Impaired swallowing reflex in patients with obstructive sleep apnea syndrome.

BACKGROUND: The swallowing reflex is well coordinated with breathing patterns in normal humans. However, patients with obstructive sleep apnea syndrome (OSAS) may have a swallowing disorder that reflects the abnormal function of nerves and muscles in the suprapharynx. OBJECTIVE: To examine the relationship between the swallowing function and sleep-disordered breathing in patients with OSAS. PARTICIPANTS: Twenty patients with OSAS with a mean (+/-SD) age of 53.4+/-8.9 years old, and 20 age-matched control subjects with a mean age of 51.4+/-9.1 years old. METHODS: OSAS was diagnosed using the recordings of overnight polysomnography. The swallowing function in the subject was tested using a swallowing provocation test. The swallowing reflex was determined according to the following criteria: latent time (LT), the time following a bolus injection of distilled water at the suprapharynx to the onset of swallowing; inspiratory suppression time (IST), the time from the termination of swallowing to the next onset of inspiration; and threshold volume, the minimum volume of water (range, 0.4 to 2 mL) that could evoke the swallowing response. RESULTS: Whereas the LT values in patients with OSAS were larger than the LT values in the control subjects, the IST values (which may reflect the switching mechanism from deglutition apnea to breathing) were actually shorter. In addition, a greater bolus volume was necessary to elicit swallowing in patients with OSAS than was necessary in the control subjects. CONCLUSION: Patients with OSAS are likely to exhibit an impaired swallowing reflex, probably due to the perturbed neural and muscular function of the upper airways.     

Characteristics and limitation of portable bedside swallowing test in elderly with dementia: comparison between the repetitive saliva swallowing test and the simple swallowing provocation test

Several bedside portable swallowing tests have been advocated for screening for dysphagia. However, the clinical usefulness and limitation of these tests have not been examined in elderly patients with dementia. We performed the repetitive saliva swallowing test (RSST) and the simple swallowing provocation test (SSPT) in 37 elderly inpatients (81.8 +/- 1.2 years old). Simultaneously, cognitive and verbal communication ability were assessed by the Hasegawa Dementia Scale revised version (HDSR) and the Mini-Communication Test (MCT). RSST was completed only in 22 patients (59%), whereas SSPT was successfully completed in all cases. Scores of HDSR and MCT were significantly lower in patients who were unable to cooperate with RSST compared to successful examinees (HDSR: 7 +/- 1 vs 15 +/- 3, p < 0.0; MCT: 47 +/- 8 vs 81 +/- 5, p < 0.01). Dysphagia was detected in 14 patients (64%) by RSST and 5 (14%) by SSPT. Patients with dysphagia showed significantly lower cognitive function (p < 0.05) and verbal communication ability (p < 0.05). In conclusion, RSST is more sensitive to detect dysphagia in elderly patients; however, compliance with RSST is strongly influenced by the patient's cognitive function and verbal communication ability. Comprehensive geriatric assessment will help to choose an alternative test for dysphagia such as SSPT which is more specific test for aspiration pneumonia.     

The usefulness of the water swallowing test and videofluorography in swallowing rehabilitation in patients with cerebrovascular disease

It has been suggested that videofluorography (VF) is useful in the diagnosis of aspiration. The aim of this study was to investigate the usefulness of the water swallowing test and VF in swallowing rehabilitation in patients with cerebrovascular disease. Fifteen patients (mean age 72.9 +/- 2.3 years) were examined. The swallowing abnormality was assessed by the water swallowing test and VF. Patients with abnormal swallowing function on the water swallowing test (Group A, n = 4) showed aspiration and silent aspiration into the trachea on VF. However, patients suspected of dysphagia on the water swallowing test (Group B, n = 11) could swallow, demonstrating the disappearance of silent aspiration, with pooling of barium in the piriform sinus on VF. All patients in Group A could not ingest any food by mouth and received percutaneous endoscopic gastrostomy or intermittent oro-esophageal tube feeding. The swallowing function in Group B improved after swallowing rehabilitation. All patients in Group B could ingest food by mouth. These findings suggest that the water swallowing test is useful for quantitative assessment of swallowing disorder and for deciding on therapy of swallowing function.     

Nasal constant positive airway pressure inhibits the swallowing reflex

The effects of constant positive airway pressure applied via a nose mask through the nares (nasal CPAP) on the swallowing reflex were studied in eight adult humans. The swallowing reflex was induced by bolus injections of a small amount of distilled water (0.5 ml) into the pharynx at four different values of endexpiratory airway pressure (0,5,10, and 15 cm H2O CPAP) or by continuous infusion of water (3 ml/min) at two different values of endexpiratory airway pressure (0 and 15 cm H2O CPAP). The latency of response from the time of bolus injection of water to the occurrence of the first swallow as well as the number of swallows elicited during the period of 10 s immediately following the water injection were measured. Our results showed that increases in endexpiratory airway pressure progressively prolonged the latency of response and decreased the number of swallows. Also, the frequency of swallows decreased greatly at nasal CPAP of 15 cm H2O during continuous infusion of water. These results indicate that nasal CPAP exerts an inhibitory influence on the swallowing reflex.     

Modulation of swallowing reflex by lung volume changes

We investigated the effects of changes in lung volume on coordination of respiration and swallowing in 11 healthy subjects. Swallowing reflexes were elicited by bolus injections of a small amount of distilled water (1 ml) and by continuous infusion of distilled water (3 ml/min) into the pharynx at three different levels of lung volume. The lung volume was changed by application of negative extrathoracic pressure (0, -20, and -40 cm H(2)O). We found that increases in lung volume prolonged the latency of swallows elicited by bolus injection of water and decreased the number of swallows during continuous infusion of water. In addition, the preponderant coupling of swallows with the expiratory phase observed before application of negative extrathoracic pressure was lost during application of negative extrathoracic pressure. These results may indicate that lung inflation has an inhibitory influence on the swallowing reflex, and modulates the timing of swallowing in reference to the respiratory cycle.     

Use of intravenous adenosine as a noninvasive diagnostic test for sick sinus syndrome

BACKGROUND: Testing for sick sinus syndrome (SSS) requires invasive stimulation protocols for sinus node recovery time (SNRT) and corrected sinus node recovery time (CSNRT). METHODS AND RESULTS: We compared the CSNRT with the lengthening of the sinus cycle length (ADO:SCL) corrected to the basic cycle length (ADO:CSNRT) after administration of an intravenous bolus of adenosine (0.15 mg/kg) in 10 patients with clinical SSS (group 1) and 67 control patients (group 2). With 550 ms as an abnormal result for the ADO:CSNRT (and for the CSNRT) as an indicator of sinus node dysfunction, the ADO:CSNRT had a sensitivity of 80% and specificity of 97% for detection of SSS compared with sensitivity and specificity of 70% and 95% for invasive CSNRT. When combined, the 2 tests had a sensitivity of 100%. There was significant difference in the CSNRT between group 1 (1848 +/- 1825 ms) and group 2 (355 +/- 169 ms, P <. 0001) and a significant difference in ADO:CSNRT between group 1 (1168 +/- 1002 ms) and group 2 (272 +/- 592 ms, P <.0001). CONCLUSIONS: We conclude that the ADO:CSNRT is a sensitive and specific test for SSS that equals invasive testing and should be considered as an alternative to invasive testing in patients with suspected SSS.     

Normal solid bolus swallowing erect position

Individuals with structural and functional abnormalities of the esophagus are frequently symptomatic when swallowing solids and have been reported to demonstrate delay during nuclide examinations. This study was performed in symptomatic individuals to determine how often a solid bolus (13 mm barium tablet or 10 mm bagel bread sphere) passed through the esophagus without delay and whether erect solid bolus swallowing occurred without significant bolus hesitation during fluoroscopic evaluation. All individuals referred for an upper gastrointestinal examination or barium swallow who complained of dysphagia, heartburn, or chest pain were evaluated with a solid bolus. Individuals demonstrating gastroesophageal reflux, a hiatal hernia, a Schatzki B ring, or any esophageal motility disturbance were given a solid bolus. Twenty-six (27%) of 98 symptomatic individuals given a barium tablet had no delay in its passage. Thirteen (8%) of 150 symptomatic individuals given a bagel sphere had an erect solid bolus swallow with no delay in its passage. Only one individual of 26 given both solids (4%) showed no delay in transit of either bolus. Solid bolus swallows without delay were noted to occur in two ways: (1) The entire solid bolus passed in less than 3 s without delay of any kind, and (2) some temporary delay (less than 5 s) occurred at regions of anatomic esophageal narrowing (circopharyngeus, thoracic inlet, transverse aorta, left mainstem bronchus, or diaphragm). These temporarily delayed swallows were assisted by coincidentally swallowed fluid or the following peristaltic wave. No additional swallows were required to complete passage into the stomach. Bolus passage was accomplished predominantly by oral thrust, gravitational pull, esophageal relaxation, and possibly because of intraluminal esophageal pressure differentials. Therefore, solid bolus erect swallowing can occur without significant delay of bolus passage into the stomach in a symptomatic population. Opinions and assertions contained herein are those of the authors and do not represent the official position of the U.S. Navy, Uniformed Services University of the Health Sciences, or the Department of Defense.     

Prognostic implications of swallowing ability in elderly patients after initial recovery from stroke

BACKGROUND: It remains unclear how swallowing assessment can help clinicians to predict the risk for pneumonia in elderly persons after ischemic stroke. A prospective case-control study was conducted to evaluate the prognostic utility of swallowing ability assessments. METHODS: Participants were 136 elderly persons who had an acute ischemic stroke 3-12 months previously. They were separated into four groups based on their history of repeated episodes of pneumonia in combination with swallowing ability: Group 1 had neither repeated pneumonia nor swallowing abnormality (n = 69); group 2 had repeated pneumonia but no swallowing abnormality (n = 0); group 3 had swallowing abnormality but no repeated pneumonia (n = 54); and group 4 had both swallowing abnormality and repeated pneumonia (n = 13). The follow-up period was as long as 2.2 years. Outcomes and causes of death were compared among the groups. RESULTS: During the study, the overall mortality rate was higher in group 3 (24 deaths, 44.4%) and group 4 (9 deaths, 69.2%) than in group 1 (3 deaths, 4.3%, both p <.05). The annual mortality rate from pneumonia was also significantly higher in group 3 (21.2%) and group 4 (38.2%) than in group 1 (0.8%, p <.0001). The odds ratio for patients who subsequently died of pneumonia was 46.8 between groups 1 and 3. CONCLUSIONS: The high sensitivity (.96) and specificity (.68) of swallowing ability indicate that the method is useful for identifying those persons at greatest risk for pneumonia and death after ischemic stroke.     

Oral function test for monitoring suction and swallowing in the neurologic patient

Disturbances in swallowing are common in neurologic disease but difficult to evaluate in the clinical setting. Fundamental variables such as bolus volume, swallow capacity (volume ingested over time), and the relation between ingestion and time for important events in oral and pharyngeal swallowing have not been sufficiently studied. We therefore employed a composite method for monitoring oral and pharyngeal swallowing function: the test of Repetitive Oral Suction Swallow (the ROSS test). The technical details are described as well as preliminary results from a pilot study of 20 healthy subjects and 5 patients with neurologic swallowing impairment. The correlation with respect to time sequences for major events in bolus ingestion and oral processing as monitored by the ROSS test and by videoradiography is explained. With this simple and rapid bedside test, the immediate and long-time result of therapeutic interventions in dysphagic patients may be monitored.     

Effect of continuous swallowing on respiration

We examined the effect of continuous swallowing on breathing pattern and ventilation in 7 adult subjects. Repetitive swallowing was induced by oral infusion of water at a variable rate of 40, 60, 80 or 100 ml/min, while the subject breathed through the nose. The number of swallows increased from a mean of 5.2 (±2.7 SD) swallows/min during the control period to 9.2 ± 2.0 to 13.7 ± 2.9 swallows/min during infusion of 40 and 100 ml/min, respectively. The duration of interruption of breathing was bolus volume-dependent, increasing from 0.55 ± 0.99 sec with a mean bolus volume of 4.6 ± 1.4 ml to 0.87 ± 0.23 sec with a bolus volume of 8.1 ± 1.9 ml. The majority of swallows (73 ± 12%) interrupted breathing during inspiration. The mean tidal volume, inspiratory and expiratory times during swallowing periods were higher than those recorded during the control period, but the mean level of ventilation was not different from control, at all swallowing frequencies. Repetitive swallowing did not result in a single incidence of aspiration or coughing. We conclude that mechanisms integrating breathing and swallowing allow repetitive swallowing to occur without compromising ventilation, and that these mechanisms perfectly orchestrate between breathing and deglutition to prevent aspiration.     

Effects of stroke‐induced damage to swallow‐related areas in the brain on swallowing mechanics of elderly patients

Aim: Our objective was to determine the relationship between defective swallowing mechanics and the location of brain lesions in stroke patients. Methods: We evaluated swallowing mechanics in 37 stroke patients and 10 age‐matched control subjects by videofluoroscopy. Subjects were asked to swallow 10 successive 1.0‐mL and three successive 2.5‐mL boluses of barium suspension at intervals of approximately 15–30 s. We measured oral transit time, pharyngeal delay time and pharyngeal transit time. Results: Patients could be divided into two groups based on the pharyngeal delay time for a 1.0‐mL bolus swallow. One group showed little variation during successive swallowing tests, similar to the control group. In the other group pharyngeal delay times varied during successive trials often tending to increase with successive swallows. Magnetic resonance imaging studies of the brain revealed infarcts or hemorrhages in swallow‐related areas in the latter group, while in the former group lesions were localized to areas unrelated to swallowing. Conclusion: Damage to swallow‐related areas may reduce their sensitivity to incoming signals from the oral cavity thereby impairing preparations to generate motor command signals and compromising their ability to send sufficient voluntary descending command signals to activate the swallowing central pattern generator located in the medulla. This deficiency becomes more evident with successive swallows and manifests as impaired swallowing mechanics.     

The effects of lingual exercise on swallowing in older adults

OBJECTIVES: To determine the effects of an 8-week progressive lingual resistance exercise program on swallowing in older individuals, the most "at risk" group for dysphagia. DESIGN: Prospective cohort intervention study. SETTING: Subjects were recruited from the community at large. PARTICIPANTS: Ten healthy men and women aged 70 to 89. INTERVENTION: Each subject performed an 8-week lingual resistance exercise program consisting of compressing an air-filled bulb between the tongue and hard palate. MEASUREMENTS: At baseline and Week 8, each subject completed a videofluoroscopic swallowing evaluation for kinematic and bolus flow assessment of swallowing. Swallowing pressures and isometric pressures were collected at baseline and Weeks 2, 4, and 6. Four of the subjects also underwent oral magnetic resonance imaging (MRI) to measure lingual volume. RESULTS: All subjects significantly increased their isometric and swallowing pressures. All subjects who had the MRI demonstrated increased lingual volume of an average of 5.1%. CONCLUSION: The findings indicate that lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age-related conditions. The potential effect of lingual exercise on reducing dysphagia-related comorbidities (pneumonia, malnutrition, and dehydration) and healthcare costs while improving quality of life is encouraging.     

Clinical and videofluoroscopic evaluation of swallowing in 41 patients with neurologic disease.

Forty-one patients with neurologic disease (ND) were evaluated by clinical and videofluoroscopic examination of the oral cavity and pharynx to assess location and severity of swallowing dysfunction using various bolus consistencies. Four different materials were given to each patient, and included low- and high-viscosity barium suspensions, barium paste, and paste-coated cookie. Thirty-five patients had abnormalities of both oral and pharyngeal function. Four patients had pharyngeal dysfunction only, and two patients were normal. Mild swallowing difficulties occurred in five patients (12%), moderate dysfunction in 29 patients (71%), and severe dysfunction in five patients (12%). Thirty-two patients had pharyngeal stasis, which was symmetric in 30 patients (94%) and asymmetric in two. Site of stasis was not related to the type of neurologic disease. Fifteen patients aspirated, most of them (13 of 15) with the low-viscosity barium suspension. The predominance of aspiration with the low-viscosity liquid emphasizes the importance of clinical and videofluoroscopic evaluation of swallowing in dysphagic patients with ND for appropriate feeding recommendations. Thus, videofluoroscopy complemented the clinical examination and defined the type and severity of swallowing abnormalities and aspiration, when present.     

Objective measures of swallowing in patients with primary Sjogren's syndrome

Primary Sjogren's syndrome (SS) is an autoimmune disorder primarily affecting salivary and lacrimal glands. Durational measures of the oral phase of swallowing were obtained on 34 patients with primary SS and 34 age-matched controls from analyses of ultrasound scans. Two conditions were examined: a basal (BA) swallow (only endogeneous secretions present in the subjects' mouths) and a 10 ml water bolus (WB) swallow. The patients with SS produced swallowing durations significantly longer (p<0.05) than those of the controls for each of the two conditions. Moreover, unlike normals, over 40% of the patients with SS produced WB swallows that were longer than their BA swallows. For further analyses, patients with SS were classified into two groups based on the difference in duration between their BA and WB swallows. These two groups differed from each other on clinical evaluations of oral motor function and presenting complaints. No significant differences were found between these two groups for salivary function or immunologic profile. These findings support the hypothesis that dysphagia can result from conditions leading to salivary gland dysfunction and document the need for the assessment of swallowing function in patients with Sjogren's syndrome.     

Compensatory swallowing methods in a patient with dysphagia due to lateral medullary syndrome—vacuum and prolonged swallowing: A case report

Introduction:The nature of pharyngeal swallowing function during the course of recovery of dysphagia due to lateral medullary syndrome (LMS) is unclear. Vacuum swallowing is a compensatory swallowing method that improves the pharyngeal passage of a bolus by creating negative pressure during swallowing in the esophagus in patients with dysphagia due to LMS. We present a case involving a patient with dysphagia due to LMS who involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing.Patient concerns:We report a unique case involving a 52-year-old patient with dysphagia due to LMS. His dysphagia was severe but improved gradually with swallowing rehabilitation. The patient involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing.Diagnosis:The patient presented with dysphagia due to left LMS. A videofluoroscopic examination of swallowing revealed pharyngeal residue.Interventions:Forty-five days after the onset of the dysphagia, the swallowing pressure along the pharynx and esophagus was measured using high-resolution manometry.Outcomes:Vacuum swallowing was observed in six out of 19 swallows (32.5%). The velopharyngeal contractile integral (CI) and mesohypopharyngeal CI values increased during swallowing, reflecting prolonged and increased pharyngeal contraction. We named this swallowing method “prolonged swallowing.”Conclusion:The findings in this case indicate that vacuum and prolonged swallowing may be compensatory swallowing methods observed in individuals recovering from dysphagia due to LMS. Further research is needed to clarify the relationship between these swallowing methods and the pathophysiology, prognosis, and treatment of dysphagia in patients with LMS.     

Coordination of mastication and swallowing

The coordination of mastication, oral transport, and swallowing was examined during intake of solids and liquids in four normal subjects. Videofluorography (VFG) and electromyography (EMG) were recorded simultaneously while subjects consumed barium-impregnated foods. Intramuscular electrodes were inserted in the masseter, suprahyoid, and infrahyoid muscles. Ninety-four swallows were analyzed frame-by-frame for timing of bolus transport, swallowing, and phases of the masticatory gape cycle. Barium entered the pharynx a mean of 1.1 s (range −0.3 to 6.4 s) before swallow onset. This interval varied significantly among foods and was shortest for liquids. A bolus of food reached the valleculae prior to swallow onset in 37% of sequences, but most of the food was in the oral cavity at the onset of swallowing. Nearly all swallows started during the intercuspal (minimum gape) phase of the masticatory cycle. Selected sequences were analyzed further by computer, using an analog-to-digital convertor (for EMG) and frame grabber (for VFG). When subjects chewed solid food, there were loosely linked cycles of jaw and hyoid motion. A preswallow bolus of chewed food was transported from the oral cavity to the oropharynx by protraction (movement forward and upward) of the tongue and hyoid bone. The tongue compressed the food against the palate and squeezed a portion into the pharynx one or more cycles prior to swallowing. This protraction was produced by contraction of the geniohyoid and anterior digastric muscles, and occurred during the intercuspal (minimum gape) and opening phases of the masticatory cycle. The mechanism of preswallow transport was highly similar to the oral phase of swallowing. Alternation of jaw adductor and abductor activity during mastication provided a framework for integration of chewing, transport, and swallowing.     

Quantitative assessment of swallowing in healthy adults

Swallowing has hitherto been evaluated during physical examination, radiologic barium studies, manometry, and cervical auscultation. Radiography principally demonstrates qualitative aspects of oral and pharyngeal function, whereas quantitative aspects have primarily been documented by manometry. To evaluate swallowing quantitatively, without using invasive methods or radiation, we have applied a combined test of water drinking, i.e., the Repetitive Oral Suction Swallow test (ROSS). The test provides reliable measurements of suction pressure, bolus volume, timing of important events in oral and pharyngeal swallow, and respiration. The test is described and results from 292 healthy, nondysphagic subjects are presented. We found a mean bolus volume of 25.6±8.5 ml during single swallow and 21.1±8.2 ml during stress (forced, repetitive swallow). During forced, repetitive swallow, the bolus volume was more strongly associated with suction time (r²=0.55) than with peak suction pressure (r²=0.04), indicating that suction time is more important than suction pressure in determining the bolus volume. The oral-pharyngeal transit time decreased: single swallow 0.56±0.36 sec, forced repetitive swallow 0.23±0.11 sec, as did the coefficient of variation (48% and 64%, respectively) indicating a more automatic neural process for pharyngeal function in forced, repetitive swallow. The postswallow respiration started with inspiration in 10% of studied individuals, but did not correlate with deviations in other variables in the test. Thus, postswallow inspiration must be considered as normal. The ROSS test offers a rapid and easy quantitative assessment of swallowing.     

The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool

BACKGROUND: dysphagia is common in acute stroke. Accurate detection of the presence or absence of aspiration by bedside swallowing assessment is difficult without objective methods, tending to over-diagnose aspiration. As a result, some patients suffer restricted oral intake unnecessarily. OBJECTIVE: we examined the predictive values of pulse oximetry and speech and language therapy bedside swallowing assessment in the detection of aspiration compared with videofluoroscopy. DESIGN: a double-blind observational study. SETTING: two university teaching hospitals. SUBJECTS: we studied 53 patients whose acute strokes were confirmed by computed tomography scan. METHODS: Each subject had initial standard bedside swallowing assessment, closely followed by simultaneous and mutually blinded pulse oximetry, swallowing assessment and videofluoroscopy. RESULTS: 15 of 53 subjects aspirated. Bedside swallowing assessment and saturation assessment at > or = 2% desaturation gave good sensitivity (80% and 87% respectively), but low positive predictive values (50% and 36% respectively). Both assessments mistook laryngeal penetration for aspiration. Re-analysis with aspiration +/- penetration as a new endpoint improved bedside swallowing assessment positive predictive values to 83% (chi2 =3.59, P=0.032). Sensitivity of saturation assessment was maintained at 86%, positive predictive values of saturation assessment improved to 69% (chi2=6.74, P=0.009). The combination of bedside swallowing assessment and saturation assessment versus aspiration + penetration gave a positive predictive value of 95%. CONCLUSIONS: screening by saturation assessments detects 86% of aspirators/penetrators and should be followed immediately by bedside swallowing assessment, as the combination of the two assessments gives the best positive predictive value. For patients with acute stroke, we advocate a 10 ml water-swallow screening test with simultaneous pulse oximetry by suitably trained medical and nursing staff. Use of this screening test would improve dysphagia detection whilst minimizing unnecessary restriction of oral intake in stroke patients.     

Three Tests for Predicting Aspiration without Videofluorography

The videofluorographic swallowing study (VFSS) is the definitive test to identify aspiration and other abnormalities of swallowing. When a VFSS is not feasible, nonvideofluorographic (non-VFG) clinical assessment of swallowing is essential. We studied the accuracy of three non-VFG tests for assessing risk of aspiration: (1) the water swallowing test (3 ml of water are placed under the tongue and the patient is asked to swallow); (2) the food test (4 g of pudding are placed on the dorsum of the tongue and the patient asked to swallow); and (3) the X-ray test (static radiographs of the pharynx are taken before and after swallowing liquid barium). Sixty-three individuals with dysphagia were each evaluated with the three non-VFG tests and a VFSS; 29 patients aspirated on the VFSS. The summed scores of all three non-VFG tests had a sensitivity of 90% for predicting aspiration and specificity of 71% for predicting its absence. The summed scores of the water and food tests (without X-ray) had a sensitivity of 90% and specificity of 56%. These non-VFG tests have limitations but may be useful for assessing patients when VFSS is not feasible. They may also be useful as screening procedures to determine which dysphagia patients need a VFSS. Experiments were performed in the Department of Rehabilitation Medicine, Fujita Health University, Aichi, Japan. This study was funded in part by Health Science Research Grant (H12-choujyu-21 and H13-21EBM-018.     

Capsaicin troche for swallowing dysfunction in older people

OBJECTIVES: To determine whether oral capsaicin troche supplementation with every meal upregulates the impairment of upper respiratory protective reflexes such as the swallowing reflex and the cough reflex. DESIGN: Randomized, controlled study with recruitment through nursing homes. SETTING: Sendai, Japan, from September 2002 through December 2003. PARTICIPANTS: Sixty-four participants in nursing homes with a mean age+/-standard deviation of 81.9+/-1.0 with stable physical status. INTERVENTION: Participants were randomly assigned to the program for the supplementation of capsaicin trochisci or placebo trochisci before every meal for 4 weeks. MEASUREMENTS: Assessment of individual latency time of the swallowing reflex (LTSR) and cough reflex sensitivity. RESULTS: Before the commencement of this study, there were no significant baseline differences in multiple parameters between the intervention group and control group. LTSR in participants in the intervention group was significantly shorter than in the control group (P<.05). The odds ratio (OR) of the shortening of the LTSR of more than 1 minute in the intervention group was 3.4 (95% confidence interval (CI)=1.1-10.4), compared with the control group (P=.03). In particular, daily capsaicin supplementation significantly increased the ratio of LTSR reduction at 4 weeks after the study to baseline LTSR in the high-risk group (baseline LTSR >6.0 seconds) compared with the low-risk group (baseline LTSR <3.0 seconds) and the intermediate group (3.0 seconds 相似文献