Swallowing Quality Of Life Scores Research Articles

The Impact of Vocal Tremor on Deglutition: A Pilot Study.

Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor-related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing remains unclear. Qualitative and quantitative measures were employed to characterize tremor phenotypes and investigate the effects on swallowing physiology. Eleven ETvt participants (1 Male, 10 Female; x̄ age = 74) and 8 iVT participants (1 Male, 7 Female; x̄ age = 71) swallowed 20 mL boluses in cued and uncued conditions under standardized fluoroscopic visualization. Sustained/a/productions were captured to assess the rate and extent of fundamental frequency (F0) modulation. Penetration and Aspiration Scale (PAS) scores were obtained and swallowing biomechanics were captured using Swallowtail™ software. Participants also completed the Swallowing Quality of Life (SWAL-QOL) questionnaire. Hypopharyngeal transit was faster in both VT phenotypes compared with Swallowtail™ normative reference data. Total pharyngeal transit times, however, were only faster in patients with iVT, relative to reference data. No significant differences were observed on the SWAL-QOL or PAS between tremor phenotypes. SWAL-QOL scores revealed that these patients rarely reported dysphagia symptoms. Subtle differences in swallowing patterns were observed across VT phenotypes, possibly related to adaptive mechanisms resulting in quicker pharyngeal bolus transit. Most patients did not report swallowing issues or dysphagia symptoms. This study is foundational for larger studies on this challenging population. 4 Laryngoscope, 2024.

The Early Effects of Longus Colli Muscle and Anterior Longitudinal Ligament Reconstructions on Swallowing Function after Anterior Cervical Surgery: A Six-Month Follow-Up Study.

Anterior cervical discectomy and fusion (ACDF) is the gold standard surgery used to treat cervical degenerative disease. Dysphagia and hoarseness are the two most common complications that occur after anterior cervical surgery (ACS). In this study, we aim to evaluate the early effects of longus colli muscle (LCM) and anterior longitudinal ligament (ALL) reconstructions on swallowing function after ACS. We recruited 91 patients (35 males and 56 females; mean age: 49.41 ± 8.60 years [range: 26-72 years]) who have undergone either ACDF or anterior cervical corpectomy and fusion (ACCF) between August 2019 and October 2021. Patients were divided into LCM and ALL suture group (Group A), and LCM and ALL non-suture group (Group B). Assessments of the incidence of dysphagia and the swallowing quality of life (SWAL-QOL) were completed in 2 days, 1 week, 1 month, 3 months and 6 months after surgery. Average prevertebral soft tissue thickness (APSTT) were measured on lateral cervical spine radiographs taken with X-rays 2 days, 1 month, 3 months and 6 months after surgery. In the 2-day, 1-week and 1-month postoperative follow-up, the incidence of dysphagia in group A was significantly lower than that in group B (p < 0.05), and the SWAL-QOL scores of group A were significantly higher than those of group B (p < 0.05). In the 3-month and 6-month postoperative follow-up, no significant differences were found between groups A and B in terms of the incidence of dysphagia (p > 0.05). In the 6-month postoperative follow-up, no significant differences were found between the groups in terms of SWAL-QOL scores (p > 0.05). There were no significant differences in APSTT between groups during postoperative follow-up (p > 0.05). The reconstructions of LCM and ALL in ACS can effectively improve short-term postoperative swallowing function.

The Effects of Adding Di-Tan Decoction (DTD) and/or Electroacupuncture (EA) to Standard Swallowing Rehabilitation Training (SRT) for Improving Poststroke Dysphagia (PSD): A Pilot, Single-Centred, Randomized Trial.

To evaluate the effect of adding Di-tan decoction (DTD) and/or electroacupuncture (EA) to standard swallowing rehabilitation training (SRT) on improving PSD. In total, 80 PSD patients were enrolled and randomly assigned to the DTD, EA, DTD + EA or control group at a 1 : 1 : 1 : 1 ratio. All patients received basic treatment and standard SRT. The DTD group received DTD orally, the EA group received EA, the DTD + EA group received both DTD and EA simultaneously, and the control group received only basic treatment and standard SRT. The interventions lasted for 4 weeks. The outcome measurements included the Standardized Swallowing Assessment (SSA) and Swallowing-Quality of Life (SWAL-QOL), performed and scored from baseline to 2, 4, and 6 weeks after intervention, and the Videofluoroscopic Dysphagia Scale (VDS), scored at baseline and 4 weeks after intervention. Scores were compared over time by repeated-measures analysis of variance (ANOVA) among all groups. Interactions between interventions were explored using factorial design analysis. (1) The effective rates (ERs) for PSD treatment were higher in the DTD, EA and DTD + EA groups than in the control group (all P < 0.05). The ER was higher in the DTD + EA group than in the DTD or EA group (both P < 0.05). (2) There were significant group effects, time effects and interactions for the SSA and SWAL-QOL scores (all P < 0.05). All groups showed decreasing trends in SSA scores and increasing trends in SWAL-QOL scores over time from baseline to 6 weeks after intervention (all P < 0.01). (3) Factorial design analysis for ΔVDS showed that there was a significant main effect for DTD intervention (F = 11.877, P < 0.01) and for EA intervention (F = 29.357, P < 0.01). However, there was no significant interaction effect between DTD and EA (F = 0.133, P = 0.717). Multiple comparisons showed that the DTD, EA and DTD + EA groups all had higher ΔVDS values than the control group (P < 0.05). The DTD + EA group had a higher ΔVDS than the DTD or EA group (both P < 0.05). (4) Most adverse reactions were mild and transient. Adding DTD or EA to SRT can better improve PSD than applying SRT alone. Adding DTD and EA simultaneously can accelerate and amplify the recovery of swallowing function versus DTD or EA alone, and both are effective and safe treatments, alone or jointly, for PSD and are a powerful supplement to routine treatments.

Effect of Ingestion Training Guided by Volume-viscosity Swallow Test on Post-Stroke Dysphagia

<bold>Objective</bold> To observe the effect of ingestion training guided by volume-viscosity swallow test (V-VST) on swallowing functions and quality of life of patients with dysphagia after stroke. <bold>Methods</bold> A total of 150 patients with dysphagia after stroke who were treated in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January 2019 to December 2020, were recruited and randomly divided into control group and observation group, with 75 cases in each group. The control group received traditional rehabilitation training, such as conventional therapy, cold stimulation training, mouthwash and so on, 15 minutes a time, twice a day, six days a week, lasting for eight weeks. The observation group received ingestion training guided by the V-VST in addition to the traditional rehabilitation training methods of the control group, 10 minutes a time, three times a day, six days a week, lasting for eight weeks. Before and after treatment, video fluoroscopy swallowing study (VFSS) was used to evaluate the swallowing functions; surface electromyography analysis system was used to detect surface electromyography (sEMG) and swallowing duration; upper arm and calf circumferences were measured and nutritional risk screening 2002 (NRS 2002) was used to evaluate the nutritional status of patients; the swallowing-quality of life (SWAL-QOL) scale was used to evaluate the quality of life; Rosenbek aspiration classification standard was used to evaluate the degree of aspiration. <bold>Results</bold> 1) VFSS score: compared with those before treatment, the swallowing function scores in the pharyngeal and oral stages after treatment significantly increased in both groups (<italic>P</italic>&lt;0.05). Compared with the control group, the swallowing function scores of the observation group in the pharyngeal and oral stages were significantly higher after treatment (<italic>P</italic>&lt;0.05). 2) Swallowing duration and maximum amplitude of laryngeal muscle by sEMG: compared with those before treatment, the swallowing duration of laryngeal muscle measured by sEMG was significantly shortened and the maximum amplitude significantly increased in both groups (<italic>P</italic>&lt;0.05). Compared with the control group, swallowing duration of laryngeal muscle by sEMG of the observation group was significantly shorter and the maximum amplitude was significantly higher after treatment (<italic>P</italic>&lt;0.05). 3) Hyoid laryngeal complex mobility: compared with those before treatment, the distances of hyoid bone forward displacement and upward displacement of both groups significantly increased after treatment (<italic>P</italic>&lt;0.05). Compared with the control group, the distances of the hyoid bone forward displacement and upward displacement of the observation group was significantly higher after treatment (<italic>P</italic>&lt;0.05). 4) Nutritional status: compared with those before treatment, the upper arm and calf circumferences of both groups increased significantly after treatment, and the NRS 2002 score decreased significantly (<italic>P</italic>&lt;0.05). Compared with the control group, the upper arm and calf circumferences of the observation group were significantly greater after treatment, and the NRS 2002 score was significantly lower (<italic>P</italic>&lt;0.05). 5) Quality of life: compared with those before treatment, the SWAL-QOL scores of both groups increased significantly after treatment (<italic>P</italic>&lt;0.05). Compared with the control group, the SWAL-QOL score of the observation group was significantly higher after treatment (<italic>P</italic>&lt;0.05). 6) Degree of aspiration: compared with the control group, the degree of aspiration of the observation group was lower after treatment (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> Ingestion training guided by V-VST can improve the swallowing function of patients with dysphagia after stroke, reduce the degree of aspiration, and improve the nutritional status and quality of life.

Scalp-nape acupuncture as adjuvant therapy for pharyngeal dysphagia of stroke at recovery stage: a randomized controlled trial

To observe the therapeutic effect of scalp-nape acupuncture for pharyngeal dysphagia of stroke at recovery stage on the basis of neuromuscular electrical stimulation (NMES) and rehabilitation training. A total of 42 patients with pharyngeal dysphagia of stroke at recovery stage were randomized into an observation group and a control group, 21 cases in each group. Conventional medical symptomatic treatment was given in both groups. NMES and rehabilitation training were adopted in the control group, 30 min for each one. On the basis of the treatment in the control group, scalp-nape acupuncture was given in the observation group, scalp acupuncture was applied at lower 2/5 of anterior and posterior oblique lines of parietal and temporal, nape acupuncture was applied at Fengchi (GB 20), Yiming (EX-HN 14), Gongxue (Extra), Zhiqiang (Extra), Tunyan (Extra), etc. The treatment was given once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the videofluoroscopic dysphagia scale (VDS) score, the Kubota water swallowing test grade, the functional oral intake scale (FOIS) grade and the swallowing quality of life (SWAL-QOL) score were observed in both groups. After treatment, the VDS scores were decreased and the SWAL-QOL scores were increased compared before treatment (P<0.05), the Kubota water swallowing test grade and FOIS grade were improved compared before treatment (P<0.05) in both groups. The changes of VDS score and SWAL-QOL score, Kubota water swallowing test grade and FOIS grade in the observation group were superior to those in the control group (P<0.05). Based on NMES and rehabilitation training, scalp-nape acupuncture can enhance the therapeutic effect on pharyngeal dysphagia of stroke at recovery stage, and improve the patients' swallowing function and quality of life.

Using Swallowing Quality of Life to Compare Oropharyngeal Dysphagia Following Cervical Disc Arthroplasty or Anterior Cervical Discectomy and Fusion

Objective: To evaluate dysphagia outcomes using the swallowing quality of life (SWAL-QOL) questionnaire between patients undergoing cervical disk arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF).Methods: A retrospective review of a prospective surgical database was performed to identify individuals who underwent cervical procedures between 2014 and 2020. Patient-reported outcome measures (PROMs) were collected using SWAL-QOL, VAS, NDI, and SF-12 PCS. All measures were recorded at the preoperative to 6-month postoperative timepoint. Patients were grouped according to cervical procedure and instrumentation used. Differences in PROMs and SWAL-QOL domains were evaluated by t-test and one-way ANOVA with post-hoc testing, respectively. Simple linear regression was employed to evaluate the relationship between number of levels operated on and postoperative outcomes. Results: A total of 161 patients were included. ACDF and CDA patients demonstrated no significant differences in VAS neck and arm, or NDI at any timepoint. However, CDA patients had significantly worse SWAL-QOL scores at 6-months. Preoperative VAS neck was significantly worse for patients who underwent either an ACDF procedure with a stand alone cage or CDA as compared to patients who underwent an ACDF with anterior plating. At 6-months postoperatively, CDA patients reported a significantly worse “fatigue” score compared to ACDF patients. At 6-months postoperatively, ACDF patients reported a significantly better “sleep” scores compared to CDA patients with both recipients of an anterior plate and stand alone cage reporting significantly better scores compared to the CDA cohort (p=0.024; p&lt;0.001). No postoperative outcome studied was significantly associated with number of levels operated on, other than the SWAL-QOL domain of symptom frequency at the 6-week postoperative time point (p=0.032). Conclusion: Patients undergoing either an ACDF or CDA procedure largely did not demonstrate differences in pain, disability, and dysphagia scores. However, at more longitudinal timepoints CDA patients reported worse fatigue and sleep scores compared to ACDF patients.

Clinical trials of Xingnao Kaiqiao needling combined with respiratory training for post-stroke dysphagia

To observe the clinical effect of Xingnao Kaiqiao needling combined with respiratory training on swallowing function, quality of life and throat surface muscle function in patients with post-stroke dysphagia. A total of 124 patients with post-stroke dysphagia were randomized into an observation group and a control group, 62 cases in each group. On the basis of conventional western medication treatment, respiratory training was applied in the control group, once daily, 5 times a week for 4 weeks. On the base of the treatment as the control group, Xingnao Kaiqiao needling was applied at Neiguan (PC6), Sanyinjiao (SP6), Fengchi (GB20), Wangu (GB12), Yifeng (SJ17), posterior pharyngeal wall, Shuigou (GV26) and Lianquan (CV23) in the observation group, once daily, 6 times a week for 4 weeks. Before and after treatment, the Kubota water swallowing test (KWST) scale, swallowing function, swallowing-quality of life (SWAL-QOL) scale, maximum amplitude of pharyngeal surface electromyography (sEMG), and complications of dysphagia were observed and recorded. After the treatment, self-comparison showed that the KWST and swallowing function scores were significantly decreased (P<0.05), the SWAL-QOL score and sEMG were notably increased in both groups (P<0.05) in comparison with their own pre-treatment. The KWST and swallowing function scores were obviously lower in the observation group than in the control group (P<0.05), whereas the SWAL-QOL score and sEMG were evidently higher in the observation group than in the control group (P<0.05). The total effective rate of the observation group was 95.16% (59/62), which was higher than 80.65% (50/62) of the control group (P<0.05). The incidence of dysphagia complications in the observation group was 24.19% (15/62), which was lower than 50.00% (31/62) of the control group (P<0.01). Xingnao Kaiqiao needling combined with respiratory training in the treatment of post-stroke dysphagia can increase the activity of throat muscles, promote the swallowing function, improve the quality of life, and reduce the incidence of dysphagia related complications.

Understanding Quality of Life for Palliative Patients With Dysphagia Using the Swallowing Quality of Life (SWAL-QOL) Questionnaire.

There are few studies concerning the differences in quality-of-life (QOL) between palliative care patients with and without dysphagia to date. We aimed to compare the QOL and symptoms in palliative patients with and without dysphagia using Swallowing Quality of Life (SWAL-QOL). Eighty-one palliative patients with and without dysphagia underwent the SWAL-QOL questionnaire. A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 11 SWAL-QOL domains. Dysphagia significantly impacted patients' QOL in the dysphagic group (mean, 69.5; SD 21.9) than non-dysphagic group (mean, 83.2; SD 14.8) (P = 0.006). Significant differences were observed between both groups for the domains of burden, eating desire, eating duration, symptoms, food selection, communication and mental health. The results also showed that the dysphagic group had lower symptom score across all symptoms, suggesting higher symptom burdens. This study is the first to examine QOL and swallow symptoms in palliative care patients with and without dysphagia. Dysphagia causes significantly worse QOL in palliative care patients. Screening for dysphagia and managing its impact on symptoms and QOL domains is important in palliative care.

Local Retropharyngeal Space Anesthetic for Dysphagia Reduction after Anterior Cervical Discectomy and Fusion Surgery: A Single-Center, Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

The main objective of this study was to analyze the ability of local anesthetic instillation into the retropharyngeal space to reduce dysphagia symptoms and occurrence rates in patients undergoing anterior cervical discectomy and fusion (ACDF) procedures. A single-center, prospective, randomized, double-blinded, and placebo-controlled clinical study was performed. We enrolled patients undergoing one- or two-level ACDF procedures for cervical degenerative disc disease with disc herniation, radiculopathy and/or myelopathy symptoms. The patients were randomly assigned (1:1 ratio) to receive either 0.5% bupivacaine hydrochloride or 0.9% NaCl solution. Forty-three (74%) and 41 (77%) of patients reported dysphagia symptoms at the time of discharge in the investigational and control groups, respectively. There were no statistically significant differences in duration of dysphagia symptoms, Swallowing-Quality of Life (SWAL-QOL) survey or pain scores between the investigational and control patient groups at any of the follow-up time points. Controlling for independent variables, only younger age significantly predicted dysphagia symptoms at discharge, 2-week, and 3-month follow-ups (P ≤ 0.03; R ≥ -0.038; OR 0.96, 95% CI 0.93-0.99. Female sex was associated with lower SWAL-QOL scores at discharge (P= 0.046; R= 0.87; OR 2.38, 95% CI 1.02-5.56). A total of 8 (13.8%) and 6 (11.3%) patients in the investigational and control groups, respectively, were referred to a specialist or underwent speech therapy for their dysphagia symptoms. There were no adverse reactions to the study drug observed. Local retropharyngeal space anesthetic instillation did not reduce dysphagia symptoms or occurrence rates in patients undergoing anterior discectomy and fusion surgeries.

P22. Local retropharyngeal space anesthetic for dysphagia reduction after anterior cervical discectomy and fusion surgery: a single-center, prospective, randomized, double-blinded, placebo-controlled clinical trial

BACKGROUND CONTEXT We hypothesized that a local anesthetic, bupivacaine hydrochloride, may facilitate the sympathetic blockade of the intraoperative stimulation, stabilize the hemodynamic profile and therefore reduce postoperative inflammation and swelling of the esophago-pharyngeal area. PURPOSE The main objective of this study was to analyze the ability of local anesthetic instillation into the retropharyngeal space to reduce dysphagia symptoms and occurrence rates in patients undergoing anterior cervical discectomy and fusion (ACDF) procedures. STUDY DESIGN/SETTING A single-center, prospective, randomized, double-blinded, and placebo-controlled clinical study was performed. PATIENT SAMPLE We enrolled 120 patients undergoing one- or two-level ACDF procedures for cervical degenerative disc disease with disc herniation, radiculopathy and/or myelopathy symptoms. OUTCOME MEASURES Swallowing-Quality of Life (SWAL-QOL) survey, occurrence rates, and duration of dysphagia symptoms. METHODS The patients were randomly assigned (1:1 ratio) to receive either 0.5% bupivacaine hydrochloride or 0.9% NaCl solution. RESULTS Twenty-seven (23.7%) patients reported no dysphagia symptoms: 15 (25.9%) in the investigational and 12 (22.6%) in the control groups. There were no statistically significant differences in duration of dysphagia symptoms, Swallowing-Quality of Life (SWAL-QOL) survey or pain scores between the investigational or control patient groups at any of the follow-up time points. Controlling for independent variables, only younger age significantly predicted dysphagia symptoms at discharge, 2-week, and 3-month follow-ups (p -0.038; OR=0.96, 95% CI 0.93 – 0.99. Female gender was associated with lower SWAL-QOL scores at discharge (p=0.046; R=0.87; OR=2.38, 95% CI 1.02-5.56). A total of eight (13.8%) and six (11.3%) patients in the investigational and control groups, respectively, were referred to a specialist or underwent speech therapy for their dysphagia symptoms. There were no adverse reactions to the study drug observed. CONCLUSIONS Local retropharyngeal space anesthetic instillation did not reduce dysphagia symptoms or occurrence rates in patients undergoing anterior discectomy and fusion surgeries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The impact of dysphagia on quality of life in stroke patients.

The objective of this study was to investigate the quality of life in stroke patients using a swallowing quality of life (SWAL-QOL) questionnaire. The correlation between SWAL-QOL questionnaire outcome and videofluoroscopic dysphagia scale (VDS) scores in stroke patients was also determined.This cross-sectional study was retrospectively conducted with 75 stroke patients with dysphagia symptoms. Videofluoroscopic swallowing study (VFSS) and SWAL-QOL questionnaires were performed for all patients. These patients were divided into an oral feeding group and a tube feeding group. SWAL-QOL scores were compared between the 2 groups. The severity of dysphagia was estimated by VDS scores according to the videofluoroscopic swallowing study results. The relationships between SWAL-QOL scores and VDS scores were also investigated.The composite score was 48.82 ± 19.51 for the tube feeding group and 53.17 ± 25.42 for the oral feeding group. There were significant differences in burden and sleep subdomains of the SWAL-QOL between the 2 groups (P = .005 and P = .012, respectively). There was a significant negative correlation between the composite score of SWAL-QOL outcome and the total VDS score (r = −0.468, P = .012). The pharyngeal-phase score of the VDS had significant negative correlations with the SWAL-QOL subdomains of burden (r = −0.327, P = .013), mental health (r = −0.348, P = .008), and social functioning (r = −0.365, P = .029).To improve the quality of life of stroke patients, dysphagia rehabilitation should focus on the pharyngeal phase of dysphagia.

Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis

BackgroundDysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications. ObjectiveTo identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires. MethodDysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS. ResultsThe mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS.There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman's rho: -0.862, p < .001). ConclusionMS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.

Is the likelihood of dysphagia different in patients undergoing one-level versus two-level anterior cervical discectomy and fusion?

BACKGROUND CONTEXTDysphagia following anterior cervical discectomy and fusion (ACDF) is a common complication, the etiology of which has not been established. Given that one potential mechanism for dysphagia is local tissue edema, it is thought that a greater number of operative levels may result in higher dysphagia rates. However, prior reports comparing one-level to two-level ACDF have shown varying results. PURPOSETo determine if there is a difference in dysphagia between one-level and two-level ACDF. STUDY DESIGN/SETTINGRetrospective review of prospectively collected data. PATIENT SAMPLEPatients who underwent one- or two-level ACDF with a plate-graft construct by a single-surgeon at a high-volume academic medical center. OUTCOME MEASURESNeck Disability Index, Visual Analog Scale for neck pain and arm pain, Short Form-12 physical and mental health components, and Swallowing Quality of Life (SWAL-QOL) Questionnaire. METHODSPatient demographics, operative data, and patient-reported outcome measures (PROMs; Neck Disability Index, Visual Analog Scale, Short Form-12, and SWAL-QOL) of patients undergoing one- and two-level ACDF were compared using Fisher exact test for categorical variables and Student's t test for continuous variables. Regression analyses were conducted to identify factors associated with 6- and 12-week SWAL-QOL scores in order to determine whether the number of surgical levels impacts these outcomes. RESULTSFifty-eight patients (22 one-level and 36 two-level ACDF) were included. Patients undergoing two-level fusions were older (54.17+8.67 vs 48.06+10.68 years, p=.02) and had longer operative times (69.08+10.51 vs 53.5+14.35 minutes, p<.0001). There were no other significant differences in demographics or operative data. Both groups showed a statistically significant improvement in PROMs from preoperatively to 12 weeks. There was no difference in PROMs or dysphagia rates between groups at any time-point. Younger age (p=.023), male sex (p=.021), longer operative times (p=.068), and worse preoperative SWAL-QOL (p<.0001) were associated with dysphagia at 6 weeks. Preoperative SWAL-QOL was the only variable associated with dysphagia at 12 weeks (p=.003). Operative time of >61.5 minutes had a sensitivity and specificity of 62.1% for worse dysphagia scores at 6 weeks compared with baseline. CONCLUSIONSThe results of our study indicate that there is no difference in the degree of postoperative dysphagia in one- versus two-level ACDF. However, other variables associated with increased postoperative dysphagia in our population included younger age, male sex, procedural time >61.5 minutes, and worse preoperative dysphagia. Larger studies are required to confirm these findings and identify additional risk factors for postoperative dysphagia.

An Absorbable Collagen Biomembrane Help Improve Swallowing Function After Anterior Cervical Spine Surgery.

The objective of this study is to investigate the changes in swallowing function after using an absorbable collagen biomembrane during anterior cervical spine surgery (ACSS). A prospective controlled study of patients who underwent two-level anterior cervical decompression and fusion (ACDF) with a zero-profile implant or single-level anterior cervical corpectomy and fusion (ACCF) with cage and plate fixation was performed in our hospital from January 2016. An absorbable collagen biomembrane was used after suturing the prevertebral fascia in the experimental groups. The thickness of prevertebral soft tissue (PST) was measured on lateral X-rays to determine the extent of swelling. In addition, the Bazaz grading system and the Swallowing-Quality of Life (SWAL-QOL) survey were used to assess the swallowing function. A total of 100 patients were included with a follow-up of 12months. Significant differences in PST swelling were found between the experimental groups and control groups at 3months, 6months, and 12months postoperatively (P < 0.05). Patients in the experimental groups had significantly increased SWAL-QOL scores compared with patients in the control groups at 3months and 6months after surgery (P < 0.05). A significant difference in the total incidence of dysphagia was observed at 3months postoperatively between the experimental groups and control groups (P < 0.05). The application of absorbable collagen biomembrane in ACSS can reduce the total incidence of dysphagia and improve swallowing function early after surgery.

Swallowing Function Following Anterior Cervical Discectomy and Fusion With and Without Anterior Plating: A SWAL-QOL (Swallowing-Quality of Life) and Radiographic Assessment.

ObjectiveAnterior cervical plating in anterior cervical discectomy and fusion (ACDF) procedures are associated with improved outcomes compared to stand-alone cages. However, concerns exist regarding increased rates of postoperative dysphagia following an ACDF. This study aims to quantify the effect of anterior plating on swallowing-quality of life (SWAL-QOL) scores and radiographic swelling assessments following a primary, single-level ACDF. MethodsPatients retrospectively reviewed. Patients grouped into those receiving a cage or anterior plate. SWAL-QOL scores were recorded preoperatively and 6 weeks and 12 weeks postoperatively. Lateral radiographs were used to create a swelling index with a ratio of the prevertebral swelling distance to the anterior-posterior diameter of each involved vertebral body. An air index was created using the same methodology. Statistical analysis was performed using chi-square analysis and independent t-tests for categorical and continuous variables. ResultsSixty-eight primary, single-level ACDF patients were included. Forty-one (60.3%) received a stand-alone cage and 27 (39.7%) received a cage with anterior plating. No differences in demographics, comorbidities, operative time, estimated blood loss, or length of hospital stay were identified between Cage and Plate cohorts. Finally, no differences were observed in postoperative SWAL-QOL scores or swelling and air indices between groups. ConclusionThe results demonstrate that patients undergoing a primary, single-level ACDF with or without anterior plating experience similar operative times and lengths of stay. Patients that receive a cage with anterior plating did not experience significant increases in dysphagia as measured by the SWAL-QOL questionnaire compared to patients that received a stand-alone cage. Furthermore, radiographic assessments of swelling are comparable.

Laryngopharyngeal reflux and dysphagia in patients with obstructive sleep apnea: is there an association?

There is evidence that patients with obstructive sleep apnea (OSA) tend to have a high prevalence of laryngopharyngeal reflux (LPR) and dysphagia. These diseases are known to share the same risk factors and may be interrelated, but there is a lack of studies evaluating their co-occurrence. To evaluate whether the presence of signs and symptoms suggestive of LPR may be associated with the presence of dysphagia in patients with moderate and severe obstructive sleep apnea (OSA), as well as assess the additional impact of these diseases on quality of life in patients with OSA. Seventy adult patients with moderate or severe OSA were included in the study. The RSI (Reflux Symptom Index) and Swallowing Quality of Life (SWAL-QOL) in dysphagia questionnaires were administered, laryngoscopy was performed to calculate the Reflux Finding Score (RFS), and fiber-optic endoscopic evaluation of swallowing (FEES) was conducted. The prevalence of LPR was 59.7%, and the prevalence of dysphagia was 27.3%. The association between LPR and dysphagia was present in 17.9% of patients, but with no statistically significant difference. Lower SWAL-QOL scores were observed in several domains in patients with LPR and in only one domain in patients with evidence of dysphagia on FEES. Although 17.9% of patients presented with findings suggestive of concomitant LPR and dysphagia, there was no statistically significant association between these two conditions. Patients with LPR had worse scores in several domains of dysphagia-related quality of life, while FEES evidence of dysphagia was associated with worse quality of life in only one domain.

Predictive Factors of Postoperative Dysphagia in Single-Level Anterior Cervical Discectomy and Fusion.

Retrospective review of prospectively collected data. To investigate if zero profile devices offer an advantage over traditional plate/cage constructs for dysphagia rates in single level anterior cervical discectomy and fusion (ACDF). Dysphagia rates following ACDF have been reported to be as high as 83%, most cases are self-limiting, but chronic dysphagia can continue in up to 35% of patients. Zero profile devices were developed to limit dysphagia, and other plate specific complications, however the literature is currently divided regarding their efficacy. Dysphagia was assessed by swallowing quality of life (SWAL-QOL) scores preoperatively, at 6 weeks and 12 weeks. Patient reported outcome measures (PROMs) including visual analog scale (VAS) and Neck Disability Index (NDI) were collected preoperatively, at 6 weeks and at 6 months. Univariate and multivariate regression analysis was conducted with SWAL-QOL score as the dependent variable. Sixty-four patients were included, 41 received a zero profile device, and 23 received plate-graft construct. Both groups were similar regarding patient demographics, except operative time, with the zero-profile group having a shorter procedure time than the cage-plate group (44.88 ± 6.54 vs. 54.43 ± 14.71 min, P = 0.001). At all timepoints dysphagia rates were similar between the groups. Regression analysis confirmed preoperative SWAL-QOL and operative time were the only significant variables. PROMs were also similar between groups at all time points, except VAS neck at 6 months, which was lower in the plate-graft group (1.05 ± 1.48 vs. 3.43 ± 3.21, P = 0.007). Operative time and preoperative SWAL-QOL scores are predictive of dysphagia in single level ACDF. Zero profile devices had a significantly shorter operative time, and may provide a benefit in dysphagia rates in this regard. 3.

A comparative study for the usage of Fidji cervical cages after multilevel anterior cervical discectomy and fusion

BackgroundPostoperative dysphagia is one major concern in the treatment for patients with cervical spine spondylosis by using anterior cervical discectomy and fusion (ACDF) with plating and cage system. PurposeTo evaluate the influence of two types of surgery for multilevel cervical spondylotic myelopathy (CSM) on postoperative dysphagia, namely ACDF with cage alone (ACDF-CA) using Fidji cervical cages and ACDF with cage and plate fixation (ACDF-CP). MethodsA retrospective study was performed in 62 consecutive patients with multilevel CSM, including 32 underwent ACDF-CA (group A) and 30 underwent ACDF-CP (group B). All enrolled patients were followed up at 48 h, 2 months and 6 months postoperatively, when the dysphagia rate, Swallowing-Quality of Life (SWAL-QOL) score and the thickness of prevertebral soft tissue were recorded. ResultsAt 48 h and 2 months, the dysphagia rate and thickness of prevertebral soft tissue were both significantly lower in group A than in group B, while the SWAL-QOL score of group A was significantly higher than that of group B. No significant difference was observed at 6 months. ConclusionFidji cervical cages could relieve postoperative dysphagia in the treatment of multilevel CSM with ACDF, especially at the first several months postoperatively.

Dysphagia-Related Quality of Life in Adults with Cerebral Palsy on Full Oral Diet Without Enteral Nutrition.

There have been no quantitative studies on dysphagia and its impact on quality of life (QOL) of adults with cerebral palsy (CP). In this cross-sectional study, we aimed to investigate the characteristics of dysphagia symptoms and their impact on QOL in adults with CP on a full oral diet compared with healthy adults. Additionally, we aimed to determine the factors affecting dysphagia-related QOL in this population. We enrolled adults with CP on full oral diet (N=117) and healthy individuals (N=117) and interviewed them using the swallowing-quality of life (SWAL-QOL) questionnaire which includes 14 items regarding dysphagia symptoms and 30 items regarding swallowing-related QOL. The functional status of each participant with CP was evaluated using the gross motor function classification system, the manual ability classification system (MACS), and the Functional Oral Intake Scale (FOIS). Among pharyngeal symptoms, choking on food was reported most frequently (sometimes or more 76.9%), followed by coughing and choking on liquid. Among oral symptoms, chewing problems were reported most frequently (sometimes or more 59.8%), followed by food dribbling from the mouth (sometimes or more 53.8%). Compared to healthy adults, those with CP reported worse QOL across all SWAL-QOL items, with the lowest scores obtained for meal duration, followed by communication, burden, fatigue, sleep, and eating desire. On multiple linear regression analysis, higher MACS level, lower FOIS level, and older age were predictors of worse SWAL-QOL score. Among adults with CP, it is necessary to evaluate swallowing function and establish an active intervention plan even if a full oral diet is established.

The correlation between SWAL-QOL outcome and functional dysphagia scale in stroke patients

There were some reports about Swallowing Quality of Life (SWAL-QOL), however still insufficient in stroke patients. This study is to evaluate the impact of dysphagia on quality of life in stroke patients by demonstrating the correlation between Swallowing Quality of Life questionnaire outcome and Functional Dysphagia Scale (FDS) score. Sixty-one stroke patients with dysphagia were enrolled. To evaluate for patients with cognitive impairment, we used the modified SWAL-QOL questionnaire for caregiver. We performed comparative analysis between the modified SWAL-QOL score of nasogastric tube feeding patients and that of oral feeding patients ( Table 1 ). The severity of dysphagia was assessed by FDS according to the result of VFSS. We investigated the correlation between the modified SWAL-QOL score and the FDS score. When using the modified SWAL-QOL, the mean score of tube feeding group was 107.59 ± 17.04, which of oral feeding group score was 112.21 ± 20.08 ( Table 2 ). A significant difference between two groups was showed in burden and sleep domains respectively ( P = 0.012, P = 0.003). There was no significant difference in total score of modified SWAL-QOL between two groups ( P = 0.345). There was a significant inverse correlation between the total score of SWAL-QOL outcome and that of total FDS score ( r = -0.465, P = 0.000). The pharyngeal phase score of FDS was significantly correlated with burden ( r = −0.361, P = 0.004), mental health ( r = −0.364, P = 0.004), social functioning ( r = −0.307, P = 0.016) and symptom frequency ( r = −0.367, P = 0.004) domains of SWAL–QOL ( Table 3 ). We think it needs to assess the SWAL-QOL in stroke patients with dysphagia and should focus the rehabilitation of pharyngeal phase to promote better patient's quality of life.