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PubMed1993

[Relationship between cervical osteophytes and globus sensation--a study based on altered swallowing function].

The swallowing function of ten patients showing marked cervical osteophytes were studied by double contrast pharyngogram and manometric examinations. In five cases in which the pharyngeal clearance was B type according to Shuzaki's classification, a significant increase in the maximal swallowing pressure value on the oral side ipsilateral to the osteophytes was often observed. In five cases in which the pharyngeal clearance showed A + A' type (marked impairment), the frequency of significantly decreased maximal swallowing pressure on the oral side ipsilateral to the osteophytes and abnormal waveforms of the swallowing pressure were high. However, no definite correlation was noted between these changes in swallowing function and osteophyte site. Therefore, there are two possible outcomes of the changes in swallowing function caused by cervical osteophytes: one is a compensatory increase in pharyngeal constriction aimed at maintaining relatively good pharyngeal clearance, the other is impaired pharyngeal constriction and the pharyngeal clearance. These changes in swallowing function would impact on globus sensation.

Aged↗
PubMed1999

The functional neuroanatomy of voluntary swallowing.

Swallowing is a complex physiological process involving voluntary and reflexive motor activity, sensorimotor integration, salivation, and visceral regulation. Despite the numerous processes required for normal deglutition, traditional models of the central control of swallowing only emphasize the involvement of the brainstem and the inferior precentral gyrus (IPCG). However a number of neurological disorders involving other brain regions also cause dysphagia. To determine the brain regions participating in voluntary swallowing, we assayed regional cerebral blood flow (rCBF) with positron emission tomography (PET) while healthy human subjects swallowed, performed lateral tongue movements, or rested with their eyes closed. Voluntary swallowing produced strong rCBF increases within the IPCG bilaterally, the right anterior insula/claustrum, and the left cerebellum. The maxima in these regions differed from those induced by lateral tongue movements. Swallowing also produced rCBF increases in the putamen, thalamus, and several additional cortical areas, but these foci were not as clearly distinguishable from activity arising during tongue movements. These findings indicate that swallowing involves the recruitment of a large-scale distributed neural network that includes the anterior insula and cerebellum. The distributed nature of this network helps to explain why so many neurological conditions produce dysphagia.

Adult↗
PubMed1999

Swallowing impairment and feeding dependency in the hospitalised elderly.

A prospective study was carried out to determine the prevalence of swallowing impairment and feeding dependency in an acute geriatric medicine unit in Singapore and the co-morbidity associated with it. A total of 211 patients were assessed over a 3-month period. Only 7.1% of patients gave a history of swallowing impairment prior to hospitalisation. We found that 29.4% of patients on admission and 28.2% on discharge had swallowing impairment, with a mortality of 8.1%. The prevalence of feeding dependency, as defined by the need for feeding assistance or tube feeding, was 26.5% before admission and 27.8% on discharge. The mode of feeding between the time of admission and discharge was changed in 14.9% of patients in response to the evolving medical condition. Swallowing impairment was significantly associated with the presence of dehydration (RR = 2.82, CI = 1.74-4.57), chest infection on admission (RR = 2.85, CI = 1.85-4.41), development of nosocomial chest infection (RR = 6.75, CI = 2.60-17.5), discharge to institutional care (RR = 2.8, CI = 1.51-3.47) and increased mortality (RR = 3.77, CI = 1.45-9.70). We concluded that swallowing impairment and feeding dependency are common in the elderly admitted to an acute geriatric unit. As elderly patients seldom inform clinicians of any underlying swallowing impairment and in view of the increased morbidity and mortality associated with this disability, it is important to screen for swallowing impairment. The high prevalence of feeding dependency adds to the burden of care in the ill elderly.

Aged↗
PubMed1999

Swallowing problems in the normal ageing population.

This study investigated the prevalence of subjectively reported swallowing problems in a group of normal ageing subjects. Twenty-five retirement village residents were included in the sample. A cross-sectional descriptive survey research design was utilised. Data was obtained through the administration of a devised interview schedule. The prevalence of reported swallowing problems in the sample was determined. The nature of the swallowing problems were examined and compared to those reported to occur in the normal ageing population. The utility of the interview schedule was critically evaluated. Results revealed an overall prevalence of 44% of subjects who experience swallowing problems that interfere with their day to day functioning. Of these, 64% experienced swallowing difficulties affecting all phases of the swallow while 36% experienced difficulties affecting the pharyngeal and oesophageal phases. The interview was found to be a useful screening measure in identifying the presence of swallowing problems. The role of the speech pathologist in dysphagia in the normal ageing population is highlighted and justified.

Aged↗
PubMed2001

The impact of swallowing disorders in the elderly.

INTRODUCTION: Swallowing disorders are common in the elderly but its prevalence is often underestimated. They can result in increased morbidity and mortality. METHODS: This article summarises the findings of selected published papers in major international journals indexed on Medline on swallowing using the key words--swallowing, dysphagia, aged, geriatrics and deglutition. RESULTS: There are age-related changes in the oral, pharyngeal and oesophageal functions. In the elderly, central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors are common causes of swallowing dysfunction. Swallowing disorders in the elderly are associated with increased mortality and morbidity. Aspiration, dehydration, pneumonia, malnutrition, functional decline and institutionalisation are often encountered in the elderly with dysphagia. There is a choice of different interventions available to reduce morbidity and mortality arising from swallowing impairments, and improving their quality of life. CONCLUSION: The effective management of swallowing impairment in the elderly requires a multidisciplinary team approach.

Age Factors↗
PubMed1987

Swallowing in ALS and motor neuron disorders.

The dysphagia of ALS is characterized by an impaired oral stage of swallowing, which has a direct impact on the seemingly more robust pharyngeal stage. Increased duration of the volitional stage (PPRT) of swallowing, including DT and lingual motility deficits, appear to be the major contributors to the dysphagia. The abnormal temporospatial events during the oral stage of swallowing have a direct and significant effect on the more automatic, pharyngeal stage. Specifically, abnormal lingual movement may result in pharyngeal residue that is aspirated after the swallow is completed and respiration is resumed. ALS patients with bulbar involvement demonstrate more severe swallowing problems (such as aspiration); however, the current work indicates that predominantly nonbulbar ALS patients may also demonstrate dysphagia. The semisolid material was more effective than liquids in eliciting temporospatial abnormalities of swallowing in the nonbulbar group. Thus, more viscous materials may be most sensitive for eliciting behaviors indicative of the onset of bulbar dysfunction in patients who otherwise appear nonbulbar, or different neurophysiologic mechanisms are involved in swallowing the distinct types of substances.

Adult↗
PubMedDate not supplied

Swallowing function and weight change observed in a phase I/II study of external-beam radiation, brachytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 9207).

BACKGROUND: A multi-institutional, prospective study was designed to determine the feasibility and tolerance of combined-modality chemotherapy, external-beam irradiation, and esophageal brachytherapy in a potentially curable group of patients with adenocarcinoma or squamous cell carcinoma of the esophagus. Swallowing function and weight were assessed before and after treatment. MATERIALS AND METHODS: Planned treatment was with 50 Gy of external-beam irradiation (25 fractions/5 weeks) followed 2 weeks later by esophageal brachytherapy (either a high dose rate of 5 Gy at weeks 8, 9, and 10 for a total of 15 Gy or a low dose rate of 20 Gy at week 8). Chemotherapy was given weeks 1, 5, 8, and 11 with cisplatinum, 75 mg/m2, and 5-fluorouracil, 1,000 mg/m2/24 hours in a 96-hour infusion. Swallowing was graded from 0 (no dysphagia) to 4 (complete obstruction for solids and liquids). Weight "loss" or weight gain was defined as a change in 3-month post- to pretherapy weight of < or = 5% or > 5%, respectively. RESULTS: The estimated survival rate at 1 and 2 years was 49% and 31%, respectively, and the estimated median survival was 11 months. Swallowing before treatment was graded as grade 1 in 14 patients, grade 2 in 22 patients, grade 3 in nine patients, and grade 4 in four patients. Swallowing grade after treatment was reported as improved in 29 patients (59%), unchanged in 12 patients (24.5%), and worse in eight patients (16.5%). The bestimproved dysphagia score after treatment in the 29 patients reporting improvement was grade 0 in 19 patients, grade 1 in five patients, grade 2 in four patients, and grade 3 in one patient. A posttreatment weight in 42 evaluable patients was categorized as a loss in 29 patients (69%), a gain in four patients (9.5%), and stable in nine patients (21.5%). Weight loss was significantly correlated with high swallowing grade, low performance status, and absence of a feeding tube. CONCLUSIONS: Swallowing function after brachytherapy and concurrent chemoradiation therapy is satisfactory in most surviving patients. Ninety-two percent of patients were able to swallow at least liquids at some point after therapy. Future plans are to compare this with other cooperative group studies that utilized chemoradiation or surgery, without brachytherapy.

Adenocarcinoma↗
PubMed2005

X-ray examination of the stomach bubble after frequent experimental swallowing of saliva: the mechanism of aerophagia.

BACKGROUND: While the mechanism of aerophagia remains unclear, the frequency of clenching has been reported to be increased when under stress. We hypothesized that, via the swallowing reflex, chronic air swallowing was induced through a "learned habit" of the oral cavity, which was acquired through psychological factors. This study examined whether the habitual repeated swallowing in the oral cavity was a process of aerophagia. METHODS: After continuous experimental saliva swallowing, changes in the stomach bubble were examined by abdominal X-rays in a standing position. The subjects included 9 males and 10 females aged 20 to 36 years that were without organic disease in the pharynx and nasal cavity. X-ray images were digitized, and the area of the stomach bubble was measured by tracing. RESULTS: A close correlation was revealed in the stomach bubble area between posteroanterior and lateral views in six males (p<0.001, r = 0.910). In 3 males and 10 females, the area of the stomach bubble by posteroanterior view after 30 swallows was significantly increased compared with that before swallowing (p = 0.004). CONCLUSIONS: In the present study, abdominal X-rays confirmed that frequent saliva swallowing expanded the stomach bubble.

Adult↗
PubMed1990

[The study on salivary clearance in children. 3. The volume of saliva in the mouth before and after swallowing].

Several kinds of substances such as acids and bacterial toxins diffuse from dental plaque into the salivary film which moves slowly between the plaque on the teeth and oral mucosa. The volume of saliva retained in the mouth before and after swallowing seem to be very important with respect to clearance of such substances from plaque. In 30 subjects, five-year-old children of each gender, the volume of saliva in the mouth after swallowing (X) could be computed by measuring the potassium concentration in unstimulated saliva and in the expectorate after a five-second rinse with 3 ml of water immediately following a swallow. The volume of saliva normally swallowed was calculated from the unstimulated salivary flow rate and the normal swallowing frequency. The volume of saliva before swallowing (Y) was calculated as the total of (X) plus the volume normally swallowed. The unstimulated salivary flow-rate was 0.22 +/- 0.14 ml/min, the mean values of (X) and (Y) were 0.38 +/- 0.11 ml and 0.50 +/- 0.15 ml, respectively, and there were no significant differences in these values based on gender. These values were about half the values of those parameters in adults (Lagerlöf and Dawes, 1985), and insertion in the computer program (Dawes, 1983) of these values suggested that sugar clearance in the five-year-old children would be slightly faster than in adults.

Child, Preschool↗
PubMed1982

Swallow apnea--rhinomanometric manifestation and classification.

Swallow apnea designates the oropharyngeal phase of swallowing during which respiration ceases. Abnormal swallowing in this phase is caused by a disturbance of the food transport and/or a disturbance of the closures of the lower airway. Respiratory movements during swallowing leave the lower respiratory tract vulnerable to invasion by food. The respiratory inactivity of swallowing and its disturbance can be demonstrated by rhinomanometric tests. These tests produce characteristic responses, which are reproducible and are not caused by other events. Three types of responses and three subgroups have been found in 639 examinations of 120 subjects. Thirty subjects had actually experienced aspiration. This event was of life-threatening nature in 11 of the subjects. The combination of multiple swallows and prolonged transport, associated with abnormal positioning and release movements points to a serious disturbance. This method has been a good screening test to detect pathologic swallow and to monitor results of treatment.

Apnea↗
PubMed1995

[Videofluorographic analysis of the swallowing disorders in spinocerebellar degeneration].

Clinical and videofluorographic (VF) studies of swallowing were performed in 11 patients with spinocerebellar degeneration (SCD). Eight patients had a subjective symptom of dysphagia. In VF study, seven patients represented abnormal findings in an oral phase such as residue on the tongue (2 patients), reduced tongue control (3 patients), uncontrolled bolus or premature loss of liquid (6 patients), and piecemeal deglutition (4 patients). Seven patients showed abnormality in a pharyngeal phase such as vallecular residue after swallow (5 patients), residue in pyriform sinuses after swallow (4 patients), delayed onset of laryngeal elevation (5 patients), and aspiration during swallow (5 patients). Aspiration was more obvious when barium liquid was swallowed. When the patients aspirated, techniques such as the chin down posture and the supraglottic swallow were tried in 4 of the 5 patients with the evidence of aspiration. The aspiration was prevented in 2 patients. It was suggested that in SCD the change in the form and volume of food is recommended for prevention of aspiration and that the rehabilitation techniques such as the chin down posture and the supraglottic swallow may also improve the dysphagia.

Adult↗
PubMed2004

Stress and immune responses of nestling tree swallows (Tachycineta bicolor) and eastern bluebirds (Sialia sialis) exposed to nonpersistent pesticides and p,p'-dichlorodiphenyldichloroethylene in apple orchards of southern Ontario, Canada.

To determine the relative effects of pesticides in current use and persistent residues of p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), we examined endocrine and immune responses in tree swallow (Tachycineta bicolor) and eastern bluebird (Sialia sialis) chicks from pesticide-sprayed apple orchards and reference sites in southern Ontario, Canada, during 2000 to 2001. Nests were exposed to as many as seven individual pesticide applications and up to five mixtures of pesticides during the egg-incubation and chick-rearing stage. Eggs collected from sprayed orchards contained higher p,p'-DDE concentrations than eggs from reference sites. In 16-d-old tree swallows, no significant differences were found in body mass, basal corticosterone concentration, or the corticosterone stress response following a 10-min restraint of chicks sampled from sprayed orchards and reference sites. Challenge with adrenocorticotrophic hormone (ACTH), however, produced a higher level of corticosterone secretion in tree swallow chicks from sprayed orchards relative to chicks from reference sites. Multiple regression analysis revealed no correlation between corticosterone concentrations and exposure to pesticide sprays or p,p'-DDE in tree swallow chicks. In contrast, bluebird chicks from sprayed orchards were less responsive to challenge with ACTH and a significant negative association was found between the response to ACTH challenge and p,p'-DDE concentration in eggs. The phytohemagglutinin (PHA)-induced cutaneous basophil hypersensitivity response was similar between exposure groups in both tree swallow and bluebird nestlings. Examination of immune organs revealed that tree swallow chicks from sprayed orchards had significantly greater thymic lymphocyte density and cortical/ medullary ratios and significant splenic B-cell hyperplasia relative to reference chicks. Our results indicate that modulation in the hypothalamus-pituitary-adrenal axis in songbird chicks tested are most associated with high p,p'-DDE egg concentrations. An alteration in the endocrine or immune system may compromise songbird survival immediately after fledging or during migration.

Adrenocorticotropic Hormone↗
PubMed2002

Does laryngectomy improve swallowing after chemoradiotherapy? A case study.

Organ preservation protocols of high-dose chemoradiotherapy have become fairly common to treat head and neck cancers. However, significant swallowing problems can occur. This study examines swallowing, oral tongue pressures, and tongue base-to-pharyngeal wall pressures in a patient who underwent total laryngectomy for improvement of swallowing after chemoradiotherapy for treatment of a hypopharyngeal tumor. The patient underwent concurrent videofluorographic and manometric examination of swallowing and examination of oral tongue pressures after the laryngectomy. One healthy subject was used as a control. After the laryngectomy, the patient no longer aspirated; however, he could swallow only liquids and pureed foods. He demonstrated difficulty with bolus clearance through the oral cavity and pharyngocervical esophagus. Pharyngeal pressures were reduced compared with those of the control subject. While total laryngectomy will stop unremitting aspiration, swallowing after chemoradiation may be severely compromised. This may not be overcome by total laryngectomy.

Aged↗
PubMed2003

Voice and swallowing in patients enrolled in a larynx preservation trial.

BACKGROUND: The main goals of larynx preservation protocols are preservation of a functional larynx with intact voice and maintenance of normal deglutition. However, few studies have addressed functional outcomes. OBJECTIVES: To evaluate voice and swallowing in patients enrolled in a larynx preservation protocol. DESIGN AND SETTING: Acoustic analysis of 15 patients and videofluoroscopic evaluation of 14 patients who underwent chemoradiotherapy in an attempt to preserve the larynx. PATIENTS: Forty-three patients with larynx or hypopharynx squamous cell carcinomas were treated with weekly paclitaxel (30 mg/m2) and cisplatin (20 mg/m2) concurrent to radiotherapy (180-rad/d fraction [1.8 Gy] to 7040 rad [70.4 Gy]). Voice was analyzed perceptually and acoustically in 15 patients. Videofluoroscopic evaluation of swallowing was performed in 14 patients, focusing on oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration, and dysphagia severity. RESULTS: Vocal analysis produced normal results in 1 patient, mild dysphonia in 4, moderate dysphonia in 6, and severe dysphonia in 4. The mean fundamental frequency for acoustic analysis was 131.4 Hz for men and 109.8 Hz for women. Acoustic measures of perturbation and noise were above the reference limits, indicating changes in the voice signal. Swallowing analysis showed inefficient bolus preparation in 13 patients and changes in the bolus propulsion in 12. Stasis was observed in all areas of the oropharynx. Five patients had reduction in laryngeal elevation, and 12 had stasis in the hypopharynx. Five patients presented with silent aspiration. We detected functional swallowing in 3 patients, mild dysphagia in 7, mild or moderate dysphagia in 2, and severe dysphagia in 2. CONCLUSIONS: Laryngeal preservation resulted in voice and swallowing abnormalities, but they tend to be mild to moderate, allowing intelligible communication and efficient swallowing in most patients.

Adult↗
PubMed1979

Swallowing disorders in three types of head and neck surgical patients.

This study examined swallowing transit times and motility problems in three groups of patients following ablative surgery for oropharyngeal carcinoma and in a control group of 10 normal subjects. A total of 30 patients was studied: 10 after anterior floor of mouth resection, 12 after tonsil/base of tongue resection, and 8 after supraglottic laryngectomy. Videofluoroscopic studies of liquid, thin paste, thick paste, and thick paste plus liquid swallows were completed 1 week post-initiation of oral feeding following surgery. From the videotapes, oral and pharyngeal transit times were measured, and motility disturbances were defined during each stage of the swallow. All three types of patients in this study showed severe problems with swallowing. The anterior floor of mouth resection patients had problems with preparation for the swallow and oral transit. Tonsil/base of tongue resection patients had slowing in the preparation for the swallow and in the oral and pharyngeal stages. After supraglottic laryngectomy, patients showed only slight slowing in oral transit and pharyngeal transit as compared to other types of surgical patients.

Adult↗
PubMed2003

Xerostomia: 12-month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation.

BACKGROUND: Previous investigators have found permanent changes in saliva production after chemoradiation but have not examined these in relation to swallowing measures, diet changes, and patient comfort over time. METHODS: Thirty patients with advanced stage cancer of the oropharynx treated with chemoradiation were followed with videofluoroscopic swallow studies, a measure of stimulated total saliva production, a questionnaire of their perception of dry mouth, and a questionnaire on the nature of their oral intake at pretreatment until 12 months after treatment. RESULTS: Saliva declined significantly from pretreatment to 12 months. Swallowing-related complaints increased significantly over the 12 months, especially in patients with lower saliva weights. Diet choices increased over time after treatment, except crunchy foods. Swallow measures did not relate to saliva weight. CONCLUSIONS: Reduced saliva weight does not correlate with slowed or inefficient swallow. Instead, reduced saliva weight seems to change patients' perceptions of their swallowing ability and, on that basis, their diet choices.

Adult↗
PubMed2005

Swallow physiology in patients with trach cuff inflated or deflated: a retrospective study.

BACKGROUND: Past research has suggested that medical diagnosis and trach cuff conditions may contribute to swallow physiology changes in patients with tracheostomy. This study attempts to investigate the differences in swallow physiology between patients with trach cuff-inflated and trach cuff-deflated conditions with respect to four medical diagnostic categories: neuromuscular disorder, head and neck cancer, respiratory diseases, and general medical diagnosis. METHODS: Retrospective database analysis of videofluoroscopic study results in 623 patients with tracheostomies with trach cuff-inflated or cuff-deflated conditions. Swallow disorders were examined for each patient. RESULTS: The frequencies of reduced laryngeal elevation and silent aspiration were found to be significantly higher in the cuff-inflated condition than the cuff-deflated condition. Significant swallow physiology changes were also found to be significantly different among various medical diagnostic categories. CONCLUSIONS: It is important to evaluate changes in swallow physiology under both the trach cuff-inflated and cuff-deflated conditions to fully assess swallow function.

Deglutition↗
PubMed2006

Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation.

BACKGROUND: The relationship between type of chemoradiation treatment, site of disease, and swallowing function has not been sufficiently examined in patients with head and neck cancer treated primarily with chemoradiation. METHODS: Fifty-three patients with advanced-stage head and neck cancer were evaluated before and 3 months after chemoradiation treatment to define their swallowing disorders and characterize their swallowing physiology by site of lesion and chemoradiation protocol. One hundred forty normal subjects were also studied. RESULTS: The most common disorders at baseline and 3 months after treatment were reduced tongue base retraction, reduced tongue strength, and slowed or delayed laryngeal vestibule closure. Frequency of functional swallow did not differ significantly across disease sites after treatment, although frequency of disorders was different at various sites of lesion. The effects of the chemotherapy protocols were small. CONCLUSIONS: The site of the lesion affects the frequency of occurrence of specific swallow disorders, whereas chemoradiation protocols have minimal effect on oropharyngeal swallow function.

Adult↗