Tinnitus in individuals without hearing loss and its relationship with temporomandibular dysfunction

Research has shown that dysfunction of the temporomandibular joint is often associated with tinnitus.Aimto characterize tinnitus in individuals with normal hearing and search for a possible relationship with Temporomandibular Disorders (TMD). Study design: prospective and cross-sectional.Materials and Methodsthe participants included 20 adults of both genders with tinnitus and normal hearing thresholds on audiometry. We studied tinnitus psychoacoustic characteristics and employed the checklist of TMD signs and symptoms from the Tinnitus Handicap Inventory (THI).Resultsthe high pitch, continuous and bilateral tinnitus was the most frequent. Upon acuphenometry, the average tinnitus pitch reported by the subjects was 8.6 kHz and the average loudness was 14.1 dBSL. The degree of discomfort caused by tinnitus was mild. We observed that the higher the pitch, the lower was the loudness and the higher was the THI score. We found that 90% of the patients had at least one TMD sign or symptom.Conclusionsthe most common was the high pitch, continuous and bilateral tinnitus; 90% of patients had at least one sign or symptom of TMD and there was no correlation between the tinnitus and acuphenometry, THI and the TMD checklist.     

Lasertherapy efficacy in temporomandibular disorders: control study

Temporomandibular dysfunction is characterized by the presence of painful joint/muscular symptoms muscle in the face. The main justification for the use of lasers in laser therapy dysfunction is its analgesic effect, which was observed in most studies in the literature.Aim: We evaluated the effectiveness of laser therapy in the treatment of temporomandibular disorders.Methods: 50 volunteers with temporomandibular disorders were divided into two groups (control and experimental) had amplitudes of movements of mouth opening, right and left laterality recorded before and after laser application. Was also recorded, the score the individual gave to pain by visual analog scale and, through physical examination, the pain points. We used the AsGaAl laser with a 40mW power, with 80J/cm2 for 16 seconds at four selected points for just one session with reassessment after a week. Study design: Clinical.Results: It was noted that laser therapy increased the mean amplitude of mandibular movements (p = 0.0317) and decreased significantly (43.6%) the pain intensity measured by the visual analog scale.Conclusions: The laser decreases the painful symptoms of the patient after application through its analgesic and/or a placebo effect.     

Fiberoptic endoscopy evaluation of swallowing in patients with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive degenerative motor neuron disease that adversely affects the muscles responsible for swallowing.ObjectiveTo assess the oral preparatory, oral transit and pharyngeal phases of swallowing in ALS patients through endoscopic evaluation.MethodThis cross-sectional historical cohort study included ALS patients submitted to endoscopic examination. Eleven patients (six males and five females; mean age of 61.7 years) were enrolled in the study from january to december of 2011.ResultsAll patients had alterations in phases of the swallowing process, but only 72.7% complained of dysphagia. The oral preparatory phase was altered in 63.6% of the subjects; the oral transit and pharyngeal phases were altered in all studied individuals, regardless of food consistency. Laryngeal penetration or tracheal aspiration were seen in 90.9% of the patients during the pharyngeal phase while they were swallowing fluids.ConclusionEven in the absence of complaints, dysphagia is a frequent comorbidity in ALS patients. The oral transit and pharyngeal phases were the most frequently affected. Laryngeal penetration or tracheal aspiration occurred more frequently during the pharyngeal phase while patients were swallowing fluids.     

Evolution of swallowing in lateral pharyngoplasty with stylopharyngeal muscle preservation

Lateral pharyngoplasty manages obstructive sleep apnea through the myotomy and repositioning of the muscles of the lateral pharyngeal wall. Dysphagia after any pharyngeal surgery is influenced by pain, discomfort from the sutures, the healing process and by the adaptation to the changes in pharyngeal structures. Experience with lateral pharyngoplasty has shown that the superior pharyngeal constrictor muscle plays a minor role in swallowing. One of them, the stylopharyngeus muscle, seems to play an important role during swallowing.ObjectiveThe aim of this study is to provide a daily analysis of the follow-up of the swallowing function.MethodWe have prospectively evaluated the swallowing function in 20 patients, through the daily application of a visual analogue scale from the first post-op until the complete disappearance of dysphagia.ResultsPatients have returned to their normal feeding habits in a mean of 10.9 days after the procedures and they presented a completely normal swallowing, on average, 21.6 days after the surgeries. All patients recover normal swallowing after the procedures, with a maximum recovery time of 33 days.ConclusionIn this study, all patients who underwent lateral pharyngoplasty with total preservation of the stylopharyngeus muscle reported complete normalization of swallowing with a recovery time up to 33 days.     

Fiberoptic endoscopic evaluation of swallowing in the pediatric population

OBJECTIVE: To investigate the diagnostic and rehabilitative usefulness of routine fiberoptic endoscopic evaluation of swallowing (FEES) in the pediatric population. STUDY DESIGN: Prospective, consecutive, blinded. PATIENTS AND METHODS: Thirty pediatric inpatients from a large, urban, tertiary care teaching hospital participated. Their ages ranged from 11 days to 20 years (mean, 10 years and 4 months). In a random fashion, seven subjects were assessed with both videofluoroscopic evaluation of swallowing (VFES) and FEES and 23 subjects were assessed solely with FEES. Diagnosis of dysphagia was determined by spillage, residue, laryngeal penetration, and aspiration. Rehabilitative strategies, e.g., positioning and modification of bolus consistencies, were based on diagnostic findings. RESULTS: There was 100% agreement between the blinded diagnostic results and implementation of rehabilitative strategies for subjects randomly assigned to receive both VFES and FEES and for subjects who received solely FEES. Of the 23 subjects assessed solely with FEES, 13 of 23 (57%) exhibited normal swallowing and 10 of 23 (43%) exhibited dysphagia. The feeding recommendation for 4 of 10 subjects with dysphagia (40%) was for a non-oral diet because of aspiration. FEES allowed for specific feeding recommendations (i.e., bolus consistency modifications, positioning, and feeding strategies) to reduce aspiration risk in 6 of 10 subjects with dysphagia (60%). CONCLUSION: FEES can be used routinely to diagnose and treat pediatric dysphagia in the acute care setting.     

鼻咽癌放疗后吞咽障碍1例

1病例报告患者,女,70岁。1998年11月在第二军医大学附属长海医院诊断为鼻咽癌。1999年3月在华东医院接受放疗1个月余。之后由于咽干、味觉减退、舌苔发黑,于2000年开始口服中药(3年),舌苔转红。2005年2月出现吞药梗阻症状,且咳嗽、痰多,检查气管及食管未见异常,开始能吃一点软     

Bedside assessment of swallowing in elderly subjects using psychotropic drugs

Neuroleptic drugs are used in several mental disorders, but are suspected of causing oropharyngeal dysphagia, mainly in the elderly.AimTo study the effect of neuroleptic agents on swallowing of institutionalized older people.Material and methodA cross sectional study of swallowing in 47 subjects that either used or did not use neuroleptic drugs. Bedside swallowing tests with foods of four different consistencies were carried out.ResultsThere was no significant difference between the two groups. Users of neuroleptic medications showed a higher percentage of multiple swallowing while non-users had a higher percentage of oral food escape.ConclusionNeuroleptic agents alone do not affect the mechanism of swallowing in the elderly; nonetheless. Further studies with a larger number of individuals and specific swallowing tests are needed.     

Videofluoroscopic and manometric evaluation of swallowing function in patients with multiple system atrophy

We investigated swallowing function of 29 patients with multiple system atrophy (MSA) by videofluoroscopy and manometry. Abnormal findings in videofluoroscopy were generally consistent with those in Parkinson's disease. Although findings of videofluoroscopy were not correlated with a history of aspiration pneumonia, severity of disease was significantly correlated with a history of aspiration pneumonia. Oropharyngeal and hypopharyngeal swallowing pressures of the patients were decreased to 73.9 +/- 48.4 mm Hg and 85.3 +/- 42.9 mm Hg, respectively, both of which were significantly different from the pressures of the control group. Incomplete relaxation of the upper esophageal sphincter was seen in 23.1% of the MSA patients, all of whom had had MSA for more than 5 years. In conclusion, patients with MSA are at risk for aspiration pneumonia as disease severity increases, and the swallowing function of patients with more than 5 years' duration of MSA should be routinely followed up with both videofluoroscopy and manometry.     

Videofluoroscopic evaluation of the swallowing function after supracricoid laryngectomy

This study was designed to evaluate the swallowing function in patients with supracricoid laryngectomy (SCL) compared to normal subjects and to search for the factors affecting postoperative aspiration. Ten patients who underwent SCL with cricohyoidopexy (CHP) for primary laryngeal squamous cell carcinoma were included in the study. The control group consisted of 13 normal adult volunteer men with similar ages. The swallowing act of the subjects was evaluated by using videofluoroscopy (VFS) and videolaryngostroboscopy (VLS). The movements of the larynx were measured with regard to the hyoid bone, mandible and vertebral spine. The patients with SCL-CHP, except for two who had slight aspiration, had effective and near normal swallowing regarding the measurements of the movements of the hyoid bone. They could tolerate a near-normal oral diet. We have observed that the preventive precautions for aspiration are preserving the superior laryngeal nerves, suturing and positioning the cricoarytenoid unit as anterosuperiorly as possible, early decannulation and early onset of swallowing rehabilitation; the risk factors for aspiration are advanced stage of cancer, postoperative radiation and shortening of bolus transit time. VFS is useful for the patients with postoperative aspiration, because it is the definitive technique for anatomical and physiological evaluation of swallowing. We consider that the parameters of VLS and VFS, such as tongue base-arytenoid contact, presence of bolus splitting, pseudoepiglottis function, maximal opening of the pharyngoeosophageal sphincter and total movement of hyoid bone are important criteria to evaluate swallowing.     

Temporomandibular disorder and generalized joint hypermobility: application of diagnostic criteria

Generalized joint hypermobility (GJH) has been considered a predisposing factor for the development of temporomandibular disorder (TMD).AimTo evaluate clinical and psychosocial aspects in individuals diagnosed with TMD with or without GJH.Materials and methodsClinical and experimental study, which enrolled 34 women, from 18 to 35 years of age with TMD diagnosed by RDC/TMD. The GJH was assessed by the Beighton score and volunteers were broken down into 2 groups: with GJH (n = 22) and without GJH (n = 12).ResultsWe found a high percentage of GJH (64.71%). All participants had myofascial pain; 79.41% had arthralgia and 41% had disk displacement. There was a correlation between higher GJH scores and higher passive mouth opening amplitude (p=0.0034), with pain (p=0.0029) and without pain (p=0.0081). Greater mandibular range of motion was observed in the group with GJH, except for protrusion. Painful mouth opening was statistically higher in the GJH group (p=0.0279).ConclusionsIndividuals with TMD associated or not to GJH do not differ significantly regarding clinical and psychosocial aspects, except in the mandibular opening range of motion, which if kept at physiological levels can lead to a late diagnosis of TMD in these individuals.     

Otolaryngology and Speech Therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal

Dysphagia is a symptom associated with an array of anatomical and functional changes which must be assessed by a multidisciplinary team to guarantee optimal evaluation and treatment, preventing potential complications.AimThe aim of the present study is to present the combined protocol of clinical and swallowing videoendoscopy carried by ENT doctors and speech therapists in the Dysphagia Group of the ENT Department - University Hospital.Materials and MethodsRetrospective study concerning the use of a protocol made up of patient interview and clinical examination, followed by an objective evaluation with swallowing videoendoscopy. The exam was performed in 1,332 patients from May 2001 to December 2008. There were 726 (54.50%) males and 606 (45.50%) females, between 22 days and 99 years old.ResultsWe found: 427 (32.08%) cases of normal swallowing, 273 (20.48%) mild dysphagia, 224 (16.81%) moderate dysphagia, 373 (27.99%) severe dysphagia and 35 (2.64%) inconclusive exams.ConclusionThe combined protocol (Otolaryngology and Speech Therapy), is a good way to approach the dysphagic patient, helping to achieve early and safe deglutition diagnosis as far as disorder severity and treatment are concerned.     

纤维内镜检查在吞咽障碍评估中的应用研究

目的 探讨纤维内镜检查吞咽状况(fibreoptic endoscopic evaluation of swallowing, FEES)在吞咽功能评估中的应用价值.方法 对52例临床筛选有吞咽障碍的神经系统疾病患者2日内行FEES和X线造影录像(videofluoroscopy)吞咽功能检查,结果进行对比分析.结果 FEES吞咽前咽渗漏25例次(48.1%),咽潴留39例次(75.0%),喉渗入36例次(69.2%),误吸29例次(55.8%),静息性误吸15例次(28.8%);X线造影吞咽检查以上各项分别为23例次(44.2%)、33例次(63.5%)、30例次(57.7%)、24例次(46.2%)、11例次(21.2%).以X线造影存咽检查结果为金标准,FEES对于喉渗入、误吸和静息性误吸的敏感度(分别为90.0%、87.5%、90.9%、)和阴性预测值(分别为81.3%、87.0%、97.3%)很高.将患者吞咽障碍严重程度分为无喉渗入、喉渗入、误吸、静息性误吸4个等级,Kappa一致性检验显示FEES和X线造影吞咽评估结果有高度的一致性(Kappa=0.452,加权Kappa=0.713).结论 FEES可有效评估吞咽功能障碍,有利于指导患者的饮食管理和康复治疗.     

‘Costen's syndrome’—correlation or coincidence: a review of 45 patients with temporomandibular joint dysfunction,otalgia and other aural symptoms

Costen's syndrome—correlation or coincidence. A review of 45 patients with temporomandibular joint dysfunction, otalgia and other aural symptoms Forty-five patients with temporomandibular joint dysfunction, and otalgia together with other aural symptoms (deafness, tinnitus, pressure/blockage and vertigo) were evaluated clinically and audiometrically. The theoretical mechanisms by which aural symptoms may be produced as a result of temporomandibular joint dysfunction are outlined and discussed in the light of the patients under review. The wide diversity in the incidence of additional aural symptoms apart from otalgia reported in the literature is noted, together with the general lack of full objective audiometric assessment. In 37 patients the aural symptoms were directly attributable to other coincidental otolaryngologies] pathology. Details of the remaining 8 cases are presented. The other aural symptoms of 4 of these patients were also probably accounted for by other coincidental otolaryngologic!] pathology. It may be significant that 2 of the other patients were suffering from concurrent psychiatric disorders. Thus in this series at least 91% of the patients were considered to have other aural symptoms coincidental to temporomandibular joint dysfunction. This is compatible with the relatively common occurrence of both temporomandibular joint dysfunction and aural symptoms in the general population. This study leads us to believe that there is no direct aetiological basis to link temporomandibular joint dysfunction and other aural symptems apart from otalgia.