Journal articles on the topic 'Dysphagia, swallowing, pneumonia, cluster analysis'
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1
Henke, Christian, Christian Foerch, and Sriramya Lapa. "Early Screening Parameters for Dysphagia in Acute Ischemic Stroke." Cerebrovascular Diseases 44, no. 5-6 (2017): 285–90. http://dx.doi.org/10.1159/000480123.
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Background: Dysphagia is a frequent symptom in patients with acute stroke. It is associated with malnutrition, aspiration and mortality. The identification of early screening parameters for dysphagia promptly leading to a professional swallowing examination is therefore of utmost importance. This study aimed to detect early and easily assessable predictors of dysphagia in a large cohort of patients with acute ischemic stroke. Methods: Our analysis was based on data from a prospective in-hospital registry. Patients with ischemic stroke were included over the course of 3 years. Patients were scheduled to undergo a clinical swallowing investigation within the first 24 h after hospital admission. Step-wise multivariate logistic regression was used to identify independent predictors of dysphagia in general and of pneumonia in particular. Results: 1,646 patients with ischemic stroke were included. Stroke severity in terms of higher National Institute of Health Stroke Scale (NIHSS) values (p < 0.001), male gender (p = 0.006) and higher age (p < 0.001) independently predicted dysphagia. A receiver operating characteristics analysis revealed an NIHSS cut-off value of 4.5 for optimal differentiation between patients with and without dysphagia (sensitivity 0.77; specificity 0.77). Dysphagia (p < 0.001), male gender (p = 0.002), higher NIHSS scores (p < 0.001) and higher age (p = 0.002) were factors that were independently associated with pneumonia. The NIHSS cut-off value for differentiating between patients with and without pneumonia was 5.5 (sensitivity 0.91; specificity 0.67). Conclusions: Stroke severity in terms of NIHSS is a simple and reliable predictor of dysphagia. Patients with NIHSS values ≥5 should be quickly directed towards a professional swallowing examination. Dysphagia was confirmed to be a strong predictor of pneumonia.
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Dai, Yong, Jia Qiao, Qiu-Ping Ye, Xin-Ya Li, Jia-Hui Hu, and Zu-Lin Dou. "Exploring the Influence of Dysphagia and Tracheostomy on Pneumonia in Patients with Stroke: A Retrospective Cohort Study." Brain Sciences 12, no. 12 (December 3, 2022): 1664. http://dx.doi.org/10.3390/brainsci12121664.
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Background: Pneumonia is common in patients with tracheostomy and dysphagia. However, the influence of dysphagia and tracheostomy on pneumonia in patients with stroke remains unclear. The aim of this study was to explore the risk factors related to pneumonia, and the association between dysphagia, tracheostomy and pneumonia in patients with stroke was investigated. Methods: Patients with stroke who experienced tracheostomy and dysphagia were included and divided into two groups based on record of pneumonia at discharge. Clinical manifestations and physical examination were used to diagnose pneumonia, whereas clinical swallowing examination, and videofluoroscopy swallowing studies (VFSS) were used to evaluate swallowing function. Results: There were significant differences between the pneumonia group and the no pneumonia group in total tracheostomy time (6.3 ± 5.9 vs. 4.3 ± 1.7 months, p = 0.003), number of instances of ventilator support (0.41 ± 0.49 vs. 0.18 ± 0.38, p = 0.007), PAS score (5.2 ± 1.92 vs. 4.3 ± 1.79, p = 0.039), impaired or absent cough reflex (76.4 vs. 55.6%, p = 0.035), oropharyngeal phase dysfunction (60.6 vs. 40.8%, p = 0.047), length of hospital stay (36.0 ± 7.2 vs. 30.5 ± 11.7 days, p = 0.025) and direct medical costs (15,702.21 ± 14,244.61 vs. 10,923.99 ± 7250.14 United States dollar [USD], p = 0.042). Multivariate logistic regression showed that the total tracheostomy time (95% confidence interval [CI], 1.966–12.922, p = 0.001), impaired or absent cough reflex (95% CI, 0.084–0.695, p = 0.008), and oropharyngeal phase dysfunction (95% CI, 1.087–8.148, p = 0.034) were risk factors for pneumonia. Spearman’s correlation analysis demonstrated that PAS scores were significantly correlated with cough reflex dysfunction (r = 0.277, p = 0.03), oropharyngeal phase dysfunction (r = 0.318, p < 0.01) and total tracheostomy time (r = 0.178, p = 0.045). The oropharyngeal phase dysfunction was significantly correlated with cough reflex (r = 0.549, p < 0.001) and UES opening (r = 0.643, p < 0.01). Conclusions: Tracheostomy and dysphagia increased the risk of pneumonia in patients with stroke. Total tracheostomy time, duration of ventilator support, degree of penetration and aspiration, and oropharyngeal phase dysfunction are risk factors. Given this, we also found that there may be a correlation between tracheostomy and dysphagia.
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Pekacka-Egli, Anna Maria, Radoslaw Kazmierski, Dietmar Lutz, Stefan Tino Kulnik, Katarzyna Pekacka-Falkowska, Adam Maszczyk, Wolfram Windisch, Tobias Boeselt, and Marc Spielmanns. "Predictive Value of Cough Frequency in Addition to Aspiration Risk for Increased Risk of Pneumonia in Dysphagic Stroke Survivors: A Clinical Pilot Study." Brain Sciences 11, no. 7 (June 25, 2021): 847. http://dx.doi.org/10.3390/brainsci11070847.
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Background: Post-stroke dysphagia leads to increased risk of aspiration and subsequent higher risk of pneumonia. It is important to not only diagnose post-stroke dysphagia early but also to evaluate the protective mechanism that counteracts aspiration, i.e., primarily cough. The aim of this study was to investigate the predictive value of cough frequency in addition to aspiration risk for pneumonia outcome. Methods: This was a single-center prospective observational study. Patients with first-ever strokes underwent clinical swallowing evaluation, fibreoptic endoscopic evaluation of swallowing (FEES), and overnight cough recording using LEOSound® (Löwenstein Medical GmbH & Co. KG, Bad Ems, Germany ). Penetration–Aspiration Scale (PAS) ratings and cough frequency measurements were correlated with incidence of pneumonia at discharge. Results: 11 women (37%) and 19 men (63%), mean age 70.3 years (SD ± 10.6), with ischemic stroke and dysphagia were enrolled. Correlation analysis showed statistically significant relationships between pneumonia and PAS (r = 0.521; p < 0.05), hourly cough frequency (r = 0,441; p < 0.05), and categories of cough severity (r = 0.428 p < 0.05), respectively. Logistic regression showed significant predictive effects of PAS (b = 0.687; p = 0.014) and cough frequency (b = 0.239; p = 0.041) for pneumonia outcome. Conclusion: Cough frequency in addition to aspiration risk was an independent predictor of pneumonia in dysphagic stroke survivors.
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Lee, Byung Joo, Hyoshin Eo, and Donghwi Park. "Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Evaluating Swallowing Function among Patients with Amyotrophic Lateral Sclerosis and Dysphagia." Journal of Clinical Medicine 10, no. 19 (September 22, 2021): 4300. http://dx.doi.org/10.3390/jcm10194300.
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Introduction: The videofluoroscopic dysphagia scale (VDS) is used to predict the long-term prognosis of dysphagia among patients with the condition. Previously, a modified version of the VDS (mVDS) was established to overcome the relatively low inter-rater reliability of VDS, and was verified in patients with dysphagia, such as stroke patients. However, the validity of mVDS in patients with amyotrophic lateral sclerosis (ALS) has never been proved. Therefore, in this study, we attempted to seek the validity of the mVDS score in patients with ALS suffering from dysphagia. Method: Data from the videofluoroscopic swallowing study (VFSS) of 34 patients with ALS and dysphagia were retrospectively collected. We investigated the presence of aspiration pneumonia and the selected feeding method based on the VFSS. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed during the data analysis. Results: In patients with ALS and dysphagia, the mVDS scores were statistically correlated with the selected feeding method (p < 0.05) and the presence of aspiration pneumonia (p < 0.05). In the ROC curve analysis, the area under the ROC curve values for the selected feeding method and the presence of aspiration pneumonia were 0.886 (95% confidence interval (CI), 0.730–0.969; p < 0.0001) and 0.886 (95% CI, 0.730–0.969; p < 0.0001), respectively. Conclusion: The mVDS can be a useful tool for quantifying the severity of dysphagia and interpreting the VFSS findings in patients with ALS and dysphagia. However, further studies involving a more general population of patients with ALS are needed to elucidate a more accurate cut-off value for the allowance of oral feeding and the presence of aspiration pneumonia.
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El Gharib, Aretuza Zaupa Gasparim, Giédre Berretin-Felix, Diogo Francisco Rossoni, and Sergio Seiji Yamada. "Effectiveness of Therapy on Post-Extubation Dysphagia: Clinical and Electromyographic Findings." Clinical Medicine Insights: Ear, Nose and Throat 12 (January 2019): 117955061987336. http://dx.doi.org/10.1177/1179550619873364.
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Introduction: Patients who require prolonged endotracheal intubation (>48 hours) are at risk of dysphagia. Speech-language pathologists should perform swallowing exercises after extubation due to the high probability of developing aspiration pneumonia. There are no studies describing the use of swallowing techniques employed in post-extubation therapy aided by surface electromyography. Objectives: To evaluate the effects of swallowing function therapy in extubated patients after prolonged orotracheal intubation by means of clinical and electromyographic evaluation. Methods: A total of 15 patients were enrolled in this study (average age 48.6 ± 16.5 years). The study was carried out in three phases: (1) Clinical and electromyographic evaluation using the Dysphagia Risk Assessment Protocol following dysphagia scores criteria, and the measurement of the suprahyoid muscles amplitude (μV) expressed by root mean square (RMS), respectively; (2) swallowing rehabilitation program; and (3) reevaluation of patients after therapy. The Wilcoxon paired test assuming a significance level of 5% was used for statistical analysis. Results: By means of the swallowing scale, it was verified that patients suffered from severe oropharyngeal dysphagia at the first evaluation (80%), but the rehabilitation therapy reduced clinical signs, persistent only in one patient (6.7%) post-therapy, thus, improving swallowing. Significant differences, pre- and post-therapy, for suprahyoid muscles during maximal voluntary isometric contractions of right ( P = .0067) and left ( P = .0215), saliva swallowing by right ( P = .0413) and left ( P = .0151), and liquid swallowing by right ( P = .0479) and left ( P = .0215) sides, were found, as shown by electromyography. Conclusions: Swallowing exercises carried out by extubated patients after prolonged orotracheal intubation increased neuromuscular recruitment of suprahyoid muscles involved with swallowing and reduced dysphagia levels.
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Bedaque, Henrique de Paula, Lidiane Maria de Brito Macedo Ferreira, Kallil Monteiro Fernandes, Cynthia Meira de Almeida Godoy, and Hipólito Virgilio Magalhães Junior. "OROPHARYNGEAL DYSPHAGIA: AN ASSOCIATION BETWEEN DYSPHAGIA LEVEL, SYMPTOMS AND COMORBIDITY." JOURNAL OF SURGICAL AND CLINICAL RESEARCH 11, no. 1 (May 22, 2020): 39–45. http://dx.doi.org/10.20398/jscr.v11i1.20955.
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Objective: Associate levels of dysphagia according to the patient health condition. Methods: Retrospective study analyzing 149 medical records of patients who underwent Fiberoptic endoscopic evaluation of swallowing (FEES) in a tertiary hospital from 2016 to 2018. Data was collected on symptoms, comorbidities, FESS findings and oropharynx dysphagia classification. Statistical analysis was performed through descriptive and bivariate analysis using the Chi-square and Fisher's exact tests with a 5% significance level. Results: Most patients are elderly, female and with the main complaint of gagging for liquids and solids (30.9%), and gagging only for liquids was associated with the presence of mild dysphagia. The most prevalent degree of oropharynx dysphagia (OD) was mild (45%). In relation to patients' diseases, associations were identified between amyotrophic lateral sclerosis and mild dysphagia, Parkinson's disease and moderate dysphagia, and past pneumonia and / or head and neck cancer with severe dysphagia. Conclusions: The main complaint of patients with dysphagia and their pathological history should guide the treatment, without dispensing with complementary exams such as FESS, highlighting Parkinson's disease with moderate oropharynx dysphagia and past pneumonia and / or head and neck cancer as severe dysphagia.
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Madhavan, Aarthi, Giselle Carnaby, Karishma Chhabria, and Michael Crary. "Preliminary Development of a Screening Tool for Pre-Clinical Dysphagia in Community Dwelling Older Adults." Geriatrics 3, no. 4 (December 7, 2018): 90. http://dx.doi.org/10.3390/geriatrics3040090.
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Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed ‘pre-clinical dysphagia’. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach’s α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.
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Jiang, Hailun, Qiang Zhang, Qi Zhao, Hao Chen, Xi Nan, Miao Liu, Chunsheng Yin, et al. "Manual Acupuncture or Combination of Rehabilitation Therapy to Treat Poststroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Evidence-Based Complementary and Alternative Medicine 2022 (October 15, 2022): 1–26. http://dx.doi.org/10.1155/2022/8803507.
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Backgroundand Objective. Poststroke dysphagia is one of the most common stroke complications with high morbidity and long course, while acupuncture treatment is easily accepted by patients due to its reliability, feasibility, simple operation, low price, and quick effect. Our objective was to evaluate the efficacy of manual acupuncture in poststroke dysphagia patients. Methods. Databases including Medline, Web of Science, PubMed, Cochrane Library databases, EMBASE, CNKI (China National Knowledge Infrastructure), WanFang (WanFang Database), and VIP (Chongqing VIP) were searched from inception until Aug 19, 2022. Data were analyzed using Revman 5.3, Stata 14.0, and TSA 0.9.5.10 Beta software. Evidence quality evaluation was performed by using GRADE profiler 3.6. Results. A total of 33 randomized control trials (RCTs) enrolled 2680 patients. Meta-analysis results revealed that compared to rehabilitation, acupuncture decreased water swallow test (WST) and standard swallowing assessment (SSA) scores. Meanwhile, in contrast to rehabilitation alone, integration of acupuncture with rehabilitation effectively decreased WST and SSA scores; improved swallowing scores of videofluoroscopic swallowing study (VFSS), swallowing scores of Fujishima Ichiro, Barthel index (BI), and swallowing quality of life questionnaire (SWAL-QOL); reduced the aspiration rates as well as aspiration pneumonia; and shortened the duration of empty swallowing and the duration of 5 mL water swallowing. Pooled analysis did not reveal any significant differences in dysphagia outcome severity scores (DOSS) ( p = 0.15 > 0.05 p) between the acupuncture group combined with rehabilitation group and the rehabilitation group alone. After the risk-of-bias assessment, these studies were not of low quality, except in terms of allocation concealment and blindness. Evidence quality evaluation showed that allocation concealment and blindness led to a downgrade and primary outcomes’ evaluation of acupuncture combined with rehabilitation were ranked as moderate-quality evidence while acupuncture alone was ranked as low-quality. Conclusion. This meta-analysis provided positive pieces of evidences that acupuncture and acupuncture combined with rehabilitation were better than using rehabilitation alone in the treatment of poststroke dysphagia.
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Labeit, Bendix, Marc Pawlitzki, Tobias Ruck, Paul Muhle, Inga Claus, Sonja Suntrup-Krueger, Tobias Warnecke, Sven G. Meuth, Heinz Wiendl, and Rainer Dziewas. "The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis." Journal of Clinical Medicine 9, no. 7 (July 8, 2020): 2150. http://dx.doi.org/10.3390/jcm9072150.
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(1) Background: Dysphagia is a clinical hallmark and part of the current American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) diagnostic criteria for idiopathic inflammatory myopathy (IIM). However, the data on dysphagia in IIM are heterogenous and partly conflicting. The aim of this study was to conduct a systematic review on epidemiology, pathophysiology, outcome and therapy and a meta-analysis on the prevalence of dysphagia in IIM. (2) Methods: Medline was systematically searched for all relevant articles. A random effect model was chosen to estimate the pooled prevalence of dysphagia in the overall cohort of patients with IIM and in different subgroups. (3) Results: 234 studies were included in the review and 116 (10,382 subjects) in the meta-analysis. Dysphagia can occur as initial or sole symptom. The overall pooled prevalence estimate in IIM was 36% and with 56% particularly high in inclusion body myositis. The prevalence estimate was significantly higher in patients with cancer-associated myositis and with NXP2 autoantibodies. Dysphagia is caused by inflammatory involvement of the swallowing muscles, which can lead to reduced pharyngeal contractility, cricopharyngeal dysfunction, reduced laryngeal elevation and hypomotility of the esophagus. Swallowing disorders not only impair the quality of life but can lead to serious complications such as aspiration pneumonia, thus increasing mortality. Beneficial treatment approaches reported include immunomodulatory therapy, the treatment of associated malignant diseases or interventional procedures targeting the cricopharyngeal muscle such as myotomy, dilatation or botulinum toxin injections. (4) Conclusion: Dysphagia should be included as a therapeutic target, especially in the outlined high-risk groups.
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Hanna, R., and D. R. Randall. "Progression of swallowing dysfunction and associated complications of dysphagia in a cohort of patients with serial videofluoroscopic swallow examinations." Journal of Laryngology & Otology 135, no. 7 (June 10, 2021): 593–98. http://dx.doi.org/10.1017/s0022215121001298.
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AbstractObjectiveDysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time.MethodThis was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities.ResultsThis study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time (p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time (p = 0.57) or severity of dysphagia (p = 0.88).ConclusionOur dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.
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Eltringham, Sabrina A., Sue Pownall, Ben Bray, Craig J. Smith, Laura Piercy, and Karen Sage. "Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers." Geriatrics 4, no. 4 (December 7, 2019): 67. http://dx.doi.org/10.3390/geriatrics4040067.
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(1) Background: Swallowing difficulties (dysphagia) after stroke are not uncommon and is a consistent risk factor for stroke-associated pneumonia. This interview study explores the perspectives of stroke survivors, who had their swallowing assessed in the first few days of admission to hospital, and their informal caregivers. (2) Methods: A participatory approach was used involving people affected by stroke in the interpretation and analysis of the interview data. Data was thematically analysed and six themes were identified. (3) Results: These themes included how past-future experiences may influence a person’s emotional response to events; understanding what is happening and adjustment; the impact of dysphagia; attitudes to care; communication to patients and procedural issues. (4) Conclusion: The findings highlight the importance of effective public health messages to improve people’s responsiveness to the signs of stroke, standardisation of assessment and management procedures, effective communication to patients about the consequences of dysphagia, and the impact of dysphagia on the person who had the stroke and their informal caregiver.
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Choi, Jayoon, Sora Baek, Gowun Kim, and Hee-won Park. "Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia." Annals of Rehabilitation Medicine 45, no. 6 (December 31, 2021): 431–39. http://dx.doi.org/10.5535/arm.21068.
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Objective To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS).Methods Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (<65 and ≥65 years), preceding conditions, modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), PCF value (<160, ≥160 and <270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed.Results Pneumonia group was more likely to be male (n=108; 78.3%), ≥65 years (n=121; 87.7%), with neurodegenerative (n=25; 18.1%) or other miscellaneous diseases (n=50; 36.2%), and in poor functional level with lower value of MBI (39.1±26.59). However, MMSE was not significantly different in comparison to that of the control group. The pneumonia group was also more likely to have dysphagia (82.6%) and lower value of PCF (<160 L/min, 70.3%). In multivariable logistic regression analysis, male sex (odd ratio [OR]=6.62; 95% confidence interval [CI], 2.70–16.26), other miscellaneous diseases as preceding conditions (OR=2.52; 95% CI, 1.14–5.58), dysphagia (OR=3.82; 95% CI, 1.42–10.23), and PCF <160 L/min (OR=14.34; 95% CI, 1.84–111.60) were factors significantly related with pneumonia.Conclusion Impaired swallowing and coughing function showed an independent association with the development of pneumonia. Patients with PCF <160 L/min require more attention with lung care and should be encouraged with voluntary coughing strategy to prevent possible pulmonary complications.
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Hawson, Frederick Y. "The Assessment of Oropharyngeal Dysphagia in Adults." Philippine Journal of Otolaryngology-Head and Neck Surgery 24, no. 2 (November 29, 2009): 43–45. http://dx.doi.org/10.32412/pjohns.v24i2.695.
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One of the more important and critical referrals that otolaryngologists can receive from colleagues in internal medicine, family medicine and geriatrics is the assessment of swallowing problems or dysphagia of their patients.
The term “dysphagia” is derived from two Greek words which literally mean difficulty in swallowing. Swallowing is a complex series of precisely coordinated voluntary and involuntary muscular movements in the mouth, pharynx and esophagus that serves to deliver food from the oral cavity into the stomach. Normal swallowing consists of three phases: oral preparatory, pharyngeal and esophageal. One normal swallow of a bolus of food should only take less than one second to reach the esophagus.
Dysphagia may manifest as difficulty managing secretions, drooling, delayed swallowing, coughing or choking with the swallow, a wet gurgly voice, and multiple swallow attempts. The complaint of dysphagia in an elderly patient should not be attributed to normal aging alone, but should be considered an alarm symptom that requires immediate definition of the exact cause and initiation of appropriate therapy.1
Dysphagia and Aspiration Pneumonia2,3
Dysphagic patients who aspirate have a seven-fold risk for acquiring pneumonia. In patients with an acute stroke, 40-70% have dysphagia. Of these, aspiration occurs in 40-50%. 50-75% of patients with degenerative diseases of the central nervous system (e.g. Alzheimer’s disease) also have dysphagia. Thus, people older than 75 years old have a six time higher risk of contracting aspiration pneumonia than younger individuals.
Factors that increase the risk of aspiration pneumonia in dysphagia patients include volume of aspirate, oropharyngeal colonization with pathogens such as Staphylococcus aureus, Klebsiella sp. or E. coli (due to decreased salivary clearance and poor oral hygiene) and poor nutritional status (that leads to decreased immunity).
Oropharyngeal Dysphagia
Dysphagia is typically distinguished into two types based on the phase of swallowing affected. Dysphagia secondary to a lesion above the esophagus is called orophayrngeal dysphagia. Dysphagia involving the upper esophageal sphincter to the stomach is considered esophageal dysphagia. This discussion will concentrate on oropharyngeal dysphagia.
Oral dysfunction causes drooling, food spillage, difficulty initiating a swallow, piecemeal swallows, and articulation problems. Pharyngeal dysfunction gives a sensation of food “getting stuck” immediately upon swallowing, regurgitation into the nose, coughing or choking while eating, and vocal problems. Difficulty is localized to the cervical region, usually involving liquids. In contrast, patients with esophageal dysphagia usually describe the onset of symptoms several seconds after initiating swallow. Difficulty is localized to the suprasternal notch or behind the sternum, usually involving solids.1
Oropharyngeal dysphagia is of unique clinical significance. Affected patients often have impaired ability to verbalize their discomfort or to cooperate with evaluation and therapy because of their neurological conditions. This dysphagia is usually not only a local problem, but just one aspect of a systemic disease syndrome. Diagnosis is a challenge because the problem is usually not obviously visible. Management therefore requires a coordinated team approach involving several medical and allied medical professionals. Aside from otolaryngologists, neurologists, radiologists, gastroenterologists, oncologists, rehabilitation medicine specialists and speech-language pathologists will have their specific roles.4
Oropharyngeal dysphagia can be locally caused by poor dentition, mucosal lesions, problems in salivary production, or by a number of neuromuscular disease syndromes. The central nervous system is commonly involved, as with cerebro-vascular accidents (usually in the brainstem), Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and brainstem tumors. The peripheral nervous system can also be involved, as with poliomyelitis or myasthenia gravis.. Local structural lesions may be inflammatory, neoplastic, compressive or post-surgical in nature. There can also be hypertensive or hypotensive motility disorders of the upper esophageal sphincter. 5,6
Physical Examination
A comprehensive physical examination should be part of the initial evaluation of all patients with oropharyngeal dysphagia. Examination of the oral cavity, head and neck, and supraclavicular region may reveal apparent problems that cause the dysphagia.
Neurological examination, which includes testing of all cranial nerves, especially those involved in swallowing (sensory components of CS V, IX, X and motor components of CN V, VII, X, XI and XII), may also detect disorders with more subtle physical findings of the various neuromuscular syndromes that could cause dysphagia. 7
Diagnostic Testing
Classic barium-swallow radiography is the most basic diagnostic test for dysphagia, though more useful for esophageal problems.
While esophageal manometry is more useful for esophageal dysphagia, it may also be helpful for patients who have oropharyngeal dysphagia with inconclusive results from other examinations. It is especially useful in cases in which surgical myotomy is being considered. 7
Videofluoroscopic evaluation of swallowing (VFES) gives a real-time and detailed analysis of swallowing mechanics from the oral to the esophageal stages, making this the gold standard of swallowing examinations. However, its prohibitive cost and the non-portability make it impractical for several patient settings, most particularly critical patients in Intensive Care Units.
Fiberoptic endoscopic evaluation of swallowing (FEES) is the diagnostic procedure performed mainly by otolaryngologists, and will be the discussed in some detail here.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Flexible Rhinopharyngoscopy is the preferred technique for examining the pharynx because anatomic structures are visualized without interfering with normal physiology of respiration and phonation.8 FEES is an extension technique done to examine swallowing events for both diagnostic and rehabilitative purposes 9 and was first described by Susan Langmore in 1988.10 FEES involves assessment of swallowing function for food and liquid, as well as the response to therapeutic interventions.
Before any food testing, velopharyngeal closure, anatomy of the tongue base and hypopharynx, vocal fold movement, status of pharyngeal musculature and patients’ ability to swallow saliva and secretions are first noted. If the equipment is available, sensory testing by eliciting the laryngeal adductor reflex (LAR), using calibrated air pulses delivered to the epithelium innervated by the internal branch of the superior laryngeal nerve, should also be performed.11 Being an involuntary reflex, this information is important when dealing with patients with impaired cognition.8,11
Food samples colored with green food dye (for better visibility) are typically presented in sequence: pureed food, honey thick liquid, nectar thick liquid, thin liquid, mechanical soft food, and regular food. The examiner may also include items from the patient’s current diet. 11
The patient may only swallow when asked to do so. Any premature spillage into the hypopharynx should be noted as this is frequently associated with laryngeal penetration. The oropharyngeal stage is not endoscopically visible because the tip of the endoscope will contact the base of the tongue, the epiglottis and the bolus itself when the swallowing reflex starts (swallowing white-out). During this stage, laryngeal penetration of food may be suspected if there are indirect signs like coughing or food in the laryngeal vestibule. After each swallow, it is likewise important to note the amount and location of residual food in the hypopharynx. When the patient talks or moves his head, these may also penetrate the larynx. 8,12,13
The most frequent adverse effect reported for FEES is discomfort. Topical anesthesia in the nose is not usually employed as it may affect the swallowing mechanism. Other adverse reactions such as changes in heart rate, epistaxis, laryngospasm and vasovagal response may be risky to the patient, but these events are not common. 7,10
Because of its ease of use, portability and lower cost, FEES is now the first choice method of swallowing investigation in Europe. The detection of aspiration of the bolus into the airways (even silent aspiration13) and the presence of bolus residue in the pharynx in FEES correlates very well with VFES, the gold standard. 8
Based on FEES results, the clinician can recommend resumption of oral feeding (with specified food consistencies) or shifting to non-oral options such as the nasogastric tube or percutaneous endoscopic gastrostomy. In either case, he can also recommend the initiation of swallowing rehabilitation therapy if deemed necessary.
A Medical Position Statement of the American Gastroenterological Association enumerates the following steps in the Management of Oropharyngeal Dysphagia, all of which are within the scope of Otolaryngologists:4
Ascertain whether oropharyngeal dysphagia is likely
Identify structural etiologies of oropharyrngeal dysfunction
Ascertain the functional integrity of the oropharyrngeal swallow
Evaluate the risk of aspiration pneumonia
Determine if the pattern of dysphagia is amenable to therapy
Otolaryngologists should be actively involved in the management of critically ill patients via a standardized endoscopy protocol,12 making it routine to perform FEES procedures on these patients, in order to make the best diagnostic decisions about their dysphagia, preventing aspiration pneumonia and its potentially fatal consequences.
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Chang, Min Cheol, Ho Yong Choi, and Donghwi Park. "Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Determining the Allowance of Oral Feeding in Patients with Dysphagia Due to Deconditioning or Frailty." Healthcare 10, no. 4 (April 1, 2022): 668. http://dx.doi.org/10.3390/healthcare10040668.
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Introduction: In patients with dysphagia due to deconditioning or frailty, as with other disorders that cause swallowing disorders, the videofluoroscopic swallowing study (VFSS) is the gold standard for dysphagia evaluation. However, the interpretation of VFSS results is somewhat complicated and requires considerable experience in the field. Therefore, in this study we evaluated the usefulness of the modified videofluoroscopic dysphagia scale (mVDS) in determining whether to allow oral feeding in patients with dysphagia due to deconditioning or frailty. Methods: Data from the VFSS of 50 patients with dysphagia due to deconditioning or frailty were retrospectively collected. We evaluated the association between mVDS and the selected feeding method based on VFSS findings, and between mVDS and the presence of aspiration pneumonia. Results: Multivariate logistic analysis showed that the mVDS total score had a significant association with oral feeding methods based on VFSS findings in patients with dysphagia due to deconditioning or frailty (p < 0.05). In the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve for the selected feeding method was 0.862 (95% confidence interval, 0.747–0.978; p < 0.0001). Conclusions: mVDS seems a valid scale for determining the allowance of oral feeding, and it can be a useful tool in the clinical setting and in studies that aim to interpret VFSS findings in patients with dysphagia due to deconditioning or frailty. However, studies involving a more general population of patients with dysphagia due to deconditioning or frailty are needed.
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Suzuki, Jun, Ryoukichi Ikeda, Kengo Kato, Risako Kakuta, Yuta Kobayashi, Akira Ohkoshi, Ryo Ishii, et al. "Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan." PLOS ONE 16, no. 7 (July 30, 2021): e0254261. http://dx.doi.org/10.1371/journal.pone.0254261.
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Background Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan. Methods A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals. Results Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicated as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group. Conclusion AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread.
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Keser, Tobias, Mario Kofler, Mariella Katzmayr, Alois J. Schiefecker, Verena Rass, Bogdan A. Ianosi, Anna Lindner, et al. "Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage." Neurocritical Care 33, no. 1 (November 15, 2019): 132–39. http://dx.doi.org/10.1007/s12028-019-00874-6.
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Abstract Background Despite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome. Methods This is a retrospective analysis of an ongoing prospective cohort study. Swallowing ability was assessed in consecutive non-traumatic SAH patients admitted to our neurological intensive care unit using the Bogenhausen Dysphagia Score (BODS). A BODS > 2 points indicated dysphagia. Functional outcome was assessed 3 months after the SAH using the modified Rankin Scale with a score > 2 defined as poor functional outcome. Results Two-hundred and fifty consecutive SAH patients comprising all clinical severity grades with a median age of 57 years (interquartile range 47–67) were eligible for analysis. Dysphagia was diagnosed in 86 patients (34.4%). Factors independently associated with the development of dysphagia were poor clinical grade on admission (Hunt & Hess grades 4–5), SAH-associated parenchymal hematoma, hydrocephalus, detection of an aneurysm, and prolonged mechanical ventilation (> 48 h). Dysphagia was independently associated with a higher rate of pneumonia (OR = 4.32, 95% CI = 2.35–7.93), blood stream infection (OR = 4.3, 95% CI = 2.0–9.4), longer ICU stay [14 (8–21) days versus 29.5 (23–45) days, p < 0.001], and poor functional outcome after 3 months (OR = 3.10, 95% CI = 1.49–6.39). Conclusions Dysphagia is a frequent complication of non-traumatic SAH and associated with poor functional outcome, infectious complications, and prolonged stay in the intensive care unit. Early identification of high-risk patients is needed to timely stratify individual patients for dysphagia treatment.
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Lee, Byung-Joo, Hyoshin Eo, Chang-Bae Lee, and Donghwi Park. "Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Choosing the Feeding Method for Stroke Patients with Dysphagia." Healthcare 9, no. 6 (May 27, 2021): 632. http://dx.doi.org/10.3390/healthcare9060632.
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Introduction: The Videofluoroscopic Dysphagia Scale (VDS) is used to predict the long-term prognosis of dysphagia in patients with strokes. However, the inter-rater reliability of the VDS was low in a previous study. To overcome the mentioned limitations of the VDS, the modified version of the VDS (mVDS) was created and clinically applied to evaluate its usefulness in choosing the feeding method for stroke patients with dysphagia. Methods: The videofluoroscopic swallowing study (VFSS) data of 56 stroke patients with dysphagia were collected retrospectively. We investigated the presence of aspiration pneumonia and the selected feeding method. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia after stroke. Univariate logistic regression and receiver operating characteristic analyses were used in the data analysis. Results: The inter-rater reliability (Cronbach α value) of the total score of the mVDS was 0.886, which was consistent with very good inter-rater reliability. In all patients with dysphagia, the supratentorial stroke subgroup, and the infratentorial stroke subgroup, the mVDS scores were statistically correlated with the feeding method selected (p < 0.05) and the presence of aspiration pneumonia (p < 0.05). Conclusions: The mVDS can be a useful scale for quantifying the severity of dysphagia, and it can be a useful tool in the clinical setting and in studies for interpreting the VFSS findings in stroke patients with dysphagia. Further studies with a greater number of patients and various stroke etiologies are required for more generalized applications of the mVDS.
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Nakamori, Masahiro, Kenichi Ishikawa, Eiji Imamura, Haruna Yamamoto, Keiko Kimura, Tomoko Ayukawa, Tatsuya Mizoue, and Shinichi Wakabayashi. "Relationship between tongue pressure and dysphagia diet in patients with acute stroke." PLOS ONE 16, no. 6 (June 4, 2021): e0252837. http://dx.doi.org/10.1371/journal.pone.0252837.
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A dysphagia diet is important for patients with stroke to help manage their nutritional state and prevent aspiration pneumonia. Tongue pressure measurement is a simple, non-invasive, and objective method for diagnosing dysphagia. We hypothesized that tongue pressure may be useful in making a choice of diet for patients with acute stroke. Using balloon-type equipment, tongue pressure was measured in 80 patients with acute stroke. On admission, a multidisciplinary swallowing team including doctors, nurses, speech therapists, and management dietitians evaluated and decided on the possibility of oral intake and diet form; the tongue pressure was unknown to the team. Diet form was defined and classified as dysphagia diet Codes 0 to 4 and normal form (Code 5 in this study) according to the 2013 Japanese Dysphagia Diet Criteria. In multivariate analysis, only tongue pressure was significantly associated with the dysphagia diet form (p<0.001). Receiver operating characteristic analyses revealed that the optimal cutoff tongue pressure for predicting diet Codes 1, 2, 3, 4, and 5 was 3.6 (p<0.001, area under the curve [AUC] = 0.997), 9.6 (p<0.001, AUC = 0.973), 12.8 (p<0.001, AUC = 0.963), 16.5 (p<0.001, AUC = 0.979), and 17.3 kPa (p<0.001, AUC = 0.982), respectively. Tongue pressure is one of the sensitive indicators for choosing dysphagia diet forms in patients with acute stroke. A combination of simple modalities will increase the accuracy of the swallowing assessment and choice of the diet form.
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Gaeckle, Maren, Frank Domahs, Angelika Kartmann, Bernd Tomandl, and Ulrike Frank. "Predictors of Penetration-Aspiration in Parkinson’s Disease Patients With Dysphagia: A Retrospective Analysis." Annals of Otology, Rhinology & Laryngology 128, no. 8 (April 2, 2019): 728–35. http://dx.doi.org/10.1177/0003489419841398.
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Objective:Penetration-aspiration is considered the most severe sign of dysphagia, with aspiration pneumonia as one of its consequences. More than half of Parkinson’s disease (PD) patients suffer from dysphagia, and aspiration pneumonia is among the primary causes of mortality in PD patients. However, the identification of predictors of penetration-aspiration in PD patients remains an understudied topic. The purpose of this study was to identify predictors of penetration-aspiration in patients with PD.Methods:The data of 89 PD patients with dysphagia who underwent routinely conducted videofluoroscopic studies of swallowing (VFSS) were included in this retrospective study. The occurrence of penetration-aspiration was defined as scores ≥3 on the Penetration-Aspiration Scale (PAS). Four commonly reported signs of dysphagia in PD patients were evaluated as possible predictors. Furthermore, the relationships between the occurrence of penetration-aspiration and liquid bolus volume as well as clinical severity of PD (modified Hoehn and Yahr scale) were examined.Results:Logistic regression showed that a delayed initiation of the pharyngeal swallow (odds ratio [OR] = 7.47, P = .008) and a reduced hyolaryngeal excursion (OR = 5.13, P = .012) were predictors of penetration-aspiration. Moreover, there was a strong, positive correlation between increasing liquid bolus volume and penetration-aspiration (γ = 0.71, P < .001). No correlation was found between severity of PD and penetration-aspiration (γ = 0.077, P = .783).Conclusion:Results of the present study allow for a better understanding of penetration-aspiration risk in PD patients. They are useful for treatment planning in order to improve safe oral intake and adequate nutrition.
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Caruso, Anna Maria, Denisia Bommarito, Vincenza Girgenti, Glenda Amato, Adele Figuccia, Alessandra Casuccio, Annalisa Ferlisi, et al. "Evaluation of Dysphagia and Inhalation Risk in Neurologically Impaired Children Using Esophageal High-Resolution Manometry with Swallowing Analysis." Children 9, no. 12 (December 17, 2022): 1987. http://dx.doi.org/10.3390/children9121987.
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Background: Dysphagia in neurologically impaired children is associated with feeding difficulties, malnutrition and aspiration pneumonia. Esophageal high-resolution manometry (HRM) has been used in the diagnosis of motility disorders affecting the swallowing process. The aim of this study was to analyze swallowing functions in NI children by using HRM in order to establish swallow parameters identifying inhalation risk. Methods: Twenty-five NI children with cerebral palsy were submitted to esophageal HRM with UES analysis, comparing the results with non-NI children. The following parameters were evaluated: maximum pressure and duration of contraction of the velopharynx (VP) and tongue base (TB), and maximal, minimal, resting pressure and relaxation duration of the upper esophageal sphincter (UES). Results: pVP max, pTB max, pUES max and resting pressure were lower, while p UES minimal was higher and relaxation duration was shorter in NI children vs. the control group. Predictive values of inhalation risk were evaluated. Conclusions: This study evaluates inhalation risk in NI children using HRM to study UES function. Our results confirm the alterations described in NI children: insufficient contraction and clearing force for bolus transmission through the pharynx and incomplete UES relaxation can predispose to pharyngeal residues and inhalation independently of swallowing because of lower values of UES resting.
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Choi, Ji Soo, Hyun Bang, Goo Joo Lee, Han Gil Seo, Byung-Mo Oh, and Tai Ryoon Han. "Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia." Annals of Rehabilitation Medicine 44, no. 1 (February 29, 2020): 1–10. http://dx.doi.org/10.5535/arm.2020.44.1.1.
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Objective To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake.Methods Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs.Results At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function.Conclusion This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.
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Park, Hae-Yeon, Hyun-Mi Oh, Tae-Woo Kim, Youngkook Kim, Geun-Young Park, Hyemi Hwang, and Sun Im. "Single Nucleotide Polymorphisms May Increase the Risk of Aspiration Pneumonia in Post-Stroke Patients with Dysphagia." Current Issues in Molecular Biology 44, no. 8 (August 19, 2022): 3735–45. http://dx.doi.org/10.3390/cimb44080255.
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This study aimed to evaluate whether genetic polymorphism is associated with an increased risk of infection, specifically post-stroke aspiration pneumonia. Blood samples were obtained from a total of 206 post-stroke participants (males, n = 136; mean age, 63.8 years). Genotyping was performed for catechol-O-methyltransferase (rs4680, rs165599), dopamine receptors (DRD1; rs4532, DRD2; rs1800497, DRD3; rs6280), brain-derived neurotrophic factor (rs6265), apolipoprotein E (rs429358, rs7412), and the interleukin-1 receptor antagonist gene (rs4251961). The subjects were stratified into two groups, aged < 65 (young) and ≥ 65 (elderly). Functional parameters and swallowing outcomes were measured at enrollment and at 3 months post-onset. The primary outcome was the incidence of aspiration pneumonia. Analysis of the association between genetic polymorphisms and aspiration pneumonia history showed that a minor C rs429358 allele was associated with the occurrence of aspiration pneumonia in the young group, both in the additive and the dominant models (odds ratio: 4.53; 95% CI: 1.60–12.84, p = 0.004). In the multivariable analysis, the minor C rs429358 allele increased the risk of post-stroke aspiration pneumonia in young stroke patients by 5.35 (95% CI: 1.64–20.88). In contrast, no such association was observed in the elderly group. Apolipoprotein E polymorphism may affect the risk of post-stroke aspiration pneumonia.
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Adlakha, Vaishali, Leona Ramos, Abigail Smith, Olivia Tsistinas, Emily Tanner-Smith, Jill Merrow, Zafer Soultan, Anthony Mortelliti, Rachel Rosen, and Aamer Imdad. "Risk of aspiration pneumonia in paediatric patients with dysphagia who were found to have laryngeal penetration on the instrumental swallow evaluation: a systematic review protocol." BMJ Open 11, no. 8 (August 2021): e048422. http://dx.doi.org/10.1136/bmjopen-2020-048422.
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IntroductionDysphagia affects several children in USA and around the globe. Videofluoroscopic Swallow Study (VFSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are the most objective studies to define swallowing function. The presence of tracheal aspiration during VFSS or FEES in children with dysphagia is associated with an increased risk of aspiration pneumonia. However, the association of laryngeal penetration with aspiration pneumonia remains unclear. This systematic review aims to assess the risk of aspiration pneumonia in children with dysphagia with laryngeal penetration on VFSS/FEES and compare it with children with tracheal aspiration and children with neither tracheal aspiration nor laryngeal penetration.Methods and analysisThis study will be a systematic review and meta-analysis. Systematic electronic searches will be conducted on PubMed, EMBASE, Web of Science, CINHAL, Scopus, Cochrane CENTRAL, LILACS and WHO Global Index Medicus. We will include studies published through 6 October 2021. Primary outcome will be the incidence of aspiration pneumonia. Secondary outcomes will be incidence of hospitalisation, paediatric intensive care unit admission, enteral tube requirement, growth, symptoms improvement and mortality. The Cochrane Risk of Bias In Non-Randomised Studies of Interventions tool will be used to assess the risk of bias. Meta-analysis will be used to pool the studies. We will pool dichotomous outcomes to obtain an odd ratio (OR) and report with 95% CI. Continuous outcomes will be pooled to obtain mean difference and reported with 95% CI. Overall grade of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and findings will be presented in a summary of findings table.Ethics and disseminationThis study is a systematic review without contact with patients. Therefore, IRB approval is not required. Authors consent to publishing this review. Data will be kept for review by editors and peer reviewers. Data will be available to general public on request.PROSPERO registration numberCRD42020222145.
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Sadeghi, Zahra, Mohammadreza Afshar, Abbas Ebadi, Kowsar Baghban, and Zahra Sadat Qureshi. "Swallowing Disorder in Multiple Sclerosis: Modified Version of the Screening Tool." Journal of Rehabilitation 21, no. 2 (July 1, 2020): 236–55. http://dx.doi.org/10.32598/rj.21.2.3036.1.
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Objective: Dysphagia is commonly encountered in Multiple Sclerosis (MS). It can consequently cause severe complications such as the increased risk of dehydration, malnutrition and aspiration pneumonia that associated with an increased risk of death in the late stages of the disease. These complications can be prevented with an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) is the only questionnaire developed specifically for patients with MS. The aim of the present study was translation and cross-culturally adaptation of DYMUS for the Persian population and estimation of the questionnairechr('39')s reliability and validity. Also, we investigated the frequency and severity of dysphagia in the patients referring to the Tehran MS Society and its association with the course of MS, disease duration, and Expanded Disability Status Scale (EDSS). Materials & Methods: This is a methodological and descriptive-analytic study. The statistical populations consist of the patients with MS referring to the Tehran Multiple Sclerosis Society in 2018. The study sample consisted of 108 patients who were selected through a convenient sampling method. The research instruments consisted of 10-items DYMUS questionnaire (in the first part of the study, translated and its psychometric properties examined), Dysphagia Handicap Index and a demographic information questionnaire. In methodological section, translation and cross-cultural adaptation were fulfilled and the Confirmatory Factor Analysis (CFA) was used to assess the construct validity and to test the goodness-of-fit of the presented model. The association between the DYMUS and Dysphagia Handicap Index (DHI) scores investigated to convergent validity. The inter-item correlation matrix was calculated to assess the homogeneity of the questionnaire items. Kuder - Richardson (KR-20) was measured to assess the internal consistency of the questionnaire. Also, the test-retest procedure was conducted on the 19 subjects understudy to assess the reliability. Finally, the frequency and severity of dysphagia and its association with the course of MS, disease duration, and EDSS was investigated. KR-20 reliability coefficient, Intraclass Correlation Coefficient (ICC), inter-item correlation matrix, Mann-Whitney U test and rank correlation coefficient or Spearmanchr('39')s were used to inferential statistical analysis. Results: Analysis of the inter-item correlations matrix indicated a positive correlation between all items, exception item 10. Based on the results of the inter-item correlation, item 10 had the lowest correlation coefficient that was deleted from the questionnaire. CFA results confirmed the two-factor model of DYMUS, “dysphagia for solids” and “dysphagia for liquids”, and revealed that the item 10 was minimally contributing to the measurement of "dysphagia of solids" and internal consistency increased after the deletion of this item. Also, the solution of the 9-item Model was the best goodness-of-fit indicator for the sample. The obtained results from the convergent validity indicated a positive significant correlation between the DYMUS and DHI (rs=0.693, P<0.001). A KR-20 reliability coefficient of the DYMUS was 0.856, indicating high internal consistency of the Persian translation of the questionnaire items. Test-retest reliability was excellent with 0.965 value. The results also showed that 65.7% of multiple sclerosis patients had a swallowing disorder. In terms of the dysphagia severity, 25.9% of participants had mild dysphagia, and 39.8% of participants had alarming dysphagia. DYMUS values were significantly correlated with disease duration (rs=0.198, P= 0.040), and EDSS (rs=0.235, P= 0.014) and significantly higher mean scores were observed in the patients with secondary progressive than the other subgroups of multiple sclerosis. Conclusion: The Persian adjusted 9-item questionnaire was demonstrated to be a simple, consistent, valid and reliable tool for the detection of patients who need more specific instrumental evaluations of swallowing. Also, about the dysphagia is very frequent in these patients, it is important that clinicians monitor these patients carefully even in early stages of the disease for early detection and planning a rehabilitation program to the prevention of serious subsequence complications.
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Kondratyeva, Ekaterina A., Nataliya A. Lesteva, Elena V. Verbitskaya, Sergey A. Kondratyev, Alina B. Petrova, Natalya E. Ivanova, and Anatolii N. Kondratyev. "Possibilities of endoscopic evaluation of swallowing function in patients with chronic disorders of consciousness." Physical and rehabilitation medicine, medical rehabilitation 4, no. 3 (October 2, 2022): 140–53. http://dx.doi.org/10.36425/rehab110856.
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BACKGROUND: The period of coma in some patients after severe brain damage ends with a transition to one of the forms of chronic disorders of consciousness ― a vegetative state/unresponsive wakefulness syndrome or a minimally conscious state. Almost all patients with chronic disorders of consciousness have dysphagia of varying severity, and therefore nutrition of this category of patients is carried out initially through a nasogastric tube, and then through a gastrostomy. Early tracheostomy cannula removal may lead to the development of aspiration and pneumonia. Dysphagia is often not diagnosed in chronic disorders of consciousness patients.
AIMS: Analysis of the results of fibrooptic endoscopic assessment of swallowing in chronic disorders of consciousness patients to identify the relationship between the presence and severity of dysphagia with the level of consciousness, data on the coma recovery scale, as well as the duration of consciousness disorders and dynamics of recovery of consciousness.
MATERIALS AND METHODS: The study was of a prospective type, conducted in the period from 2019 to 2021. 39 chronic disorders of consciousness patients (18 ― vegetative state/unresponsive wakefulness syndrome, 18 ― minimally conscious state "minus" and minimally conscious state "plus" and 3 patients with a level of consciousness corresponding to the emergence from the minimally conscious state). The average duration of chronic disorders of consciousness was 7.79.4 months. All patients underwent a neurological examination using the CRS-R upon admission to the hospital and a month later, an endoscopic examination of the swallowing function was performed with scores calculated according to the Federal Endoscopic Dysphagia Severity Assessment Scale (FEDSS) and aspiration assessment scale in accordance with the Rosenbek criteria.
RESULTS: Dysphagia of varying severity was detected in 36 patients (92.3%). The correlation of the total CRS-R score with the degree of dysphagia (Ro=-0.481, p=0.002) was found. The degree of dysphagia did not depend on the chronic disorders of consciousness duration.
CONCLUSION: Regardless of the chronic disorders of consciousness severity (vegetative state/unresponsive wakefulness syndrome, minimally conscious state "minus", minimally conscious state "plus") before tracheostomy removing and switching to the oral feeding, it is necessary to perform fibrooptic endoscopic studies of swallowing to detect dysphagia, determine its degree, which is a method of preventing complications of the decanulation consequences.
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Umemoto, George, Yoshio Tsuboi, Hirokazu Furuya, Takayasu Mishima, Shinsuke Fujioka, Naoki Fujii, Hajime Arahata, Miwa Sugahara, and Mitsuaki Sakai. "Dysphagia in Perry Syndrome: Pharyngeal Pressure in Two Cases." Case Reports in Neurology 9, no. 2 (June 14, 2017): 161–67. http://dx.doi.org/10.1159/000457900.
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Background: To investigate the impact of dysphagia in Perry syndrome (PS), an autosomal dominant parkinsonism caused by mutation of DCTN1, which is associated with hypoventilation, depression, and weight loss. Case Presentation: We used tongue pressure measurements and manofluorography to investigate swallowing function in 2 patients with PS. Case 1, a 60-year-old male showing parkinsonism, and case 2, a 49-year-old male admitted with pneumonia, were diagnosed as having PS based on the DCTN1 gene analysis. Case 1 showed a pharyngeal retention of the bolus on videofluorography (VF) and a few swallows were required for its passage into the esophagus. However, tongue pressure and manometry were within the normal range. This patient could eat a normal diet under supervision. Case 2 required artificial ventilation and tube feeding on admission. The VF image showed a slow transfer of the bolus, delayed swallow reflex, and pharyngeal retention of the bolus that required several swallows for its passage into the esophagus. The tongue pressure was within the normal range, but manometry showed a significant decrease in pressure at the hypopharynx and upper esophageal sphincter. The oral intake of the patients was limited to 2 cups of jelly per day. Conclusions: The investigation of swallowing dysfunction of 2 cases of PS showed that maintaining pharyngeal pressure within the normal range was very important for oral feeding success and prognosis.
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Jang, Bo Seong, Jun Young Park, Jae Hyun Lee, Young Joo Sim, Ho Joong Jeong, and Ghi Chan Kim. "Clinical Factors Associated With Successful Gastrostomy Tube Weaning in Patients With Prolonged Dysphagia After Stroke." Annals of Rehabilitation Medicine 45, no. 1 (February 28, 2021): 33–41. http://dx.doi.org/10.5535/arm.20149.
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Objective To investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke.Methods This study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients’ demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated.Results There were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634–0.987) and PAS scores (OR=0.205; 95% CI, 0.059–0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively.Conclusion In patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.
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Md Mizan Asrori, Nur Fatin Najihah, and Chin Yi Ying. "Association Between Muscle Strength and the Risk of Dysphagia Among Elderly in Kuala Nerus, Terengganu." Asian Journal of Medicine and Biomedicine 6, S1 (November 4, 2022): 3–4. http://dx.doi.org/10.37231/ajmb.2022.6.s1.501.
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Dysphagia affects 5 to 10% of Malaysia's elderly population [1]. Dysphagia is a sort of anomaly that causes discomfort and difficulty swallowing that could be caused by age-related disorders such as stroke, malignancy, and muscle diseases [2]. If left unaddressed, swallowing impairment can lead to social isolation, aspiration pneumonia, and nutritional issues [3–5]. As predicted by 2030, Malaysia will have a 14% rise in the population aged ≥ 60 years old [6]. Thus, a rise in age-related illnesses such as sarcopenia, Parkinson’s disease (PD), and dementia may lead to an increase in the prevalence of dysphagia among the elderly.
This cross-sectional study was conducted from April to June 2022 in a rehabilitation center in Kuala Nerus with 61 participants aged ≥ 60 years old. The muscle strength was measured using the Camry Electronic Hand Dynamometer, which helps to assess the overall muscle strength from a handgrip [7]. This device is light and comes with grooves for finger placement that is more ideal for usage by the elderly. Meanwhile, the risk of dysphagia was evaluated using the Malay version of the 10-item Eating Assessment Tool (M-EAT-10) since it applies to a wide spectrum of swallowing problems [8].
The mean age of participants was (65.67 ± 5.62 years) with 43% being males and 57% being females. Most of the participants were married (77%), have more than one comorbidity (56%), and originates from B40 households (62%). Those who scored ≤ 2 in EAT-10 were 29 (48%) participants while 32 (53%) participants scored ≥ 3 showing a risk of dysphagia. Analysis showed 58% of males presented muscle strength of below 26.00 kg while 42% have normal muscle strength. Similarly, 54% presented with muscle strength of below 18.00 kg while 46% have normal muscle strength among females. There is an association between muscle strength and the risk of dysphagia for both males (p = 0.001) and females (p < 0.001).
This study found a higher prevalence of those at risk of dysphagia compared to those with no risk of dysphagia. There is also an association between muscle strength and the risk of dysphagia for both genders in this study [9,10].
Dysphagia was significantly associated with muscle strength among the elderly in Kuala Nerus. Some limitations in this study include the lack of participants and the source of the population.
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Chang, Min Cheol, Changbae Lee, and Donghwi Park. "Validation and Inter-rater Reliability of the Modified Videofluoroscopic Dysphagia Scale (mVDS) in Dysphagic Patients with Multiple Etiologies." Journal of Clinical Medicine 10, no. 13 (July 4, 2021): 2990. http://dx.doi.org/10.3390/jcm10132990.
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Background: the Videofluoroscopic Dysphagia Scale (VDS) is used to interpret and predict the long-term prognosis of patients with dysphagia. However, the inter-rater agreement of the VDS was shown to be lower in a previous study. To overcome the mentioned limitation of the VDS, a modified version (mVDS) was created and applied clinically. We aimed to validate its usefulness in determining the appropriate feeding method and predicting the prognosis of dysphagia. Methods: the videofluroscopic swallowing study (VFSS) data of 50 patients with dysphagia were collected retrospectively. The VFSS data were evaluated using the mVDS, and the inter-rater reliability was calculated. We also evaluated the association between the mVDS and type of feeding method selected, and between the mVDS and presence of aspiration pneumonia in patients with dysphagia. Results: among the different parameters of mVDS, “aspiration” showed the highest reliability (k = 0.767), followed by “mastication” and “lip closure” (k = 0.648 and k = 0.634, respectively). Conversely, “triggering pharyngeal swallow” and “pyriformis residue” demonstrated the lowest reliabilities (k = 0.312 and k = 0.324, respectively). The intraclass correlation coefficient (ICC), which is used as a measure of the reliability of the total mVDS score, was 0.876. In all patients with dysphagia, the mVDS score correlated significantly with the type of feeding method selected (p < 0.05), and the presence of aspiration pneumonia (p < 0.05). Conclusion: the ICC of the total mVDS score was 0.876. Therefore, the mVDS could be a useful tool for quantifying the severity of dysphagia. It could be helpful in the analysis of the VFSS findings among patients with dysphagia in clinical settings and research.
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Qiao, Jia, Zhi-Min Wu, Qiu-Ping Ye, Yong Dai, and Zu-Lin Dou. "Relationship between Post-Stroke Cognitive Impairment and Severe Dysphagia: A Retrospective Cohort Study." Brain Sciences 12, no. 6 (June 19, 2022): 803. http://dx.doi.org/10.3390/brainsci12060803.
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Objective: To investigate the relationship between post-stroke cognitive impairment (PSCI) and severe post-stroke dysphagia (PSD) and explore the risk factors related to PSCI combined with severe PSD. Methods: Data from patients were collated from the rehabilitation-specific disease database. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Videofluoroscopy Swallowing Study (VFSS), Penetration-aspiration Scale (PAS), and Functional Oral Intake Scale (FOIS) were used to evaluate cognitive and swallowing functions. Differences between groups were determined by the Pearson chi-square test (χ2) or Fisher exact test. PAS and FOIS data were analyzed with the use of the Wilcoxon rank-sum or Kruskal–Wallis test in the prespecified subgroup analysis. Risk factors were investigated by multivariate logistic regression. Results: A total of 1555 patients were identified with PSCI. The results indicated that patients with PSCI had a higher incidence rate of severe PSD as compared to patients without PSCI (p < 0.001). Patients with severe PSCI were more likely to clinically manifest oral phase dysfunction (p = 0.024), while mild PSCI patients mainly manifested pharyngeal phase dysfunction (p < 0.001). There was a significant difference in FOIS score changes between subgroups during the hospitalization period (severe PSCI vs. moderate PSCI and severe PSCI vs. mild PSCI) (all p < 0.001). In addition, multivariate logistic regression revealed pneumonia (p < 0.001), tracheotomy (p < 0.001), and dysarthria (p = 0.006) were related to PSCI, combined with severe PSD. Conclusion: PSCI may be related to severe PSD. Patients with severe PSCI were more likely to manifest oral phase dysfunction, while mild PSCI manifested pharyngeal phase dysfunction. Pneumonia, tracheotomy, and dysarthria were risk factors related to PSCI combined with severe PSD.
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Watila, M. M., Y. W. Nyandaiti, S. A. Balarabe, B. Bakki, N. Alkali, A. Ibrahim, E. Tonde, and I. Chiroma. "Aspiration pneumonia in patients with stroke, northeast nigeria." NATIONAL JOURNAL OF NEUROLOGY, no. 3 (January 9, 2019): 48–55. http://dx.doi.org/10.28942/nnj.v1i3.182.
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Objectives: Aspiration pneumonia is a common complication in patients with stroke, having a negative influence on morbidity and mortality. This study sought to assess the frequency of aspiration pneumonia and the independent predictors for its development among Nigerian patients with stroke.
Methods: Five hundred and twenty-four stroke patients were prospectively enrolled during the study period at the University of Maiduguri Teaching Hospital, Maiduguri, from January 2005 and May 2011. All patients who developed aspiration pneumonia during hospital stay and follow–up were recorded. A student’s t-test and a Pearson chi-square analysis was used to compare baseline characteristics of subjects who developed aspiration pneumonia and those who did not. A multiple logistic regression was used to assess the independent predictors of aspiration pneumonia. We also recorded the rate of deaths and duration hospital stay within this period.
Results: Aspiration pneumonia occurred in 65 (12.4%) of our stroke patients, A univariate analysis showed that patients with aspiration pneumonia were older (P<0.001), had a lower Glasgow coma score on presentation (P<0.001), were more likely to have swallowing (P<0.001) and speech problems (P=0.003). They were also more likely to have severe stroke (NIHSS, P<0.001) and disability (mRDS, P<0.001; Barthel’ ADL index, P<0.001) both on admission and discharge. They had a higher 60 – day fatality (75.4% versus 9.4%; P<0.001) and a lower duration of stay (25.3±17.5 versus 34.6±28.3; P=0.01). Factors associated with the development of aspiration pneumonia are; Age > 60 years (OR, 2.3; 95% CI, 1.37 – 3.91; P=0.002); Initial GCS≤12 (OR, 4.5; 95% CI, 2.60 – 8.00; P<0.001); dysphagia (OR, 12.1; 95% CI, 6.50 – 22.70; P<0.001); dysphasia (OR, 2.2; 95% CI, 1.29 – 3.70; P=0.004); admission mRDS≥4 (OR, 4.1; 95% CI, 1.43 – 11.50; P=0.008); admission NIHSS≥11 (OR, 2.5; 95% CI, 1.34 – 4.66; P=0.004); admission Barthel’ ADL index <30 (OR, 16.9; 95% CI , 4.07 – 70.29; P<0.001).
Conclusion: Aspiration pneumonia is a common complication in our stroke patients. Decline in consciousness, swallowing and speech difficulties, and severe strokes are associated with the development of aspiration pneumonia.
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Huang, Jinke, Yao Shi, Xiaohui Qin, Min Shen, Manli Wu, and Yong Huang. "Clinical Effects and Safety of Electroacupuncture for the Treatment of Poststroke Dysphagia: A Comprehensive Systematic Review and Meta-Analysis." Evidence-Based Complementary and Alternative Medicine 2020 (September 26, 2020): 1–9. http://dx.doi.org/10.1155/2020/1560978.
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Objectives. Electroacupuncture (EA), an extension of acupuncture, which is based on traditional acupuncture combined with modern electrotherapy, is commonly used for poststroke dysphagia (PSD) in clinical treatment and research. However, there is still a lack of sufficient evidence to recommend the routine use of EA for PSD. The aim of this study was to assess the efficacy and safety of EA in the treatment of PSD. Methods. Randomized controlled trials (RCTs) evaluating the effects of EA on PSD were identified through a comprehensive literature search of the PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, and VIP databases from their inception to July 2020. The quality assessment of the included trials was performed based on the guidance of the Cochrane Reviewers’ Handbook, and meta-analysis (MA) was performed by using the RevMan 5.3 software. Results. Sixteen trials were identified, and these included 1,216 patients with PSD. The results demonstrated that EA in combination with swallowing rehabilitation training (SRT) was significantly superior to SRT alone with regard to effective rate (OR 5.40, 95% CI [3.78, 7.72], P < 0.00001 , water swallow test (WST) (MD −0.78, 95% CI [−1.07, −0.50], P < 0.00001 ), the video fluoroscopic swallowing study (VFSS) (MD 1.47, 95% CI [1.11, 1.84], P < 0.00001 ), the Ichiro Fujishima Rating Scale (IFRS) (MD 1.94, 95% CI [1.67, 2.22], P < 0.00001 ), and the incidence of aspiration pneumonia (IAP) (OR 0.20, 95% CI [0.06, 0.61], P = 0.005 ). Conclusions. The results showed that EA was better than the control treatment in terms of the effective rate, WST, VFSS, IFRS, and IAP of dysphagia after stroke. Strict evaluation standards and high-quality RCT designs are necessary for further exploration.
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Shim, Ga Yang, Ju Sun Oh, Seunghee Han, Kyungyeul Choi, Son Mi Lee, and Min Woo Kim. "Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients." Annals of Rehabilitation Medicine 45, no. 2 (April 30, 2021): 108–15. http://dx.doi.org/10.5535/arm.20171.
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Objective To investigate the correlation between videofluoroscopic swallowing study (VFSS) and radionuclide salivagram findings in chronic brain-injured patients with dysphagia.Methods Medical records of chronic brain-injured patients who underwent radionuclide salivagram and VFSS were retrospectively analyzed. Patients were divided into two groups according to salivagram findings. Differences in patient characteristics and clinical factors, including Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulatory Category (FAC), feeding method, tracheostomy state, and VFSS findings between the two groups were investigated.Results A total of 124 patients were included in this study. There were no significant differences in MMSE, MBI, FAC, feeding method, and presence of tracheostomy between the two groups. However, the incidence of aspiration pneumonia history was significantly higher in the positive salivagram group. The Functional Dysphagia Scale (FDS) was significantly associated with positive salivagram findings, especially in the pharyngeal phase. A multivariate logistic regression analysis showed that laryngeal elevation and epiglottic closure was statistically significant FDS parameter in predicting salivary aspiration on a salivagram (odds ratio=1.100; 95% confidence interval, 1.017–1.190; p=0.018). The receiver operating characteristic (ROC) curve of FDS in the pharyngeal phase showed that an optimum sensitivity and specificity of 55.1% and 65.4%, respectively, when the cut-off value was 39.Conclusion In chronic brain-injured patients, inappropriate laryngeal elevation and epiglottic closure is predictive variable for salivary aspiration. Therefore, performing a radionuclide salivagram in patients with FDS of 39 or less in the pharyngeal phase for prevents aspiration pneumonia from salivary aspiration.
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Waseem, Muhammad Hassan, Fahad Farooq Lasi, Jitendar Valecha, Bakhtawar Samejo, Sikandar Ali Sangrasi, and Syed Murtaza Ali. "Effectiveness of Chest Physiotherapy in Cerebrovascular Accident Patients With Aspiration Pneumonia." Journal of Modern Rehabilitation 15, no. 1 (December 23, 2020): 47–52. http://dx.doi.org/10.32598/jmr.15.1.7.
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Introduction: According to WHO, a stroke refers to rapidly developing clinical signs of focal (or global) disturbance of cerebral functions, with symptoms lasting 24 hours or longer or leading to death. The damage caused by a stroke can interrupt your normal swallowing and food or fluid is entered into your airways and lungs. Dysphagia can damage the lungs, which can trigger a lung infection (pneumonia). To assess the efficacy of chest physiotherapy in the prevention of aspiration pneumonia in stroke patients.Materials and Methods: A quasi-experimental study was conducted with a sample size of 35 participants from C1 ward Agha Khan Hospital in Karachi City, Pakistan. The participants were selected via random sampling method. The inclusion criteria include patients of the C1 ward with a cerebrovascular accident, both male and female gender, with the age ranges from 45 to 63 years. All statistical analysis was done by using SPSS v. 19. The paired t test was used to evaluate the effectiveness of chest physiotherapy in a patient with aspiration pneumonia. The chest physiotherapy includes turning, postural drainage, percussion, vibration, deep breathing exercises, coughing, and suctioning were performed on a patient with aspiration pneumonia.Results: The results of this study show pre-treatment and post-treatment chest congestion, heart rate, and respiratory rate show that the P value is highly significant.Conclusion: This study concludes that chest physiotherapy seems to be effective in treating aspiration pneumonia in cerebrovascular accident patients.
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Ando, Akane, Koichi Ando, Shuichiro Oka, Takehiko Iijima, and Katsunori Oe. "Comparative efficacy of swallowing therapies for dysphagia to prevent pneumonia in patients with acute or subacute stroke: A network meta-analysis of randomized controlled trials." Showa University Journal of Medical Sciences 34, no. 2 (2022): 47–53. http://dx.doi.org/10.15369/sujms.34.47.
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Lee, Seong Jae, Joo Young Ko, Hyun Il Kim, and Sang-Il Choi. "Automatic Detection of Airway Invasion from Videofluoroscopy via Deep Learning Technology." Applied Sciences 10, no. 18 (September 5, 2020): 6179. http://dx.doi.org/10.3390/app10186179.
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In dysphagia, food materials frequently invade the laryngeal airway, potentially resulting in serious consequences, such as asphyxia or pneumonia. The VFSS (videofluoroscopic swallowing study) procedure can be used to visualize the occurrence of airway invasion, but its reliability is limited by human errors and fatigue. Deep learning technology may improve the efficiency and reliability of VFSS analysis by reducing the human effort required. A deep learning model has been developed that can detect airway invasion from VFSS images in a fully automated manner. The model consists of three phases: (1) image normalization, (2) dynamic ROI (region of interest) determination, and (3) airway invasion detection. Noise induced by movement and learning from unintended areas is minimized by defining a “dynamic” ROI with respect to the center of the cervical spinal column as segmented using U-Net. An Xception module, trained on a dataset consisting of 267,748 image frames obtained from 319 VFSS video files, is used for the detection of airway invasion. The present model shows an overall accuracy of 97.2% in classifying image frames and 93.2% in classifying video files. It is anticipated that the present model will enable more accurate analysis of VFSS data.
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Gao, Minxing, Ying Wang, Lingyuan Xu, Xin Wang, Heying Wang, Jinan Song, Xiaoqiu Yang, and Fenghua Zhou. "Safety and performance of oropharyngeal muscle strength training in the treatment of post-stroke dysphagia during oral feeding: protocol for a systematic review and meta-analysis." BMJ Open 12, no. 6 (June 2022): e061893. http://dx.doi.org/10.1136/bmjopen-2022-061893.
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IntroductionDysphagia is a common functional disorder after stroke. Most patients post-stroke are incapable of oral feeding, which often leads to complications such as malnutrition, aspiration pneumonia and dehydration that seriously affect the quality of life of patients. Oropharyngeal muscle strength training is a major method of swallowing training, and recent studies have focused on healthy adults, elderly persons, and patients with head and neck cancer or neurodegenerative diseases; but there have been few studies on such training in patients with post-stroke dysphagia. Our study aims to systematically review the safety and performance of oropharyngeal muscle strength training in the treatment of post-stroke dysphagia during oral feeding.Methods and analysisThe Cochrane Library, Web of Science, PubMed, Embase and ClinicalTrials.gov databases will be systematically searched, and all relevant articles in English from the establishment of the databases to January 2022 will be reviewed. The study will be conducted in accordance with the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. The primary outcome measures include the Penetration–Aspiration Scale and the Functional Oral Intake Scale. Two authors will independently screen the articles, extract the data and assess the study quality. Any disagreements during this process will be resolved by discussion or by consultation with a third author. Next, quantitative or qualitative, subgroup and sensitivity analyses of the included literature data will be performed as appropriate.Ethics and disseminationEthical approval is not required for this systematic review as no primary data collection will be required. The results of the present study will be published in a peer-reviewed journal in the field of deglutition disorders.PROSPERO registration numberCRD42022302471.
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Tareke, Amare Abera, Masrie Getnet Abate, Addis Alem, Yoseph Merkeb Alamneh, Alehegn Aderaw Alamneh, Yikeber Argachew Deml, Mulu Shiferaw, Woldeteklehaymanot Kassahun, and Abraham Teym. "Magnitude and Predictors of In-Hospital Stroke Mortality in Ethiopia: A Systematic Review and Meta-Analysis." Stroke Research and Treatment 2022 (May 24, 2022): 1–13. http://dx.doi.org/10.1155/2022/7202657.
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Introduction. Stroke is the second leading cause of mortality worldwide, accounting for approximately 5.5 million deaths each year. Due to demographic and health changes, the epidemiology of stroke is shifting from industrialized to low- and middle-income nations. Ethiopia is a developing country with a population that reflects this shift. Therefore, this systematic review and meta-analysis are aimed at evaluating the extent of in-hospital mortality of both ischemic and hemorrhagic stroke in Ethiopia and determining relevant factors associated with the mortality. Methods. Observational studies published as of July 15, 2020, that reported the magnitude, predictors, and causes of in-hospital mortality of stroke were systematically and comprehensively retrieved using the PRISMA 2020 criteria from databases such as PubMed/MEDLINE, Science Direct, and Google Scholar. The review papers were chosen based on the study methodology (facility-based observational), the study area (Ethiopia), the study population (adult patients with stroke), the outcome (in-hospital mortality), and the fact that they were published in English. Result. A total of 3709 patients with stroke were included in this systematic review and meta-analysis, which included 19 publications. In-hospital mortality was 14.03 percent on average in the studies, with reports ranging from 6.04 percent to 37.37 percent. Patients with hemorrhagic type stroke, admission Glasgow Coma Scale less than or equal to 12, impaired mental status, National Institutes of Health Stroke Scale stroke level greater than 13, prolonged hospital stay, any incontinence, pneumonia, and/or swallowing trouble had an increased risk of death after stroke. Conclusion. The magnitude of in-hospital mortality of patients with stroke in Ethiopia is high. The assessment of the level of consciousness is vital for clinical management and as an indicator of prognosis. Patients with unfavorable prognostic signs, such as entry Glasgow Coma Scale, National Institutes of Health Stroke Scale stroke level > 13 , hemorrhagic stroke, pneumonia, incontinence, and dysphagia, should be given priority.
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Hedberg-Oldfors, Carola, Niklas Darin, Christer Thomsen, Christopher Lindberg, and Anders Oldfors. "COX deficiency and leukoencephalopathy due to a novel homozygous APOPT1/COA8 mutation." Neurology Genetics 6, no. 4 (June 16, 2020): e464. http://dx.doi.org/10.1212/nxg.0000000000000464.
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ObjectiveTo describe the long-term follow-up and pathogenesis in a child with leukoencephalopathy and cytochrome c oxidase (COX) deficiency due to a novel homozygous nonsense mutation in APOPT1/COA8.MethodsThe patient was clinically investigated at 3, 5, 9, and 25 years of age. Brain MRI, repeat muscle biopsies with biochemical, morphologic, and protein expression analyses were performed, and whole-genome sequencing was used for genetic analysis.ResultsClinical investigation revealed dysarthria, dysphagia, and muscle weakness following pneumonia at age 3 years. There was clinical regression leading to severe loss of ambulation, speech, swallowing, hearing, and vision. The clinical course stabilized after 2.5 years and improved over time. The MRI pattern in the patient demonstrated cavitating leukoencephalopathy, and muscle mitochondrial investigations showed COX deficiency with loss of complex IV subunits and ultrastructural abnormalities. Genetic analysis revealed a novel homozygous mutation in the APOPT1/COA8 gene, c.310T>C; p.(Gln104*).ConclusionsWe describe a novel nonsense mutation in APOPT1/COA8 and provide additional experimental evidence for a COX assembly defect in human muscle causing the complex IV deficiency. The long-term outcome of the disease seems in general to be favorable, and the characteristic MRI pattern with cavitating leukoencephalopathy in combination with COX deficiency should prompt for testing of the APOPT1/COA8 gene.
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Lin, Zhu, Min Sun, Yang Peng, and Sun Weiqing. "Application of Cluster Nursing Among Post-Stroke Patients with Dysphagia." Journal of Clinical and Nursing Research 2, no. 3 (July 13, 2018). http://dx.doi.org/10.26689/jcnr.v2i3.388.
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Objective: To explore the effect of cluster nursing care among post-stroke patients. Methods: Post-stroke patients with dysphagia (n=72) were randomly divided into two groups: experimental (or intervention) (n=36) the control (n=36). Patients in the experimental group were given cluster care, including swallowing assessment, safe eating guide, swallowing rehabilitation, the establishment of cluster prevention strategy and health education to patients and caregivers. Patients in the control group were given conventional nursing care, and the score of swallowing function, the prevalence of aspiration pneumonia and nursing care satisfactory level in both groups were assessed before and after the intervention. Results: The swallowing function of patients in the two groups were improved after intervention, but patients in the experimental group showed significantly higher improvement than the control group (P<0.05). The incidence of aspiration pneumonia was significantly lower in the experimental group compared to the control group (P<0.05). Moreover, the satisfactory level of nursing management was higher in the experimental group than the control group (P<0.05). Conclusion: Cluster nursing (CN) practice has significantly improved the swallowing function of stroke patients with dysphagia, reduced the incidence of aspiration pneumonia and enhanced the satisfaction of nursing care.
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Battini, Vera, Sara Rocca, Greta Guarnieri, Anna Bombelli, Michele Gringeri, Giulia Mosini, Marco Pozzi, et al. "On the potential of drug repurposing in dysphagia treatment: New insights from a real-world pharmacovigilance study and a systematic review." Frontiers in Pharmacology 14 (March 3, 2023). http://dx.doi.org/10.3389/fphar.2023.1057301.
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Background: Polypharmacy is common in patients with dysphagia. Routinely used drugs may influence swallowing function either improving or worsening it. We aimed to explore the potential effects of three commonly used drug classes on dysphagia and aspiration pneumonia through a systematic review and a real-world data analysis to probe the possibility of drug repurposing for dysphagia treatment.Material and Methods: Five electronic databases were searched. Studies on adults at risk for dysphagia, treated with Dipeptidyl-Peptidase IV Inhibitors (DPP-4i), Adrenergic Beta-Antagonists (beta-blockers), or Angiotensin-Converting Enzyme Inhibitors (ACEi), and reporting outcomes on dysphagia or aspiration pneumonia were included. A nested case/non-case study was performed on adverse events recorded in the FDA Adverse Event Reporting System (FAERS) on patients >64 years. Cases (dysphagia or aspiration pneumonia) were compared between patients only treated with Levodopa and patients who were concomitantly treated with the drugs of interest.Results: Twenty studies were included in the review (17 on ACEi, 2 on beta-blockers, and 1 on DPP-4i). Contrasting findings on the effects of ACEi were found, with a protective effect mainly reported in Asian studies on neurological patients. Beta-blockers were associated with a reduced dysphagia rate. The study on DPP-4i suggested no effect on dysphagia and an increased risk of aspiration pneumonia. The FAERS analysis showed a reduction of the risk for dysphagia/aspiration pneumonia with ACEi, beta-blockers, and DPP-4i.Conclusion: Our study explores the potential drug repurposing of ACEi, beta-blockers and DPP-4i in neurological patients with dysphagia to improve swallowing function and reduce aspiration pneumonia risk. Future randomized controlled studies should confirm these results and clarify the underlying mechanisms of action.
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Kamarunas, Erin, Rachel Mulheren, Seng Mun Wong, Lindsay Griffin, and Christy L. Ludlow. "The Feasibility of Home-Based Treatment Using Vibratory Stimulation in Chronic Severe Dysphagia." American Journal of Speech-Language Pathology, November 8, 2022, 1–18. http://dx.doi.org/10.1044/2022_ajslp-22-00045.
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Purpose: Previously, externally placed vibratory laryngeal stimulation increased rates of swallowing in persons with and without dysphagia. This study examined the feasibility of using a vibratory device on the skin over the thyroid cartilage for home-based swallowing rehabilitation in long-standing dysphagia. Method: Only participants with long-standing dysphagia (> 6 months) following cerebrovascular accident or head/neck cancer who had not previously benefited from dysphagia therapy participated. The device had two modes used daily for 90 days. In automatic mode, participants wore the device when awake, which vibrated for 4–8 s every 5 min to trigger a volitional swallow. In manual mode, participants practiced by activating vibration while swallowing rapidly. Study-related adverse events, such as pneumonia, and device-recorded adherence were tracked. Swallowing function on a modified barium swallow study was assessed at baseline and after 3 months of device use. Outcome measures included the Dysphagia Outcome and Severity Scale (DOSS), Penetration–Aspiration Scale (PAS), and swallowing timing measures. Participants' perceptions of the vibratory device and training were obtained. Results: The intent to treat analysis showed seven of 11 participants completed the study, all with severe chronic dysphagia. Of those seven participants completing the study, two developed respiratory complications (possibly due to pneumonia) that cleared after antibiotic intervention. For prescribed practice trials, adherence was 80% or greater in four of seven participants (57%) whereas prescribed automatic stimulations were met in only two of seven participants (29%). Three participants (43%) had a modest benefit on DOSS. The time to vestibule closure after the bolus passed the ramus was reduced in five participants (71%) on the modified barium swallow study. Conclusion: Overall, the results have indicated that intensive home-based practice with stimulation may provide limited functional benefits in severe chronic dysphagia. Supplemental Material: https://doi.org/10.23641/asha.21498591
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Wada, Ayako, Michiyuki Kawakami, Yuka Yamada, Kentaro Kaji, Nanako Hijikata, Fumio Liu, Tomoyoshi Otsuka, and Tetsuya Tsuji. "Relationship Between Pneumonia and Dysphagia in Patients With Multiple System Atrophy." Frontiers in Neurology 13 (July 4, 2022). http://dx.doi.org/10.3389/fneur.2022.904852.
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IntroductionDysphagia is one of the most clinically significant disabilities in patients with multiple system atrophy (MSA), because it can cause aspiration pneumonia, which is potentially fatal. In this study, the Neuromuscular disease Swallowing Status Scale (NdSSS), which was developed to evaluate dysphagia in patients with neuromuscular diseases, was used to evaluate patients with MSA. In addition, correlation between a history of pneumonia and swallowing function was evaluated.MethodsStudy 1: Reliability, concurrent validity, and responsiveness of the NdSSS in patients with MSA. In 81 patients for whom evaluation items could be collected, the NdSSS was tested for its interrater and intrarater reliability using weighted kappa statistics. Concurrent validity was assessed by correlating the NdSSS with existing scales (Functional Oral Intake Scale (FOIS), Functional Intake LEVEL Scale (FILS), and the unified MSA rating scale (UMSARS)) using Spearman's rank correlation coefficients. Sixty-three patients were evaluated by videofluorographic (VF) swallowing examination. To evaluate concurrent validity, Spearman's rank correlation coefficients were calculated between the NdSSS and VF swallowing assessments. Additionally, scale responsiveness was determined using the standardized response mean (SRM) in 23 patients who could be followed up to assess their long-term course. Study 2: Cross-sectional survey of swallowing function and history of pneumonia. Data regarding history of pneumonia, UMSARS, NdSSS, age, sex, MSA subtype, and disease duration were retrospectively obtained from the medical records of 113 patients with MSA. Differences in these parameters and NdSSS stage between those with and without a history of pneumonia were examined using the Mann-Whitney test or chi-squared test. Furthermore, clinical factors related to a history of pneumonia were examined by binomial logistic regression analysis.ResultsThe NdSSS showed satisfactory reliability, concurrent validity, and responsiveness. A history of pneumonia was related to the severity of MSA, age, MSA subtype, and NdSSS stage. Binomial logistic regression analysis showed that NdSSS stage (odds ratio (OR), 0.490; 95% confidence interval (CI), 0.301–0.797, p = 0.001) and MSA subtype (OR, 4.031; 95% CI, 1.225–13.269, p = 0.021) were significantly associated with a history of pneumonia.ConclusionsIn patients with MSA, the NdSSS has sufficient reliability, concurrent validity, and responsiveness for assessing dysphagia. Patients with a history of pneumonia have more severe dysphagia. We found that the pneumonia risk was related to NdSSS stage and MSA-p (predominantly parkinsonism). Meticulous care to prevent aspiration is needed from early stages of the disease.
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Lin, Tai-Han, Chih-Wei Yang, and Wei-Kuo Chang. "Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia." Frontiers in Immunology 12 (February 2, 2022). http://dx.doi.org/10.3389/fimmu.2021.800029.
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ObjectiveNasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization.MethodsWe performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization.ResultsMultivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11–0.63, P = 0.003).ConclusionsFor older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
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Oliveira, Isabel de Jesus, Germano Rodrigues Couto, and Liliana Andreia Neves da Mota. "Nurses' preferred items for dysphagia screening in acute stroke patients: A qualitative study." Nursing Practice Today, June 21, 2020. http://dx.doi.org/10.18502/npt.v7i3.3351.
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Background & Aim: Formal dysphagia screening protocols are not yet implemented in some hospitals although there is growing evidence that early dysphagia screening reduces pneumonia rates in stroke patients. Trained professionals are not often available outside weekdays working hours in stroke units, meaning that early screening is usually performed by nurses that use informal detection to screen dysphagia in acute stroke patients. The purpose of this study was to identify which items stroke nurses prioritize in their clinical practice to screen dysphagia in acute stroke patients.
Methods & Materials: A qualitative study was developed using a focus group technique in five stroke units with a total of 20 stroke nurses selected by purposive sampling in march 2019. Qualitative Data Analysis Software Miner Lite 4.0 was used to assist in content analysis.
Results: Two categories emerged: clinical data and swallowing and non-swallowing signs, each with a set of dimensions. In the category clinical data, relevance was noted for the dimension Glasgow Coma Scale and sex, identified as the most and least relevant, respectively, for dysphagia screening. In the category swallowing and non-swallowing signs no relevance evolved for preferred items. However, in this category, data suggest that nurses find less relevant in clinical practice speech disorders for dysphagia screening.
Conclusions: Results reinforce the importance of a standardized approach through the use of valid and reliable dysphagia screening protocols, arguing the need for clear guidance in acute stroke clinical pathways on procedures for dysphagia screening.
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Tanaka, Nobukazu, Kanji Nohara, Chisato Uota, Nami Fujii, Aya Obana, Katsuji Tanaka, and Takayoshi Sakai. "Relationship between daily swallowing frequency and pneumonia in patients with severe cerebral palsy." BMC Pediatrics 22, no. 1 (August 13, 2022). http://dx.doi.org/10.1186/s12887-022-03547-0.
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Abstract Background Aspiration pneumonia is a major complication that occurs in patients with severe cerebral palsy and is associated with their survival prognosis, necessitating appropriate assessment and response. We focused on swallowing frequency as an index of daily swallowing function due to the difficulty in evaluating the risk of pneumonia. The swallowing motion protects the airway by safely directing the food, saliva, and secretions accumulated in the pharynx into the esophagus to prevent aspiration and entry into the trachea. Thus, swallowing frequency may be correlated with the incidence of pneumonia. In this study, we aimed to investigate the relationship between swallowing frequency and history of pneumonia in patients with severe cerebral palsy. Methods Fifty-seven patients with cerebral palsy were included in this study. Swallowing frequency was measured three times for each patient on separate days, and the reproducibility was examined by calculating the intraclass correlation coefficient. Further, the relationship between swallowing frequency and history of pneumonia was investigated using multivariate logistic regression analysis. Results While swallowing frequency differed between participants, it was constant within individuals (intraclass correlation coefficient: 0.941). Furthermore, the swallowing frequencies per hour were 12.2 ± 12.2 and 27.0 ± 20.4 in the patient groups with and without a history of pneumonia, respectively (P < 0.001). Swallowing frequency (odds ratio: 10.489, 95% confidence interval: 2.706–40.663, P = 0.001) was significantly associated with the incidence of pneumonia in the previous year. Conclusions Swallowing frequency could be used as an index for assessing the risk of dysphagia and pneumonia in patients with severe cerebral palsy.
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Jannini, T. B., M. Ruggiero, A. Viganò, A. Comanducci, I. Maestrini, G. Giuliani, E. Vicenzini, et al. "The role of the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke (GLOBE-3S) in the prevention of stroke-associated pneumonia (SAP)." Neurological Sciences, July 16, 2021. http://dx.doi.org/10.1007/s10072-021-05449-y.
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Abstract Background and purpose Stroke-associated pneumonia (SAP) affects 10 to 38% of patients in the acute phase of stroke. Stroke patients diagnosed with dysphagia have an 11-fold higher risk of developing SAP. Thus, identifying dysphagic patients through a highly accurate screening tool might be crucial in reducing the incidence of SAP. We present a case–control study designed to evaluate efficacy in reducing the risk of SAP between two swallowing screening tools, the classic water swallow test (WST) and a recently validated tool such as the GLOBE-3S (the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke), which is a highly sensitive swallowing screening tool particularly accurate in detecting silent aspiration as well. Methods We analyzed the occurrence of dysphagia in 100 acute stroke patients distributed in two groups: half were screened with WST and the other half with GLOBE-3S. Results Dysphagia was diagnosed in 28 patients. The main result is that, among patients who passed the dysphagia screenings, none of those screened with the GLOBE-3S method developed pneumonia compared to 31.82% in the WST group. Discriminant function analysis (DFA) showed that NIH Stroke Scale (NIHSS) score and the dysphagia screening method (i.e., GLOBE-3S vs. WST) were the two main factors in the SAP’s predicting model and the only significant ones per se. Conclusions The new GLOBE-3S screening test can reduce the risk of SAP compared to WST.
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Lee, Ban Hyung, Jun Chang Lee, Sun Myoung Lee, Yulhyun Park, and Ju Seok Ryu. "Application of Automatic Kinematic Analysis Program for the Evaluation of Dysphagia in ALS patients." Scientific Reports 9, no. 1 (October 30, 2019). http://dx.doi.org/10.1038/s41598-019-52246-x.
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Abstract Dysphagia in amyotrophic lateral sclerosis (ALS) increases the risk of malnutrition, dehydration, and aspiration pneumonia. Kinematic analysis of videofluoroscopic swallowing study (VFSS) can provide detailed movement of the hyoid bone, revealing abnormalities of swallowing in ALS patients. We developed an automated kinematic analysis program (AKAP) that analyzes the trajectory of the hyoid bone via a visual tracking method. The aim of this study was to investigate the hyoid movement in ALS patients using AKAP and compare it with non-dysphagic subjects. Thirty ALS patients who underwent VFSS in Seoul National University Bundang Hospital between 2015 and 2017 were recruited. For comparison, 30 age-matched control subjects were also enrolled; the same swallowing study was conducted using thin fluid and yogurt. The hyoid bone movement was analyzed by evaluating the vertical and horizontal distances with four peak points (A, B, C, D), and the time of each point were also calculated. With respect to distance parameters, only vertical peak distance (distance between B, D points) during thin fluid swallowing was significantly decreased in ALS patients. (p = 0.038) With respect to temporal parameters, Time ABC, Time ABCD, and Duration C were significantly increased in ALS patients when swallowing both thin fluid and yogurt. (Time ABC p = 0.019, p = 0.002; Time ABCD p = 0.001, p = 0.004; Duration C p = 0.004, p = 0.025 respectively). This result revealed that dysphagia in ALS patient is caused by decreased velocity of hyoid bone movement due to the development of weakness in swallowing-related muscles. The parameters of kinematic analysis could be used to quantitatively evaluate dysphagia in motor neuron disease.
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Won, Sae-Yeon, Simon Krieger, Daniel Dubinski, Florian Gessler, Bedjan Behmanesh, Thomas M. Freiman, Juergen Konczalla, Volker Seifert, and Sriramya Lapa. "Neurogenic Dysphagia in Subdural Hematoma." Frontiers in Neurology 12 (January 26, 2022). http://dx.doi.org/10.3389/fneur.2021.701378.
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IntroductionDysphagia is a common and severe symptom of traumatic brain injury (TBI) affecting up to 78% of patients. It is associated with pneumonia, increased morbidity, and mortality. Although subdural hematoma (SDH) accounts for over 50% of TBI, the occurrence of dysphagia in this subtype has not been investigated yet.MethodsAll patients with SDH admitted to the author's institution between the years 2007 and 2020 were included in the study. Patients with SDH and clinical suspicion for dysphagia received a clinical swallowing assessment by a speech and language pathologist (SLP). Furthermore, the severity of dysphagia was rated according to swallowing disorder scale. Functional outcome was evaluated by the Glasgow outcome scale (GOS).ResultsOut of 545 patients with SDH, 71 patients had dysphagia (13%). The prevalence of dysphagia was significantly lower in the surgical arm compared to the conservative arm (11.8 vs. 21.8%; OR 0.23; p = 0.02). Independent predictors for dysphagia were GCS <13 at admission (OR 4.17; p < 0.001), cardiovascular disease (OR 2.29; p = 0.002), and pneumonia (OR 2.88; p = 0.002), whereas the operation was a protective factor (OR 0.2; p < 0.001). In a subgroup analysis, right-sided SDH was an additional predictor for dysphagia (OR 2.7; p < 0.001). Overall, patients with dysphagia improved significantly under the SLP treatment from the initial diagnosis to hospital discharge (p < 0.01). However, a subgroup of patients with the most severe grade of dysphagia showed no significant improvement. Patients with dysphagia had significantly worse outcomes (GOS 1–3) compared to those without dysphagia (48.8 vs. 26.4%; p < 0.001).ConclusionDysphagia is a frequent symptom in SDH, and the early identification of dysphagia is crucial regarding the initiation of treatment and functional outcome. Surgery is effective in preventing dysphagia and should be considered in high-risked patients.
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Byun, Seong-Eun, Kyeu Back Kwon, Sang Ho Kim, and Seung-Jae Lim. "The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea." BMC Geriatrics 19, no. 1 (December 2019). http://dx.doi.org/10.1186/s12877-019-1382-x.
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Abstract Background Dysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery. Methods In this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed. Results Dysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]). Conclusions Dysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.