Severe Dysphagia Research Articles

Gastrointestinal involvement in monkeypox.

A 40-year-old man presented to the clinic with vesiculopustular lesions on the face, and genital area (A) and two weeks history of fever, sore throat and severe dysphagia. On physical examination, a macular rash, painful lymphadenopathy were observed and multiple 10 mm umbilicated and non-tender lesions on his penis. Due to dysphagia, an endoscopy was performed, showed ulcerated lesions covered by fibrin in the oral cavity and hypopharynx (B), ulcers well defined, less than 1 cm, with normal-appearing intervening mucosa, in the proximal esophagus (C-D). HIV test was positive, syphilis, chlamydia, and gonorrhea were negative. Polymerase-chain-reaction assays of swabs obtained from lesions were positive for monkeypox. Human monkeypox is a zoonosis caused by monkeypox virus, an orthopoxvirus and close relative of variola virus (smallpox) Complications of infection with the monkeypox virus can include respiratory distress, encephalitis, as well as gastrointestinal involvement, which can include vomiting, diarrhea and oral ulcers, proliferative and necrotizing or ulcerative lesions in the esophagus and stomach has been shown in necropsies of animal models. the patient was treated with mouthwash formulations, Proton Pump Inhibitors and clear liquid diet. Gastrointestinal involvement may develop in the early stage of the disease. Hence, diagnostic suspicion is fundamental for early diagnosis and management.

A retrospective chart review of palliative care consultation during curative-intent chemoradiation for head and neck cancer.

e24165 Background: Head and neck cancer (HNC) treatment with chemoradiation therapy (CRT) is highly morbid. Patients develop significant symptoms including severe pain, dysphagia, and malnutrition resulting in poor quality of life (QOL), frequent hospitalizations, and high rates of depression. Although integration of palliative care (PC) teams into the care of incurable cancers has resulted in improved QOL, less is known about its integration into the care of patients receiving curative-intent treatments. We sought to characterize the use of PC during HNC CRT at a single cancer center. Methods: We performed a retrospective chart review of patients who received curative-intent CRT for HNC from 1/2008 to 1/2019 at Fox Chase Cancer Center. We excluded patients with metastatic disease or who participated in a PC intervention study. Data extracted included: demographics, comorbidities, cancer subtypes, human papilloma virus (HPV) status, inpatient admissions, feeding tube use, pain medication usage, and PC referrals throughout CRT. We used parametric and non-parametric statistics for hypothesis testing. Results: A total of 332 patients were included; median age was 60, 73% were male, 57.8% had oropharynx HNC, 10.2% had a history of chronic pain, and 18.9% had a psychiatric diagnosis. At the start of treatment, 38.5% of patients were on opioids for cancer pain or chronic pain, which increased to 90.7% of patients by the end of CRT. Six months after CRT, 30% of patients remained on opioids. 44.7% of patients required a feeding tube and 51.4% were admitted to the hospital. Despite the significant symptomatology, only 64 patients (19.2%) were referred to PC during treatment. The patients referred to PC were more likely to be younger (p=0.002), have an inpatient admission during treatment (p=0.001), a history of a psychiatric disorder (p=0.001) or substance abuse (p=0.003), and less likely to have HPV-related HNC. Conclusions: A large majority of patients receiving CRT for HNC faced significant pain with a high hospitalization rate, yet few had the expertise of PC involved in their care. Those who were referred to PC were more likely to have pre-existing substance use or chronic pain. These data provide strong rationale for the development of standardized, PC-based interventions to help with the symptomatology of HNC treatment to better serve this high needs population. [Table: see text]

Predictors of toxicity after curative reirradiation with intensity modulated radiotherapy or proton therapy for recurrent head and neck carcinoma: new dose constraints for pharyngeal constrictors muscles and oral cavity.

Our study aims to identify predictive factors of moderate to severe (grade ≥ 2) late toxicity after reirradiation (reRT) of recurrent head and neck carcinoma (HNC) and explore the correlations between dose organs at risk (OAR) and grade ≥ 2toxicity. Between 09/2007 and 09/2019, 55patients were re-irradiated with IMRT or proton therapy with curative intent for advanced HNC. Our study included all patients for whom data from the first and second irradiations were available. Co-variables, including interval to reRT, size of re-irradiated PTV, and dose to OAR, were analyzed as potential predictors for developing moderate to severe long-term toxicity with death as acompeting risk. Receiver-operator characteristics (ROC) analysis assessed the association between dose/volume parameters and the risk of toxicity. Twenty-three patients participated in our study. After amedian follow-up of 41months, 65% of the patients experienced grade ≥ 2late toxicity. The average dose to pharyngeal constrictor muscles (PCM) at the time of reRT showed an association with the risk of grade ≥ 2dysphagia: AUC = 0.78 (95% CI: 0.53-1), optimal cut-off value = 36.7 Gy (sensitivity 62%/specificity 100%). The average dose to the oral cavity at the time of reRT showed an association with the risk of grade ≥ 2dysgeusia: AUC = 0.96 (0.89-1), optimal cut-off value = 20.5 Gy (sensitivity 100%/specificity 88%). Our analysis depicted an association between the dose to OAR and the risk of developing moderate to severe dysphagia and dysgeusia and proposed new dose constraints for PCM (36.7 Gy) and oral cavity (20.5 Gy).

A Predictive Model and Survival Analysis for Tube Feeding in ALS Patients: A Prospective Cohort Study in a Chinese ALS Clinic

Objectives. Tube feeding is an effective way to provide nutritional support for amyotrophic lateral sclerosis (ALS) patients with severe dysphagia. Currently, the predictors of tube feeding and the survival affected by tube feeding were poorly studied in Chinese ALS patients. Therefore, we aimed to explore predictive factors and establish a prediction model to quantitatively predict the risk of tube feeding. Furthermore, we explored the survival benefit provided by tube feeding. Methods. In this longitudinal, prospective cohort study, we included patients diagnosed with ALS using the Awaji criteria at the ALS clinic in Huashan Hospital. Follow-up was conducted by telephone interview from January 1, 2019, to December 30, 2021, or until death. All statistical analyses were performed using R software. Results. Overall, 218 patients were recruited for the study. The multivariate Cox regression analysis showed a high ALSFRS-R slope (adjusted hazard ratio aHR = 4.94 (95% confidence interval (95% CI: 2.26-10.81), p < 0.001 ), low bulbar score ( aHR = 0.81 (95% CI: 0.69-0.96), p = 0.01 ), history of ischemic stroke ( aHR = 5.69 (95% CI: 1.3-24.82), p = 0.02 ), and bulbar involvement ( aHR = 11.87 (95% CI: 1.42-99.31), p = 0.02 ) as independent risk factors of tube feeding. The nomogram model was established with moderate discrimination and calibration. Among 71 ALS patients with tube feeding indication, 33.8% accepted gastrostomy suggestion and 14.1% had nasogastric tube (NGT) insertion. However, gastrostomy and NGT did not accelerate disease progression ( aHR = 0.57 (95% CI: 0.20-1.67), p = 0.31 and aHR = 1.72 (95% CI: 0.43-6.88), p = 0.43 , respectively). Conclusions. We developed a nomogram that could be a prediction tool to predict individual timing of tube feeding for ALS patients. In addition, we found that gastrostomy and NGT did not affect ALS patients’ survival.

Monophasic-quadri-burst stimulation robustly activates bilateral swallowing motor cortices.

A stable, reliable, non-invasive, quantitative assessment of swallowing function remains to be established. Transcranial magnetic stimulation (TMS) is commonly used to aid in the diagnosis of dysphagia. Most diagnostic applications involve single-pulse TMS and motor evoked potential (MEP) recordings, the use of which is not clinically suitable in patients with severe dysphagia given the large variability in MEPs measured from the muscles involved in swallowing. Previously, we developed a TMS device that can deliver quadripulse theta-burst stimulation in 16 monophasic magnetic pulses through a single coil, enabling the measurement of MEPs related to hand function. We applied a system for MEP conditioning that relies on a 5 ms interval-monophasic quadripulse magnetic stimulation (QPS5) paradigm to produce 5 ms interval-four sets of four burst trains; quadri-burst stimulation (QBS5), which is expected to induce long-term potentiation (LTP) in the stroke patient motor cortex. Our analysis indicated that QBS5 conditioned left motor cortex induced robust facilitation in the bilateral mylohyoid MEPs. Swallowing dysfunction scores after intracerebral hemorrhage were significantly correlated with QBS5 conditioned-MEP parameters, including resting motor threshold and amplitude. The degree of bilateral mylohyoid MEP facilitation after left side motor cortical QBS5 conditioning and the grade of severity of swallowing dysfunction exhibited a significant linear correlation (r = -0.48/-0.46 and 0.83/0.83; R2 = 0.23/0.21 and 0.68/0.68, P < 0.001; Rt./Lt. side MEP-RMT and amplitudes, respectively). The present results indicate that RMT and amplitude of bilateral mylohyoid-MEPs after left motor cortical QBS5 conditioning as surrogate quantitative biomarkers for swallowing dysfunction after ICH. Thus, the safety and limitations of QBS5 conditioned-MEPs in this population should be further explored.

Endoscopic treatment of stenosing esophageal cancer

Objective. To highlight the main criteria for selection of patients and materials for endoscopic stenting in stenotic esophageal cancer of different localization, to consider the key stages of surgery and its possible complications. Materials and Methods. 102 endoscopic stenting surgeries in patients with stenotic esophageal cancer of various degrees of obstruction were performed in S. P. Botkin GKB in the period from 2019 to 2021. The analysis of the literature data and comparison of the existing types of esophageal stents were performed, the stenting technique used in our clinic and the review of the causes of complications after endoscopic stenting were considered. Results. Endoscopic stenting in 101 cases (99%) was technically successful; in 99 patients (97%) stenting resulted in positive clinical effect. Conclusion. Endoscopic treatment of stenotic esophageal cancer is an effective and safe method of surgical treatment of patients with clinical manifestations of severe dysphagia.

Demographic and clinical factors associated with recovery of poststroke dysphagia: A meta-analysis.

Poststroke dysphagia (PSD) recovery depends on various factors. We aimed to provide evidence concerning predictive variables for the recovery of PSD. PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP database of Chinese periodicals, Chinese biomedical literature service system (SinoMed), and Cochrane Library databases were systematically searched up to September 21, 2022. According to the inclusion criteria, the literature searched in the database was screened. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed to identify the factors prognostic for PSD. Twenty-eight studies were eligible, and pooled analyses were allowed for 12 potential prognostic factors. We identified older age, higher National Institutes of Health Stroke Scale (NIHSS) score, lower activities of daily living (ADL) score, lower body mass index (BMI), severe dysphagia on admission, aspiration, brainstem stroke, severe cognitive impairment, and bilateral hemispheric stroke were negative factors for the recovery of PSD, while early intervention and Modified Rankin Scale (mRS) = 0 before onset were protective factors for the recovery of PSD. There was no significant association between stroke type and prognosis of PSD. Prognostic factors of PSD summarized in this meta-analysis could be useful for developing reasonable treatment plan to better promote recovery of swallowing function after stroke.

Cut-Off Value of Voluntary Peak Cough Flow in Patients with Parkinson's Disease and Its Association with Severe Dysphagia: A Retrospective Pilot Study.

Background and Objectives. Swallowing and coughing reflexes are both closely associated with airway protection. Peak cough flow (PCF) is associated with dysphagia in several neurogenic diseases. In this study, we aimed to analyze the relationship between PCF and aspiration in Parkinson's disease (PD) and determine the cut-off value of PCF. Materials and Methods. We retrospectively analyzed the records of patients with PD who underwent a videofluoroscopic swallowing study and checked for PCF. A total of 219 patients were divided into an aspiration group (n = 125) and a non-aspiration group (n = 94). Results. Significantly lower PCF values were observed in the aspiration group compared to the non-aspiration group (132.63 ± 83.62 vs. 181.38 ± 103.92 L/min, p < 0.001). Receiver operating characteristic curve analysis revealed that a PCF cut-off value of 153 L/min (area under the receiver operating characteristic curve, 0.648; sensitivity, 73.06%; specificity, 51.06%) was associated with aspiration in PD. Additionally, a univariate analysis showed that the male sex, lower body mass indexes, higher Hoehn and Yahr scales, and PCF values of ≤153 L/min indicated an increased risk of aspiration. Conclusions. Through a multivariate analysis, we demonstrated that a PCF value ≤153 L/min was associated with an increased risk of aspiration (odds ratio 3.648; 1.797-7.407), highlighting that a low PCF is a risk factor for aspiration in patients with PD.

Gut dysmotility in children with neurological impairment: the nutritional management.

Intestinal motility disorders represent a frequent problem in children with neurological impairment. These conditions are characterized by abnormal movements of the gut, which can result in symptoms such as constipation, diarrhea, reflux, and vomiting. The underlying mechanisms leading to dysmotility are various, and the clinical manifestations are often nonspecific. Nutritional management is an important aspect of care for children with gut dysmotility, as it can help to improve their quality of life. Oral feeding, when safe and in the absence of risk of ingestion or severe dysphagia, should always be encouraged. When oral nutrition is insufficient or potentially harmful, it is necessary to switch to an enteral by tube or parenteral nutrition before the onset of malnutrition. In most cases, children with severe gut dysmotility may require feeding via a permanent gastrostomy tube to ensure adequate nutrition and hydration. Drugs may be necessary to help manage gut dysmotility, such as laxatives, anticholinergics and prokinetic agents. Nutritional management of patients with neurological impairment often requires an individualized care plan to optimize growth and nutrition and to improve overall health outcomes. This review tries to sum up most significant neurogenetic and neurometabolic disorders associated with gut dysmotility that may require a specific multidisciplinary care, identifying a proposal of nutritional and medical management.

Salvage transoral videolaryngoscopic surgery for post-irradiation recurrence of hypopharyngeal carcinoma.

Transoral salvage surgery has the potential to preserve a patient's quality of life. Therefore, we investigated the outcomes, safety, and risk factors for postoperative complications of salvage transoral videolaryngoscopic surgery (TOVS) for recurrent hypopharyngeal carcinoma after radiotherapy (RT) or chemoradiotherapy (CRT). This retrospective analysis enrolled patients with hypopharyngeal cancer who had a history of RT or CRT and underwent TOVS from January 2008 to June 2021. The factors related to postoperative complications, postoperative swallowing functions and survival rates were analyzed. Seven patients (36.8%) of the 19 patients developed complications. Severe dysphagia was the primary complication, and post-cricoid resection was a complication risk factor. The FOSS score was significantly lower in the salvage treatment group. The survival rates were: 3-year overall survival: 94.4%; disease-specific survival: 94.4%; 5-year overall survival: 62.3%; and disease-specific survival: 86.6%. Salvage TOVS for hypopharyngeal cancer was feasible, and oncologically and functionally reasonable. Level of Evidence: 2b.

Cancer-associated Regional Ischemic Myopathy: A Rare Immune Myopathy (P9-8.008)

<h3>Objective:</h3> To describe clinical and pathological features of a rare immune myopathy featured by regional ischemia in the setting of cancer. <h3>Background:</h3> Regional ischemic immune myopathy (RIIM) is a rare disorder attributed to myovasculopathy and considered paraneoplastic. It has a high mortality rate. Contrary to dermatomyositis, where microvasculopathy leads to perifascicular pathology and sometimes muscle ischemia, RIIM is characterized by regional necrosis in border zones between perimysial vessels. <h3>Design/Methods:</h3> Review of patient’s clinical and laboratory findings. <h3>Results:</h3> An 81-year-old man manifested subacute proximal limb weakness, dysphagia, and 25-pound weight loss. He had stage IV prostate cancer, diagnosed 3 months prior to weakness-onset. Examination revealed mild facial weakness, flaccid dysarthria, moderate-to-severe neck and limb girdle weakness and atrophy. Videofluoroscopic swallow study showed severe oropharyngeal dysphagia with aspiration. CK was 689 U/L (normal 39–108 U/L) at presentation but 6,145 U/L six weeks earlier. Myositis-associated and HMGCR antibodies were negative. EMG showed proximal-predominant myopathic changes with fibrillation potentials. Muscle biopsy revealed several well-demarcated areas of ischemia involving adjacent fascicles. Necrotic fibers were in a similar early stage of necrosis with no macrophagic infiltration and diffuse sarcoplasmic C5b-9 deposition. A few small collections of perimysial perivascular inflammatory cells were present in the areas of the specimen not affected by ischemia. There was patchy capillary depletion and dilation; some capillaries in areas not affected by ischemia showed complement deposition. Myxovirus resistance protein A (MxA) expression occurred diffusely, especially in necrotic fibers, but without perifascicular predominance. Patient received IVIG 2g/Kg and prednisone 40 mg daily. The limb weakness stabilized while the dysphagia progressed. He expired 3 weeks later. <h3>Conclusions:</h3> RIIM is a rare myovasculopathy leading to muscle weakness in the setting of cancer. In keeping with published data, it has a poor prognosis. The identification of RIIM myopathological changes should trigger the search for underlying malignancy in patients without known cancer. <b>Disclosure:</b> Dr. Granger has nothing to disclose. Dr. Soontrapa has nothing to disclose. Dr. Klein has a non-compensated relationship as a Klein with Neurology Journal that is relevant to AAN interests or activities. Dr. Milone has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Milone has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Genetics, AAN. The institution of Dr. Milone has received research support from Mayo Clinic, CCaTS-CBD. The institution of Dr. Milone has received research support from Mayo Clinic, SGP Award. The institution of Dr. Milone has received research support from MDA for Care Center grant. The institution of Dr. Milone has received research support from Regenerative medicine Minnesota.

UMSARS Versus Laryngoscopy-Based Assessment of Dysphagia.

Multiple System Atrophy (MSA) dysphagia is routinely assessed by the Unified Multiple System Atrophy Rating Scale (UMSARS) part I-item 2. To compare the UMSARS part I-item 2 with an ear/nose/throat (ENT) expert physician assessment. We retrospectively analyzed the data of MSA patients who underwent an ENT assessment (nasofibroscopic and radioscopic exam) and an annual UMSARS assessment. Deglutition Handicap Index (DHI) and pulmonary/nutrition complications were collected. Seventy-five MSA patients were included. The ENT assessment revealed more severe dysphagia compared to the UMSARS part I-item 2 score (P = 0.003). A higher proportion of patients with impaired protective mechanisms showed severe UMSARS-based dysphagia (P = 0.005). Patients with choking and oral/pharyngeal transit defects and nutritional complications were equally distributed across UMSARS part I-item 2 scores. Worse UMSARS part I-item 2 scores had worse DHI scores. The UMSARS-based assessment of dysphagia does not capture key aspects of pharyngo-laryngeal dysfunction reflecting swallowing efficiency.

Preliminary clinical outcomes of head and neck squamous cell carcinoma treated with particle beam radiation therapy.

Further improvement in clinical outcomes is needed for patients with head and neck squamous cell carcinoma (HNSCC), as there is typically a poor prognosis at diagnosis. This study aimed to report the preliminary therapeutic outcomes and side effects in patients with HNSCC receiving particle beam radiotherapy (PBRT), owing to the physical and biological advantages of this approach. We retrospectively analyzed 68 patients with newly diagnosed HNSCC who received PBRT at the Shanghai Proton and Heavy Ion Center (SPHIC) between August 2015 and December 2020. The Kaplan-Meier approach was used to determine overall survival (OS), disease-specific survival (DSS), progression-free survival (PFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS). Common Terminology Criteria for Adverse Events (CTCAE) 4.03 was also used to grade acute and late toxicities. With a median follow-up time of 24.5 months (range, 3-65), the 3-year OS, DSS, PFS, LRFS, RRFS, and DMFS rates for the entire cohort were 79.0%, 84.7%, 67.9%, 83.5%, 83.3%, and 96.1%, respectively. Univariate and multivariate analyses showed that N category was a significant predictor of OS, PFS, and RRFS. In terms of acute toxicities, two patients demonstrated severe mucositis or dysphagia, and two patients also displayed a late toxicity of significant mucosal necrosis. These findings suggest that PBRT can provide patients with HNSCC with a promising therapeutic benefit and manageable toxicity. Prospective evaluation of clinical outcomes with PBRT for HNSCC is warranted, with an emphasis on clinical effectiveness as well as adverse effects and patient quality of life.

Symptom Cluster Experiences of Patients Operated for Oral Cancer: A Mixed Methods Study

ObjectiveThis convergent mixed methods study aimed to obtain a comprehensive understanding of symptom cluster experiences in patients with oral cancer. Survey and phenomenological interviews were conducted in parallel to identify distinct patient subgroups based on symptom cluster experiences along with their predictors and explore experiences of living with symptom clusters, respectively. Data SourcesA convenience sample of 300 patients with oral cancer who had completed surgery provided the quantitative data, and a maximum variation purposive subsample of 20 participants, drawn from the survey sample, provided the qualitative data. Agglomerative hierarchical cluster analysis was used to identify subgroups, multivariate analyses were done to identify predictors, and thematic analysis was used for patient narratives. ConclusionAlmost 94% of the survey participants had two or more co-occurring symptoms. The four most severe and prevalent symptoms were dysphagia, problems with teeth or gums, speech difficulty, and dry mouth. A distinct subgroup consisting of 61% of patients reported severe dysphagia and teeth problems, which was associated with age, oral cancer stage and site. Interviews revealed the causes and the context influencing the perception and response to these symptoms. Thus, the quantitative data provided information on severity and patient subgroups based on symptom cluster experiences, while the qualitative data validated these conclusions and additionally provided in-depth details and meaningful insight on perceived causes and contextual influences of their experiences. This comprehensive picture of symptom cluster experiences can aid in the development of patient-centered interventions for people with oral cancer. Implications for Nursing PracticeAn interdisciplinary approach to targeting concurrent symptoms incorporating psychological and physical interventions is necessary. Older patients treated for Stage IV cancers and for buccal mucosa tumors are at high-risk of having severe dysphagia postoperatively, and these patients should be targeted for dysphagia interventions. The contextual factors play an important role in developing patient-centered interventions.

Benefits of precise endoscopic incision on post-dilation mucosal scars to treat refractory esophageal stricture after endoscopic submucosal dissection

Endoscopic dilation (ED) is the mainstream treatment for esophageal stricture after endoscopic submucosal dissection (ESD). However, some complex esophageal strictures do not respond well to dilation. Endoscopic radial incision (ERI) has proved to be effective in treating anastomotic strictures, but it is rarely used to treat post-ESD esophageal strictures due to technical difficulties and risks, not to mention the optimal method and timing to perform ERI. Here, we developed an integrated procedure in which ED was performed first, followed by ERI on the stiff scars that remained intact after dilation. The ED + ERI procedure resulted in complete, uniform expansion of the esophageal lumen. Between 2019 and 2022, 5 post-ESD patients who received a median number of 11 sessions of ED (range, 4-28) of ED over a period of 322 days (range, 246-584) but still had moderate to severe dysphagia were admitted. 2 or 3 sessions of ED + ERI were performed for each patient interspersed with ED. After a median number of 4 treatments (range, 2-9), all patients were symptom-free or had minimal symptoms. No serious complications occurred in any patients who underwent ED + ERI. Therefore, ED + ERI is safe, feasible, and may serve as a useful therapeutic method for refractory esophageal stricture after ESD.

Intensive Dysphagia Rehabilitation Program Post Covid-19: Case Series Report

Dysphagia often occurs in the most severe cases of Covid-19 infection and has an impact on clinical outcomes and patients’ quality of life. Objective: This study aimed to describe the effects of intensive speech rehabilitation in cases of post-Covid-19 dysphagia in a hospital environment. Methods: This is a series of five patients admitted to a medical ward between May and August 2021. They were dysphagic, underwent orotracheal intubation and were submitted to evaluation and intensive speech therapy for five consecutive days. The intervention involved myofunctional exercises and in three cases electrical stimulation were also associated. The outcomes were: evolution of the Functional Oral Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS) - according to videofluoroscopy - degree of dysphagia according to the Dysphagia Outcome and Severity Scale (DOSS) and improvement in quality of life (SWAL-QOL). Results: After therapy, one patient remained with severe dysphagia, two evolved to mild dysphagia, and two to functional deglutition. In four cases, there was an evolution of the PAS to level 1, showing reduction of aspiration episodes and laryngotracheal penetration, FOIS level 6 and improvement in the quality-of-life questionnaire scores. Conclusion: The therapy promoted an increase in the levels of oral intake, a reduction in the degree of severity of dysphagia and episodes of penetration and laryngotracheal aspiration, in addition to an improvement in the quality of life index in four of the five patients in this series.

Evaluation of the improvement of laryngeal penetration using complete lateral position through videoendoscopic evaluation of swallowing in patients with dysphagia

AbstractAimSome patients with severe dysphagia can eat in a complete lateral position. On this basis, we assessed whether the laryngeal penetration that can occur during videoendoscopic examination of swallowing could be reduced when patients were evaluated in this position.MethodsPatients who underwent videoendoscopic examination of swallowing during hospitalization at Towada City Hospital were at high risk of aspiration in the sitting position and were introduced to the complete lateral position method were included in the study. The penetration–aspiration scale score was evaluated and compared for patients in the sitting and complete lateral positions.ResultsA total of 19 patients (14 men and 5 women, mean age 84.9 ± 5.6 y, mean body mass index 17.9 ± 3.7) were included in the study. The penetration–aspiration scale score was as follows: the sitting position: 4 points, n = 1; 5 points, n = 1; 6 points, n = 11; 7 points, n = 3; 8 points, n = 3; the complete lateral position: 1 point, n = 15; 2 points, n = 2; 3 points, n = 1; 6 points, n = 1. The laryngeal penetration score improved significantly from the sitting position to the complete lateral position (p &lt; 0.001) and 15 patients (78.9%) were able to eat at discharge.ConclusionThe complete lateral position improves laryngeal penetration and may allow patients with dysphagia to continue to eat.

Gamma Knife Thalamotomy for Essential Tremor: A Retrospective Analysis

Gamma knife (GK) thalamotomy has been used as a treatment option for essential tremor (ET). Numerous studies on GK use in ET treatment have reported more varied responses and complication rates. Data from 27 patients with ET who underwent GK thalamotomy were retrospectively analyzed. The Fahn-Tolosa-Marin Clinical Rating Scale for Tremor, handwriting, and spiral drawing were evaluated. Postoperative adverse events and magnetic resonance imaging findings were also evaluated. The mean age at GK thalamotomy was 78.1±4.2years. The mean follow-up period was 32.5±19.4months. The preoperative postural tremor, handwriting, and spiral drawing scores were 3.4±0.6, 3.3±1.0, and 3.2±0.8, respectively, all of which showed significant improvements to 1.5±1.2 (55.9% improvement, P < 0.001), 1.4±1.1 (57.6% improvement, P < 0.001), and 1.6±1.3 (50% improvement, P < 0.001), respectively, at the available final follow-up evaluations. Three patients presented with no improvement in tremor. Six patients presented with adverse effects, including complete hemiparesis, foot weakness, dysarthria, dysphagia, lip numbness, and finger numbness, at the final follow-up period. Two patients presented with serious complications, including complete hemiparesis due to massive widespread edema and chronic encapsulated expanding hematoma. One patient died of aspiration pneumonia following severe dysphagia secondary to chronic encapsulated expanding hematoma. GK thalamotomy is an efficient procedure for treating ET. Careful treatment planning is necessary to reduce complication rates. The prediction of radiation complications will increase the safety and effectiveness of GK treatment.

Ventral cervical spondylophytes as differential diagnosis of neurogenic dysphagia

Ventral cervical spondylophytes can lead to severe dysphagia if they are of sufficient extent and height localization and represent an important differential diagnosis of neurogenic dysphagia, especially in older patients. Presentation of various etiologies of ventral cervical spondylophytes, specific symptoms and abnormalities of the swallowing function caused by spondylophytes, their manifestation in the instrumental swallowing diagnostics and an outlook on treatment options. Summary of the current literature on spondylophyte-related dysphagia and an overview of research results regarding differential diagnostic aspects of neurogenic dysphagia. The manifestation forms of ventral cervical spondylophytes can be very diverse. With respect to dysphagia, disorders of pharyngeal bolus transfer and an increased tendency to aspiration have been observed. The occurrence and severity of the symptoms depend primarily on the extent of the bony attachments and their height localization. In some cases, symptomatic ventral cervical spondylophytes can be arelevant differential diagnosis of neurogenic dysphagia. For amore precise evaluation of the dysphagic symptoms and their association with the spondylophytic outgrowths, avideo fluoroscopy of swallowing (VFS) should be added to the fiber endoscopic evaluation (FEES). In most cases, aresection of the bone spurs leads to asignificant improvement or even to acomplete restitution of the swallowing disorders.

Bilateral Vocal Cord Abduction Paralysis after C1 Laminectomy in a Child with Type 1 Arnold Chiari Malformation.

Background: Type 1 Arnold Chiari is a neurological malformation that may be associated with vocal cord paralysis in Children. In most cases, the vocal cord paralysis is related to protrusion of medulla and cerebellum in the foramen magnum, which led to compression on the vagus nerve.Case report: A 12-year-old child underwent suboccipital decompression and C1 laminectomy for a symptomatic type 1 Arnold Chiari malformation. After the surgery, patient reported severe dyspnea, aphonia, and dysphagia. The videolaryngostroboscopy and neurological examinations reported a postoperative bilateral vocal cord abduction paralysis due to bilateral IX and X cranial nerve paralyzes and a bilateral paralysis of the tongue.Discussion: The type 1 Arnold Chiari malformation clinical picture may present with unilateral or bilateral vocal cord paralysis, which may resolve with an adequate management of the disease. However, the neurosurgical decompression and C1 laminectomy may result in bilateral lesion of the IX, X, and XII cranial nerves, and related severe swallowing, aspiration and vocal cord disorders.Conclusion: We reported the first case of bilateral vocal cord abduction paralysis occurring post-neurosurgical decompression and C1 laminectomy in a child with type 1 Arnold Chiari malformation. This case highlights the importance of surgical steps of the procedure in front of the C1 vertebrae where there are IX, X, and XII cranial nerves.