Pharyngeal Abnormalities Research Articles

Globus sensation: Value of static radiography combined with videofluoroscopy of the pharynx and oesophagus

Pharyngo-oesophageal abnormalities are found in a high proportion of patients with globus sensation. This study compares the diagnostic value of static single- and double-contrast radiography of the pharynx and oesophagus with videofluoroscopy and with videofluoroscopy combined with static radiography in these patients. Pharyngeal and oesophageal morphology and motor function were studied in 130 consecutive patients with globus sensation (46 males, 84 females; mean age, 47 years) by means of static single and double-contrast radiography and by videofluoroscopy. Videofluoroscopy revealed significantly more functional and structural abnormalities compared to static radiography. Pharyngeal and/or oesophageal disorders were found in 89 vs. 47 patients (chi2 [1] = 19.82, P = 0.0001), pharyngeal abnormalities in 54 vs. 27 patients (chi2 [1] = 13.5, P < 0.0002), and oesophageal abnormalities in 72 vs. 27 patients (chi2 [1] = 28.13, P < 0.0001). Videofluoroscopy combined with static radiography revealed significantly more abnormalities than videofluoroscopy alone (chi2 [1] = 4.23, P < 0.05), and assessed mucosal details more reliably than videofluoroscopy alone. The most frequent abnormalities found were nonspecific oesophageal motor disorders, pharyngo-oesophageal sphincter dysfunction, pharyngeal stasis, achalasia, and laryngeal penetration or aspiration of barium. In most patients with globus sensation, pharyngeal and/or oesophageal abnormalities can be detected radiographically. Videofluoroscopy revealed significantly more functional but not morphological abnormalities than did static radiography. Videofluoroscopic studies combined with static radiography had a higher diagnostic value than videofluoroscopic studies alone.

Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations

Clinical and videofluoroscopic evaluation of swallowing were correlated to determine their agreement and relationship to feeding recommendations. We reviewed a total of 148 patients with swallowing difficulties, of which 93 (45 women, 48 men; mean age 62 years) were evaluated by both clinical and radiographic examinations. A variety of materials were used for clinical bedside evaluation of oral and pharyngeal function. Radiographic examination was done with variable viscosity materials and videotape recording of the oral cavity and pharynx. The severity of oral and pharyngeal abnormalities was graded and findings of the examinations were compared. The combined results of both evaluations generated an index of swallowing difficulty which was correlated to the type of diet used if oral feeding was recommended or to a nonoral route of nutrition. In the assessment of oral and pharyngeal dysfunction, clinical evaluation and radiographic examination correlated closely in 94% of patients; however, the status of pharyngeal function was not determined in 61 (66%) of the 93 patients by clinical examination alone. The combined swallowing index was calculated in 89 patients and its severity correlated significantly with the type of feeding recommended; 64 patients were placed on one of three types of diets and 25 had enteral feedings. In conclusion, combined clinical and radiographic examinations correlated well, but clinical evaluation alone was limited by failure to evaluate the pharynx in many patients. The swallowing severity correlated well with final feeding recommendations.

Radiographic techniques and interpretation of abnormal swallowing in adult and elderly patients.

The radiologic evaluation of oropharyngeal dysfunction requires interpretation of observed morphodynamics and bolus movements. This can be facilitated if a simplified biomechanical approach is used to understand basic physiology. Oral stage activity can be described as a lingual delivery pump and pharyngeal stage activity as a glossopharyngeal propulsion pump. Bolus misdirection into the airway is more often due to oral rather than pharyngeal abnormalities and is frequently inconsistent with regard to timing and degree. The video-deglutition examination is still a relatively new diagnostic study and its purpose, indications, and criteria for patient selection should be clearly understood.

Evaluation of the pharyngeal airway in patients with sleep apnea: value of ultrafast MR imaging.

Sleep apnea is often caused by obstruction of the pharyngeal airway. The goal of this study was to use ultrafast MR imaging to examine the pharyngeal airway in patients with sleep apnea and to evaluate the usefulness of this technique for localizing the site of obstruction. Fifteen patients with sleep apnea and five healthy volunteers underwent ultrafast MR imaging while awake and during sleep induced with hydroxyzine hydrochloride. Sequential midline sagittal images of the pharynx were obtained and displayed in the cine mode. Patients with sleep apnea were found to have sites of pharyngeal abnormality that were not present in healthy volunteers. Nine sites of narrowing in seven patients (47%) were detected with the patient awake; 21 sites of obstruction in 13 patients (87%) were diagnosed with the patient asleep. Six patients showed only one obstruction, and seven had several obstructions: five had obstructions at the velum palatinum and at the oropharynx; one had obstructions at the velum palatinum, oropharynx, and hypopharynx; one had obstructions at the velum palatinum and the hypopharynx. The sites of narrowing during wakefulness and the sites of obstruction during sleep were the same in only four (31%) of the patients with pharyngeal airway obstruction. Ultrafast MR imaging is useful for localizing the sites of pharyngeal airway obstruction in patients with sleep apnea.

Deglutition after near-fatal choking episode: radiologic evaluation.

Acute airway obstruction during oral intake is a relatively common event that may be fetal if not relieved immediately. Deglutition was studied in 75 individuals who had experienced a near-fatal choking episode (NFCE) or sudden inability to breathe during food intake that was promptly relieved by means of a Heimlich maneuver, suctioning, or intubation. Videofluoroscopy supplemented by static imaging revealed abnormal stages of deglutition in 58 individuals: oral, 32; pharyngeal, 19; pharyngoesophageal segment (PES), 28; and esophageal, 23. Forty individuals aspirated a liquid bolus; this was more often due to oral dysfunction (bolus leakage, n = 17; delayed initiation, n = 18) than pharyngeal abnormality (defective closure, n = 13; incomplete transport, n = 9). Oral-stage dysfunction was common in those with neurologic disease, a history of dysphagia, and structural or motor abnormalities of the PES or esophagus. Fourteen patients were able to vocalize during the NFCE, and each demonstrated an abnormality of the PES or esophagus that could obstruct a solid bolus, suggesting that symptoms were not due to airway obstruction. A variety of unsuspected deglutition abnormalities were documented, indicating the usefulness of radiographic evaluation after NFCE.

Oropharynx in patients with cerebrovascular disease: evaluation with videofluoroscopy.

Forty-six patients with cerebrovascular disease underwent videofluoroscopic examination of the oropharynx to assess location and severity of swallowing dysfunction with use of boluses of various consistencies. Low- and high-viscosity barium suspensions, a barium paste, and a paste-coated cookie were used; not all patients were given all materials. Thirty-nine patients had abnormalities of both oral and pharyngeal function. Two patients had oral dysfunction only, and five had pharyngeal abnormalities only. Mild swallowing difficulties occurred in 18 patients (39%), moderate dysfunction in 23 (50%), and severe dysfunction in five (11%). Thirty-one patients had pharyngeal stasis, which was symmetric in 25 patients (81%), right-sided in three, and left-sided in three. Asymmetric stasis did not correlate to the site of cerebrovascular disease. Twenty-four episodes of aspiration occurred, half of them with the low-viscosity barium suspension. Thus, video-fluoroscopy can be used to define the location and severity of oropharyngeal abnormalities, which is critical for feeding recommendations. The abnormalities present, however, were not useful in predicting the type of cerebrovascular disease.

Failure of Tonsil and Nose Surgery in Adults With Long-standing Severe Sleep Apnea Syndrome

Seven adult patients with a severe form of sleep apnea syndrome (mean apnea index, 47) underwent surgery for significant structural abnormalities at nose and/or throat level (septal deviation, turbinal hypertrophy, enlarged tonsils, long uvula, pharyngeal tumor). Although a subjective benefit was claimed by most patients, the polygraphic data showed no improvement or only a modest improvement in breathing pattern, oxyhemoglobin saturation, or general sleep architecture except in one patient. In this patient the evolution of the syndrome was recent (3 years) and surgical management of a parapharyngeal tumor resulted in a cure. We conclude that in adults with sleep apnea syndrome of long-standing, surgical correction of nasal or pharyngeal abnormalities should not be expected to normalize sleep and breathing. This contrasts with the known benefits achieved by the same type of surgery in children. Surgery might nevertheless be necessary in some adults to permit the application of other therapeutic means (ie, nasal continuous positive airway pressure).

Swallowing complaints and cineradiographic abnormalities of the pharynx.

In a retrospective study, a comparison was made between a classification of symptoms and cineradiographic findings to clarify the relevance of roentgenologic findings and thus evaluate diagnostic and therapeutic procedures in patients with swallowing disorders. Of 188 patients with swallowing complaints who underwent cineradiography, a total of 152 cases were included in the study at follow-up after 4 years. Their symptoms were classified into three groups: (A) a sensation of obstruction during meals, (B) abnormal sensation felt when eating, or (C) a sensation felt when not eating (globus). In group A, 85% (34/40) had roentgenologic pharyngeal abnormalities, compared to 68% (34/50) in group B and 63% (39/62) in group C. Among the various cineradiographic findings, web and cricopharyngeal incoordination were significantly associated with obstructive symptoms. The cineradiographic findings showed good agreement with the results of endoscopic examinations.

The width of the pharyngo-esophageal junction area.

In order to elucidate the pharyngo-esophageal segment in normal and abnormal conditions the width of the pharyngo-esophageal junction area on three different levels: hypopharynx, infracricoid segment of the cervical esophagus (ICCO) and cervical esophagus was measured in 150 non-dysphagial volunteers and in 252 dysphagial patients examined with cineradiography during barium swallowing. The result indicates that a narrow ICCO in absolute figures reflects the size of the swallowed bolus and is not a predictor of pharyngeal abnormality, per se. However, when the width of the ICCO in a.p. projection is less than 3/4 of the width in lateral projection this can indicate a narrow ICCO and should lead to endoscopy for further evaluation.