Swallowing Quality Of Life Research Articles

CHEN Yinglong's ziwu reinforcing and reducing acupuncture method for post-stroke swallowing dysfunction in the pharyngeal phase: a randomized controlled trial

To observe the clinical effect of CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method on post-stroke swallowing dysfunction (PSD) in the pharyngeal phase, and explore its biomechanical mechanism. A total of 72 patients with PSD in the pharyngeal phase were randomly divided into a ziwu reinforcing and reducing acupuncture group (36 cases, 2 cases dropped out and 1 case was eliminated) and a conventional acupuncture group (36 cases, 1 case dropped out and 1 case was eliminated). The patients in the conventional acupuncture group were treated with conventional acupuncture at Lianquan (CV 23) and bilateral Fengchi (GB 20), Wangu (GB 12), Tongli (HT 5), Zhaohai (KI 6), Hegu (LI 4), Taichong (LR 3). The patients in the ziwu reinforcing and reducing acupuncture group were treated with CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method on the basis of the conventional acupuncture group's acupoints. Both groups were treated with acupuncture for 30 min each time, once a day, and rested for 1 day after 6 days of treatment, and the treatment lasted 4 weeks. Before and after treatment, the standardized swallowing assessment (SSA) score, Rosenbek penetration aspiration scale (PAS) grade, the shortening rate of mandibular-hyoid distance, swallowing quality of life (SWAL-QOL) score were evaluated in the two groups. The removal rate of nasogastric feeding tube was compared in the two groups, and the clinical efficacy and safety of the two groups were compared. After treatment, the SSA scores and PAS grade of the two groups were lower than those before treatment (P<0.001), and above indexes in the ziwu reinforcing and reducing acupuncture group were lower than those in the conventional acupuncture group (P<0.01, P<0.05). After treatment, the shortening rates of mandibular-hyoid distance and SWAL-QOL scores in the two groups were higher than those before treatment (P<0.001), and the shortening rate of mandibular-hyoid distance in the ziwu reinforcing and reducing acupuncture group was higher than that in the conventional acupuncture group (P<0.001). The removal rate of nasogastric feeding tube in the ziwu reinforcing and reducing acupuncture group was 87.9% (29/33), which was higher than 61.8% (21/34) in the conventional acupuncture group (P<0.05). The total effective rate of the ziwu reinforcing and reducing acupuncture group was 84.8% (28/33), which was higher than 61.8% (21/34) of the conventional acupuncture group (P<0.05). Neither group experienced serious adverse reactions. CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method can effectively improve swallowing dysfunction in the pharyngeal phase after stroke, reduce the risk of aspiration, and improve quality of life. Its therapeutic effect may be related to increasing the displacement amplitude of the hyoid bone.

Dysphagia-Specific Instrument Based on Item Response Theory and International Classification of Functioning, Disability and Health.

This study aimed to identify functional challenges faced by individuals with non-esophageal dysphagia and to offer a tool for quantitatively evaluating the person abilities within the framework of the International Classification of Functioning, Disability and Health (ICF). Additionally, this study attempted to differentiate the personal abilities of individuals with dysphagia and hierarchize item difficulties using the ICF-based Item Response Theory (IRT) modeling approach. This cross-sectional study enrolled a cohort of 150 patients with dysphagia (105 male and 45 female) from a tertiary hospital in China. Participants were assigned to evaluate the 114-item ICF dysphagia questionnaire. To further assess their swallowing capabilities, eating patterns, quality of life, and nutritional status, participants underwent a battery of five additional scales. The ICF qualifiers underwent data shaping including dichotomization and missing value imputation, Mokken scale analysis (MSA) for checking unidimensionality, local independence, monotonicity, and invariant item ordering (IIO), and parametric IRT modeling for identifying an optimal model from the 1-parametric logistic model (1PLM), 2PLM, 3PLM, and 4PLM. Finally, we tested the robustness of the optimal model via Monte Carlo simulation and illustrated the usefulness of the model by its person-item map. The 1PLM emerged as the optimal model with a total of 50 ICF items (12 'd-Activities and Participation', 33 'b-Body Functions', and 5 'e-environmental' items). The final scale presented strong reliability with Cronbach's Alpha = 0.967. Furthermore, the scale showed good validity with a significant positive correlation (p < 0.001, = 0.60) between model-estimated person abilities and swallowing-quality of life (SWAL-QoL) scores. The findings also demonstrated measurement equivalence of the final model for individuals with different genders or across various age groups. The utilization of the person-item map can effectively compare the difficulty levels of items with the abilities of patients, thereby facilitating the delivery of tailored care and precise rehabilitation strategies that match the individual competency of those suffering from dysphagia. This study developed a parsimonious dysphagia-specific ICF outcomes tool derived from the IRT, named iSWAL-Performance Scale. The findings complement quantitative information on the psychometric characteristics of this 50-item scale.

Therapeutic effect of proprioceptive neuromuscular facilitation combined with muscle energy technique on post-stroke dysphagia.

According to the Global Burden of Disease Study the prevalence of stroke worldwide has significantly increased from 1990 to 2019, making it the second leading cause of death worldwide. Approximately 70%-80% of stroke patients are unable to live independently due to disability. To explore the therapeutic effect of proprioceptive neuromuscular facilitation (PNF) combined with muscle energy technique (MET) on post-stroke dysphagia. A total of 122 stroke patients with dysphagia admitted to our hospital from January 2017 to December 2020 were divided into the control group (n= 61) and the study group (n= 61). Patients in the control group received conventional rehabilitation plans, while those in the study group were given a combined therapy of MET and PNF. Standard Swallowing Function Assessment Scale (SSA), Videofluoroscopic Swallow Study (VFSS), Swallowing Quality of Life (SWAL-QOL) scores, Water Swallow Test (WST) grading, and efficacy indicators were compared between two group with t-tests, Wilcoxon signed-rank test, χ2 test or Fisher's exact probability test. After treatment, the study group showed lower SSA score (P= 0.036), and VFSS, P= 0.013 than the control group. The changes in SSA score (P= 0.013) and VFSS score (P< 0.001) in the study group were greater than the control group. Furthermore, after treatment, both the study group and the control group showed a decrease in WST grading (P< 0.001); and the degree of post-treatment WST grading decline in the study group was higher (P= 0.009). Besides, after treatment, the SWAL-QOL score of the study group was higher than the control group (P< 0.001); and the effective rate of patients in the study group was higher than that in the control group (P= 0.021). Compared with traditional rehabilitative training strategies, PNF combined with MET can effectively improve swallowing function, and enhance the quality of life in patients with post-stroke dysphagia.

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, 134:4599-4603, 2024.

How enteral nutrition modes influence nasopharyngeal carcinoma survivors with late dysphagia after radiotherapy: a randomized controlled study.

Palliation to late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC) continues to be a challenge. Intermittent oro-esophageal tube feeding (IOE) is an emerging enteral nutrition mode that can address nutrition and quality of life issues related to nasogastric tube feeding (NGT). This study aims to investigate the effect of IOE versus NGT in late dysphagia after radiotherapy for NPC. This randomized controlled study included 82 NPC survivors with late dysphagia after radiotherapy. The subjects were randomized divided into the IOE and NGT groups (n1 = n2 = 41). Both groups received standard-of-care rehabilitation. Enteral nutrition supports were administered through IOE or NGT accordingly. This study lasted 2weeks for each participant. The primary outcome was nutritional status including albumin, hemoglobin, total serum protein, and body mass index. The secondary outcomes were (i) the functional oral intake scale (FOIS), (ii) the penetration-aspiration scale (PAS), (iii) oral transit time (OTT), (iv) hyoid pause time (HPT), (v) pharyngeal transport time (PTT), and (vi) swallowing-quality of life (SWAL-QoL). Three cases quitted the study halfway and there were no significant baseline differences between the IOE (n = 40) and NGT (n = 39) groups. Both time and group effects were significant in all nutritional indicators. The time effect was significant in the FOIS levels, OTT and PTT, while the group effect was not. Either time or group effect were insignificant in the PAS levels and HPT. Both group and time effects were significant in the SWAL-QoL total scores (zGroup = 5.080, P < 0.001; zTime = 18.005, P < 0.001). The significance of time and group effects varied across different dimensions of the SWAL-QoL. Rehabilitation interventions can improve swallowing function among NPC survivors with late dysphagia after radiotherapy. In this population who received standard-of-care rehabilitation, IOE is more conducive to the improvement of nutritional status, and swallowing-related quality of life. ClinicalTrials.gov Identifier: NCT06301763.

Effects of Huoxue Qufeng Decoction combined with Tongguan Liquefying Acupoint Penetration therapy on swallowing function and quality of life in patients with ischemic stroke.

To analyze the effects of Huoxue Qufeng Decoction combined with Tongguan Liquefying Acupoint Penetration therapy on swallowing function and quality of life in patients with ischemic stroke. A total of 145 patients with post-stroke dysphagia admitted to Dingxi People's Hospital from January 2019 to May 2022 were selected with 65 patients in the control group and 80 patients in the observation group. The control group received Huoxue Qufeng Decoction alone, while the observation group received additional Tongguan Liquefying Acupoint Penetration therapy. Clinical efficacy, NIH Stroke Scale (NIHSS) score, Water Swallow Test, Swallowing Function Assessment (SSA) score, MD Anderson Dysphagia Inventory (MDADI) score, overall incidence of adverse events, and Swallowing Quality of Life (SWAL-QOL) score were compared between the two groups. The total response rate in the observation group was higher than that in the control group, with a statistically significant difference (P<0.01). After treatment, the SSA score and NIHSS score were statistically lower in the observation group than in the control group (P<0.01). The MDADI and SWAL-QOL scores were higher in the observation group than in the control group, with a statistically significant difference (both P<0.01). The total effective rate reflected by the Water Swallow Test was significantly higher in the observation group than in the control group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05). Univariate analysis revealed that age and treatment plan were factors influencing the recovery of swallowing function. Logistic multivariate regression analysis further identified age and treatment plan as independent risk factors affecting patient prognosis (P<0.05). Huoxue Qufeng Decoction combined with Tongguan Liquefying Acupoint Penetration has a significant effect on post-stroke dysphagia, effectively improving swallowing function and enhancing quality of life.

The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye.

The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Dysphagia is closely related to frailty in mild-to-moderate Alzheimer’s disease

IntroductionPhysical phenotype and the cumulative deficit model are two well-known concepts of frailty. One of the main components of frailty is loss of muscle mass and function, which may also include swallowing muscles, therefore is a risk factor for dysphagia. Since dysphagia is seen starting from the early stages of Alzheimer’s Disease (AD), in this study we aimed to reveal the relationship between frailty and dysphagia and dysphagia-related quality of life through Swallow Quality of Life (SwalQoL) tool in patients with AD and compare them with cognitively intact older adults.MethodsComprehensive geriatric assessment, dysphagia evaluation by Eating-Assessment Tool (EAT-10) and SwalQoL questionnaire, and frailty assessment via FRAIL and Clinical Frailty Scale (CFS) were performed on all 101 participants of the study. Thirty-five patients were cognitively intact, 36 patients were diagnosed with mild AD, and 30 patients were diagnosed with moderate AD.ResultsSex distribution was similar between the groups, however, there was a statistically significant age difference. The prevalence of frailty increased according to both frailty indexes as the cognitive status deteriorated. All parameters of SwalQoL except fear and sleep parameters deteriorated as cognitive status impaired. In quantile regression of the total score of the SwalQoL questionnaire and multivariable logistic regression of EAT-10, frailty, as defined by CFS and FRAIL, was associated with dysphagia and poor quality of life regardless of age, presence of dementia, as well as nutritional status.ConclusionSwallowing difficulties in AD negatively affects the quality of life, and it is closely related to frailty in mild-to-moderate AD.

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.

Dysphagia May Attenuate Improvements in Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion.

Past studies outline potential risk factors for dysphagia following anterior cervical discectomy and fusion (ACDF). Few studies explored the impact of dysphagia, as measured by the swallowing quality of life (SWAL-QOL), on postoperative patient-reported outcome measure (PROM) improvement. This study aimed to determine the relationship between dysphagia and improvement in pain, disability, physical function, and mental health following ACDF. A retrospective review of patients undergoing primary 1- or 2-level ACDF was performed. Individuals without a completed preoperative SWAL-QOL were excluded. Outcomes were collected for visual analog scale (VAS) neck and arm pain, Neck Disability Index (NDI), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), 9-Item Patient Health Questionnaire (PHQ-9), and SWAL-QOL. Postoperative improvement from preoperative values was evaluated using a paired t test. The impact of SWAL-QOL on each PROM was assessed using linear regression. A total of 91 patients were included. Mean preoperative SWAL-QoL was 90.4, which worsened at 6 weeks and resolved by 6 months (P ≤ 0.007, both). VAS neck and arm scores significantly improved postoperatively (P < 0.001), as did the NDI score (P < 0.001). Physical function significantly improved at 12 weeks and 6 months (P ≤ 0.021, both). Depressive symptoms improved at 6 weeks and 12 weeks (P ≤ 0.007, both). Preoperatively, SWAL-QOL demonstrated significant relationships with all PROMs (P ≤ 0.005, all). At 6 weeks, 12 weeks, and 6 months (P ≤ 0.048, all), SWAL-QoL again demonstrated a similar significant association with all PROMs. Multiple regression did not demonstrate common demographic or operative variables that were significant predictors of PROMs. Following ACDF, patients experienced a worsening of dysphagia but resolved by 12 weeks. All PROMs demonstrated significant improvements by the 6-month timepoint, except for PHQ-9. SWAL-QoL demonstrated a significant effect on all postoperative outcomes, which may suggest that this questionnaire could effectively evaluate dysphagia and predict positive or negative outcomes following ACDF. 3 CLINICAL RELEVANCE: The severity of dysphagia has a significant association with pain, disability, mental health, and physical function patient-reported outcome measures in patients undergoing ACDF.

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.

Effect of Absorbable Collagen Sponge and Steroid Injection for 1- or 2-Segment Anterior Cervical Discectomy and Fusion: A Retrospective Comparison Study

Dysphagia, mostly resulting from prevertebral soft tissue swelling (PSTS), is a common and refractory complication of anterior cervical discectomy and fusion (ACDF). Although the symptoms are mild and moderate in most cases, severe dysphagia can incur significant mental burdens and morbidity in some patients. This retrospective study aims to analyze the effect of absorbable collagen sponge and steroid injection (ACS-SI) for patients with ACDF. A total of 150 patients in the ACS-SI group and 175 in the ACDF without absorbable collagen sponge and steroid injection (ANCS-SI) group were enrolled in this study from the Affiliated Lihuili Hospital of Ningbo University from January 2018 to November 2020. Baseline characteristics and operation parameters were collected from medical records. Swallowing function was evaluated by the Swallowing-Quality of Life (SWAL-QOL) survey, odynophagia was assessed by visual analog scale (VAS), and prevertebral soft tissue swelling index (PSTSI) was measured. There was no significant difference in baseline characteristics and operation parameters between the 2 groups. The improvement of PSTSI and recovery of swallowing function in the ACS-SI group was better than that in the ANCS-SI group at 1 day and 1-month follow-up visit (P < 0.05). The VAS score was significantly higher at 2 and 7 days after operation in the ANCS-SI group than that in the ACS-SI group (6.61 ± 0.68 vs. 5.52 ± 0.74 and 4.23±0.90 vs. 2.08 ± 0.56, P < 0.05). There was no significant difference in clinical outcomes between the 2 groups after 1 month (P > 0.05). The use of ACS-SI is beneficial to relieve postoperative odynophagia, reduce PSTS, and recover swallow function.

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.

Electromyographic measures of asymmetric muscle control of swallowing in Parkinson's disease.

During the early stages, Parkinson's disease (PD) is well recognized as an asymmetric disease with unilateral onset of resting tremor with varying degrees of rigidity, and bradykinesia. However, it remains unknown if other impairments, such as swallowing impairment (i.e., dysphagia), also present asymmetrically. The primary aim of this study was to examine muscle activity associated with swallow on the most affected side (MAS) and least affected side (LAS) in persons with PD. A secondary aim was to explore the relationship between differences in muscle activity associated with swallow and subjective reports of swallowing impairment and disease severity. Function of muscles associated with swallowing was assessed using surface electromyography placed over the right and left submental and laryngeal regions during three swallows for a THIN and THICK condition. The Swallowing Quality of Life (SWAL-QOL) questionnaire and the Unified Parkinson's Disease Rating Scale (UPDRS) were collected as measures of subjective swallow impairment and disease severity, respectively. Thirty-five participants diagnosed with idiopathic PD and on a stable antiparkinsonian medication regimen completed this study. Results revealed no significant mean difference in muscle activity during swallow between the more and less affected side. For the laryngeal muscle region, a significant difference in coefficient of variation between the MAS and LAS was revealed for peak amplitude for the THIN swallow condition. For the laryngeal muscle region, a significant association was revealed between muscle activity and disease severity but not subjective reports of swallowing impairment. Superficially it appears that swallowing impairment present symmetrical during the early stages of PD, however, our variability data indicates otherwise. These results will be used to inform future studies in specific types of swallowing impairment (i.e., oral dysphagia, pharyngeal dysphagia, and esophageal dysphagia), disease progression, and overall asymmetry.

Randomized Trial of Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Long-Term Results of the ORATOR Trial.

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has risen rapidly, because of an epidemic of human papillomavirus infection. The optimal management of early-stage OPSCC with surgery or radiation continues to be a clinical controversy. Long-term randomized data comparing these paradigms are lacking. We randomly assigned patients with T1-T2, N0-2 (≤ 4 cm) OPSCC to radiotherapy (RT) (with chemotherapy if N1-2) versus transoral robotic surgery plus neck dissection (TORS + ND) (with or without adjuvant therapy). The primary end point was swallowing quality of life (QOL) at 1-year using the MD Anderson Dysphagia Inventory. Secondary end points included adverse events, other QOL outcomes, overall survival, and progression-free survival. All analyses were intention-to-treat. Herein, we present long-term outcomes from the trial. Sixty-eight patients were randomly assigned (n = 34 per arm) between August 10, 2012, and June 9, 2017. Median follow-up was 45 months. Longitudinal MD Anderson Dysphagia Inventory analyses demonstrated statistical superiority of RT arm over time (P = .049), although the differences beyond 1 year were of smaller magnitude than at the 1-year timepoint (year 2: 86.0 ± 13.5 in the RT arm v 84.8 ± 12.5 in the TORS + ND arm, P = .74; year 3: 88.9 ± 11.3 v 83.3 ± 13.9, P = .12). These differences did not meet the threshold to qualify as a clinically meaningful change at any timepoint. Certain differences in QOL concerns including more pain and dental concerns in the TORS + ND arm seen at 1 year resolved at 2 and 3 years; however, TORS patients started to use more nutritional supplements at 3 years (P = .015). Dry mouth scores were higher in RT patients over time (P = .041). On longitudinal analysis, the swallowing QOL difference between primary RT and TORS + ND approaches persists but decreases over time. Patients with OPSCC should be informed about the pros and cons of both treatment options (ClinicalTrials.gov identifier: NCT01590355).

Pharyngeal electrical stimulation in amyotrophic lateral sclerosis: a pilot study.

Background:Patients with amyotrophic lateral sclerosis (ALS) suffer from dysphagia that increases the risk for aspiration, pneumonia and weight loss. Pharyngeal electrical stimulation (PES) is a therapeutic technique that applies electric stimuli to the patient’s pharynx in order to improve swallowing based on the principle of cortical plasticity and reorganization. Previous studies have demonstrated positive effects in patients with various neurological diseases.Objective:This study was initiated to investigate the effect of PES on swallowing function in patients with ALS.Methods:In all, 20 ALS patients with severe dysphagia [characterized by a Penetration Aspiration Scale (PAS) of at least 4 in thin liquid] were randomized to receive either PES for 10 min at 3 consecutive days in addition to Standard Logopaedic Therapy (SLT) or SLT alone. Swallowing function was evaluated by Fiberoptic Endoscopic Evaluation of Swallowing (FEES) at five timepoints: at baseline, 1 day, 4 days, 3 weeks and 3 months after treatment. Primary endpoint was the severity of penetrations or aspirations as classified by PAS. Secondary endpoints were adverse events, dysphagia-related quality of life, Swallowing Quality of Life (SWAL-QOL), Dysphagia Severity Rating Scale (DSRS), residues, leaking, ALS Functional Rating Scale Revised (ALSFRS-R), and the performance in Clinical Evaluation of Swallowing (CES). The trial is registered under the name of ‘Pharyngeal Electrical Stimulation in Amyotrophic Lateral Sclerosis’ with ClinialTrials.gov, number NCT03481348 (https://clinicaltrials.gov/ct2/show/NCT03481348).Results:Both groups combined showed a significant improvement (p = 0.003) of median Total-PAS from 3.6 [interquartile range (IQR) = 2.9–5.0] at baseline to 2.3 (IQR = 1.8–4.0) 1 day after treatment. During subsequent study visits, PAS increased again but remained below baseline. PES and control group did not differ significantly 1 day after intervention (p = 0.32). Similar effects were found in the majority of secondary endpoints.Interpretation:The findings suggest that PES may not provide an additional positive effect on swallowing function in ALS. SLT seems to yield at least short-term positive effects on swallowing function and swallowing-specific life quality in ALS.Registration: ClinialTrials.gov: NCT03481348

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.

The Effect of Esophageal Temperature Probes on Postoperative Dysphagia Following Primary Anterior Cervical Discectomy and Fusion: A Randomized Prospective Study.

The anterior approach to the cervical spine is associated with postoperative dysphagia. It is difficult to predict which patients are most at risk for dysphagia. The objective of this study was to determine if placing an esophageal temperature probe preoperatively would affect the severity and length of postoperative dysphagia. We hypothesize that use of an esophageal temperature probe would result in worse postoperative dysphagia at all measured time points as measured by the Swallowing-Quality of Life (SQAL-QOL) survey after anterior cervical discectomy and fusion (ACDF). A total of 44 patients were enrolled in a prospective, randomized controlled trial and randomized into groups: 1 with an esophageal temperature probe placed at the time of surgery and 2 without. A total of 39 patients filled out postoperative SWAL-QOL questionnaires at their preoperatives. Using the survey results, the data were analyzed between groups and subanalyzed based on number of operative levels and sex. SWAL-QOL scores for patients undergoing 2-level ACDF with an esophageal temperature probe were significantly better compared with those without a probe at 2 weeks and 6 months postoperatively. These results were not significant at other time points in in the overall analysis, but a trend toward improved dysphagia scores at each time point postoperatively was seen with the probe group. No differences were found between the 2 groups with respect to age at the time of surgery, sex, and preoperative SWAL-QOL score. Placement of an esophageal temperature probe at the time of surgery significantly improved postoperative dysphagia scores in patients undergoing 2-level ACDF at 2 weeks and 6 months postoperatively. 2 CLINICAL RELEVANCE: Placement of a temperature probe is a safe and effective technique that is readily available and easily applicable to the practice of spine surgery and may improve postoperative dysphagia after ACDF.