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1.
The aim of this study was to retrospectively investigate swallowing capacity and dysphagia severity using VFSS and to determine
their relationships to intra- and postoperative factors in long-lasting dysphagia patients who had undergone an operation
unrelated to pharyngeal and laryngeal structures. Twenty-six patients without a definite cause of dysphagia were selected
from among patients admitted to our hospital from January 2006 to December 2007. Videofluoroscopic dysphagia scale (VDS) and
ASHA NOMS swallowing level (ASHA level) at 1 month postoperatively were used to determine dysphagia severity and swallowing
capacity. Intraoperative factors (endotracheal tube size, intubation time, and total anesthetic time) and postoperative factors
(tracheostomy history, vocal cord palsy, and postoperative delirium) were investigated to determine their relationhips with
VDS and ASHA level. No significant relationship was found between these factors and VDS or ASHA level by Pearson’s or Spearman’s
correlation testing. Further prospective studies are required to identify the causative factors of long-lasting dysphagia
after surgical procedures unrelated to pharyngeal and laryngeal structures.
相似文献
Sang Jun KimEmail: |
2.
The ability to measure normality and abnormality and to accurately assess true changes in swallowing function over time, is
important for the management of dysphagia. Despite this, there is a paucity of information regarding the stability and reliability
of measurements tools used for dysphagia research. As both head and neck (H&N) cancer and its treatment(s) have been shown
to significantly affect deglutitive tongue function, it is important that we have a reliable method to measure swallowing
tongue function in this population. In this study we evaluate the reliability and stability of oro-lingual swallowing pressures
captured from H&N cancer patients and from healthy, age- and gender-matched controls using the Kay Swallowing Workstation
(KSW) fixed, three-transducer tongue pressure array. Significant differences between the two samples (H&N cancer and controls),
with respect to mean peak oro-lingual pressures were recorded during swallowing. Furthermore, reliability of these measures
was lower in H&N cancer patients. These differences highlight the importance of obtaining information about the reliability
of dysphagia assessment tools with the specific population with whom they will be used.
相似文献
Alison PerryEmail: |
3.
Elevated muscular tone associated with spastic syndromes can cause excessive contractility at the upper esophageal sphincter
and impede swallowing. A 47-year-old male patient with spasticity predominantly of the lower extremities after a subarachnoid
hemorrhage suffered from severe dysphagia and chronic salivary aspiration. He was dependent on a cuffed tracheostomy tube
and a percutaneous enterogastric feeding tube. Barium swallow and esophageal manometry revealed cricopharyngeal spasm, while
laryngeal elevation and pharyngeal contractility were well preserved. We endoscopically injected 180 MU botulinum toxin A
into the cricopharyngeus muscle. Two days post injection, swallowing function had improved and oral nutrition was possible.
This improvement lasted for six weeks. After another injection 8 weeks later, an undesired diffusion into the hypopharynx
occurred and manometry showed diminished contractility without amelioration of dysphagia. Botulinum toxin therapy of cricopharyngeal
spasm improves swallowing function in a subgroup of patients with spastic syndromes. The therapeutic effect is of limited
duration. Toxin diffusion into the pharynx should be avoided. Manometry is useful in planning and monitoring the therapy.
相似文献
Eike KrauseEmail: |
4.
The aim of this study was to report on nine dysphagic patients with medullary infarction and to evaluate swallowing characteristics
based on the location of the lesions.We retrospectively reviewed the medical records of these nine patients. The medullary
lesions were midlateral (three patients), dorsolateral (one patient), inferodorsolateral (four patients), and paramedian (one
patient). The levels of the lesions were upper (four patients), middle (two patients), upper and middle (two patients), and
middle and lower medulla (one patient). Dysphagia after medullary infarction was more common in patients with upper or middle
medullary level and dorsolateral medullary level lesions. The common findings on videofluoroscopic swallowing studies in patients
with lateral medullary infarctions were impaired upper esophageal sphincter opening, aspiration from pyriform sinuses’ residue
caused by pharyngeal weakness, and multiple swallowing to clear boluses from the pharynx to the esophagus. In patients with
medullary infarctions, the lesion levels and loci and their related clinical findings can be useful in predicting dysphagia
and aspiration. Because severe dysphagia with serious complication is very common in patients with medullary infarctions,
active diagnostic and therapeutic approaches are needed.
相似文献
Sam-Gyu LeeEmail: |
5.
The impact of medications on the physiology of swallowing has received much attention in dysphagia literature. This article
reviews the potential effects of medications commonly prescribed in an adult continuing care and rehabilitation facility on
swallowing. An audit of medications prescribed to 153 adults accessing age-related respiratory, neurology, and learning disability
services was performed. This was followed by an investigation of relevant sources to identify the potential side effects of
these medications. One side effect, namely, xerostomia, which our investigations revealed could be a side effect of 24.8%
of the medications used at our institution, was further investigated. The prevalence of xerostomia was then investigated in
a randomly selected sample of ten subjects whose dysphagia had been confirmed by videofluoroscopy. It was found that six of
the ten dysphagic clients displayed xerostomia. Review of the medications of these ten subjects indicated that all were using
from three to nine drugs that could cause xerostomia. This article highlights the need for health-care professionals to consider
the potential effects of these medications on swallowing and, indeed, the general presentation of clients.
相似文献
Louise GallagherEmail: |
6.
Swallowing dysfunction in the elderly is common and affects not only nutrition but also the ingestion of medicines. This qualitative
study used a focus group to collect data from ten healthcare professionals who are involved in the care of people with swallowing
difficulties. The group discussed their experiences of the problems associated with and solutions to the administration of
medicines to patients with dysphagia. The focus group was audiotaped, and the data analysed using Colaizzi’s technique. Six
themes were identified, three main ones: (1) the wide spectrum of dysphagia; (2) medicine formulation, which affects how drugs
can be administered; (3) problems with data flow, i.e., the correct information being with the right person at the right time
and in the right place; and three minor ones which arose from the major themes: (4) the primary function of swallowing is
nutrition rather than taking medication; (5) cost of medicines; and (6) therapeutic dilemmas. The study concludes that improvements
in interprofessional communication are needed to improve medicine administration to dysphagic patients.
相似文献
David WrightEmail: |
7.
Neuroplasticity and Swallowing 总被引:1,自引:1,他引:0
Ruth E. Martin 《Dysphagia》2009,24(2):218-229
Recent research has suggested that the central nervous system controlling swallowing can undergo experience-dependent plasticity.
Moreover, swallowing neuroplastic change may be associated with behavioural modulation. This article presents research evidence
suggesting that nonbehavioural and behavioural interventions, as well as injury, can induce swallowing neuroplasticity. These
studies indicate that while swallowing and limb neuroplasticity share certain features, certain principles of swallowing neuroplasticity
may be distinct. Thus, an understanding of swallowing neuroplasticity is necessary in terms of explaining and predicting the
(1) behavioural effects of injury to the swallowing nervous system and (2) effects of swallowing interventions applied in
rehabilitation.
相似文献
Ruth E. MartinEmail: |
8.
The prevalence of swallowing disorders (dysphagia) following a total laryngectomy remains unknown, with estimates varying
from 17 to 70%. The primary aim of this study was to investigate the prevalence and nature of self-reported dysphagia following
a total laryngectomy across New South Wales (NSW), Australia. A secondary aim was to document the effect of dysphagia on the
respondents’ social activities and participation. A questionnaire battery, with a prepaid envelope for return, was sent to
all laryngectomy members (n = 197) of the Laryngectomee Association of NSW. One hundred twenty questionnaires (61%) were completed and returned. Dysphagia
was self-reported by 71.8% of the cohort. In this cohort with dysphagia, the most commonly reported features included an increased
time required to swallow, a need for fluids to wash down a bolus, and avoidance of certain food consistencies. Severe distress
was reportedly associated with dysphagia for 39.7% of these respondents and prevented 57% of them from participating in social
activities, such as eating at friends’ houses and/or at restaurants. The prevalence of self-reported dysphagia following total
laryngectomy in this Australian study was 72%. Dysphagia can result in laryngectomees making significant changes to their
diets and it has a marked impact on their activities and social participation.
相似文献
Julia MacleanEmail: |
9.
Wakasugi Y Tohara H Hattori F Motohashi Y Nakane A Goto S Ouchi Y Mikushi S Takeuchi S Uematsu H 《Dysphagia》2008,23(4):364-370
Many screening tests for dysphagia can be given at bedside. However, they cannot accurately screen for silent aspiration (SA).
We studied the usefulness of a cough test to screen for SA and combined it with the modified water swallowing test (MWST)
to make an accurate screening system. Patients suspected of dysphagia (N = 204) were administered a cough test and underwent videofluorography (VF) or videoendoscopy (VE). Sensitivity of the cough
test for detection of SA was 0.87 with specificity of 0.89. Of these 204 patients, 107 were also administered the MWST. Fifty-five
were evaluated as normal by the screening system, 49 of whom were evaluated as normal by VF or VE. Sixteen were evaluated
as “SA suspected” by the screening system; seven of them were normal, and seven were evaluated as having SA by VF or VE. Nineteen
were evaluated as aspirating with cough, 14 of whom had aspiration with cough as shown by VF or VE. Seventeen were evaluated
as having SA, 15 of whom had SA shown by VF or VE. The cough test was useful in screening for SA. Moreover, a screening system
that included MWST and a cough test could accurately distinguish between the healthy who were safe in swallowing and SA patients
who were unsafe.
相似文献
Yoko WakasugiEmail: |
10.
We describe a patient who suddenly developed dysphagia for liquids as the sole manifestation of stroke. Magnetic resonance
imaging (MRI) revealed a right-sided infarction of the superior part of the anterior insula and a small portion of the adjacent
medial frontal operculum. These findings confirm the role of the anterior insula as a critical area in humans with regard
to the origin of dysphagia.
相似文献
Mario Prosiegel (Corresponding author)Email: |
11.
Bilateral medial medullary infarct is a rare stroke syndrome and only a handful of cases have been described. Dysphagia as
a manifestation of medullary infarcts is well recognized but often associated with lateral medullary infarct. Bilateral medial
medullary infarcts are commonly associated with severe dysphagia in addition to a number of other signs and symptoms. We describe
a patient who had bilateral medial medullary infarct with severe dysphagia in addition to quadriplegia and respiratory difficulty,
and analyze infarct topography with respect to dysphagia, risk factors, vascular territories involved, and prognosis in view
of previously reported cases.
相似文献
Vimal K. PaliwalEmail: |
12.
Katsinelos P Chatzimavroudis G Zavos C Pilpilidis I Paroutoglou G Kountouras J 《Dysphagia》2009,24(1):109-113
Symptomatic esophageal epiphrenic diverticula are usually repaired with diverticulectomy and esophagomyotomy with substantial
morbidity and mortality rates, especially in elderly patients. We describe the cases of two elderly patients who had dysphagia
caused by large epiphrenic diverticula. Due to severe comorbid diseases, both patients were unable to withstand surgical intervention;
botulinum toxin solution was injected endoscopically at multiple sites in the region of the lower esophageal sphincter and
esophageal wall near the diverticulum. Symptoms improved immediately and the beneficial effect of botulinum toxin remained
for 5–6 months. During the long-term follow-up, the patients developed symptomatic relapses treated by subsequent botulinum
toxin solution reinjections resulting in longer-lasting symptom relief.
相似文献
Grigoris ChatzimavroudisEmail: |
13.
Omohyoid muscle syndrome (OMS) is a rare clinical condition that has the pathognomonic feature of the appearance of a lateral
neck mass when swallowing due to dysfunction of the omohyoid muscle (OH). We present two cases of typical OMS with electrophysiologic
and dynamic imaging studies. The study results indicate that OMS is caused mainly by the loosening of the fascial attachment
to the intermediate tendon of the OH. The characteristic clinical features and pathomechanism underlying OMS are also discussed.
相似文献
Sung-Bom PyunEmail: |
14.
To understand disordered physiology, it is first necessary to determine what constitutes normal function. Liquid sip size
during swallowing in healthy individuals has been investigated with varied results. Bolus size is a variable that is manipulated
in both research studies and clinical swallowing assessments, so defining normal sip size has relevance in both domains. This
study looked at sip size under instruction in experimental tasks and compared it to sip size in free drinking while participants
were unaware that drinking was being observed. A statistically significant difference was found in water sip volume between
natural drinking (mean = 16 ml) and instructed experimental drinking tasks (mean = 6.6–6.8 ml). This difference far exceeded
the magnitude of sip-size variation observed between instructed drinking tasks using different stimuli and as a function of
participant’s gender or age group.
相似文献
Catriona M. SteeleEmail: |
15.
This systematic review explores the effects of dysphagia treatment for Parkinson’s disease. The review includes rehabilitative,
surgical, pharmacologic, and other treatments. Only oropharyngeal dysphagia is selected for this literature search, excluding
dysphagia due to esophageal or gastric disorders. The effects of deep brain stimulation on dysphagia are not included. In
general, the literature concerning dysphagia treatment in Parkinson’s disease is rather limited. Most effect studies show
diverse methodologic problems. Multiple case studies and trials are identified by searching biomedical literature databases
PubMed and Embase, and by hand-searching reference lists. The conclusions of most studies cannot be compared with one another
because of heterogeneous therapy methods and outcome measures. Further research based on randomized controlled trials to determine
the effectiveness of different therapies for dysphagia in Parkinson’s disease is required.
相似文献
Laura W. J. BaijensEmail: |
16.
Poststroke dysphagia is frequent and significantly increases patient mortality. In two thirds of cases there is a spontaneous
improvement in a few weeks, but in the other third, oropharyngeal dysphagia persists. Repetitive transcranial magnetic stimulation
(rTMS) is known to excite or inhibit cortical neurons, depending on stimulation frequency. The aim of this noncontrolled pilot
study was to assess the feasibility and the effects of 1-Hz rTMS, known to have an inhibitory effect, on poststroke dysphagia.
Seven patients (3 females, age = 65 ± 10 years), with poststroke dysphagia due to hemispheric or subhemispheric stroke more
than 6 months earlier (56 ± 50 months) diagnosed by videofluoroscopy, participated in the study. rTMS at 1 Hz was applied
for 20 min per day every day for 5 days to the healthy hemisphere to decrease transcallosal inhibition. The evaluation was
performed using the dysphagia handicap index and videofluoroscopy. The dysphagia handicap index demonstrated that the patients
had mild oropharyngeal dysphagia. Initially, the score was 43 ± 9 of a possible 120 which decreased to 30 ± 7 (p < 0.05) after rTMS. After rTMS, there was an improvement of swallowing coordination, with a decrease in swallow reaction
time for liquids (p = 0.0506) and paste (p < 0.01), although oral transit time, pharyngeal transit time, and laryngeal closure duration were not modified. Aspiration
score significantly decreased for liquids (p < 0.05) and residue score decreased for paste (p < 0.05). This pilot study demonstrated that rTMS is feasible in poststroke dysphagia and improves swallowing coordination.
Our results now need to be confirmed by a randomized controlled study with a larger patient population.
相似文献
E. VerinEmail: Email: |
17.
Pseudoachalasia due to adenocarcinoma is well known. We report a case of nutcracker esophagus in the setting of outflow obstruction
from esophageal adenocarcinoma. Endoscopy is warranted to exclude similar lesions in patients with “pseudo-nutcracker esophagus”.
相似文献
Stephen AntonikEmail: |
18.
Julie A. Theurer Kathy A. Czachorowski Lyndsay P. Martin Ruth E. Martin 《Dysphagia》2009,24(3):302-313
While previous research has shown that air-pulse stimulation of the oropharynx facilitates saliva swallowing in young adults,
the effects of air pulses in older adults have not been examined. Responses to air-pulse stimulation may differ in young and
older adults given age-related changes in sensation, swallowing physiology, and swallow-related brain activation. Therefore,
this study sought to determine the effects of oropharyngeal air-pulse stimulation on saliva swallowing rates in 18 healthy
older adults. Saliva swallowing rates were monitored across six conditions: baseline without mouthpiece, baseline with mouthpiece
in situ, unilateral right oropharyngeal stimulation, unilateral left oropharyngeal stimulation, bilateral oropharyngeal stimulation,
and sham stimulation. Results indicated that bilateral oropharyngeal air-pulse stimulation was associated with a statistically
significant increase in mean saliva swallowing rate compared to baseline without mouthpiece, baseline with mouthpiece in situ,
and sham stimulation. In previous studies, young adults reported an irrepressible urge to swallow in response to oropharyngeal
air-pulse delivery, but the older adults in the current study did not perceive the air-pulse stimulation as being associated
with swallowing or other behaviors. These findings indicate that oropharyngeal air-pulse stimulation facilitates the elicitation
of saliva swallowing in older adults.
相似文献
Ruth E. MartinEmail: |
19.
The purpose of this study was to contrast the psychometric properties (stability, test-retest reliability, construct, and
concurrent validity) of three different tools used for evaluating videofluoroscopy swallowing studies (VFSS): (1) rating the
presence or absence of a swallowing disorder, (2) the Bethlehem Assessment Scale (BAS), and (3) biomechanical measures. These
three tools were applied to the same three examinations of two different consistencies (liquid and semisolid), taken from
40 VFSSs of patients with head and neck (H&N) cancer. Stability of swallowing across three swallows was a concern for three
measures with the liquid consistency and nine measures with the semisolid consistency. Test-retest reliability was found to
vary considerably for the two consistencies (liquids, 0.53–1.00; semisolids, 0.45–1.00). Examination of construct validity
of the BAS and biomechanical measures indicated that six factors represented swallowing function, but different factors represented
swallowing under liquid and semisolid conditions. Concurrent validity of the presence/absence of disorder variables was less
than adequate. These results are discussed in the following contexts: (1) psychometric properties of VFSS may not be adequate
for clinical and research environments and (2) psychometric properties of VFSS measures appear to vary as a function of bolus
consistency.
相似文献
Jacqui J. FrowenEmail: |
20.
Pauloski BR Rademaker AW Lazarus C Boeckxstaens G Kahrilas PJ Logemann JA 《Dysphagia》2009,24(2):196-203
Pharyngeal manometry complements the modified barium swallow with videofluoroscopy (VFS) in diagnosing pressure-related causes
of dysphagia. When manometric analysis is not feasible, it would be ideal if pressure information about the swallow could
be inferred accurately from the VFS evaluation. Swallowing function was examined using VFS and concurrent manometry in 18
subjects (11 head and neck patients treated with various modalities and 7 healthy adults). Nonparametric univariate and multivariate
analyses revealed significant relationships between manometric and fluoroscopic variables. Increases in pressure wave amplitude
were significantly correlated with increased duration of tongue base to pharyngeal wall contact, reduced bolus transit times,
and oropharyngeal residue. Pharyngeal residue was the most important VFS variable in reflecting pharyngeal pressure measurements.
Certain VFS measures were significantly correlated with measures of pressure assessed with manometry. Further research is
needed before observations and measures from VFS alone may be deemed sufficient for determining pressure-generation difficulties
during the swallow in patients who are unable or unwilling to submit to manometric testing.
相似文献
Barbara Roa PauloskiEmail: |