Incidence Of Dysphagia In Patients Research Articles

Modified Tracheal Traction Exercise Reduces the Incidence of Dysphagia in Patients with Multilevel Anterior Cervical Discectomy and Fusion.

Dysphagia, an impairment in swallowing, is a frequent and debilitating complication for patients undergoing anterior cervical discectomy and fusion (ACDF), a common surgical treatment for degenerative cervical myelopathy (DCM). This retrospective study aimed to assess the efficacy of modified tracheal traction exercise (MTTE) in alleviating postoperative dysphagia and improving clinical outcomes for these patients. A cohort of 143 patients underwent multilevel fusions, equally distributed between MTTE (n = 75) and traditional tracheal traction exercise (TTTE) (n = 68) groups. Demographic parity was observed in gender distribution, age averages (MTTE: 51.43 ± 11.25 years; TTTE: 52.35 ± 10.43 years), body mass index (BMI), comorbidities, fusion segments, and preoperative hospitalization days. Surgical duration differences were assessed. Clinical outcomes, dysphagia incidence, blood loss, postoperative complications, Cervical Japanese Orthopedic Association (c-JOA) scores, and functional outcome swallowing scale evaluations were conducted. Univariate and multivariate logistic regression analyses were used to explore factors influencing dysphagia. Modified tracheal traction exercise demonstrated advantages with a significantly lower dysphagia incidence (25.33% vs. 44.12%, p = 0.018), reduced blood loss (102.03 ± 17.04 vs. 113.46 ± 14.92, p < 0.001), shorter surgical durations (159.04 ± 9.82 vs. 164.41 ± 12.22 min, p = 0.004), and fewer postoperative complications (choking cough, cerebrospinal fluid leakage, and hoarseness). Postoperative c-JOA scores at 2 and 6 weeks favored MTTE, but no significant differences were observed at 12 and 24 weeks. Functional outcome swallowing scale evaluations favored MTTE with significantly higher percentages of "normal" and lower incidences of "mild" and "moderate dysphagia" at various postoperative intervals compared to TTTE. Factors significantly associated with dysphagia included MTTE, age, and BMI according to logistic regression analyses. Modified tracheal traction exercise demonstrates superior short-term outcomes in multilevel ACDF, showcasing reduced dysphagia incidence, blood loss, and specific postoperative complications. Notably, factors contributing to dysphagia, including operation technique and patient-related variables, emphasize the significance of MTTE and patient characteristics in optimizing postoperative outcomes in multilevel ACDF procedures.

Tongue Acupuncture to Treat Dysphagia in Patients with Parkinson's Disease: A Randomized Controlled Trial.

Parkinson's disease (PD) is a chronic degenerative disease that lacks specific treatment. The incidence of dysphagia in patients with PD is 35%-82%. Dysphagia not only affects nutritional intake but also leads to pneumonia, even asphyxia. This study explored the efficacy of tongue acupuncture for treating dysphagia in patients with PD. From March 2021 to June 2023, 64 patients with PD-related dysphagia were chosen from Qingdao Central Hospital and the Affiliated Hospital of Qingdao Binhai University, both in Qindao, Shandong, China. The patients were divided into a tongue acupuncture group (n = 32) and a control group (n = 32). The control group was treated with a VitalStim® 5900 Swallowing Disorder Therapeutic Instrument (CA, USA), and the tongue acupuncture group had tongue acupuncture at Juquan (Ex-HN-10) and Haiquan (Ex-HN-11). Swallowing function and nutritional conditions were compared between the 2 groups after all treatments. The total clinical effective rate in the tongue acupuncture group was higher than that of the control group (P < 0.05). The proportion of grade 1 and grade 2 of the 5-scaled Kubota drinking-water test in the tongue acupuncture group was significantly higher than that in the control group (78.13 % versus 31.26 %; P < 0.05), and the proportion of grade 3, grade 4, and grade 5 was significantly lower than that in the control group (21.87 % versus 68.74 %; P < 0.05). After tongue acupuncture, levels of body mass index, upper-arm circumference, triceps skinfold thickness, hemoglobin, serum albumin, and prealbumin were significantly higher than those in the control group (P < 0.05) and the incidence of complications caused by PD was significantly lower than that in the control group (P < 0.05). Treatment of dysphagia in PD by tongue acupuncture significantly improved swallowing function and nutritional level, and decreased the incidence of complications.

Incidence of dysphagia requiring medical attention in various types of cancers: A nationwide population-based cohort study

Most previous reports on dysphagia in cancer have focused on specific cancer types, particularly head and neck cancer. Therefore, we aimed to investigate the incidence of dysphagia in patients with various cancers using a nationwide database in South Korea. This was a retrospective cohort study using the National Health Insurance Service database. Claim codes were used for the selection criteria and operational definitions. The total population data from 2010 to 2015 were extracted. The crude incidence of dysphagia was calculated per 1,000 person-years. The multivariate adjusted Cox proportional hazards regression was used to determine the effects of different cancers on the incidence of dysphagia. People with cancer had a lower income and suffered from a higher risk of comorbidities compared to people without cancer. The risk of dysphagia increased in all types of cancers, particularly in the oral cavity and pharynx (hazard ratio [HR]: 20.65, 95% confidence interval [CI]: 17.73-24.06), esophagus (HR: 18.25, 95% CI: 15.66-21.26), larynx (HR: 12.87, 95% CI: 10.33-16.02), and central nervous system (HR: 12.42, 95% CI: 10.33-14.94). The risk of dysphagia was significantly higher in the cancer group than in the non-cancer group. As the survival of cancer patients is improving with the development of new treatments, more attention should be paid to dysphagia in the management of cancer. Prompt and appropriate multidisciplinary interventions for dysphagia are necessary to improve the recovery and quality of life in cancer patients.

Dysphagia in patients with coronavirus disease undergoing orotracheal intubation.

ObjectiveTo assess the incidence and the risk factors for the development of dysphagia in patients with coronavirus disease 2019 (COVID‐19) undergoing orotracheal intubation.Study DesignProspective cohort study.MethodsIn this prospective cohort study, we evaluated consecutive patients diagnosed with COVID‐19 and underwent orotracheal intubation were evaluated. During hospitalization, extubated patients were classified as dysphagic and nondysphagic based on bedside functional assessment of swallowing. Patients discharged from hospital were asked to complete the Eating Assessment Tool‐10 (EAT‐10) questionnaire, followed by an endoscopic examination to identify laryngotracheal lesions, and a fiberoptic endoscopic evaluation of swallowing (FEES). The food consistencies used for FEES were moderately thick, extremely thick, thin, and regular.ResultsBased on the functional assessment of swallowing, performed a mean of 5.3 days and a median of 4 days after extubation, the incidence of dysphagia in patients with COVID‐19 undergoing orotracheal intubation was 53.6%. In the late evaluation, performed a mean of 102 days after extubation, 12.8% of patients had an EAT‐10 score >2. Orotracheal intubation (OTI) duration and tracheostomy were risk factors for the development of dysphagia. There was an association between EAT‐10 > 2 and the presence of laryngotracheal lesion, with no difference between lesion type and EAT score >2.ConclusionsThe incidence of dysphagia varied according to the time of assessment, being higher the earlier the assessment after extubation. OTI duration and tracheostomy were risk factors for the development of dysphagia, and the presence of laryngotracheal lesions demonstrated an association with dysphagia.Level of Evidence3.

Factors Related to the Incidence of Dysphagia in Patients Using Tracheal Cannula at Dr. Mohammad Hoesin General Hospital Palembang

Background: The need for tracheostomy increases during the coronavirus diseases 2019 (COVID-19) pandemic. However, some studies suggest that tracheostomy causes dysphagia which can lead to other health problems such as pneumonia, choking, weight loss, malnutrition, and dehydration with serious side effects. This study aims to determine the factors associated with the incidence of dysphagia in patients using a tracheal cannula.&#x0D; Methods: This study is an observational study using a cross-sectional design. Data collection was carried out using medical record data on 58 patients who used a tracheal cannula recorded in the medical record data for the FEES examination at Dr. Mohammad Hoesin General Hospital Palembang from January 2019 to September 2021. The data were analyzed by descriptive statistics, chi-square, and multiple logistic regression.&#x0D; Results: Of 58 patients who used a tracheal cannula, it was found that 75.9% had dysphagia. The results of the comparison test showed that the factors associated with the incidence of dysphagia were gender (p=0.001), nutritional status (p=0.013), incision location (p=0.043), and primary disease (p=0.021). Factors that were not associated with the incidence of dysphagia were age (p=0.933), tracheostomy indication (p=0.741), and the type of tracheal cannula (p=1,000). Patients are male, with low and high tracheal cannula incision locations, and have a primary neurological disease. The probability or chance of dysphagia is 79.8%.&#x0D; Conclusion: Tracheostomy can cause dysphagia which is influenced by gender, location of tracheal cannula incision, and primary disease.

Study on Factors Influencing Dysphagia in Elderly Patients with Chronic Obstructive Pulmonary Disease Based on Structural Equation Modeling

Dysphagia can occur in elderly patients with chronic obstructive pulmonary disease due to poor coordination between breathing and swallowing. Dysphagia can not only lead to aspiration pneumonia and acute exacerbation of chronic obstructive pulmonary disease, but also increase the risk of death. Previous studies only analyzed the influencing factors, but did not explore the interaction and size of the influencing factors, and there is still a lack of epidemiological investigation of dysphagia in chronic obstructive pulmonary disease patients in China. This study investigated the current situation of dysphagia in patients with chronic obstructive pulmonary disease in elderly chronic obstructive pulmonary disease patients in China, and used structural equation model to explore the direct and indirect effects of influencing factors. From April 2019 to April 2020, 1020 elderly chronic obstructive pulmonary disease patients who met the inclusion and exclusion criteria in the department of respiratory Medicine in 9 tertiary hospitals in Ningxia were selected as study subjects. The data were collected through questionnaires, including general information, chronic obstructive pulmonary disease Assessment Test, Activities of Daily Living, Geriatric Depression Scale, The Mini Nutritional Assessment-Short Form, FRAIL assessment scale, and Water Swallowing Test. On the basis of exploratory factor analysis, Amos was used to construct the initial model in combination with literature and professional knowledge, and the overall fitting evaluation and modification of the model were carried out to construct the final model. The incidence of Dysphagia in patients with chronic obstructive pulmonary disease in elderly chronic obstructive pulmonary disease patients was 19.71 %. The modified structural equation model fitted well, and the comprehensive condition of the elderly, smoking condition and comorbidities directly affects the dysphagia (the effect values respectively were 0.372, 0.112 and 0.095).The disease condition not only directly affects dysphagia, but also influences it through the comprehensive condition of the elderly (direct effect 0.109, indirect effect 0.109, total effect 0.218); age factors not only directly affects dysphagia, but also influences it through The disease condition and comprehensive condition of the elderly (direct effect 0.113, indirect effect 0.183 and total effect 0.296). eating condition not only directly affects dysphagia, but also influences it through comprehensive condition of the elderly (direct effect 0.127, indirect effect 0.074, total effect 0.201). The comprehensive condition of the elderly, smoking status and comorbidities directly affects the swallowing function, and the effect value of comprehensive condition of the elderly on swallowing function is 0.372. The disease status, age factors and eating status not only directly affect swallowing function, but also indirectly affect it through other factors.

INCIDENCE OF DYSPHAGIA IN PATIENTS WITH UNILATERAL VOCAL CORD PARALYSIS

Background: It is essential and evaluates dysphagia among patients with UVCP to help the management, improves the quality of life, and prevents secondary complications. Aim of the work: This research aims to find the incidence of dysphagia in patients with unilateral vocal cord paralysis [UVCP]. Patients and Methods: This study was performed in 245 patients with UVCP; 98 males and 147 females. There were two groups of patients: the non-dysphagia group [130 patients] and the dysphagia group [115 patients]. Assessment of patients was performed by the verified 10-item Eating Assessment Tool [EAT-10] and Dysphagia Handicap Index [DHI]. Results: Performing EAT-10 questionnaire revealed average values of 18.5 ± 9.56 and 34.3 ± 11.3 in the non-dysphagia group and dysphagia groups, respectively. DHI showed mean values of 45.7 ± 18.12 and 85.42 ± 21.7 in the non-dysphagia group and dysphagia groups, respectively. All of them demonstrated a highly significant variation [P = 0.001]. Regarding the etiology of UVCP, iatrogenic was the first cause of UVCP; it was the cause of 36.9% and 36.52%, followed by idiopathic; 23.1% and 24.34 %, intubation injury; 12.6% and 11.3%, tumor; 10% and 9.56%, trauma; 8.46% and 8.69%, thyroid surgery; 4.62% and 5.22%, and neurodegenerative disease; 4.62% and 4.35% of non-dysphagia and dysphagia groups, respectively. Conclusion: The incidence of dysphagia in unilateral vocal cord paralysis depends mainly on the cause; however, vocal cord paralysis itself increases the incidence of dysphagia whatever the cause.

Does the Number of Attempts of Endotracheal Intubation Influence the Incidence of Post-Extubation Dysphagia in Patients Undergoing Maxillofacial Surgical Procedures? - A Prospective Analysis

Does the Number of Attempts of Endotracheal Intubation Influence the Incidence of Post-Extubation Dysphagia in Patients Undergoing Maxillofacial Surgical Procedures? - A Prospective Analysis

Role of O-C2 angle in the development of dysphagia in patients with halo-vest fixation

The halo-vest brace has been a common mode for immobilization of the cervical spine. The incidence of complications such as pin loosing and infection are known in patients with halo-vest fixation. Dysphagia is one of the most serious complications seen with the use of a halo-vest brace. The aim of this study was to elucidate factors associated with the incidence of dysphagia in patients treated using a halo-vest brace in terms of not only demographic data, but also radiological findings of the cervical spine. We retrospectively reviewed medical records and radiological measurements using lateral plain X-rays of the cervical spine in patients who had undergone halo-vest fixation in our institute between January 2006 and August 2016. Severity of dysphagia was assessed using the Food Intake Level Scale (FILS) from medical records. Patients were classified into non-dysphagia (FILS level: 10) and dysphagia (FILS level: 1–9) groups. Forty-three patients were attributed for analysis. Twenty-eight patients were classified into non-dysphagia group, 15 patients were classified into dysphagia group. Mean age was grater ( P = 0.041), length of ICU stay was longer ( P = 0.002), and frequency of tracheostomy was larger ( P = 0.043) in the dysphagia group. Mean O-C2 angle was smaller in the dysphagia group ( P = 0.027). Body mass index [odds ratio (OR) = 0.522, 95% confidence interval (CI) = 0.377–0.934, P = 0.024], ICU stay (OR = 1.302, 95% CI = 1.272–10.624, P = 0.016), and O-C2 angle (OR = 0.911, 95% CI = 0.833–0.996, P = 0.041) remained independent risk factors related to incidence of dysphagia. Spearman rank correlation showed a negative linear correlation between ICU stay and FILS level ( r = 0.476, P = 0.001) and a positive linear correlation between O-C2 angle and FILS level ( r = 0.385, P = 0.011). This study suggested the significance of O-C2 angle as well as ICU stay for incidence and severity of dysphagia in patients with halo-vest fixation.

Efficacy and needs of secondary dysphagia screening in post-acute care for change in diet program in patients after acquired brain injuries

Recent studies have shown the incidence of dysphagia in patients after traumatic brain injury up to 50% and in stroke patients between 35–40%. This paper presents the effectiveness and needs of secondary dysphagia screening in post-acute care with consequent influence on the change in diet program. Current situation shown that not all patients with presence of dysphagia are adequately screened in acute hospital settings with concurrent safety and quality of life's compromise. We have placed issue whether secondary dysphagia screening will help identify another dysphagia patients in post-acute care (rehab setting) and thus to improve patients safety and quality of life. Patients with diagnosis acquired brain injury in subacute phase, who were hospitalized in Kladruby Rehabilitation Centre with primary dysphagia screening, were included. One hundred and twenty-four patients were secondary GUSS screened and different types of dysphagia were diagnosed in 27 of them. Dysphagic patients were divided into 4 groups according to the dysphagic diet levels. Twenty-six patients had specific speech therapist's intervention and electrostimulation therapy was applied in 13 of them. Out of 26 patients, 73.1% were improved. Among the patients, 57.7% were improved in one diet category, 2 patients changed from PEG to non-dysphagic diet program and one patient changed form PEG to advanced level. From all of 26 dysphagia patients were 61.5% with out dysphagic diet program. The effectiveness of secondary screening in 124 patients, when 27 dysphagic patients were determined, supported a need of secondary screening in post-acute care (rehab setting) and led to set appropriate speech intervention using electrostimulation of the pharyngeal muscles and in 73.1% dysphagic patients the diet category was changed. The application of electrostimulation to the pharyngeal muscles under the leading of the speech therapist shows one of the very good ways how to improve quality of life in patients with acquired brain injury.

The Incidence of Dysphagia in Patients Receiving Cerebral Reperfusion Therapy Poststroke

The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann-Whitney test and considered significant if P is less than .05. The moderate and severe degrees of dysphagia were more frequent (P=.013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia (P=.045). We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy.

Dysphagia in Parkinson’s disease: a therapeutic challenge?

This article focuses on the current status and research directions on swallowing disorders (dysphagia) in patients with Parkinson’s disease (PD). Although epidemiological data are scarce, increased incidence of dysphagia in patients with PD leads to increased risk of mortality, secondary to aspiration pneumonia. Although studies show that aspiration pneumonia is a common cause of death in this group of patients, clinical practice lacks an evidence base and there is an increased need for randomized clinical trials. Importantly, the underlying mechanisms accounting for the progression of dysphagia in PD are still unclear. Furthermore, evidence shows that dopaminergic medication does not affect swallowing performance. Future research in the field is urgently needed and may result in improved management of dysphagia in patients with PD.

Esophageal motor function in primary Sjögren's syndrome: correlation with dysphagia and xerostomia.

The incidence of dysphagia in patients with primary Sjogren's syndrome (pSS) has been underestimated and all too often ascribed to xerostomia, without considering the possible presence of esophageal motor abnormalities affecting other nonscleroderma connective tissue diseases. Esophageal and salivary functions were prospectively evaluated in 27 females who met the four criteria proposed by Fox for the diagnosis of pSS, using esophageal manometry after wet swallows and Saxon's test, respectively. Dysphagia was graded using a standard symptoms questionnaire and results were compared with those obtained in a group of 21 healthy controls. Seven patients with pSS (26%) had no swallowing discomfort, 2 (7.4%) had mild dysphagia, 7 (26%) had moderate dysphagia, and 11 (40.6%) had severe dysphagia. Saxon's test revealed an overall decrease in the salivary flow rate compared to controls, with no difference between patients with or without dysphagia. Esophageal manometry demonstrated the absence of any lower or upper esophageal sphincter function abnormalities in all patients. In the patients with pSS as a whole, manometric study of the esophageal body showed a motor pattern comparable with that of controls, with no difference between patients with and without dysphagia. Defective peristalsis, ie, the presence of simultaneous contractions in more than 30% of wet swallows was detected, however, in the distal tract of the esophagus of six patients (22.2%) and in the proximal tract of three (11.1%). All these patients had severe dysphagia and the modified Saxon's test revealed a salivary secretion comparable with that of patients with a normal peristalsis. Dysphagia is a very common complaint in patients with pSS and does not seem to correlate with xerostomia, which is a constant and typical finding of the disease. About one third of patients with pSS have an abnormal esophageal peristalsis that is responsible for severe dysphagia, whereas decreased salivary outflow exacerbates the swallowing discomfort. This has to be taken into account and justifies the routine use of esophageal manometry in patients with pSS. The cause of dysphagia in pSS patients without peristaltic disorders of the esophagus has to be investigated.

Does surgery correct esophageal motor dysfunction in gastroesophageal reflux.

The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

Transmigration of the lower esophageal mucosa.

From the earliest days of roentgenology the esophagogastric segment has intrigued the observer, and the anatomical landmarks have been variously interpreted by a multitude of workers. As pointed out by Cimmino (1), over a thousand papers dealing with this very small area appeared between 1930 and 1946. A variety of terms has been used to describe an appearance seen both at fluoroscopy with barium swallow and on roentgenograms, suggesting prolapse of the lower esophagus into a gastric hiatal hernia or into the gastric fundus below the diaphragm. A paper published in France in 1934 made the first mention of “invagination of the esophagus” (5). Since its appearance there have been sporadic references to the subject, almost all in the European literature. In 1951, Feldman described retrograde extrusion or prolapse of the gastric mucosa into the esophagus in 2 cases, and referred to the only other known example, reported by Wells in 1947 (11). Feldman considered the condition completely separated from hiatal hernia but noted that it might present a picture which could easily be confused with hernia (2). In the illustration of his second case, the lower esophagus presents an appearance which would now be called invagination, but no mention of this entity was made in the paper. In 1955 an Australian surgeon, K. W. Starr, reported a case in which there was incompetence of the cardioesophageal sphincter, with no hiatal hernia. At operation, cardioesophageal intussusception could easily be produced and reduced. The condition was thought to be very rare (10). Klinefelter, in 1956, added 3 cases of his own to the 11 then recorded in the world literature in which invagination occurred in hiatal hernia. In his opinion there was a greatly increased incidence of dysphagia in patients with invagination. He also believed it was usually necessary to bring the patient from the Trendelenburg to the erect position to demonstrate the invagination, a view not shared by other workers (4). After careful review, the present author feels that in the 3 cases illustrated in Klinefelter's paper no true hiatal hernia was demonstrated; in each instance esophagoscopy was negative and no surgical exploration was made. It seems likely, therefore, that invagination occurred in a normal phrenic ampulla, although the fact may not have been recognized. In June 1959, Haakon Ödegaard reported a further 8 cases of invagination of the esophagus into gastric hiatal hernia (6). The incidence in sliding hernia was found to be about 26 per cent, but no mention was made of the condition apart from hernia. This worker found no specific symptoms related to the invagination. Again, careful review of the cases illustrated suggests that invagination had frequently occurred into a prominent phrenic ampulla rather than into a hernia. Undoubtedly many cases reported by radiologists as small sliding hiatal hernias are not in fact true herniations.