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PubMed2006

[Fiberoptic endoscopic evaluation of swallowing--the Tel Aviv Voice and Swallowing Disorders Clinic].

Fiberoptic endoscopic evaluation of swallowing (FEES) involves passing a fiberoptic laryngoscope transnasally to visualize the hypopharynx, larynx, and proximal trachea in order to assess swallowing disorders. FEES has been compared with the modified barium swallow (MBS) (the presumed "gold standard"). To date, reports have demonstrated that FEES is as sensitive as, or even more sensitive, for use as a tool in swallowing assessment compared with the MBS. FEES provides the clinician with a safe, portable, effective, and valid means of evaluating individuals with swallowing disturbances. FEES allows the examiner to identify swallowing physiology, determine the safest and least restrictive level of oral intake, implement appropriate compensatory techniques, and identify a dysphagia rehabilitation plan. In this article we present the Tel-Aviv Voice and Swallowing Disorders Center experience. Out of 100 patients that were referred to our center for swallowing evaluation 97 patients underwent 102 FEES examinations. Three patients couldn't tolerate the examination. In 63% of the patients swallowing pathology was found. FEES were performed by teamwork involving a speech-language pathologist and otolaryngologist collaborating together thus optimally managing the individual with dysphagia safely and efficiently.

Deglutition↗
PubMed1990

Evaluation of swallowing disorders: the modified barium swallow.

Swallowing is a complex process. The diagnosis and treatment of swallowing dysfunction are more objective due mostly to recent research. The performance of a barium swallow, modified to study the dynamics of swallowing and its value in the management of patients with swallowing dysfunction, is described. The conventional barium swallow assesses structure and function of the thoracic esophagus, including gastroesophageal reflux and its sequelae. The modified barium swallow is a dynamic technique designed to evaluate swallowing function and dysfunction as it relates to the oral and pharyngeal phases of swallowing.

Barium Sulfate↗
PubMed2002

Supraglottic swallow, effortful swallow, and chin tuck did not alter hypopharyngeal intrabolus pressure in patients with pharyngeal dysfunction.

Simultaneous videoradiography and solid-state manometry (videomanometry) were performed in 8 patients (4 women, 4 men; age range = 46-81 years, mean age = 70 years) with pharyngeal dysfunction in order to disclose any changes in intrabolus pressure during swallowing maneuvers. Five of the patients had severe pharyngeal dysfunction with frequent misdirected swallows. Three of the patients had moderate pharyngeal dysfunction with delayed initiation of pharyngeal swallow. Three different swallowing techniques were applied: supraglottic swallow, effortful swallow, and chin tuck. Pharyngeal intrabolus pressure was analyzed at the level of the inferior pharyngeal constrictor. Supraglottic swallow, effortful swallow, and chin tuck did not alter peak amplitude or duration of the intrabolus pressure.

Aged↗
PubMed1990

Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing.

In this investigation, we studied the effects of bolus volume and viscosity on the quantitative features of the oral and pharyngeal phases of swallowing. Concurrent videofluoroscopic and manometric studies were done in 10 healthy volunteers who were imaged in lateral projection. Videofluorography was done at 30 frames/s while concurrent manometry was done with 5 intraluminal transducers that straddled the pharynx and upper esophageal sphincter (UES). Submental electromyography was recorded also. Swallows of 2-20 ml were recorded for low-viscosity liquid barium and high-viscosity paste barium. Analysis indicated that the major effect of increases in bolus volume was an earlier onset of anterior tongue base movement, superior palatal movement, anterior laryngeal movement, and UES opening. These events provide receptive adaptation for receiving a swallowed bolus. Earlier UES opening was associated with an increase in the duration of sphincter opening and sphincter diameter. The major effects of high bolus viscosity, unrelated to bolus volume, were to delay oral and pharyngeal bolus transit, increase the duration of pharyngeal peristaltic waves, and prolong and increase UES opening. Thus the specific effect of bolus viscosity per se differs substantially from that of bolus volume. We conclude that 1) specific variables of swallowing are affected significantly by the variables of the swallowed bolus, such as volume and viscosity; 2) overall, bolus volume and viscosity affect swallowing in a different manner; and 3) the study findings have implications about the neural control mechanisms that govern swallowing as well as about the diagnosis and treatment of patients with abnormal oral-pharyngeal swallowing.

Adult↗
PubMed1993

A comparison of esophageal motility in response to bread swallows and water swallows.

Studies of esophageal manometry during eating have demonstrated abnormal motility in patients with dysphagia in whom standard water-swallow manometry was normal. However, there have been few concurrent motility studies making a direct comparison of food swallows with water swallows. This paper presents the results of such a study in 20 healthy volunteers. A comparison of bread swallows with water swallows revealed that both peristaltic amplitude in the proximal esophagus and peristaltic duration throughout the esophagus were significantly increased (p < 0.05). Peristaltic propagation velocity was significantly decreased in the proximal and mid-esophagus (p < 0.05). Percentages of nonconducted and nonperistaltic contractions were significantly increased (p < 0.05-0.001) during bread-swallow manometry. Therefore, the response of the normal esophagus to food has been shown to be different from its response to water swallows. In particular, the high percentage of nonpropagated swallows in normal subjects when eating indicates that the results of food manometry in patients with dysphagia must include wider limits of normality.

Adult↗
PubMed2006

Manofluorographic evaluation of swallowing in amyotrophic lateral sclerosis and its relationship with clinical evaluation of swallowing.

The aim of this cross-sectional study was, first, to identify swallowing dysfunctions in an ALS population of 40 consecutive patients through combined videofluoroscopy and manometry. Secondly, these objective swallowing data were correlated with the functional feeding status as reported by the patient or family member. Videofluoroscopic evaluation showed dysfunctions in the oral phase of swallowing, pharyngeal initiation and pharyngeal transport. In addition, manometric data revealed low tongue driving forces and pharyngeal contraction amplitudes but normal relaxation of the upper oesophageal sphincter (UES). Aspiration was noted in a not negligible number of 9/40 patients. These objective data were then correlated with the clinical swallowing and feeding status, assessed by means of the ALS Swallowing Severity Scale. Patients receiving scores of 6 or lower on the ALSSSS, report dietary consistency changes but are considered 'safe oral feeders'. Nevertheless, our data revealed that these patients showed significant aspiration during videofluoroscopy. Although not every patient with ALS should be referred routinely for radiographic evaluation of swallowing, our findings suggest referral for a radiological examination as soon as the ALSSSS drops to a score of 6 or lower, to evaluate the presence of (silent) aspiration.

Amyotrophic Lateral Sclerosis↗
PubMed1994

The synchronization of respiration and swallow sounds with videofluoroscopy during swallowing.

Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints were examined and schematic drawings of the relevant radiographs were made. These were superimposed on to the actual EDAT printed chart of the same swallow event, their exact time relationship with respiration and cervical swallow sounds being preserved. The results allow events in the barium videofluoroscopy to be related to events in the feeding respiratory pattern and swallow sounds recorded by EDAT.

Adult↗
PubMed1993

The videoendoscopic swallowing study: an alternative and partner to the videofluoroscopic swallowing study.

A new, physical examination-based videoendoscopic method of evaluation can enhance considerably the understanding and efficiency of clinicians working with patients with swallowing difficulties. Using the fiberoptic nasolaryngoscope, evaluation of structure and function of palate, pharynx, and larynx, along with sensation of the laryngopharynx, is carried out. Next, patients' swallowing capabilities are assessed as they ingest various food consistencies. This method, formerly called videoendoscopic evaluation of dysphagia (VEED), but perhaps more appropriately termed videoendoscopic swallowing study (VESS) has particular value for patients who cannot undergo the videofluoroscopic swallowing study (VFSS)--for example, because they are bedfast--or those whose swallowing function is changing so rapidly (after a stroke or surgery) as to call for frequent reassessments. This technique is often useful during the initial consultation with new patients complaining of dysphagia, as a "stand alone" method of diagnosis and management. Less frequently, VESS findings, along with patient history, will indicate when VFSS should also be obtained. VESS will orient the examiner to the nature and severity of the problem even in this latter circumstance. In follow-up circumstances, VESS is generally more useful than the VFSS. Case presentations are utilized to illustrate the usefulness of VESS as compared to VFSS.

Aged↗
PubMed1991

Measuring pressures under maxillary complete dentures during swallowing at various occlusal vertical dimensions. Part II: Swallowing pressures.

The swallowing pressures of seven edentulous patients were measured at seven different occlusal vertical dimensions. In addition, the projection surfaces of the maxillary dentures were measured and the forces on the maxillary denture-bearing surfaces were calculated. The swallowing pressures were measured from the maxillary denture base-mucosal surface interface by means of a "closed" hydraulic system described in Part I. The mean values of swallowing pressures increased from 7.95 +/- 2.25 to 10.18 +/- 3.42 kPa as the occlusal vertical dimension increased, and then decreased to 8.38 +/- 3.55 kPa at the highest occlusal vertical dimension. The results of a two-way analysis of variance showed significant differences of swallowing pressures between patients (p less than 0.001) and between different occlusal vertical dimensions (p less than 0.001). The projection surfaces of maxillary denture bases were measured and ranged from 21.65 to 27.78 cm2. The forces exerted on these surfaces during swallowing were also calculated and ranged from 12.5 to 47.7 N.

Adult↗
PubMed2000

Effect of swallowing training on swallowing disorders in Parkinson's disease.

The purpose of the present study was to determine whether swallowing training improves swallowing function in patients with Parkinson's disease. Ten patients (5 males, 5 females) who had symptoms of dysphagia and 12 healthy volunteers were studied. The initiation time of the swallowing reflex, the "premotor time" (PMT), was calculated from an electromyogram of the submental muscles before and after swallowing training. Patients with Parkinson's disease had a significantly longer PMT (p = 0.0014) than did healthy controls. There was no correlation between PMT and the duration of the disease (r = -0.146; p = 0.6867) or the patient's age (r = 0.602; p = 0.0653). After swallowing training, the patients' PMTs decreased significantly (p = 0.0051).

Aged↗
PubMed2002

Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows.

The critical integration of timing and patterning between respiratory and swallowing events was studied with simultaneous videofluoroscopic and respiratory recording during single liquid swallows. Respiratory phase patterns and the onsets and durations of 12 predetermined swallowing events and associated respiratory activities were studied. Results showed four highly repeatable, temporally oriented sequences (clusters) of swallowing and related respiratory events. Two respiratory phase patterns were identified without statistically significant differences in frequency of occurrence between age, gender, or race. These findings will aid in the identification of normal and abnormal patterns of breathing and swallowing in patients with dysphagia.

Adult↗
PubMed1990

[Human mandibular movements during swallowing saliva. 2. Duration of swallowing saliva and that of tooth contact].

The sagittal incisal jaw movement during swallowing saliva was measured on 11 subjects (range: 24-30 years old) with "normal occlusion" by using a two-dimensional system applied infrared sensor. The duration of swallowing saliva and that of tooth contact were calculated with the program developed in our laboratory. The results obtained were as follows: 1. The average of the duration of swallowing saliva (T1) was approx. 3.5 sec on 11 subjects. 2. The average of the duration of tooth contact during swallowing saliva (T2) was approx. 2.1 sec on 11 subjects. Type Ia had the longest T2 (approx. 2.5 sec) among the types of tooth contact. 3. Type Ia had a greater ratio T2/T1 (74.4%) than those of the other types. In conclusion, it was clearly shown that the subject of type Ia had a longer duration of tooth contact during swallowing saliva than those of the other types in the absolute and relative values.

Adult↗
PubMed1997

[Swallowing rehabilitation in an elderly patient with Wallenberg's syndrome--role of videofluorography and the swallowing provocation test].

A 65-year-old man was admitted to our department due to severe dysphagia, dysarthria, and aspiration pneumonia. Dysphagia and dysarthria were caused by lateral medullary infarction (Wallenberg' s syndrome). After the patient recovered from pneumonia, the abnormality of swallowing was assessed by a swallowing provocation test and videofluorography. Two months after the start of swallowing training, a swallowing provocation test showed that the swallowing reflex had improved and videofluorography showed that the magnitude of aspiration to the trachea had decreased. The patient began taking food by mouth. These tests are useful for quantitative assessment of dysphagia and for deciding when to start oral intake in elderly patients.

Aged↗
PubMed1984

A field study on the effects of Fort Morgan virus, an arbovirus transmitted by swallow bugs, on the reproductive success of cliff swallows and symbiotic house sparrows in Morgan County, Colorado, 1976.

We studied the transmission of Fort Morgan (FM) virus within colonies of nesting Cliff Swallows and House Sparrows under three bridges in Morgan County, Colorado during 1976. Nests were examined, and blood or brain specimens were collected from nestlings once or twice a week. Flying birds and small mammals were also studied. We analyzed nesting activity, virus isolations from nestlings of both species, fledging success, multiple infections within a brood of nestlings, infection frequency by age of nestlings, nestling mortality, and infection frequencies by avian species and bridge site. Fort Morgan virus was isolated from 7% (80/1, 156) of the blood and brain samples collected from nestlings. The duration of viremia for nestling House Sparrows was at least 3-4 days based on virus isolation from sequential blood samples. Viremia of nestling Cliff Swallows and House Sparrows did not reduce fledging success, nor were young nestling sparrows viremic more frequently than older nestling sparrows. Nest destruction (by falling down) was a more important cause of nestling mortality than FM virus infection. All age groups of nestling sparrows were viremic at equal rates, but younger nestlings (less than or equal to 7 days old) were more likely than older nestlings (greater than 7 days old) to develop an encephalitic infection. Among nestling House Sparrows, FM virus infections were clustered in time and space. Nestling House Sparrows with FM virus-infected nest-mates were infected more often than conspecifics whose nest-mates were not infected. We concluded that nestling Cliff Swallows and symbiotic House Sparrows that reside in swallow nesting colonies are the principal vertebrate hosts for the maintenance and amplification of FM virus.

Animals↗
PubMed2005

[The effectiveness of fiberoptic endoscopic swallow study and modified barium swallow study techniques in diagnosis of dysphagia].

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of fiberoptic endoscopic evaluation of swallowing (FEES) and the modified barium swallow test (MBST) in patients with dysphagia. PATIENTS AND METHODS: Eighty patients with dysphagia were evaluated in three groups consisting of 27 patients with oral, pharyngeal, or esophageal masses; 26 patients with neurogenic dysphagia; and 27 patients with no distinct pathology. All the patients underwent FEES and MBST to examine elevation of the soft palate, nasal regurgitation, pharyngeal residue, penetration, aspiration, and pooling of secretions in the pyriform sinus and vallecula. RESULTS: In neurogenic dysphagia, MBST was more efficacious in detecting aspiration and pooling in the vallecula (p<0.05). Evaluation of the internal anatomy, visualization of masses, and laryngopharyngeal sensory discrimination were only possible with the FEES. On the other hand, evaluation of the elevation of the larynx and the hyoid, the relaxation of the upper esophageal sphincter, and the oral phase of swallowing, and the detection of esophageal pathologies were only possible with the MBST. CONCLUSION: The leading advantages of the two evaluation techniques seem to lie in the detection of aspiration for the FEES, and dynamic evaluation of the oral and esophageal phases of swallowing for the MBST.

Adolescent↗
PubMed2005

Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES).

This study investigated the effects, if any, that the presence of a tracheotomy tube has on the incidence of laryngeal penetration and aspiration in patients with a known or suspected dysphagia. This was a prospective, repeated-measure design study. A total of 37 consecutive patients with a tracheotomy tube underwent a fiberoptic endoscopic evaluation of swallowing (FEES). Patients were first provided with pureed food boluses with the tracheotomy tube in place. The tracheotomy tube was then removed and the tracheostoma site was covered with gauze and gentle hand pressure was applied. The patients were then evaluated without the tracheotomy tube in place with additional puree. Aspiration status was in agreement with and without the tracheotomy tube in place in 95% (35/37) of the patients. The two patients who demonstrated a different swallowing pattern with regard to aspiration demonstrated aspiration only when the tracheotomy tube was removed. Laryngeal penetration status was in agreement with and without the tracheotomy tube in place in 78% (29/37) of the patients. For the majority of the patients, the removal of the tracheotomy tube made no difference in the incidence of aspiration and/or laryngeal penetration. Results of this study do not support the clinical notion that the patient's swallowing function will improve once the tracheotomy tube has been removed.

Aged↗
PubMed2000

Comparison between videofluoroscopy and milk-swallow endoscopy in the assessment of swallowing function.

The investigation of swallowing function and the detection of aspiration has evolved over the past 10 years with the introduction of the fibreoptic endoscopic assessment. Practical reasons can limit the use of videofluoroscopy in some patients. A prospective study of 20 sets of videofluoroscopic and endoscopic assessments of swallowing function were compared. Endoscopic assessment was found to be a highly sensitive and specific method of determining swallowing safety. Reduced or absent laryngeal sensation at endoscopy correlates with silent aspiration and thus a high risk of aspiration pneumonia.

Aged↗
PubMed1992

Diagnosis of esophageal motor disorders: a prospective study comparing barium swallow, food barium mixture, and continuous swallows with manometry.

Radiography and manometry of the esophagus were compared in 77 patients consecutively referred for manometric investigation on suspicion of esophageal motility disorder. Radiography and manometry were carried out simultaneously, and the results were assessed blindly. The examination comprised barium swallow, bread barium swallow, and barium swilling. Considering manometry as the standard, the overall sensitivity and specificity of the radiologic examinations were 90.4% and 92.0%, respectively. We conclude that radiology is an excellent investigation for the separation of patients with and without esophageal motility disorders, but correct subclassification often required manometry.

Administration, Oral↗