% per procedure or 36% per patient, almost all complications required procedural intervention, and all complications occurred in patients with complete stenosis. Our study suggests further caution when considering CARD, careful patient selection, and close post-operative monitoring.

Modified external approach to the pediatric cricopharyngeal myotomy: A case series

ObjectiveTo assess the success of a modified approach to external pediatric cricopharyngeal myotomy in children with inappropriate upper esophageal sphincter relaxation as determined by video fluoroscopic swallow study (VFSS) and pediatric manometry findings. MethodsThis is a case series in which hospital records of all patients who underwent a modified external approach to pediatric cricopharyngeal myotomy 2017 to 2019 were reviewed at a single institution. The primary outcome measure was post-operative diet and presence of aspiration/penetration on post-operative VFSS. ResultsA total of 7 patients underwent modified external approach to pediatric cricopharyngeal myotomy. The average age of the child at the time of surgery was 5.6 (±3.7) years. The average duration (SD) of surgery was 90 (±30) minutes and no complications were observed. 6 of 7 patients (86%) demonstrated an improvement in swallow function after the procedure. The single child who did not was suffering from a posterior fossa tumor which was resected and radiated, which likely made their dysphagia multi-factorial. Although no pediatric normative data exists for upper esophageal sphincter pressure, we observed an average decrease in UES residual pressure of 8.5 (±15.1) mmHg and an average decrease in mean UES pressure of 21.2 (±35.1) mmHg. ConclusionsThe modified external approach to the pediatric cricopharyngeal myotomy appears to be a safe and efficient procedure with no apparent complications to date. However, further longitudinal data is needed to formally evaluate the efficacy of this procedure when treating pediatric cricopharyngeal achalasia

Neuromuscular electrical stimulation for treatment of dysphagia in infants and young children with neurological impairment: a prospective pilot study

ObjectivesTo describe the acceptability, safety and effectiveness of neuromuscular electrical stimulation (NMES) in infants and young children with neurological impairment (NI) who have severe dysphagia.DesignA prospective pilot study using a...

Post-extubation Dysphagia: Does Timing of Evaluation Matter?

Swallowing evaluations are often delayed at least 24h following extubation with the assumption that swallow function improves over time. The purpose of this prospective cohort study was to determine if dysphagia, as measured by aspiration and need for diet modification, declines over the first 24-h post-extubation, whereby providing evidence-based evaluation guidelines for this population. Forty-nine patients completed FEES at 2-4h post-extubation and 24-26h post-extubation. We compared Penetration-Aspiration Scale scores and diet recommendation between time points. Multivariable logistic regression models were created to investigate associations between age, reason for admission, reason for intubation, and a history of COPD and outcomes of aspiration or silent aspiration at either FEES exam. Sixty-nine percent of participants safely swallowed at least one texture without aspiration at 2-4h post-extubation. Within participants, there was a significant decrease in penetration/aspiration at 24h and 79% showed improvement in airway protection on at least one bolus type, suggesting an improvement in swallow function over the first day following extubation. These findings suggest that although patients may be safe to begin a modified diet soon after extubation, delaying evaluation until 24-h post-extubation may allow for a less restricted diet.

Changes in Patient-reported Swallow Function in the Long Term After Chemoradiotherapy for Oropharyngeal Carcinoma

AimsTo assess long-term patient-reported swallow function after chemoradiotherapy for oropharyngeal carcinoma and to evaluate the frequency of deterioration/improvement over years. Materials and methodsFifty-nine patients with oropharyngeal carcinoma treated with parotid-sparing intensity-modulated radiotherapy and concurrent chemotherapy between 2010 and 2012 had previously completed the MD Anderson Dysphagia Inventory (MDADI) at a median of 34 months (range 24–59) after treatment. An MDADI was posted to 55 alive and disease-free patients after a 30 month interval; 52/55 replies were received, a median of 64 months (range 52–88) after treatment; 27/52 (52%) had been managed with a prophylactic gastrostomy. A 10 point or greater change in the MDADI scores was defined as clinically significant. ResultsOverall, in the whole cohort, patient-reported swallow function showed a small absolute improvement in MDADI composite score on the second MDADI questionnaire (>5 years after treatment) compared with the first MDADI (>2 years after treatment); mean 68.0 (standard deviation 19.3) versus 64.0 (standard deviation 16.3), P = 0.021. Using the composite score, swallow function was stable over time in 29/52 (56%) patients; a clinically significant improvement in swallow function over time was noted in 17/52 (33%) patients; conversely 6/52 (12%) patients experienced a clinically significant deterioration with time. Abnormality of pre-treatment diet and a prophylactic gastrostomy correlated with an inferior MDADI composite score on the later questionnaire (P = 0.029 and P = 0.044, respectively). ConclusionsLong-term dysphagia is prevalent >5 years after treatment. Although long-term swallow function is stable in most patients, it is not static in a minority. On MDADI composite summary scores, 33% of patients experienced an improvement, whereas 12% deteriorated with time. Further investigation is needed to determine underlying mechanisms behind these divergent outcomes.

Abstract WP305: Predictors of Early Improvement of Swallow Function in Acute Ischemic Stroke Patients With Severe Dysphagia

Introduction: Dysphagia is a common complication of stroke that often improves with time. Percutaneous endoscopic gastrostomy (PEG) tubes are used to bridge patients with dysphagia until oral feeding is safe. We sought to evaluate factors associated with early improvement in swallow for patients in whom PEG tube was deferred after an initial failed instrumental assessment of swallow (IAS) study. Methods: Consecutive cases of AIS were identified from our inpatient registry (6/14- 4/15). We included patients who failed an initial IAS with Fiberoptic Endoscopic Evaluation of Swallowing or Modified Barium Swallow Study. Speech language pathologists (SLP) calculated Penetration-Aspiration (PEN-ASP) scores (1-2 normal; 3-5 penetration; 6-8 aspiration) based on performance on IAS. Recovery of swallow was defined as improvement in the PEN-ASP category with thin or nectar-thickened liquids. Univariate analyses and multiple logistic regression were used to assess predictors of improvement in swallow with demographic data, medical history, stroke etiology, and NIHSS as independent variables. Results: Among 104 patients who failed an IAS an average of 5.5 days after hospital admission, PEG was deferred in 60 pending repeat IAS. Younger patients (62.9±13.1 vs 69.3±14.2) and those with lower NIHSS (median 10.5; IQR 5,15 vs median 13.5; IQR 8.0, 20) were more often referred for second IAS (p &lt; 0.05). Improvement in swallow function was seen in 45% of patients on a 2 nd IAS performed an average of 3.9 days after the initial study. Race, but not stroke etiology, stroke severity, stroke location or other clinical factors, was associated with recovery of swallow. The odds (adjusted) of improving on a subsequent evaluation in African Americans (AA) were 5.91 (95% CI: 1.56, 22.40 ) times higher than the odds for Whites. Conclusion: Our study shows that AA race is associated with early improvement in swallow function for reasons that are unclear. There was no association with age, stroke severity, or stroke etiology. Further analysis of factors associated with recovery of swallow is necessary in order to avoid PEG placement in patients with rapid recovery. A follow-up IAS 3-4 days after an initial study should be considered in select patients before PEG placement.

Application effect of systematic rehabilitation intervention in postradiotherapy dysphagia of patients with nasopharyngeal carcinoma

Objective To analyze the application effect of systematic rehabilitation intervention in postradiotherapy dysphagia of patients with nasopharyngeal carcinoma. Methods Totally 60 patients with nasopharyngeal carcinoma and postradiotherapy dysphagia admitted in our hospital from June 1st, 2013 to Feburary 28th, 2016 were selected and divided into the treatment group and the control group according to random number table, with 30 cases in each group. Patients in the control group were treated with conventional rehabilitation exercises, combined with routine care and conventional drug therapy, while those in the treatment group were treated with systematic rehabilitation intervention model, including rehabilitation exercises and swallowing apparatus. Improvement of swallowing function and satisfaction toward the nursing were compared between two groups. Results There were 14 effective cases and 16 ineffective cases in the control group. Two cases in the treatment group were cured. There were 23 effective cases and five ineffective cases in the treatment group. The total efficiency of the treatment group (83.33%) was significantly higher than that of the control group (46.67%) (χ2=2.159, P<0.05) . The experimental results of drinking water and improvement of limitation of mouth opening in the treatment group were obviously better than that in the control group (Z=5.012, 7.018; P<0.05) . Satisfaction in the treatment group (86.67%) was obviously higher than that in the control group (43.33%) (χ2=6.321, P<0.05) . Conclusions Systematic rehabilitation intervention in postradiotherapy dysphagia of patients with nasopharyngeal carcinoma can significantly improve patients' swallowing difficulties. Key words: Nasopharyngeal neoplasm; Deglutition disorders; Systematic rehabilitation intervention; Postradiotherapy

Treatment of oropharyngeal dysphagia secondary to idiopathic cricopharyngeal bar: Surgical cricopharyngeal muscle myotomy versus dilation

ObjectiveTo compare swallowing outcomes following cricopharyngeal (CP) dilation versus surgical myotomy in patients with dysphagia secondary to idiopathic CP bar. MethodsAll patients had an idiopathic CP bar without a history of Zenker's diverticulum, head and neck cancer, or systemic neurologic disease treated between 2000 and 2013. The Functional Outcome Swallowing Scale (FOSS) was utilized to assess dysphagia symptoms. ResultsTwenty-three patients underwent 46 dilations and 20 patients had a myotomy. Nineteen of 23 (83%) patients in the dilation group and all patients in the myotomy group reported improved swallow function. The median difference in pre- versus post-intervention FOSS scores was not statistically significant (p=0.07) between the dilation and myotomy groups with mean reductions of 1.3 and 1.8, respectively. Seventeen of 23 (74%) dilation patients had persistent or recurrent dysphagia with 13 (57%) requiring repeat dilation and 4 (17%) undergoing CP myotomy. The median time to first reintervention in the dilation group was 13.6months. Nineteen of 20 (95%) surgical myotomy patients did not experience recurrent dysphagia. ConclusionBoth endoscopic CP dilation and myotomy led to similar initial improvement in swallow function for patients with primary idiopathic CP bar; however, dilation is more likely to provide temporary benefit.

The efficacy of low-frequency electrical acupoint stimulation plus rehabilitation training in improving the swallowing function of stroke survivors

Objective To test the efficacy of low-frequency electrical acupoint stimulation plus rehabilitation training in improving swallowing function after stroke. Methods Eighty dysphagic stroke patients were randomly allocated into 2 groups of 40.Patients in the experimental group received low-frequency electrical acupoint stimulation plus 2 courses of rehabilitation training.Control group patients received the same protocol,but the electrical stimulation was not over acupoints.Their swallowing function was assessed using the Kubota water drinking test.Results After treatment,both groups showed significantly lower Kubota scores compared with pre-treatment.Prepost test difference was 1.25 ± 0.78 in the experimental group and 0.70 ± 0.72 in the control group,a significant difference.The total recovery rate in the experimental group was 87.5％.In the control group it was 55％.The improvement in swallowing function was significantly better in the experimental group. Conclusion Both groups showed a significant improvement in swallowing function,but low-frequency electrical acupoint stimulation increased the effectiveness of the rehabilitation training. Key words: Dysphagia; Acupoints; Low-frequency electrical stimulation; Stroke

Swallowing training combined with acupuncture for treating chronic neurogenic dysphagia

Objective To study the effect of swallowing training combined with acupuncture on patients with dysphagia more than one month after stroke or traumatic brain injury (TBI). Methods 61 patients with dysphagia meeting the inclusion criteria were randomly divided into a control group (31 cases) and a treatment group (30 cases). Both groups were subdivided according to the course of disease-1 ～ 2 months or ＞ 2 months. The patients in the control group received only swallowing training, 30 min per day, 5 times a week for 9 weeks. The patients in the treatment group were treated with the same swallowing training as the control group, additionally combined with acupuncture at the acupoints around the neck, including Lianquan (Ren23), Jinjin (EX-HN12), Yuye (EX-HNI3),Fengchi (GB20) , Yifeng (SJ17) and Wangu (GB12). Acupuncture was performed 5 times a week, 30 min per session for 8-week courses with a week's break between them. Results Both groups and their sub-groups demonstrated statistically and clinically significant improvements in swallowing function. Scores in the 2 treatment subgroups showed more improvement than in the control group. There was, however, no significant difference between the 2 treated subgroups in either their post-treatment or pre-treatment swallowing function scores. The cure rate in the treatment group was significantly higher than in the control group, but there was no significant difference in the total effectiveness rate between the two groups. Conclusion Swallowing training alone or combined with acupuncture can improve the swallowing of patients with chronic neurogenic dysphagia. The combination therapy was more effective. The improvement was not related with the course of the disease. Key words: Stroke; Traumatic brain injury; Dysphagia; Acupuncture

Rehabilitation nursing on hepatolenticular degeneration patients complicated by dysphagia

Objective To explore the effect of integrated nursing on hepatolenticular degeneration patients with dysphagia. Methods A total of 87 patients with hepatolenticular degeneration complicated by dysphagia were divided into the intervention group and the control group according to patients' swallowing capacity. The intervention group performed integrated nursing measures and the control group conducted routine nursing measures. Patients' swallowing capacity was compared between two groups. Results There was a significant difference in improvement of swallowing function between two groups. Conclusions Integrated nursing measures can benefit swallowing function and improve quality of life for patients with hepatolenticular degeneration complicated by dysphagia. Key words: Hepatolenticular degeneration; Dysphagia; Nursing

Effects of chemoradiotherapy on voice and swallowing

Chemotherapy has been found to result in comparable survival rates to surgery for head and neck cancer. However, toxicity can often be worse after chemoradiotherapy, with impairment in voice, swallowing, nutrition, and quality of life. Investigators are attempting to modify radiotherapy treatment regimens to spare organs that have an impact on swallowing. This review will highlight voice and swallowing impairment seen after chemoradiotherapy, as well as treatment for voice and swallowing disorders in this population. Results of newer radiotherapy regimens will also be highlighted. Specific oropharyngeal swallowing motility disorders after chemoradiotherapy have been identified. Damage to specific structures has been correlated with specific pharyngeal phase swallow impairment. Swallowing function and quality of life have been examined over time, with improvement seen in both. Preventive/prophylactic swallow exercise programs have been encouraging. Chemoradiotherapy effects on voice have been identified in terms of acoustic, aerodynamic, and patient and clinician-rated perception of function. Improvement in voice has also been observed over time after chemoradiotherapy. Voice therapy has been found to have a positive impact on voice and perceptual measures in this population. Current studies show some improvement in swallow function after swallow and voice therapy in patients treated with chemoradiotherapy. Further, there is a suggestion of improved swallow function with sparing of organs with specific radiotherapy protocols. Future research needs to focus on specific voice and swallow treatment regimens in the head and neck cancer patient treated with chemoradiotherapy, specifically, timing, frequency, duration, and specific treatment types.