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Rondanelli M, Faliva MA, Peroni G, Perna S, Gasparri C, Fazia T, Bernardinelli L, Infantino V. A favorable effect on nutritional status of 12-week tailored texture-modified sous-vide cooking meals in institutionalized elderly women with oropharyngeal dysphagia: an intervention study. Minerva Endocrinol (Torino) 2020; 46:202-213. [PMID: 32969627 DOI: 10.23736/s2724-6507.20.03232-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dysphagic patients are not always able to meet their energy, micro and macronutrients needs for various causes and therefore are at high risk of malnutrition. The aim of the present study was to evaluate the effectiveness on satisfaction of the meal (by a 10-cm visuo-analogical scale), food intake (by visual estimation of food waste), nutritional status (anthropometric measures, mini nutritional assessment [MNA], vitamin D, B12, folic acid), functional (handgrip) and blood chemistry metabolic parameters of a tailored texture-modified sous-vide cooking meals (TTMSVC), well balanced in macro and micronutrients, in elderly women suffering from oropharyngeal dysphagia at long-term care facilities. METHODS A 12-week intervention study was conducted on female elderly subjects affected by oropharyngeal dysphagia of level 3-5. The treated group received TTMSVC with the consistencies standardized using viscosimeter (5000-10000 mP/s). The control group maintained pureed hospital diet. RESULTS 50 subjects, 25 in treatment group and 25 in control group, with mean±SD age 89.12±4.18 and mini mental state examination (MMSE) 20.58±1.63 were enrolled. The treatment and control groups were similar at baseline. The changes over time between the two groups showed significant differences for food intake, meal appreciation, Body Mass Index (BMI), calf circumference, arm circumference, MNA, prealbumin, albumin, folic acid, vitamin D, ionized calcium, C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), handgrip. Significant positive correlations were observed in the treatment group between the meal appreciation and prealbumin and vitamin D. CONCLUSIONS This study demonstrated that elderly dysphagic women at long-term care facilities can eat better and increase nutritional status by eating 12-week tailored appealing TTMSVC.
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Affiliation(s)
- Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, Italy.,Unit of Human and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Milena A Faliva
- Unit of Endocrinology and Nutrition, ASP Santa Margherita Institute, University of Pavia, Pavia, Italy
| | - Gabriella Peroni
- Unit of Endocrinology and Nutrition, ASP Santa Margherita Institute, University of Pavia, Pavia, Italy -
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir, Bahrain
| | - Clara Gasparri
- Unit of Endocrinology and Nutrition, ASP Santa Margherita Institute, University of Pavia, Pavia, Italy
| | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Vittoria Infantino
- Unit of Human and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Losco L, Aksoyler D, Chen S, Bolletta A, Velazquez‐Mujica J, Di Taranto G, Lo Torto F, Marcasciano M, Cigna E, Chen H. Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration. Microsurgery 2020; 40:630-638. [DOI: 10.1002/micr.30623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/05/2020] [Accepted: 06/19/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Luigi Losco
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Pisa Italy
| | - Dicle Aksoyler
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
| | - Shih‐Heng Chen
- Department of Plastic SurgeryChang Gung Memorial Hospital Taipei Taiwan
| | - Alberto Bolletta
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
| | | | - Giuseppe Di Taranto
- Plastic Surgery Unit, Department of SurgerySapienza University of Rome Rome Italy
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of SurgerySapienza University of Rome Rome Italy
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno Cecina, Piombino ElbaAzienda USL Toscana Nord Ovest Leghorn Italy
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Pisa Italy
| | - Hung‐Chi Chen
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
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Abstract
Patients with dysphagia, heartburn and chest pain are regularly referred for radiologic evaluation of swallowing. The liquid barium swallow has been of great value for the biphasic evaluation of the pharynx and esophagus. Though many patients complain of dysphagia specifically for solids, solid bolus swallow is usually not part of the evaluation. For the present study we therefore included the use of a solid bolus with a diameter of 13 mm and interviewed the patients carefully for any symptoms during this tablet swallow. Of 200 patients examined, the tablet passed through the esophagus without delay in 102. In the 98 patients with delayed passage, the solid bolus arrest occurred in the pharynx in 5 and in the esophagus in 93. Arrest in the esophagus was due to esophageal dysmotility in 48 patients. Twenty of these were symptomatic during the tablet swallow. A narrowing was the cause in 45, of whom 9 had symptoms. In 18 patients (9%) the solid bolus added key information to the radiologic evaluation. We therefore recommend that the solid bolus is included in the routine radiologic work-up of patients with dysphagia. Careful attention to symptoms during the tablet swallow is important.
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The Clinical and Radiological Approach to Dysphagia. Dysphagia 2012. [DOI: 10.1007/174_2012_617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Krefting L, Norman B, Hagel J, Wevik E, Elm D. A Retrospective Analysis of Interdisciplinary Dysphagia Assessment Data. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v09n02_05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grant PD, Morgan DE, Scholz FJ, Canon CL. Pharyngeal Dysphagia: What the Radiologist Needs to Know. Curr Probl Diagn Radiol 2009; 38:17-32. [DOI: 10.1067/j.cpradiol.2007.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Gastrointestinal disorders are common in elderly patients, and the clinical presentation, complications, and management may differ from those in younger patient. Most impairment occurs in the proximal and distal tract of the gastrointestinal system. Swallowing abnormalities with a wide span of symptoms and pelvic floor pathologies involving all the pelvic compartments are common. Acute abdomen, often from small bowel obstruction or mesenteric ischemia, can pose a diagnostic challenge, because a mild clinical presentation may hide serious visceral involvement. In this setting, the radiologist often is asked to suggest the appropriate management options and to guide the management.
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Lo Re G, Galia M, La Grutta L, Russo S, Runza G, Taibbi A, D'Agostino T, Lo Greco V, Bartolotta TV, Midiri M, Cardinale AE, De Maria M, Lagalla R. Digital cineradiographic study of swallowing in patients with amyotrophic lateral sclerosis. Radiol Med 2007; 112:1173-87. [PMID: 18080096 DOI: 10.1007/s11547-007-0214-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 02/26/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE This study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach. MATERIAL AND METHODS From January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3+/-8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm. RESULTS The cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded. CONCLUSIONS The videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.
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Affiliation(s)
- G Lo Re
- Sezione di Scienze Radiologiche del Dipartimento di Biotecnologie Mediche e Medicina Legale, via del Vespro 127, Palermo, Italy.
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Papavero L, Heese O, Klotz-Regener V, Buchalla R, Schröder F, Westphal M. The impact of esophagus retraction on early dysphagia after anterior cervical surgery: does a correlation exist? Spine (Phila Pa 1976) 2007; 32:1089-93. [PMID: 17471090 DOI: 10.1097/01.brs.0000261627.04944.cf] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective study of 92 patients who underwent anterior cervical surgery. Intraoperative esophagus retraction and postoperative dysphagia were recorded and evaluated. OBJECTIVE Early dysphagia after anterior cervical discectomy and fusion is an underestimated side effect. The aim of this study was to investigate whether postoperative swallowing disturbances correlate with the amount of intraoperative retraction of the pharynx/esophagus wall measured during the procedure. SUMMARY OF BACKGROUND DATA The anterior approach to the cervical spine is a routinely used and, in general, safe procedure. A recent prospective study focused on the underreported side effect of postoperative dysphagia, with an incidence of up to 50% at 1 month and 12.5% at 12 months. The etiology of postoperative dysphagia is not known in detail. METHODS An online pressure transducer between the retractor and pharynx/esophagus recorded the epi-esophageal pressure in 92 patients. In 31 patients, a transducer was additionally inserted into the pharynx/esophagus in order to measure the endo-esophageal pressure. The patients rated swallowing difficulty during the first postoperative 5 days using a 10-point score. A control group of 32 lumbar surgery patients was also evaluated for swallowing disturbances. RESULTS Mean epi-esophageal pressure after retractor opening was 76.3 mm Hg, and mean endo-esophageal pressure was 16.3 mm Hg. An adjustment to 75% and 76%, respectively, of the initial value occurred within the first hour. Of patients, 49.3% complained of swallowing disturbances. There was a significant prevalence of the female gender. No correlation between the amount of retraction and postoperative dysphagia was observed. CONCLUSIONS A correlation between intraoperative pharynx/esophagus retraction and postoperative swallowing disturbances could not be confirmed. The cause of the prevalence of the female gender is unknown. However, the absence of impaired deglutition in the control group suggests that a local phenomenon must be causative of swallowing disturbances following anterior cervical discectomy and fusion.
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Affiliation(s)
- Luca Papavero
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ozkan O, Mardini S, Salgado CJ, Cigna E, Feng GM, Chen HC. Tubed deltopectoral flap for creation of a controlled esophagocutaneous fistula in patients with persistent choking following esophageal reconstruction with free diversionary jejunum. Ann Plast Surg 2006; 55:648-53. [PMID: 16327469 DOI: 10.1097/01.sap.0000187180.32925.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Esophageal reconstruction in patients with abnormal pharyngeal muscles or epiglottis may result in episodes of choking. The jejunal flap has been used to prevent choking by insetting the proximal end into the gingivobuccal sulcus and separating the digestive tract from the airway. A technique has been developed to deal with patients with aspiration due to collection of food near the nonfunctioning epiglottis. Between 1997 and 2004, 25 patients underwent reconstruction with jejunal flaps inset into the gingivobuccal sulcus. Postoperatively, 5 patients presented with episodes of choking. All patients underwent creation of an esophagocutaneous fistula using a deltopectoral flap. All flaps survived. Choking resolved and vocal performance was preserved in all patients. The jejunum, inset proximally into the gingivobuccal sulcus, has been successful in reconstructing patients unable to separate the airway from the digestive tract. The deltopectoral flap provides tissue for creation of a tubed flap and allows for the creation of a long fistula that prevents aspiration and can divert oral fluids away from a tracheostomy or a fresh wound.
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Affiliation(s)
- Omer Ozkan
- Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
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Eisenhuber E, Schima W, Stadler A, Schober E, Schibany N, Denk DM. Evaluation of swallowing disorders with videofluoroscopy in Austria: a survey. Eur J Radiol 2005; 53:120-4. [PMID: 15607862 DOI: 10.1016/j.ejrad.2004.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2003] [Revised: 03/22/2004] [Accepted: 03/26/2004] [Indexed: 11/26/2022]
Abstract
AIM The aim of our study was to assess the availability of videofluoroscopy to examine patients with swallowing disorders in Austria. MATERIALS AND METHODS A questionnaire was sent to the department heads of the radiology departments of all hospitals (n=143) and to all non-hospital-based radiologic practices (n=226) throughout Austria. The survey focused on the availability of videofluoroscopic swallowing studies and on the studies performed in patients with deglutition disorders. RESULTS The questionnaire was completed and returned by 134 of 143 radiology departments (94%) and 65 of 226 non-hospital-based radiologists (29%). Videofluoroscopic swallowing studies were performed in 38 of 134 radiology departments (28%) and in 21 of 65 practices (32%). The method is available in all nine Austrian states (100%) and 27 of 99 districts (27%). The number of examinations performed in different states ranged from 0.7 to 19 studies/10,000 population per year. The number of videofluoroscopic examinations per department or practice in the year 2001 ranged between 5 and 690 (median, 100 examinations). To 85% of videofluoroscopy units patients were referred from otorhinolaryngology/phoniatrics-logopedics, to 69% of videofluoroscopy units referrals were also from internal medicine, from neurology in 54%, and from pediatrics in 20%. CONCLUSION Despite the widespread availability of videofluoroscopy throughout Austria, its use still varies largely between different states. The data show that in general there is a wide-spread demand for videofluoroscopic swallowing studies.
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Affiliation(s)
- Edith Eisenhuber
- Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Chen HC, Chana JS, Chang CH, Feng GM, Ho-Asjoe M, Tang YB. A New Method of Subcutaneous Placement of Free Jejunal Flaps to Reconstruct a Diversionary Conduit for Swallowing in Complicated Pharyngoesophageal Injury. Plast Reconstr Surg 2003; 112:1528-33. [PMID: 14578780 DOI: 10.1097/01.prs.0000083377.41505.bb] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Choking is a serious problem in pharyngoesophageal reconstruction, which may occur following tumor ablation of the pharynx or following corrosive injury involving the epiglottis and other parts of the upper airway. To prevent choking and the risk of severe pulmonary complications, patients have to give up oral intake and assume feeding via jejunostomy for the rest of their lives. After reconstruction of the esophagus, eight patients experienced frequent choking and aspiration. With a free jejunal flap, the inlet for food could be separated from the route of the upper airway by a diversion technique. The jejunum segment was transferred microsurgically to reconstruct the cervical esophagus, with its inlet at the buccogingival sulcus. There were no surgical complications related to either the free jejunal flap transfer or the donor site. Postoperatively, patients require re-education of their pattern of swallowing, but after the rehabilitation period all patients reported a satisfactory oral intake through the reconstructed esophagus to the abdomen without choking. There were no episodes of aspiration following reconstruction. With this new method to create a separate food pathway, patients can resume oral intake safely without choking and without permanent jejunostomy. This technique offers a useful solution for patients who suffer from recurrent choking and aspiration following injury or ablation of the pharynx.
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Affiliation(s)
- Hung-chi Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.
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Sun J, Xu B, Yuan YZ, Xu JY. Study on the function of pharynx & upper esophageal sphincter in globus hystericus. World J Gastroenterol 2002; 8:952-5. [PMID: 12378649 PMCID: PMC4656594 DOI: 10.3748/wjg.v8.i5.952] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Globus pharyngeus is not an uncommon symptom. Presently, its unclear dated pathophysiology remains unclear and the disease can not be evaluated correctly with routine diagnostic methods. The objective of this study is to establish the normal values of pharyngeal and UES pressure, pharyngeal transit time in healthy volunteers and to compare the differences between healthy volunteers and patients with globus pharyngeus.
METHODS: Twenty-four healthy volunteers and thirty-two patients clinically diagnosed as globus pharyngeus entered the study. Pressures of pharynx and UES were measured. Pharyngeal transit time was measured by videofluoroscopic procedure.
RESULTS: Normal pressure of pharynx, and normal resting pressure of UES were 157.81 ± 63.86 mm Hg and 68.33 ± 37.56 mm Hg, respectively. The corresponding values in the patients were 175.50 ± 93.47 mm Hg and 71.38 ± 41.42 mm Hg. The pharyngeal transit time was 1.44 ± 0.30 s in normal control group, among them there were 4 cases with stasis of barium in the valleculae and one in the piriform sinus. No laryngeal penetration or aspiration was found. In the patient group, the pharyngeal transit time was 1.37 ± 0.41 s, among them there were 6 cases with stasis of barium in the valleculae and 5 in the piriform sinus. Nine cases had laryngeal penetration and 2 had aspiration. There were no statistical differences of pressures of pharynx, UES and the pharyngeal transit time between the two groups. But there was an association between laryngeal penetration and globus pharyngeus
CONCLUSION: Radiographic examination of the pharynx show specific findings of pharyngeal dysfunction in patients with globus pharyngeus. UES pressure is normal in most patients. Hence, we find no role for UES hypertonicity as an etiologic factor in globus pharyngeus.
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Affiliation(s)
- Jing Sun
- Department of Gastroenterology, Ruijin hospital, Shanghai Second Medical University, Shanghai 200025, China
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Chan CB, Chan LK, Lam HS. Scattered radiation level during videofluoroscopy for swallowing study. Clin Radiol 2002; 57:614-6. [PMID: 12096861 DOI: 10.1053/crad.2001.0904] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the scattered radiation exposure to the surroundings during videofluoroscopy for swallowing study (VFSS). MATERIALS AND METHODS Scattered radiation exposure was measured using an ion chamber survey meter for 17 adult patients undergoing videofluoroscopy for swallowing study. The cumulative dose area product of each case was also recorded. Data were presented as mean +/- standard deviation. RESULTS The scattered radiation exposure at a distance of 150 cm from the patient and the dose area product recorded were 149 +/- 78 microR (range 42-308 microR) and 842 +/- 544 cGy.cm(2) (range 258-2151 cGy.cm(2)), respectively, for a single study of 18 +/- 6 minutes. A formula was then derived for estimating the scattered radiation dose to muscle tissue at an arbitrary distance based on the accumulated dose area product. With this formula, the mean scattered radiation dose to naked muscle tissue of the surrounding people at a distance of 30-100 cm from the patient were estimated to be 33.68-3.03 microSv respectively. CONCLUSION The scattered radiation detriment associated with videofluoroscopy for swallowing study was well within acceptable levels.
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Affiliation(s)
- C B Chan
- Department of Radiology, Kwong Wah Hospital, Kowloon, Hong Kong.
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Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, Oschatz E. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. AJR Am J Roentgenol 2002; 178:393-8. [PMID: 11804901 DOI: 10.2214/ajr.178.2.1780393] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study evaluated the clinical significance of pharyngeal retention to predict aspiration in patients with dysphagia. MATERIALS AND METHODS At videofluoroscopy, pharyngeal retention was found in 108 (28%; 73 males, 35 females; mean age, 60 years) of 386 patients with a suspected deglutition disorder. Swallowing function was assessed videofluoroscopically. The amount of residual contrast material in the valleculae or piriform sinuses was graded as mild, moderate, or severe. The frequency, type, and grade of aspiration were assessed. RESULTS Pharyngeal retention was caused by pharyngeal weakness or paresis in 103 (95%) of 108 patients. In 70 patients (65%) with pharyngeal retention, postdeglutitive overflow aspiration was found. Aspiration was more often found in patients who had additional functional abnormalities such as incomplete laryngeal closure or impaired epiglottic tilting (p < 0.05). Postdeglutitive aspiration was diagnosed in 25% patients with mild, in 29% with moderate, and in 89% with severe pharyngeal retention (p < 0.05). CONCLUSION Postdeglutitive overflow aspiration is a frequent finding in patients with pharyngeal retention, and the risk of aspiration increases markedly with the amount of residue. Functional abnormalities other than pharyngeal weakness, such as impaired laryngeal closure, may contribute to aspiration.
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Affiliation(s)
- Edith Eisenhuber
- Department of Radiology and Ludwig Boltzmann-Institute for Clinical and Experimental Radiologic Research, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Strasser G, Schima W, Schober E, Pokieser P, Kaider A, Denk DM. Cervical osteophytes impinging on the pharynx: importance of size and concurrent disorders for development of aspiration. AJR Am J Roentgenol 2000; 174:449-53. [PMID: 10658723 DOI: 10.2214/ajr.174.2.1740449] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study evaluated the clinical significance of cervical osteophytes impinging on the pharynx in patients with dysphagia and the importance of concurrent disorders that may affect swallowing function. MATERIALS AND METHODS On videofluoroscopy, anterior cervical osteophytes were found in 55 (32 men, 23 women; mean age, 69 years) of 3318 patients with dysphagia (1.7%). Coexisting diseases that affected swallowing function were found in 28 patients (stroke, n = 7; thyroidectomy, n = 7; tongue base or laryngeal cancer surgery, n = 5; other diseases, n = 9). Swallowing function was assessed with videofluoroscopy evaluating epiglottic tilting, laryngeal closure, impression of the hypopharynx, pharyngeal residue, and aspiration. RESULTS With advancing age, the probability of aspiration (odds ratio, 1.07; p < 0.05) and of enlarging osteophytes (odds ratio, 1.26; p < 0.01) increased; the probability was higher for osteophytes at more than one vertebrae (odds ratio, 8.00; p < 0.01) and for concurrent diseases (odds ratio, 8.02; p < 0.01). Aspiration was found in 75% of patients with osteophytes larger than 10 mm and in 34% with osteophytes smaller than or equal to 10 mm. In 88% of patients with small osteophytes who aspirated, other diseases affected swallowing function. CONCLUSION Aspiration is common in patients with dysphagia and cervical osteophytes larger than 10 mm. Aspiration is rare in patients with osteophytes smaller than or equal to 10 mm unless these patients suffer from other disorders that may affect swallowing.
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Affiliation(s)
- G Strasser
- Department of Radiology and Ludwig Boltzmann-Institute for Radiologic Tumor Research, University of Vienna, Austria
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Communication and Swallowing Issues in Tracheostomized/Ventilator-Dependent Geriatric Patients. TOPICS IN GERIATRIC REHABILITATION 1999. [DOI: 10.1097/00013614-199912000-00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Swallowing disorders affect a large and growing number of people in the United States, particularly the elderly. An appreciation of the anatomy, physiology and pathophysiology of swallowing disorders allows the practitioner to assess these problems and to make arrangements for their treatment. The purpose of this article, therefore, is to give an overview of the diagnosis and treatment of swallowing disorders.
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Affiliation(s)
- E Domenech
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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Becker KJ, Purcell LL, Hacke W, Hanley DF. Vertebrobasilar thrombosis: diagnosis, management, and the use of intra-arterial thrombolytics. Crit Care Med 1996; 24:1729-42. [PMID: 8874314 DOI: 10.1097/00003246-199610000-00022] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To review the diagnosis and management of vertebrobasilar thrombosis and to discuss the use of thrombolytics in the treatment of this disease. DATA SOURCES Selected references discussing epidemiology, anatomy, pathophysiology, diagnosis, therapy, and rehabilitation of vertebrobasilar occlusive disease. STUDY SELECTION Studies addressing acute intervention and outcome in the therapy of vertebrobasilar thrombosis were reviewed. DATA EXTRACTION Only those studies with angiographic documentation of arterial thrombosis and, in the case of thrombolysis, recanalization, were considered valid. DATA SYNTHESIS Thrombosis of the vertebrobasilar system is a highly fatal disease and should be treated as a neurologic emergency. The key to effective management depends on early recognition of the symptom complex and a thorough understanding of the anatomy and pathophysiology of the disease process. CONCLUSIONS A timely, integrated, multidisciplinary approach to the patient with vertebrobasilar thrombosis can improve outcome. The use of thrombolytics in the treatment of vertebrobasilar occlusion holds promise but the benefits have not yet been proven in a controlled, randomized study.
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Affiliation(s)
- K J Becker
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
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Abstract
This article reviews the presentation, diagnosis, and treatment of the varied pathologic conditions that result in dysphagia. The description of difficulty swallowing by a patient should direct the physician to an orderly series of diagnostic tests of esophageal function to help determine the cause of dysphagia. Some conditions that cause dysphagia also are presented in this review.
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Affiliation(s)
- D M Trate
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Parkman HP, Maurer AH, Caroline DF, Miller DL, Krevsky B, Fisher RS. Optimal evaluation of patients with nonobstructive esophageal dysphagia. Manometry, scintigraphy, or videoesophagography? Dig Dis Sci 1996; 41:1355-68. [PMID: 8689912 DOI: 10.1007/bf02088560] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aims of this study were to compare diagnostic accuracy, cost, and patient tolerance of videoesophagography and esophageal transit scintigraphy to esophageal manometry in the evaluation of nonobstructive esophageal dysphagia. Eighty-nine consecutive patients underwent videoesophagography, scintigraphy, and manometry. The sensitivities for diagnosing specific esophageal motility disorders, using esophageal manometry as the standard, were 75% and 68% for videoesophagography and scintigraphy, respectively, with positive predictive accuracies of 96% and 95% for achalasia, 100% and 67% for diffuse esophageal spasm, 100% and 75% for scleroderma, 50% and 67% for isolated LES dysfunction, 57% and 48% for nonspecific esophageal motility disorders, and 70% and 68% for normal esophageal motility. The cost for videoesophagography is less than that for either manometry or scintigraphy. Both videoesophagography and scintigraphy were better tolerated than manometry. It is concluded that videoesophagography and scintigraphy accurately diagnose primary esophageal motility disorders, achalasia, scleroderma, and diffuse esophageal spasm, but are less accurate in distinguishing nonspecific esophageal motility disorders from normal. When considering accuracy, cost, and patient acceptance, these findings suggest that videoesophagography is a useful initial diagnostic study for the evaluation of nonobstructive esophageal dysphagia.
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Affiliation(s)
- H P Parkman
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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24
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Schima W, Pokieser P, Schober E, Denk DM, Moser G, Uranitsch K, Eibenberger K, Herold CJ, Stacher G. Globus sensation: value of static radiography combined with videofluoroscopy of the pharynx and oesophagus. Clin Radiol 1996; 51:177-85. [PMID: 8605748 DOI: 10.1016/s0009-9260(96)80320-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pharyngo-oesophageal abnormalities are found in a high proportion of patients with globus sensation. This study compares the diagnostic value of static single- and double-contrast radiography of the pharynx and oesophagus with videofluoroscopy and with videofluoroscopy combined with static radiography in these patients. Pharyngeal and oesophageal morphology and motor function were studied in 130 consecutive patients with globus sensation (46 males, 84 females; mean age, 47 years) by means of static single and double-contrast radiography and by videofluoroscopy. Videofluoroscopy revealed significantly more functional and structural abnormalities compared to static radiography. Pharyngeal and/or oesophageal disorders were found in 89 vs. 47 patients (chi2 [1] = 19.82, P = 0.0001), pharyngeal abnormalities in 54 vs. 27 patients (chi2 [1] = 13.5, P < 0.0002), and oesophageal abnormalities in 72 vs. 27 patients (chi2 [1] = 28.13, P < 0.0001). Videofluoroscopy combined with static radiography revealed significantly more abnormalities than videofluoroscopy alone (chi2 [1] = 4.23, P < 0.05), and assessed mucosal details more reliably than videofluoroscopy alone. The most frequent abnormalities found were nonspecific oesophageal motor disorders, pharyngo-oesophageal sphincter dysfunction, pharyngeal stasis, achalasia, and laryngeal penetration or aspiration of barium. In most patients with globus sensation, pharyngeal and/or oesophageal abnormalities can be detected radiographically. Videofluoroscopy revealed significantly more functional but not morphological abnormalities than did static radiography. Videofluoroscopic studies combined with static radiography had a higher diagnostic value than videofluoroscopic studies alone.
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Affiliation(s)
- W Schima
- Department of Radiology, University of Vienna, Austria
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25
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Ott DJ, Hodge RG, Pikna LA, Chen MY, Gelfand DW. Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations. Dysphagia 1996; 11:187-90. [PMID: 8755463 DOI: 10.1007/bf00366383] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Clinical and videofluoroscopic evaluation of swallowing were correlated to determine their agreement and relationship to feeding recommendations. We reviewed a total of 148 patients with swallowing difficulties, of which 93 (45 women, 48 men; mean age 62 years) were evaluated by both clinical and radiographic examinations. A variety of materials were used for clinical bedside evaluation of oral and pharyngeal function. Radiographic examination was done with variable viscosity materials and videotape recording of the oral cavity and pharynx. The severity of oral and pharyngeal abnormalities was graded and findings of the examinations were compared. The combined results of both evaluations generated an index of swallowing difficulty which was correlated to the type of diet used if oral feeding was recommended or to a nonoral route of nutrition. In the assessment of oral and pharyngeal dysfunction, clinical evaluation and radiographic examination correlated closely in 94% of patients; however, the status of pharyngeal function was not determined in 61 (66%) of the 93 patients by clinical examination alone. The combined swallowing index was calculated in 89 patients and its severity correlated significantly with the type of feeding recommended; 64 patients were placed on one of three types of diets and 25 had enteral feedings. In conclusion, combined clinical and radiographic examinations correlated well, but clinical evaluation alone was limited by failure to evaluate the pharynx in many patients. The swallowing severity correlated well with final feeding recommendations.
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Affiliation(s)
- D J Ott
- Department of Radiology, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157, USA
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26
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Somers S. Contemporary radiological examination of the upper gastrointestinal tract. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1994; 8:665-81. [PMID: 7742570 DOI: 10.1016/0950-3528(94)90018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Barium and endoscopy both have advantages. Endoscopy not only gives you direct visualization but also the ability to biopsy tissue. It does not give you the ability to determine the exact anatomy or the gross appearance of a lesion. Barium on the other hand gives you a dynamic examination which is particularly useful for the assessment of swallowing disorders and oesophageal motility. When the pharynx and oesophagus are not of prime concern and cost is not a problem then endoscopy is the examination of choice. It has been shown that dyspeptic patients who have had both examinations have a definite preference for endoscopy (Stevenson et al, 1991). As endoscopy requires minimal physical effort, it is also a preferable examination for the unwell patient.
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Affiliation(s)
- S Somers
- Department of Gastrointestinal Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada
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27
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Schima W, Pokieser P, Forstinger C, Uranitsch K, Kalhs P, Schober E, Kier P, Tscholakoff D. Videofluoroscopy of the pharynx and esophagus in chronic graft-versus-host disease. ABDOMINAL IMAGING 1994; 19:191-4. [PMID: 8019340 DOI: 10.1007/bf00203504] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Successful allogeneic bone marrow transplantation (BMT) for hematologic disorders may be complicated by graft-versus-host-disease (GVHD). Chronic GVHD is a systemic disease, involving, among other organs, the skin, mouth, liver, and esophagus. Esophageal involvement results in mucosal inflammation, leading to submucosal fibrosis and, occasionally, formation of webs and strictures. We investigated 25 allogeneic BMT recipients (17 with and eight without chronic GVHD). All patients had a videofluoroscopic study of the pharynx and esophagus to determine the radiographic abnormalities characteristic of chronic GVHD. Oropharyngeal abnormalities (poor bolus control, pharyngeal retention, or excessive mucous secretions) were found in five patients with and three patients without GVHD. Only one patient with GVHD had a pharyngo-esophageal stricture. There was no significant difference between the two groups with regard to pharyngo-esophageal radiographic abnormalities and esophageal symptoms. Radiographic evidence of esophageal motility disorder is not specific for GVHD involvement. In the absence of specific radiographic features, endoscopy is the most accurate method for the diagnosis of esophageal involvement by GVHD.
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Affiliation(s)
- W Schima
- Department of Radiology, University of Vienna, Austria
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28
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All GN. Severe complications following a “barium swallow” investigation for dysphagia. Med J Aust 1994. [DOI: 10.5694/j.1326-5377.1994.tb138299.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Galib N All
- NHMRC Postgraduate Research Scholar Department of Gastroenterology The St George Hospital Belgrave StreetKogarahNSW2217
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29
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Abstract
The potential causes of neurogenic oropharyngeal dysphagia in cases in which the underlying neurologic disorder is not readily apparent are discussed. The most common basis for unexplained neurogenic dysphagia may be cerebrovascular disease in the form of either confluent periventricular infarcts or small, discrete brainstem stroke, which may be invisible by magnetic resonance imaging. The diagnosis of occult stroke causing pharyngeal dysphagia should not be overlooked, because this diagnosis carries important treatment implications. Motor neuron disease producing bulbar palsy, pseudobulbar palsy, or a combination of the two can present as gradually progressive dysphagia and dysarthria with little if any limb involvement. Myopathies, especially polymyositis, and myasthenia gravis are potentially treatable disorders that must be considered. A variety of medications may cause or exacerbate neurogenic dysphagia. Psychiatric disorders can masquerade as swallowing apraxia. The basis for unexplained neurogenic dysphagia can best be elucidated by methodical evaluation including careful history, neurologic examination, videofluoroscopy of swallowing, blood studies (CBC, chemistry panel, creatine kinase, B12, thyroid screening, and anti-acetylcholine receptor antibodies), electromyography, and magnetic resonance imaging (MRI) of the brain, plus additional procedures such as lumbar puncture and muscle biopsy as indicated. Little is known about aging and neurogenic dysphagia, specifically the relative contributions of natural age-related changes in the oropharynx and of diseases of the elderly, including periventricular MRI abnormalities, in producing dysphagia symptoms and videofluoroscopic abnormalities in this population.
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Affiliation(s)
- D W Buchholz
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0876
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30
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31
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Hendrix TR. Commentary on the determination of the evaluation of dysphagia. Dysphagia 1993; 8:83-4. [PMID: 8467729 DOI: 10.1007/bf02266985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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32
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Abstract
Bolus volume is an important modifier of the biomechanical events of the oropharyngeal swallow. The biomechanical events comprising a swallow can be divided into events associated with the reconfiguration of the pharynx into a swallow pathway and events associated with bolus transport from the oropharynx into the esophagus. Volume modification is achieved differently for the events of reconfiguration and propulsion. In the case of reconfiguration, a longer time is allocated to the process, as exemplified by sustained laryngeal elevation and hyoid excursion during larger volume swallows. On the other hand, in the case of bolus expulsion, volume accommodation is accomplished within the same period of time by utilizing increased vigor of expulsion. The result of deglutitive volume accommodation is a remarkably different fluoroscopic appearance of a small vs. a large volume swallow. The larger volume swallow seemingly takes longer and results in much more vigorous bolus expulsion than a small volume. However, this is more related to the bolus than the swallow.
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Affiliation(s)
- P J Kahrilas
- Department of Medicine, Northwestern University, Chicago, Illinois
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33
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Buchholz DW. Clinically probable brainstem stroke presenting primarily as dysphagia and nonvisualized by MRI. Dysphagia 1993; 8:235-8. [PMID: 8359044 DOI: 10.1007/bf01354544] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Ten patients with clinically probable brainstem stroke presenting primarily as acute dysphagia but without visible brainstem abnormality by MRI are described. The patients were evaluated with neurologic examinations, cinepharyngoesophagography, and brain MRI studies. Each patient solely or predominately experienced sudden pharyngeal dysphagia, and additional symptoms or signs other than dysphonia or dysarthria were scarce. Small vessel disease or cardiac embolism were the apparent causes of what appear to have been very discrete brainstem strokes in these patients. Acute pharyngeal dysphagia can be the sole or primary manifestation of brainstem stroke. A negative MRI study should not preclude consideration of this diagnosis, if brainstem stroke is otherwise clinically probable.
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Affiliation(s)
- D W Buchholz
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland 21287
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34
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Abstract
The cricopharyngeus is a narrow band of muscle strategically placed between the pharynx and esophagus. Its normal function is vital to the efficient transfer of foodstuffs to the esophagus. Cine- and videoradiography are the major methods of studying the pharyngo-esophageal segment. More recently, refinements in manometric methods have complemented radiology, and have enabled us to achieve a better understanding of cricopharyngeal function in health and disease. Such an understanding of the physical forces necessary for normal bolus transfer, and the recognition of abnormal patterns of pharyngeal and cricopharyngeal motility, will hopefully lead us to a more rational approach to therapy in patients with pharyngeal dysphagia.
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Affiliation(s)
- I J Cook
- Gastroenterology Department, St. George Hospital, Kogarah, Sydney, Australia
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35
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36
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Abstract
Certain swallowing disorders characteristically may follow head and neck surgeries and neurologic disorders. Aspiration is one of the possible symptoms of dysphagia. Since aspiration can be life-threatening, prosthodontists should help to identify patients who aspirate. This article describes the normal swallowing physiology, the pathophysiology of swallowing disorders, and the prosthetic role in the treatment of patients experiencing head and neck surgical operations and neurologic disorders that may cause aspiration.
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Affiliation(s)
- J J Gary
- William Beaumont Army Medical Center, El Paso, Tex
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37
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Wein B, Böckler R, Klajman S. Temporal reconstruction of sonographic imaging of disturbed tongue movements. Dysphagia 1991; 6:135-9. [PMID: 1914541 DOI: 10.1007/bf02493515] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Documentation of tongue movement during swallowing has been restricted to the recording of fluorographic or ultrasound images on cine- or videofilm. The new approach of temporal sonographic imaging with reconstruction of one single image for the total act of swallowing presents a direct approach to obtaining substantial information concerning tongue movements and motility. The applicability of this reconstructed image for the documentation, interpretation, and comparison of tongue movements is demonstrated using examples of normal and pathologic swallowing.
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Affiliation(s)
- B Wein
- Clinic of Diagnostic Radiology, Hospital of Rheinisch-Westfälisch Technical University of Aachen, Germany
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38
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Penington GR, Krutsch JA. Swallowing disorders in stroke. Med J Aust 1991; 154:69. [PMID: 1984591 DOI: 10.5694/j.1326-5377.1991.tb112858.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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39
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Muz J, Mathog RH, Hamlet SL, Davis LP, Kling GA. Objective assessment of swallowing function in head and neck cancer patients. Head Neck 1991; 13:33-9. [PMID: 1989928 DOI: 10.1002/hed.2880130106] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Swallowing function was evaluated with scintigraphy in 37 patients with head and neck cancer. The patients were examined before and during the course of either surgery, chemotherapy, and/or radiotherapy. A total of 118 scintigraphic studies were performed. Scintigraphic results of bolus flow and aspiration were correlated with clinical findings. Both scintigraphic and clinical studies indicated a worsened swallowing function in 12 patients. These same studies indicated improvement of swallowing in another 13 patients. In 11 patients, both studies revealed either no apparent change or mixed changes in swallowing function after the course of therapy. In only 1 patient was there disagreement between the scintigraphic and clinical assessment of swallowing function. It is our opinion that scintigraphy is a useful method for objective assessment of swallowing function during and after the course of treatment of head and neck cancer patients.
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Affiliation(s)
- J Muz
- Department of Radiology, Harper Hospital, Detroit, MI 48201
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40
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Abstract
The decisions involved in the institution of artificial feeding in patients with chronic and/or terminal illness are difficult. They are more complex when one is deciding if nutrition and hydration are to be withdrawn. In both instances the decision must be based on a combination of factors: the patient's right to self-determination; documented medical evidence demonstrating the need for artificial feeding, combined with a risk/benefit analysis if alternative alimentation is recommended; and an appreciation of prior legal decisions as they relate to the implementation of alternative forms of nutrients to sustain life.
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Affiliation(s)
- M E Groher
- Department of Veterans Affairs Medical Center, New York, New York
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41
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Stein M, Williams AJ, Grossman F, Weinberg AS, Zuckerbraun L. Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. Chest 1990; 97:347-52. [PMID: 2298059 DOI: 10.1378/chest.97.2.347] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dysphagia due to cricopharyngeal dysfunction is well known; however, there have been no previous data indicating an association between cricopharyngeal dysfunction and COPD. After observing marked cricopharyngeal dysfunction with aspiration in three patients who had frequent and severe exacerbations of COPD, we performed pharyngoesophageal examinations with videotaping in another 22 nonrandomized patients. Cineradiography or videofluoroscopic recording with capabilities of slow-motion and freeze-frame playback is mandatory, since the transit time of the bolus through the pharynx is rapid. Severe cricopharyngeal dysfunction was observed in 17 elderly patients with COPD. Deglutition disorders were elicited by careful questioning in 15 of these. In eight subjects, cricopharyngeal myotomy resulted in improvement of swallowing and complete or partial relief of acute exacerbations of respiratory distress. In one subject, myotomy relieved only the swallowing problem. The mechanism of cricopharyngeal dysfunction in elderly patients with COPD is unknown at this time, but may be related to gastroesophageal reflux, therapeutic agents, and/or alterations in pharyngoesophageal anatomic structures. We conclude that investigations for swallowing disorders should be considered in patients with COPD who have frequent acute exacerbations of respiratory distress.
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Affiliation(s)
- M Stein
- Medical Service, Brotman Medical Center, Culver City
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42
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Radiology '89. Proceedings of the 47th annual Congress of the British Institute of Radiology. Eastbourne, 4-6 May, 1989. Abstracts. Br J Radiol 1989; 62 Suppl:S1-102. [PMID: 2765757 DOI: 10.1259/bjr.1989.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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43
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Muz J, Mathog RH, Nelson R, Jones LA. Aspiration in patients with head and neck cancer and tracheostomy. Am J Otolaryngol 1989; 10:282-6. [PMID: 2764241 DOI: 10.1016/0196-0709(89)90009-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Tracheopulmonary aspiration is a common occurrence in patients with dysphagia associated with head and neck cancer. We performed quantitative scintigraphic analysis of tracheopulmonary aspiration in 125 patients with head and neck cancer; 58 of these patients had a tracheostomy. Tracheopulmonary aspiration occurred in 58% of patients with a tracheostomy and in 23% of patients without a tracheostomy. In six of seven patients with a tracheostomy, tracheopulmonary aspiration significantly increased when the obturator was removed and, in these patients, occlusion of the tracheostomy tube during feedings eliminated or reduced the complication. Our studies suggest that aspiration can be monitored accurately and conveniently by scintigraphy, and that this technique is useful in the evaluation and management of dysphagia in debilitated patients.
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Affiliation(s)
- J Muz
- Department of Radiology, Harper Hospital, Wayne State University School of Medicine, Detroit, MI
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44
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Abstract
Oropharyngeal and esophageal dysphagia involve different phases of swallowing, have different causes, and can usually be distinguished by a thorough patient history. Initial evaluation of patients with suspected oropharyngeal dysphagia includes patient history, physical and neurologic examination, and careful videofluoroscopic study of pharyngeal dynamics. Initial evaluation of patients with suspected esophageal dysphagia includes patient history and barium swallow with esophagography. Lesions such as Schatzki's ring or peptic stricture may not be detected unless the esophagus is sufficiently distended and the patient is given a bolus challenge.
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Affiliation(s)
- J B Marshall
- Division of Gastroenterology, University of Missouri, Columbia School of Medicine 65212
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