Videofluoroscopic Swallowing Study Research Articles

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.

Exposures and coexisting conditions in pediatric nodular tracheobronchitis.

The aim of our study was to investigate the prevalence of coexisting conditions and exposures in children with nodular tracheobronchitis diagnosed by flexible bronchoscopy. We conducted a single-center retrospective review of 100 children diagnosed with nodular tracheobronchitis by flexible bronchoscopy between 2012 and 2023. Common coexisting diagnoses included gastroesophageal reflux disease (GERD, 50%), dysphagia/aspiration (40%), asthma (30%), recurrent croup (30%), tracheostomy dependence (19%) and eosinophilic esophagitis (EOE) (12%). Bronchoalveolar lavage (BAL) demonstrated cellular inflammation with elevated proportions of neutrophils in 63%, and lymphocytes in 24%. Among 88 patients in whom bacterial cultures were performed, 52% were positive, with Moraxella, Haemophilus, Streptococcal and Pseudomonas species predominating. Among 30 patients who underwent viral testing, 57% were positive, with rhinovirus (82%) and adenovirus (29%) predominating. Patients with neutrophilic inflammation were more likely to have a positive respiratory bacterial culture and/or viral polymerase chain reaction (p = 0.003, 0.005). Evaluation of the gastrointestinal tract included 79 patients with a history of esophagogastroduodenoscopy, 45 patients with a videofluoroscopic swallow study (VFSS), and 45 patients with multi-channel intraluminal impedance and pH testing. The majority of VFSS were abnormal (60%) demonstrating either laryngeal penetration (33%) or intratracheal aspiration (27%). Median pH reflux and impedance proximal reflux indices were 3.8% and 0.5% respectively. Potential contributing factors in the pathophysiology of nodular tracheobronchitis include bacterial and viral infections, GERD, dysphagia/aspiration, and EOE. When nodular tracheobronchitis is observed during bronchoscopy, further evaluation to assess for these conditions should be considered.

Interventions and evaluation to improve oral health in patients with stroke: a scoping review

Objectives: This scoping review aimed to identify and analyze intervention strategies and assessment methods for oral hygiene management (OHM) and oral function management (OFM) in patients with stroke admitted to general wards, with the goal of providing directions for future research. Methods: We conducted a comprehensive literature search on studies published over the past 10 years across databases, including Cochrane, Embase, Medline, PubMed, and ProQuest. A total of 18 studies met the inclusion and exclusion criteria. Results: In the OHM studies (N=7), oral hygiene care was primarily provided by nurses, dental assistants, and nursing care aides. Oral hygiene was assessed using plaque and gingival bleeding indices with products such as electronic toothbrushes and mouth rinses. In the OFM studies (N=11), care was provided by speech-language pathologists, occupational therapists, and dental hygienists. Assessment tools included the Functional Oral Intake Scale, the PenetrationAspiration Scale, and Video Fluoroscopic Swallowing Studies. Conclusions: Improving the oral health of patients with stroke requires both hygiene and functional management. Therefore, it is necessary to develop a method that provides specialized oral care tailored to the hospitalization environment and the specific conditions of patients with stroke.

Anterior-Posterior View Acquisition During Videofluoroscopy: A Survey Study Exploring Influential Factors on Speech-Language Pathologists' Practice Patterns.

This study explored factors influencing speech-language pathologists' (SLPs') decision making surrounding anterior-posterior (AP) view inclusion practices during videofluoroscopic swallowing studies (VFSSs) in the United States. SLPs completing VFSSs were recruited to complete an online anonymous survey. Questions represented six constructs of interest including: (a) clinician demographics, (b) practice patterns, (c) diagnostic perceptions, (d) professional influences, (e) training and education, and (f) logistical facilitators and barriers. Binary logistic regression was used to explore the relationship between construct items and likelihood of AP view inclusion. A total of 136/213 (64%) of respondents reported obtaining an AP view routinely. Facilitators of AP view inclusion were post-acute work setting (OR = 3.40, p = .001); perception that department practices "probably" (OR = 5.65, p = .006) or "definitely" align (OR = 5.30, p = .006) with evidence-based practice; perception the AP view has "a lot" (OR = 4.17, p = .025) or "a great deal" (OR = 4.77, p = .028) of diagnostic value; perception that their department is "definitely" supportive (OR = 4.69, p = .040); "moderate" (OR = 4.75, p = .001) or "no" (OR = 7.51, p < .001) equipment limitations; and radiologist support greater than "extremely unsupportive or resistant" ("somewhat unsupportive" [OR = 5.74, p = .041], "neutral" [OR = 11.23, p = .002], "somewhat supportive" [OR = 13.92, p = .001], or "extremely supportive" [OR = 13.92, p = .001]). Barriers to AP view inclusion were geographic location in the southern U.S. census region (OR = 0.31, p = .007), being "significantly" influenced by coworker opinions (OR = 0.13, p = .018), and productivity tracking (OR = 0.21, p = .008). Environmental factors and organizational culture heavily influence AP view inclusion practices.

A survey of dysphagia services practice in China.

Dysphagia services have only recently been formalised within Chinese health services. There has been no comprehensive evaluation of all aspects of dysphagia services practice in China. To provide a profile for the dysphagia practice in China by assessing various facets of dysphagia services. This is a survey study carried out from December 2022 to May 2023 online in China. One hundred fifty-nine respondents comprising doctors, nurses or therapists involved in the field of dysphagia rehabilitation completed a questionnaire via Sojump. The questionnaire included dichotomous (e.g., yes/no) and multiple-choice questions related to participants' general information and their provision of dysphagia management services. Results were analysed descriptively and the differences among different levels of hospitals were analysed. Approximately two-thirds of hospitals (67.9%) started dysphagia services within the last 5 years. A significant difference in the initiation of dysphagia rehabilitation was observed across different hospital levels (χ2=32.70;p<0.001). Routine dysphagia screening was a standard practice in most hospitals (71.7%), with the most frequently employed screening method being the water swallow test (95.6%). Clinical swallowing evaluation emerged as the preferred initial assessment method (80.5%) and the most utilised assessment method (91.8%). Video fluoroscopic swallow study and flexible endoscopic evaluation swallowing were used by 22.7% and 12.6% of respondents. A significant difference was observed in the choice of assessment methods across hospitals of different levels (χ2=43.397; p < 0.001). The majority of respondents (53.5%) primarily employed rehabilitation as the main intervention method (76%-100%). Most respondents indicated that they would reevaluate patients after treatment (74.8%) and reported routine follow-up with patients (60.4%). Despite the relatively recent development of dysphagia management in China, the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. However, the use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. There is a need for policy and resource support in the field of dysphagia rehabilitation in China. What is already known on this subject Assessment and treatment methods for dysphagia are various across different patients, medical facilities and settings. There has been no comprehensive evaluation of all aspects of dysphagia rehabilitation practice in China. What this study adds to existing knowledge The study assessed various facets of dysphagia rehabilitation in China through an online survey. We found that the relatively recent development of dysphagia management in China, but the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. Variations in practice patterns between hospitals of different levels may be attributed to resource constraints and patient needs. Besides, while rehabilitation exercises are the primary intervention method for dysphagia in China, the assessment largely centres on clinical swallowing evaluation. The use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. What are the clinical implications of this work? The study assessed various facets of dysphagia rehabilitation in China, and the results indicate that the use of instrumental assessments needs to be improved and there is a need for policy and resource support in the field of dysphagia rehabilitation in China.

Swallowing Kinematics in Male Patients with Total Laryngectomy.

The present study aimed to investigate the symptomatic swallowing complaints in individuals with total laryngectomy (TL) and reveal how swallowing kinematics differs between those with and without symptomatic dysphagia complaints. A total of 34 subjects with TL were included in the study. Swallowing kinematics of those with symptomatic swallowing complaints (Group 1) were compared to those without (Group 2). Kinematic parameters including pharyngeal transit duration (PTD), maximum pharyngeal constriction ratio (MPCR), upper esophageal sphincter opening ratio (UESOR), upper esophageal sphincter opening duration (UESOD), and bolus clearance ratio (BCR) were investigated from Videofluoroscopic Swallowing Study (VFSS) records via ImageJ software. Symptomatic swallowing complaints were determined in 47.1% of the subjects (n = 16). Difficulty while swallowing solid foods and pills, diminished pleasure of eating, food getting stuck in the throat, and increased level of stress during swallowing were among the major swallowing complaints in the present cohort. PTD, MPCR, and BCR parameters were significantly higher in subjects with symptomatic swallowing complaints than those without. These preliminary findings indicate that almost half of individuals with TL may have symptomatic swallowing complaints. The underlying pathophysiology of this phenomenon may be the devianced kinematic parameters including PTD, MPCR, and BCR in this population. Therefore, it is recommended to include the kinematic measurements in the dysphagia evaluation protocol in individuals with TL, most notably in those with symptomatic swallowing complaints. 3 Laryngoscope, 2024.

Validation of Manipal Bedside Swallowing Screening Test for Assessing Aspiration in Individuals with Tracheostomy.

To validate the Manipal Bedside Swallowing Screening Test (MBSST) for assessing aspiration in individuals with tracheostomy using Video Fluoroscopic Swallow Study (VFSS). A total of 53 tracheostomized participants were screened for aspiration at bedside and VFSS across different consistencies. Penetration Aspiration Scale (PAS) was used to substantiate the severity of aspiration if present. The test demonstrated both high sensitivity (91%; 95% confidence interval = 70.8-98.9) and diagnostic accuracy (96%; 95% confidence interval = 87.0-99.5) for detecting aspiration in individuals with tracheostomy. The Manipal Bedside Swallowing Screening Test is an easy to administer tool that has sufficient sensitivity to detect aspiration in individuals with tracheostomy. The MBSST will be an easy to administer tool and will help in screening for aspiration at bedside without any instrumental examination.

Predicting Swallowing Recovery in Subacute Stroke Patients via Temporal and Spatial Parameters of Videofluoroscopy.

The purpose of this study was to identify the temporal and spatial parameters of videofluoroscopic swallowing study (VFSS) that could predict the recovery of swallowing function in subacute stroke patients. We included 102 patients who were admitted to the Department of Rehabilitation Medicine between 2019 and 2022. Patients were classified into good and poor prognosis groups according to whether they had restored prestroke swallowing function or were able to consume sufficient nutrition via oral feeding to meet their body's needs. Univariate and multivariate regression analyses were used to identify the predictors. Calibration and discrimination were tested using the Hosmer-Lemeshow test and area under the curve (AUC), respectively. Of the 102 included patients, 51 had a good prognosis for swallowing function within 6 months of onset. The final multivariate regression model included three significant factors: laryngeal closure duration (LCD) (OR: 0.998; 95% CI: 0.996-0.999; p < 0.05), maximum width of the upper esophageal sphincter opening (MWUESO) (OR: 1.251; 95% CI: 1.073-1.458; p < 0.05), and pharyngeal residual grade (PRG) (p < 0.05). The shorter LCD and larger MWUESO were positive predictors of good swallowing function outcomes, while higher PRG was a negative predictor of good outcomes. The AUC for PRG, MWUESO, and LCD were 0.767 (p < 0.05), 0.738 (p < 0.05), and 0.681 (p < 0.05), respectively. Identifying prognostic factors for the recovery of swallowing function in patients with poststroke dysphagia is essential for developing treatment strategies. The findings of this study may provide an important reference for developing appropriate therapeutic interventions to promote the recovery of swallowing function in stroke patients.

Prevalence and Risk Factors for Swallowing Dysfunction in Patients With Laryngomalacia Treated Medically and Surgically

AbstractObjectiveTo identify the prevalence, pattern, and nature of swallowing dysfunction (SwD) in a consecutive cohort of patients with laryngomalacia (LM), and to determine factors associated with a higher burden of SwD.Study DesignThis was a retrospective review of consecutive patients diagnosed with LM by 2 pediatric otolaryngologists between 2013 and 2022 and a minimum of 3‐month follow‐up.SettingTertiary care pediatric otolaryngology referral center.MethodsConsecutive cohort of patients less than 3 years old with LM diagnosed on flexible laryngoscopy were reviewed. Patients with incomplete follow‐up, lack of swallowing assessment, and genetic conditions or syndromes were excluded. All patients underwent at minimum a systematic clinical swallowing evaluation by a speech‐language pathologist specialized in pediatric dysphagia. Patients with concerning clinical exams underwent instrumental swallow evaluation (Videofluoroscopic Swallow Study [VFSS] or Flexible Endoscopic Evaluation of Swallowing [FEES]). The prevalence of abnormalities of clinical swallowing evaluation, instrumental swallow evaluation data, and details of management were collected.ResultsTwo hundred and twelve patients met criteria and were included in the final analysis. One hundred and fifteen patients (54%) had an instrumental assessment (VFSS or FEES). Of the instrumental assessments performed, 96 (69%) were abnormal. Of the total patient cohort, 55 (26%) had laryngeal penetration and/or aspiration. One hundred and seventeen (55%) had clinical or instrumental indications for intervention, with 18 (8%) requiring tube feeding. Patients with severe LM and those treated surgically had a statistically significant higher rate of penetration and aspiration.ConclusionPatients with LM have a high burden of dysphagia requiring medical intervention. The authors advocate for routine and systematic assessment of all patients with LM for swallowing dysfunction.

Videofluoroscopic Swallowing Studies: A Proposed Checklist.

The videofluoroscopic swallowing study (VFSS) is used widely in dysphagia research. However, variations exist in the conduct and interpretation of VFSS, including differences in contrast agents, food and fluid consistencies tested, patient positioning, intervention strategies trialed, fluoroscopy settings, resolution, and image storage solutions. It cannot be assumed that VFSS exams yield directly comparable results across different studies. It is essential that relevant elements of VFSS be clearly reported in research. The goal of this article is to outline optimal VFSS reporting as part of the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a critical appraisal tool intended to promote rigor and transparency in dysphagia research. We developed a set of 27 questions regarding the rigor and transparency of VFSS reporting, based on review of previous research articles. These were reviewed by all members of the FRONTIERS Framework collaborative, to determine which questions were mandatory, unnecessary, or needed revision, prior to inclusion in the final critical appraisal tool. The final FRONTIERS Framework tool contains 20 questions and seven subquestions regarding VFSS. These are grouped into four themes: patient/participant positioning, equipment and recording settings, contrast agents, and rating methods, including operational definitions and reliability. The VFSS section of the FRONTIERS Framework tool is intended to facilitate and promote rigorous and transparent reporting of all elements that may influence the interpretation of VFSS in research. This critical appraisal tool can also be used to guide research design and the evaluation of study outcomes contributing to best practices in the field of dysphagia research.

Factors associated with adherence to swallowing therapy among patients diagnosed with oropharyngeal dysphagia.

The objective of this study is to assess disparities in adherence to swallowing therapy for clinically diagnosed oropharyngeal dysphagia (OD) patients. Analysis was conducted on data from 600 patients with OD and confirmed impairments in swallowing safety and/or efficiency on a videofluoroscopic swallow study. Patients were classified based on their adherence to treatment sessions, defined as the number of swallow treatment sessions attended. The outcome of treatment adherence was categorized into two groups: those who attended fewer than 50% of the prescribed treatment sessions and those who attended 50% or more of the sessions. Continuous variables were presented as mean ± standard deviation or median ± interquartile range. Categorical variables were compared using Pearson chi-square tests and Fisher's exact test when appropriate. Univariable and multivariable binary logistic regression models were employed to identify factors associated with successful adherence. Approximately 79% adhered to swallowing treatment. We found no significant relationship between adherence and age, sex, race, ethnicity, primary language, marital status, insurance status, occupation, median income, distance, education, OD severity, and diagnosis year (p > 0.05). We found no covariables to be significant predictors to swallowing treatment nonadherence in both univariable and multivariable binary regression models (p > 0.05). The variables analyzed in this study were not significantly associated with nonadherence to swallow therapy. Nevertheless, our study still addressed an important knowledge gap and future studies would benefit from exploring other relevant socioeconomic and disease-related factors. Level 4.

Fiberoptic endoscopic evaluation of swallowing (FEES) in children with spinal muscular atrophy type 1: feasibility, swallowing safety and efficacy, and dysphagia phenotype.

Although dysphagia is a common symptom among patients with Spinal Muscular Atrophy Type 1 (SMA1), scant data exist on the application of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in this population. The aim was to analyze FEES feasibility, swallow safety and efficacy, dysphagia phenotype, and agreement with VideoFluoroscopic Swallow Study (VFSS) in children with symptomatic, medication-treated SMA1 and oral feeding. 10 children with SMA1 underwent FEES. Six patients had also a VFSS. Two clinicians independently rated FEES and VFSS videos. Swallowing safety was assessed using the Penetration-Aspiration scale (PAS). Dysphagia phenotypes were defined according to the classification defined by Warnecke et al. Swallowing efficacy was evaluated with the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in FEES, whereas pharyngeal residue was rated as present or absent in VFSS. FEES was performed in all children without complications. Four children tolerated bolus trials during FEES, in 4 children swallowing characteristics were inferred based on post-swallow residues, while 2 children refused to eat and only saliva management was assessed. The dysphagia phenotype of predominance of residue in the piriform sinuses was documented in 7/8 children. The PAS score was < 3 in 3 children and > 5 in one child. Swallowing efficacy was impaired in 8/8 children. VFSS showed complete agreement with FEES. FEES is a feasible examination in children with SMA1. Swallowing safety and efficacy are impaired in nearly all patients with strong agreement between FEES and VFSS. Dysphagia is characterized by the predominance of residue in the piriform sinus.

Prevalence of respiratory signs in dogs with chronic gastroenteropathy in a referral population in the United Kingdom: 42 cases (2020).

To determine the prevalence of respiratory signs in a referral population of dogs with chronic gastroenteropathy in the United Kingdom, and to describe the epidemiology and clinical presentation of the affected dogs. Retrospective review of canine patients diagnosed with chronic gastroenteropathy in a referral centre in the United Kingdom. Data included signalment, gastrointestinal and respiratory signs, blood analysis results and, where present, diagnostic imaging techniques, endoscopy, videofluoroscopic swallow study, bronchoalveolar lavage results and treatment response. To be included, a follow-up of a minimum of 3 months was required. Cases were excluded if there was no minimum diagnostic dataset, the aetiology of the respiratory signs was other than gastrointestinal disease or a non-gastrointestinal systemic disease was the cause of the gastrointestinal signs. One hundred and forty-eight dogs were included and 42 (28.4%) had concurrent respiratory signs. Gagging (69%) and vomiting (52.4%) were the most common gastrointestinal signs, while coughing (50%), tachypnoea (33.3%) and reverse sneezing (30.9%) were the most common respiratory signs. Abdominal ultrasound was performed in 31 (73.8%) while CT scan was the most common modality for thoracic (62.5%) and head (21.9%) imaging. Endoscopic procedures included gastrointestinal (54.8%), bronchoscopy (19%) and rhinoscopy (23.8%). Dietary modification was the most common treatment (66.67%). Eleven dogs (26.2%) had a relapse of the respiratory signs during the follow-up period, of which, nine (81.8%) had a concurrent relapse of the gastrointestinal signs. Concurrent respiratory signs in dogs with chronic gastroenteropathy are frequent. A clinical improvement of these respiratory signs might be achieved during the therapeutic management of gastrointestinal disorders.

2794: New DL approach for dysphagia analysis in videofluoroscopy swallowing studies in HN cancer patients

2794: New DL approach for dysphagia analysis in videofluoroscopy swallowing studies in HN cancer patients

The relationship between swallowing oral hesitation and cognition in frontal lobe stroke.

Oral stage dysphagia mostly caused by frontal lobe lesions. We investigated the relationship between oral hesitation and cognitive impairment after frontal lobe stroke. We consecutively collected 946 patients with stroke from January 2016 to December 2020. Among them, 38 patients had only frontal lobe lesions. Video fluoroscopic swallowing study (VFSS) was performed in 5 stages from water to solid food. Patients who progressed to solid food are very rare, so we focused on liquid and soft food. Diagnosis of stroke was limited to cases in which cerebral infarction or haemorrhage had been verified by magnetic resonance imaging (MRI). Cognitive impairment was evaluated by MMSE in patients with frontal lobe lesions. Of the total 946 patients, 35 patients with frontal lobe lesions were enrolled in the study. Of them, 22 were judged to have cognitive impairment. The oral hesitation of the liquid component was analysed, and a conclusion was drawn that the group with cognitive impairment showed significant oral hesitation than the group without cognitive impairment. On the other hand, in the case of soft food, it was found that there was no correlation between cognition and oral hesitation. It was confirmed that oral hesitation during swallowing in patients with frontal lobe stroke had a meaningful relationship with cognition, and oral hesitation during swallowing was significantly higher in liquid swallowing rather than soft food.

The association of temporalis muscle thickness with post-stroke dysphagia based on swallowing kinematic analysis

Background/purposePost-stroke dysphagia (PSD) is a common functional deficit after stroke. Temporal muscle thickness (TMT) had been proven to be an independent factor for PSD. However, the relationship between TMT and PSD based on quantitative swallowing kinematic analysis remains unexplored. We aimed to investigate the association between TMT and PSD using videofluoroscopic swallow study (VFSS). MethodWe retrospectively recruited stroke patients from May 2015 to March 2020 in the tertiary referral hospital. A total of 83 patients with dysphagia met all the enrollment criteria and were included in the study. TMT was measured by non-contrast brain computed tomography (CT) images. Parameters of VFSS were obtained, including penetration-aspiration scale (PAS), oral transit time (OTT), pharyngeal transit time (PTT) and swallowing trigger time (STT) in four standardized barium formulas respectively. The association between TMT and variables of VFSS were analyzed by adjusted linear and logistic multivariate regression models. Subgroup analysis based on age, sex, and premorbid modified Rankin Scale (mRS) stratification was conducted. ResultsTMT was significantly correlated with gender and premorbid mRS as the confounders. Univariate regression showed smaller TMT (p = 0.010) and poorer premorbid mRS (p = 0.018) was associated with prolonged PTT of the thick formula; lesser TMT was associated with prolonged PTT of the paste formula (p = 0.037). Multivariate analyses after confounder-adjustment demonstrated TMT was an independent indicator for PTT in the thick formula (p = 0.028). ConclusionsTMT was associated with swallowing kinematic changes in patients diagnosed with PSD. TMT is an independent indicator for delayed pharyngeal stage in the thick standardized formula during deglutition in PSD patients.

The Effect of Oral Diet Training in Indwelling Nasogastric Tube Patients with Prolonged Dysphagia.

Background: Patients with severe dysphagia are usually fed using a nasogastric tube (NGT). Many patients who receive long-term NGT feeding are unable to obtain sufficient nutrients orally immediately after NGT removal. Thus, a transitional period involving oral diet training is required to transition from NGT feeding to exclusive oral feeding. We aimed to investigate the therapeutic effect of oral diet training in indwelling NGT patients with prolonged dysphagia. Methods: A total of 175 patients who were fed using an NGT for more than 4 weeks were enrolled. Their swallowing function was evaluated by a videofluoroscopic swallowing study (VFSS). During the VFSS, patients received thick and thin barium while the NGT was inserted. Then, the patients underwent a VFSS without an NGT thirty minutes after NGT removal. If a patient had no aspiration with NGT inserted during the VFSS, oral diet training combined with NGT feeding was recommended. Results: Of the 49 indwelling NGT patients who were recommended to receive oral diet training, 39 (79.6%) transitioned to exclusive oral feeding. A transition period of 2-8 weeks was required for them to achieve full oral feeding. Patients who were eligible for oral feeding trials showed no significant aspiration during the VFSS with an NGT inserted and had sufficient cough function. Patients who required prolonged NGT feeding and who could not complete oral trials showed significant aspiration during the VFSS when an NGT was inserted. Conclusions: This study demonstrated that oral diet training combined with NGT feeding is safe in patients with prolonged dysphagia who have sufficient cough function and no aspiration during VFSS. We suggest that if the patient is a proper candidate for NGT removal, direct oral feeding training with an NGT inserted could be a useful therapeutic strategy during the transitional period from long-term NGT feeding to successful oral feeding.

Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES).

The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs=0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study's results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.

Ileal free flap for hypopharynx reconstruction – case series

Abstract Objectives Reconstructing the hypopharynx while preserving the larynx poses a complex surgical challenge due to the limited space and the high position of the hypopharynx in the neck. We present our experience with hypopharyngeal reconstruction and larynx preservation using an ileal free flap. Case presentation Six consecutive cases were reported (age range 17–75; 2 females). Indications for surgery were tumor excision, postexcision flap failure, postradiation stenosis, caustic ingestion injury, and cervical esophageal perforation. The larynx was preserved in four cases. Graft survival rate was 100 %. Videofluoroscopic swallowing studies conducted at postoperative day 20–80 were normal in three cases. Two cases presented with stenosis but responded well to endoscopic dilations. Unfortunately, the third case expired due to tumor recurrence. Conclusions The ileal free flap is a surgical alternative for the reconstruction of the hypopharynx, especially in cases where the larynx is preserved.

How Do Quantitative Videofluoroscopy Measures Differ Between People With Amyotrophic Lateral Sclerosis and Age-Matched Healthy Adults?

Dysphagia is a leading cause of morbidity in people with amyotrophic lateral sclerosis (PwALS). Previous videofluoroscopic swallowing studies (VFSS) in PwALS do not account for the influence of senescence. We aimed to compare swallowing in PwALS and an age- and sex-matched control group using healthy reference data to define typical and atypical values. We conducted retrospective analysis of VFSS data from 19 PwALS (10 male, Mage = 63 years, range: 47-82) compared to control data from a cohort of healthy adults. Participants swallowed 20% w/v liquid barium from thin to extremely thick consistency. Blinded duplicate VFSS analysis using the ASPEKT (Analysis of Swallowing Physiology: Events, Kinematics and Timing) method yielded descriptive statistics for 16 quantitative VFSS parameters by consistency. Mann-Whitney U tests were used to identify significant cohort differences. Additionally, the frequencies of atypical values (in the 25% tails of the reference distribution) were tabulated by cohort and compared using odds ratios. PwALS showed increased frequencies of multiple swallows per bolus, incomplete laryngeal vestibule closure, and reduced hyoid speed across consistencies. By contrast, similar frequencies of atypical values for pharyngeal constriction and residue in both cohorts suggest that age-related changes may contribute to the presence of these features in PwALS. This analysis builds on previous descriptions of swallowing pathophysiology in amyotrophic lateral sclerosis (ALS) by clarifying the extent to which aging may account for some of the atypical findings seen in this patient population. Longitudinal studies are recommended to further differentiate the effects of ALS from age-related changes in swallowing over the course of disease progression.