Videofluoroscopic Examination Of Swallowing Research Articles

Factors influencing the decision to introduce alternative nutrition in patients with Duchenne muscular dystrophy.

Nutritional management of adults with Duchenne muscular dystrophy (DMD) is an important clinical issue. However, it is not clear which dysphagia-related factors should prompt introduction of alternative nutrition (AN). We aimed to determine which patients with DMD were introduced to AN. This retrospective study included 56 patients with DMD (median age, 23.5 years). They were divided into patients able to continue oral feeding (OF) and those introduced to AN. Body weight, frequency of ventilator use, daily meals, history of steroid treatment, results of videofluoroscopic examination of swallowing (VF), and awareness of dysphagia were evaluated. Of 56 patients, 19 were in the AN group. After AN introduction, 93% of the patients continued oral intake. The proportion of patients who consumed chopped and liquid diets was higher, and body weight was lower, in the AN than in the OF group. There were no significant differences in age, upper limb function of feeding, frequency of ventilator use, or history of steroid therapy between the two groups. The frequencies of aspiration and residue in the pyriform sinus in VF were higher in the AN group than in the OF group. Decision-tree analysis showed that food form and subjective difficulty swallowing solid foods were the most important factors affecting the decision-making for AN. Patients with DMD who had difficulty eating solid foods were started on AN because they were unable to maintain their weight. These findings provide information for future longitudinal studies to assess the value of AN.

Impact of the perioperative assessment of deglutition on postoperative respiratory complications in elderly patients undergoing gastrectomy for gastric cancer.

To investigate the association between perioperative deglutition screening and postoperative respiratory complications (PRCs) in elderly patients undergoing gastrectomy for gastric cancer. We analyzed data from 86 patients with gastric cancer (aged ≥ 70years) who underwent gastrectomy between October, 2016 and November, 2018. Videofluoroscopic swallowing examinations (VFSEs) were performed before and after surgery. We examined the association of these results with postoperative respiratory complications, as well as the relationships between demographic, operative, and swallowing function assessment data. PRCs were identified in 16 patients. The results of pre- and postoperative VFSE showed abnormalities in 28 and 32 patients, respectively. Multivariate analysis revealed that abnormalities in the postoperative VFSEs were strongly associated with the development of PRCs (P = 0.002). The findings of this analysis suggests that ventilatory impairment, a Charlson comorbidity index score ≥ 3, and an open surgical approach are independent risk factors for PRCs. This is the first study to demonstrate the efficacy of perioperative assessment of swallowing function using VFSE for predicting PRCs in elderly patients undergoing gastrectomy for gastric cancer.

Airway Protection in Children With Dysphagia: A Preliminary Study

Purpose : The physiology and pathophysiology of pediatric swallowing are challenging due to anatomical differences. There are only a few videofluoroscopic case studies examining the relationship between physiologic events and aspiration in infants, especially, airway protection mechanisms using temporal measurements. This study examined the airway protection mechanisms using two temporal measurements: the initiation and duration of laryngeal closure between two groups of children who were referred for dysphagia evaluation.BRMethods : Twelve children (8 younger and 4 older children) were patriciate in the study. Initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) were measured using videofluoroscopic swallowing examinations (VFSEs) with a 100-ms timer for bottle-fed or 2mL thin liquids and/or puree boluses. Two-way analysis of variance (ANOVA) was used at a significance level of p.05.BRResults : Younger children showed longer LCD than older children. There was no significant difference in ILC between younger and older children with dysphagia. The puree had longer ILC and shorter LCD than the thin liquid bolus.BRConclusions : The longer duration of laryngeal closure in younger children may indicate that their anatomical structure is more prone to better protect their airways than older children. Longer ILC and shorter LCD were observed in both children groups who presented penetration or aspiration. These pathophysiological phenomena should be observed closely as indicators of the higher risk of dysphagia. Bolus modification such as thickened liquid may help the children to keep from aspiration.

Effect of three tongue needles acupoints Lianquan (CV23) and Hegu (LI4) combined with swallowing training on the quality of life of laryngeal cancer patients with dysphagia after surgery.

To evaluate the effect of acupuncture therapies administered in combination with swallowing training on the quality of life of laryngeal cancer patients with dysphagia after surgery. Seventy-one postoperative patients with laryngeal cancer participated in this study. The patients diagnosed with swallowing dysfunction by video fluoroscopic swallowing examination (VFSE) were randomly divided into experimental group (n = 36) and control group (n = 35). Patients in both groups were provided swallowing training and rehabilitation consultation. Patients in the experimental group were additionally provided with acupuncture therapies. All patients were evaluated using VFSE and MD Anderson dysphagia inventory (MDADI) and Quality of Life Questionnaire-core 30 (QLQ-c30) score immediately after surgery and three months later. The effective rate of 97.1% (n = 35) and the complete remission rate of 36.1% (n = 13) in the experimental group were higher than those in the control group of 60% (n = 21) and 14.3% (n = 5) (P < 0.01). The scores of VFSE, MDADI and QLQ-c 30 in the experimental group and the control group at three months after therapies were significantly improved compared with those before therapies (P < 0.05). The scores of VFSE, MDADI and QLQ-c30 in the experimental group at three months after therapies were significantly improved compared with the control group. The improvement in the intervention group was significantly better than that in the control group. There were no adverse reactions in two groups. Acupuncture therapies combined with swallowing training can improve the swallowing function and the quality of life of laryngeal cancer patients with dysphagia after surgery.

Differences of laryngeal closure during the swallow between stroke and head and neck cancer survivors

Purpose: The purpose of this study was to examine the difference of two laryngeal closure transition measures: initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) among stroke survivors, head and neck cancer survivors, and healthy age-matched controls.Methods: ILC and LCD were determined by analyzing two 5ml thin liquid swallows exhibited by each of the 15 stroke survivors, 15 head and neck cancer survivors, and 15 healthy controls from the videofluoroscopic swallowing examinations (VFSEs). Statistical analyses were made using one-way analysis of variance (ANOVA) using the three groups as independent variables with the statistical level set at p&lt;0.05.Results: ILC was longer in stroke survivors compared to head and neck survivors and healthy controls; however, these results were only significant compared to controls. Head and neck cancer survivors exhibited significantly longer LCD when compared to healthy controls, but not to stroke survivors.Conclusions: Differential diagnosis based on swallowing pathophysiology is critical to manage and treat dysphagia in these populations.

Effect of swallowing training combined with nutritional intervention on the nutritional status and quality of life of laryngeal cancer patients with dysphagia after operation and radiotherapy.

Dysphagia is a common complication in patients with laryngeal cancer after surgery and radiotherapy. To explore the effect of swallowing training administered in combination with nutritional intervention on the nutritional status and quality of life of laryngeal cancer patients with dysphagia after surgery and radiotherapy. Sixty-six patients with laryngeal cancer who developed dysphagia were randomly divided into control group and intervention group (n=33 in each group). Patients in both groups received total laryngectomy and prophylactic radiotherapy and were provided routine health counseling and swallowing training. Patients in the intervention group were additionally provided with nutritional intervention. All patients were evaluated using video fluoroscopic swallowing examination (VFSE), Patient-Generated Subjective Global Assessment on nutritional status (PG-SGA) score, and Quality of Life Questionnaire-core 30 (QLQ-c30) score immediately after radiotherapy and 3months later. Prior to swallowing training, there was no significant between-group difference with respect to VFSE evaluation, PG-SGA score, or QLQ-c30 score. Both groups showed improvement in these measures at 3months after radiotherapy; however, the improvement in the intervention group was significantly better than that in the control group. Swallowing training combined with nutritional intervention can improve swallowing function, nutritional status and the quality of life of laryngeal cancer patients with dysphagia after operation and radiotherapy.

Effects of head flexion posture in patients with dysphagia.

The chin-down posture is often used as a compensatory manoeuvre for patients with dysphagia. This posture presumably involves flexion of the head and/or neck, but this is not clearly defined. This study aimed to assess the effects of head flexion posture in a retrospective study of videofluoroscopic examination of swallowing (VF). A total of 73 patients who underwent VF both with and without head flexion posture in the lateral projection were included in the analysis. The head and neck angles at the initiation of the swallowing reflex, penetration-aspiration scale (PAS), nasopharyngeal closure time, stage transition duration, duration of laryngeal closure, time from swallowing reflex to laryngeal closure and to the opening of upper oesophageal sphincter (UES), duration of UES opening, location of the bolus leading edge at swallowing reflex, and bolus transition time were evaluated. The head flexion angle increased (p<0.001), but the neck flexion angle did not change in the head flexion posture. Moreover, PAS improved (p<0.001), aspiration was reduced (p<0.001), the time between the swallowing reflex and the onset of laryngeal closure was shortened (p=0.006), and the leading edge of the bolus at swallowing reflex became shallower (p=0.004) in the head flexion posture. Other parameters did not significantly change. The head flexion posture resulted in earlier laryngeal closure and a shallower position of the leading bolus edge at swallowing reflex, resulting in PAS improvement and decreased aspiration.

Cough-Inducing Method Using a Tartaric Acid Nebulizer for Patients with Silent Aspiration.

The tartaric acid nebulizer is a well-known cough test to evaluate cough function. This study aimed to evaluate the effectiveness of a cough-inducing method using tartaric acid (CiTA). Patients with dysphagia examined by videofluoroscopic examination of swallowing (VF) at a single institution from May 2017 to August 2017 were included in this retrospective observational study. Although undergoing VF, patients who had aspirated without reflexively coughing or who had coughed insufficiently, were instructed to cough voluntarily. Patients who could not cough voluntarily or had expectorated insufficiently underwent the CiTA method. The rate of cough induction and the effectiveness of expectoration using the CiTA method were evaluated. One hundred fifty-four patients (mean age 69.2 ± 16.8 years) were evaluated. Eighty-seven patients aspirated during VF. Of those patients, 15 were able to expectorate via the cough reflex, 18 were able to expectorate with a voluntary cough, and 12 required suctioning for removal of aspirated material. The remaining 42 patients underwent the CiTA method. Thirty-eight patients (90.4%) could reflexively cough, and 30 (71.4%) could expectorate the aspirated material. This novel method, CiTA, was effective for cough induction in patients with dysphagia, especially for those with silent aspiration.

嚥下造影検査（VF）における検査者の放射線被曝線量の推定

嚥下造影検査（VF）における検査者の放射線被曝線量の推定

Investigation of Embodied Language Processing on Command-Swallow Performance in Healthy Participants.

Purpose During videofluoroscopic examination of swallowing, patients commonly are instructed to hold a bolus in their mouth until they hear a verbal instruction to swallow, which usually consists of the word swallow and is commonly referred to as the command swallow condition. The language-induced motor facilitation theory suggests that linguistic processes associated with the verbal command to swallow should facilitate the voluntary component of swallowing. As such, the purpose of the study was to examine the linguistic influences of the verbal command on swallowing. Method Twenty healthy young adult participants held a 5-ml liquid bolus in their mouth and swallowed the bolus after hearing one of five acoustic stimuli presented randomly: congruent action word (swallow), incongruent action word (cough), congruent pseudoword (spallow), incongruent pseudoword (pough), and nonverbal stimulus (1000-Hz pure tone). Suprahyoid muscle activity during swallowing was measured via surface electromyography (sEMG). Results The onset and peak sEMG latencies following the congruent action word swallow were shorter than latencies following the pure tone and pseudowords but were not different from the incongruent action word. The lack of difference between swallow and cough did not negate the positive impact of real words on timing. In contrast to expectations, sEMG activity duration and rise time were longer following the word swallow than the pure tone and pseudowords but were not different from cough. No differences were observed for peak suprahyoid muscle activity amplitude and fall times. Conclusions Language facilitation was observed in swallowing. The clinical utility of the information obtained in the study may depend on the purposes for using the command swallow and the type of patient being assessed. However, linguistic processing under the command swallow condition may alter swallow behaviors and suggests that linguistic inducement could be useful as a compensatory technique for patients with difficulty initiating oropharyngeal swallows.

The effect of reclining position on swallowing function in stroke patients with dysphagia.

Dysphagia is a common problem in patients with a history of stroke. In Japan, a reclined position is commonly used as a compensatory technique to address this problem. To evaluate the effect of reclined position on swallowing function in patients with stroke who had dysphagia. A retrospective analysis was carried out on the videofluoroscopic examination of swallowing (VF) of 4ml honey-thick liquid swallows collected over 9years. Penetration-aspiration scale (PAS) and residue scores were compared for the following: a body position at 90° upright (90°U) and 60° reclining (60°R) groups, as well as 60°R and 45° reclining (45°R) groups. Two hundred and five records from 98 subjects were reviewed. These included patients with ischaemic stroke (62%), haemorrhagic stroke (32%) and subarachnoid haemorrhage (6%). PAS scores were lower when the body was in a more reclined position (P<.001). The amount of residue in the valleculae and pyriform sinus also reduced in the more reclined position (P<.001). The deeper bolus head at swallowing onset was positively correlated with severe PAS (P<.001). These findings suggest that in patients with stroke who had dysphagia, a reclined position may be useful in reducing the risk of penetration and aspiration, and in decreasing the amount of residue in the pharyngeal area. The depth of the bolus head at the onset of swallowing increases the severity of penetration and aspiration.

Obstruction-related dysphagia in inclusion body myositis: Cricopharyngeal bar on videofluoroscopy indicates risk of aspiration

ObjectiveTo show the predictive risk factors for aspiration pneumonia and prognostic importance of a cricopharyngeal bar (CPB) on videofluoroscopic examination of swallowing (VFS) in inclusion body myositis (IBM). MethodsIn this retrospective study, we examined a consecutive series of 37 patients with clinico-pathologically defined IBM based on the European Neuromuscular Center diagnostic criteria for IBM from 2013. The Swallowing Disturbance Questionnaire was used for the evaluation of dysphagia. A standard VFS was performed at diagnosis. The primary outcome was aspiration pneumonia. Secondary outcomes included IBM Functional Rating Scale score, forced vital capacity (FVC), and body mass index. ResultsAspiration pneumonia occurred in 10 of 37 IBM patients (27%). Based on univariate analysis, 4 factors increased aspiration pneumonia risk: BMI < 18.5 (n = 5; hazard ratio [HR], 10.7; 95% CI, 2.50–46.0; p = .001); aspiration (n = 7; HR, 7.57; 95% CI, 1.82–31.6; p = .005); insufficient opening of the upper esophageal sphincter (n = 11; HR, 4.53; 95% CI, 1.12–18.3; p = .03); and CPB presence (n = 15; HR, 11.6; 95% CI, 1.46–91.8; p = .02). Clinical features of IBM-CPB(+) were elderly onset, obstruction-related dysphagia, and mild decreases in FVC, resulting in aspiration pneumonia in 1.3 years (interquartile range, 0.9–5.2); 67% of IBM-CPB(+) patients underwent interventional procedures for dysphagia. IBM-CPB(+) patients had a lower FVC than IBM-CPB(−). ConclusionsA CPB in IBM largely contributes to obstruction-related dysphagia and is a risk factor that predicts aspiration pneumonia and refractory dysphagia requiring aggressive therapy.

Hyoid excursion during the swallow in stroke survivors

Purpose: To examine whether duration, distance or velocity of hyoid excursion is associated with aspiration during the swallow in post-stroke survivors. Method: Duration, distance and velocity of hyoid excursion were calculated using videofluoroscopic swallowing examinations (VFSEs) of 39 post-stroke survivors. Statistical comparisons were made by two-way repeated measures analysis of variance (ANOVA) with between subject variable being aspirators and non-aspirators, and within subject variable being bolus volume (5 ml and 10 ml). Significance level was set as p<0.05. Results: The duration of hyoid excursion in aspirators was significantly slower than in non-aspirators. There were no significant differences in hyoid velocity or distance between aspirators and non-aspirators. Conclusion: Slower hyoid excursion duration may put stroke survivors at risk of aspiration. It is necessary for the clinician to design the intervention strategies to compensate for or rehabilitate from slow hyoid excursion in stroke survivors.

How a personalised transportable folding device for seating impacts dysphagia

PurposeA personalised transportable folding device for seating (DATP) on a standard seat was developed by an occupational therapist at the Toulouse University Hospital Centre (patent no. WO 2011121249 A1) based on the hypothesis that the use of a seat to assist with better positioning on any chair during meals modifies the sitting posture and has an impact on cervical statics which increases the amplitude of movements of the axial skeleton (larynx and hyoid bone) and benefits swallowing. The aim of this work is to demonstrate that an improvement in sitting posture with the help of the DATP, through Hyoid bone motion, has an impact on the quality of swallowing in a dysphagic population which benefits from the device in comparison to a dysphagic population which does not benefit from the device after 1 month of care. The secondary endpoints concern the evaluation of the impact on other characteristics of swallowing, posture, the acceptability of the device and the quality of life.MethodologyThis is a randomised comparative clinical trial. The blind was not possible for the patients but the examiner who evaluated the outcome criterion was blinded to the group to which the patient belonged. The outcome criterion was the measurement of the hyoid bone movement during swallowing. The other criteria were collected during the videofluoroscopic examination of swallowing and by use of a questionnaire. Fifty-six (56) patients were included: 30 in the group without device (D−) and 26 in the group with the device (D+). All the patients benefited from a training course on seating. Only the D+ patients participated in this course where the use of the device was explained and the device was then kept for use at home for 1 month.ResultsA significant improvement was noted in the postural criteria before and after use, in favour of a better posture for the two groups (p < 0.001) and more hyoid bone motion in the D+ group. The difference was significant in the bivariate analysis for horizontal movement (p = 0.04). After adjustment of potential factors of confusion, we noted a significant mean difference for the three distances in the D+ group in comparison to the D− group, of + 0.33 (95% CI [+ 0.17; + 0.48]) for horizontal movement, + 0.22 (95% CI [+ 0.03; + 0.40]) for vertical movement and + 0.37 (95% CI = [+ 0.20; + 0.53]) for horizontal movement. However, the other parameters, and notably the other swallowing markers were not significantly modified by the use of the device.ConclusionThe personalised transportable folding device for seating developed to reduce dysphagia has an action on hyoid bone motion during swallowing. However, this positive effect on an intermediate outcome criterion of the quality of swallowing was not associated with an improvement in swallowing efficiency in the study population. The diversity of diseases with which the patients in this study were afflicted is a factor to be controlled in future studies with this device.

Evaluation of swallowing function in patients with oropharyngeal secretions.

BackgroundSeveral studies have reported a strong association between the presence of oropharyngeal secretions in the laryngeal vestibule and the likelihood of aspiration of food or liquid. However, no previous studies have evaluated the accumulation of saliva and swallowing dynamics.ObjectiveThe objective of this study was to examine the factors related to decreased function that result in saliva accumulation based on images from videofluoroscopic examination of swallowing (VF) performed on the same day as videoendoscopic examination of swallowing (VE).MethodsThis retrospective study investigated 47 patients with dysphagia who underwent VF and VE on the same day. Saliva accumulation in the pharynx was assessed on VE and classified by the Murray secretion scale. Pharyngeal residue was assessed on VF. In addition, displacement of the hyoid bone and larynx on swallowing and the opening size of the esophageal orifice were measured, and contact between the base of the tongue and the posterior pharyngeal wall was examined on VF.ResultsModerate correlations were found between saliva accumulation and perpendicular displacement of the larynx and upper esophageal sphincter opening. The percentage of patients showing contact between the base of the tongue and the posterior pharyngeal wall was significantly greater in those with a saliva accumulation score of 0 or 1.ConclusionLess laryngeal elevation and upper esophageal sphincter opening and absence of contact between the base of the tongue and the posterior pharyngeal wall when swallowing tended to result in accumulation of saliva in the pharynx.

Investigation of Safety When Using Low Osmotic Nonionic Iodinated Contrast Agent in Videofluoroscopic Examination of Swallowing

Investigation of Safety When Using Low Osmotic Nonionic Iodinated Contrast Agent in Videofluoroscopic Examination of Swallowing

Consideration of the Effects of Patient’s Real Images on Videofluoroscopic Examination of Swallowing

Consideration of the Effects of Patient’s Real Images on Videofluoroscopic Examination of Swallowing

Bolus Transition During Oropharyngeal Swallowing after Unilateral Cortical Stroke

Purpose Bolus transition during swallowing represents neuromuscular coordination between oropharyngeal structures and bolus movement. The purpose of this study was to examine the difference between stroke patients with left and right hemisphere lesion in terms of oral and pharyngeal transitions using oral transit time (OTT), pharyngeal transit time (PTT), and duration of upper esophageal sphincter opening (DUESO) during swallowing. Methods Thirty-four unilateral cortical stroke patients were divided into two groups depending on the hemispheric site of the lesion. Means and standard deviations of OTT, PTT, and DUESO were measured on 2 mL and 5 mL of thin liquid swallows from videofluoroscopic swallowing examinations (VFSEs). Statistical comparison was performed by repeated measurements of analysis of variance (ANOVA). Significance level was set at <0.025. Results In OTT, PTT, and DUESO, there was no significant difference between left and right hemispheric stroke groups. There was a significant bolus volume effect on OTT and DUESO. Conclusions The site of the lesion may not affect the transition of bolus during oropharyngeal swallowing. Clinicians should not only examine physiological swallowing disorders of individual patients regardless of hemispheric site of the lesion, but also investigate various volumes during VFSEs in order to find the proper diet recommendation. Keywords: Bolus transition; Oral stage; Pharyngeal stage; Swallowing; Unilateral stroke

Efficacy of Swallowing Training Combined with Nutritional Intervention on Quality of Life in Laryngeal Cancer Patients with Dysphagia

Objective: To investigate the efficacy of swallowing training combined with nutritional intervention on quality of life in laryngeal cancer patients with dysphagia. Patients and Methods: A total of 66 patients who suffered from laryngeal cancer with dysphagia were selected and divided into control group (CG) and intervention group (IG), each of 33, according to random number tables. Both groups received total laryngectomy and prophylactic radiotherapy and were given routine health counseling and swallowing training, while intervention group was additionally provided with nutritional intervention. To evaluate all patients with Video Fluoroscopic Swallowing Examination (VFSE), Scored Patient-Generated Subjective Global Assessment on Nutritional Status (PG-SGA), and Quality of Life Questionnaire-core 30 (QLQ-c30) after radiotherapy and three months after. Results: VFSE, PG-SGA, QLQ-c 30 scores after swallowing training in IG were significantly greater than data collected instantly before swallowing training in IG and those collected after swallowing training in CG (P<.05). VFSE score after swallowing training in CG was significantly greater than data collected instantly before swallowing training (P<.05). Difference between before and after swallowing training on VFSE, PG-SGA, and QLQ-c 30 scores in IG were statistically significant greater than those of CG (P<.05). Conclusion: Swallowing training combined with nutritional intervention can improve swallowing function, nutritional status and quality of life in laryngeal cancer patients with dysphagia.

The correlation between findings of video-endoscopic examination of swallowing (VE) or video-fluoroscopic examination of swallowing (VF) before percutaneous endoscopic gastrostomy (PEG) and recovery of swallowing function

The correlation between findings of video-endoscopic examination of swallowing (VE) or video-fluoroscopic examination of swallowing (VF) before percutaneous endoscopic gastrostomy (PEG) and recovery of swallowing function