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At least 595 records · Page 33Linked to original sources
PubMed2004

Decreased short- and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma.

OBJECTIVE: To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment. DESIGN: Prospective case series. SETTING: Tertiary care referral center. PATIENTS: A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated, accelerated radiotherapy. INTERVENTIONS: Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems, prompting a dose reduction to 60.0 Gy. Eighteen patients were followed up for this study in the 74.4-Gy group, while 11 were in the 60.0-Gy group. MAIN OUTCOME MEASURES: Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy. RESULTS: Patient demographics and tumor characteristics were similar in each group, while significant differences were noted in the posttreatment clinical swallowing variables. Persistent severe odynophagia at 4 months (89% [16/18] vs 30% [3/10]) and at 12 months (64% [7/11] vs 11% [1/9]) was greater in the 74.4-Gy group (P =.002). Clinical signs of aspiration were also increased in the 74.4-Gy group, with 81% (13/16) vs 11% (1/9) at 4 months and 60% (6/10) vs 11% (1/9) at 12 months (P<.05). Most striking, however, was the incidence of long-term gastrostomy, with 78% (14/18) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18% (2/11) in the 60.0-Gy group (P =.002). Local control was unchanged by the altered dosing, with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups, respectively. CONCLUSION: Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications.

Adult↗
PubMed2005

Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer.

OBJECTIVE: To determine whether laryngeal penetration and aspiration in oropharyngeal cancer survivors differ by treatment group. DESIGN: Cross-sectional study of patients with stage III or IV oropharyngeal squamous cell carcinoma who were at least 12 months removed from combined modality therapy and clinically free of disease. SUBJECTS: Potential subjects were stratified by tumor site and tumor T stage to achieve a similar comparison between chemoradiotherapy (n = 10) and surgery/radiotherapy (n = 11) groups. Validated instruments used to evaluate swallowing included the Penetration-Aspiration Scale and the M. D. Anderson Dysphagia Inventory. RESULTS: Patients with oropharyngeal cancer treated with chemoradiotherapy demonstrated greater airway protection according to Penetration-Aspiration Scale scores than those treated with surgery and radiotherapy on 5-mL (P = .02), 10-mL (P = .04), and 20-mL (P = .04) liquid barium swallows. Also, the oropharyngeal chemoradiotherapy group had better self-perceived swallowing ability than the surgery-radiotherapy group on the basis of the M. D. Anderson Dysphagia Inventory (P = .02). CONCLUSION: The present study suggests that patients with oropharyngeal cancer who successfully complete chemoradiotherapy protocols without surgical salvage retain greater airway protection during swallowing and better swallowing-related quality of life than patients treated with primary surgery and radiotherapy.

Carcinoma, Squamous Cell↗
PubMed1996

Using botulinum toxin A to improve speech and swallowing function following total laryngectomy.

OBJECTIVE: To evaluate a technique to reduce dysfunctional spasm in the pharyngoesophageal segment (PES) in patients after laryngectomy. DESIGN: Pharyngoesophageal segment function related to voice and/or swallowing in patients who had undergone a laryngectomy was evaluated before and after the injection of botulinum toxin A. SETTING: Academic referral medical center. PATIENTS: Eight outpatients with voice and/or swallowing complaints after undergoing a total laryngectomy. INTERVENTIONS: Videofluoroscopic contrast examination was completed to identify stricture vs spasm in the PES in patients with voice and/or swallowing complaints after undergoing a laryngectomy. Lidocaine hydrochloride injection under fluoroscopic guidance was completed to facilitate immediate relaxation of spasm. After positive results with lidocaine, botulinum toxin was injected into the same area to facilitate longer-lasting benefit. MAIN OUTCOME MEASURE: Patient report of benefit and videofluoroscopic evaluation of PES function. RESULTS: Six of 8 patients demonstrated improved function within the PES after lidocaine injection. Five of these 6 received transcutaneous injection of botulinum toxin. Four of the 5 patients demonstrated improved swallowing and/or voice function, and 3 of these 4 received subsequent injections of botulinum. No serious complications were encountered. CONCLUSIONS: Transcutaneous injection of botulinum toxin in the PES under videofluoroscopic guidance provides improvement in voice and/or swallowing function without significant complications. Additional clinical study will be required to evaluate dose and technique influences on degree and duration of benefit and complications.

Administration, Cutaneous↗
PubMed2001

Effects of xerostomia on perception and performance of swallow function.

BACKGROUND: Head and neck cancer treatment with high-dose chemoradiation may cause xerostomia and affect the patient's perception of swallowing ability. METHOD: Whole saliva production was measured in 36 patients with advanced-stage cancer of the oropharynx before treatment and 3 months after treatment by weighing a 4 x 4 inch gauze before and after a 2-minute chewing period. Presence of multiple eating difficulties was measured by patient interview. Swallowing was examined videofluorographically (VFG). RESULTS: Saliva weight decreased from a mean (SEM) of 5.1 (0.5) g pretreatment to 1.4 (0.5) g after treatment (p<.0001). At 3 months, significantly more patients perceived difficulty swallowing, dry mouth, needing water while eating, food stuck in the mouth or throat, and change in taste. Saliva weight was not correlated with VFG measures of bolus transit or observations of residue. CONCLUSIONS: Chemoradiation treatment results in xerostomia and a significant increase in patient perception of swallowing difficulties. Saliva weight in patients who perceive swallowing problems was lower. Xerostomia did not affect the physiologic aspects of bolus transport. Xerostomia affected the sensory process and comfort of eating more than bolus transport.

Adult↗
PubMed2006

Swallowing outcomes after radiotherapy for head and neck cancer: a systematic review.

BACKGROUND: A systematic review of the current data on swallowing function after radiotherapy or chemoradiotherapy is presented. METHODS: Electronic databases were searched for 1966-2005. Papers were categorized according to level of evidence, methodological quality, and the specific domain of swallowing being measured. RESULTS: Of 109 papers retrieved, 33 were identified and reviewed. Evidence was primarily classified as either level III.2 (cohort studies) or level IV (case series). Methodological quality was found to be compromised in most studies. Although many researchers had investigated swallowing impairment, a wide variety of measurement tools were employed. CONCLUSIONS: There are limited data on swallowing outcomes after radiotherapy or chemoradiotherapy for head and neck cancer. Further work is needed to ascertain which aspects of swallowing should be measured, and then to use such measures in well-designed clinical trials and prospective cohort studies of this under-researched population.

Clinical Trials as Topic↗
PubMedDate not supplied

Swallowing recovery following anterior tongue and floor of mouth surgery.

Videofluoroscopic and clinical data are presented for postsurgical recovery of tongue and hyoid activity during swallowing. Comparison is made to normal controls. Postsurgery, but prior to radiotherapy, both the lingual propulsive gesture and hyoid velocity were slower than normal. These features of the swallow had returned to the normal range following radiotherapy. The general sequencing of swallowing events, and the relationship of the end of the tongue propulsion to anterior hyoid motion were normal in those patients able to swallow. In this patient group, postsurgical radiotherapy did not prevent continued recovery of swallowing function sufficient for oral nutrition.

Adult↗
PubMedDate not supplied

Speech and swallowing function after oral and oropharyngeal resections: one-year follow-up.

BACKGROUND: The purpose of this study was to determine whether the speech and swallowing function of surgically treated oral cancer patients improves between 1 month and 1 year after surgery. METHODS: Speech and swallowing performances were assessed for 28 men and 10 women preoperatively and at 1, 3, 6, and 12 months postoperatively following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined using videofluoroscopy. Data were also collected on the number and duration of speech/swallowing therapy sessions, as well as the amount and duration of radiotherapy. RESULTS: Statistical analyses revealed that the speech and swallowing function of surgically treated oral and oropharyngeal cancer patients did not improve progressively between 1 and 12 months postsurgery; the level of functioning that these patients demonstrated at the 1- and 3-month posthealing evaluations was characteristic of their status at 1 year after surgery. CONCLUSION: The lack of improvement between 1 and 12 months postsurgery may be related to the relatively small amount of therapy that these patients received during that period. Several outcome variables worsened significantly at the 6-month evaluation; the reversal of function at the 6-month evaluation point could be the effect of postoperative radiotherapy, because irradiated and nonirradiated patients differed in their pattern of recovery on oropharyngeal swallow efficiency and several speech variables.

Analysis of Variance↗
PubMedDate not supplied

Timing of glottic closure during normal swallow.

BACKGROUND: The purpose of this study was to determine the temporal characteristics and patterns of glottic closure during normal swallow using concurrent videofluoroscopy and videoendoscopy. METHODS: Three swallows each of four bolus types were examined in eight healthy volunteers with the endoscope in two positions: at the level of the uvula and at the laryngeal vestibule. Data analysis compared: (1) temporal relationships between laryngeal behaviors and oropharyngeal swallow events and (2) airway conditions at the time of key oropharyngeal events. RESULTS: Although arytenoid adduction and subsequent arytenoid contact occurred as one of the initial events during swallow, the timing of these events was highly variable. On the other hand, true vocal cord (TVC) closure occurred mainly after the onset of laryngeal elevation, and it was affected by bolus volume. CONCLUSIONS: In normal swallow, arytenoid closure did not always mean complete TVC closure, and complete TVC closure might be accomplished during the process of laryngeal elevation and arytenoid tilting.

Analysis of Variance↗
PubMedDate not supplied

Examination of swallowing after total laryngectomy using manofluorography.

Investigation of postlaryngectomy dysphagia is usually limited to the standard barium swallow. Manofluorography (mano, manometry; fluoro, videofluoroscopy; graphy, picture) is a new technique that permits analysis of simultaneous manometry and videofluoroscopy of deglutition. Manofluorography provides more detailed analysis of the swallowing dynamics during the pharyngeal stage of deglutition than either barium studies or manometry used alone. This study uses manofluorography to examine swallowing in two patient groups, total laryngectomees and total laryngectomees with tongue impairment, to analyze the role of various anatomic components in the swallowing process. Pharyngeal transit times were prolonged in both patient groups studied, with the tongue impairment group exhibiting the longest times. The postlaryngectomy pharynx offered greater resistance to bolus flow. The laryngectomy patients compensated by using increased lingual propulsion, whereas the patients with tongue impairment and total laryngectomy could not. This emphasizes the importance of the tongue in bolus propulsion in the pharynx. Other postoperative changes in swallowing are discussed.

Deglutition Disorders↗
PubMed2006

Aspiration during swallowing in typically developing children of the First Nations and Inuit in Canada.

Children of the First Nations and Inuit in Canada have a high propensity for lower respiratory tract infections. Overcrowding, poor housing, passive smoke exposure, and lack of breast feeding (Martens P, Bond R, Jebamani L, Burchill C, et al. http://www.umanitoba.ca/centres/mchp/reports/pdfs/rfn_pdfs/rfn_report.pdf.; MacMillan H, Walsh C, Jamieson E, Crawford A, Boyle M. http://www.hcsc.gc.ca/fnihbdgspni/fnihb/aboriginalhealth/reports_summaries/regional_survey_ch1.pdf.; Wardman AE, Khan NA. Int J Circumpolar Health 2004;63:81-92) have been cited as important contributing factors in the occurrence of lower respiratory tract infections. However, aspiration during swallowing has thus far not been considered as a co-factor in the occurrence of lower respiratory tract infections in these children. We present a retrospective case series of seven typically developing children of the Canadian First Nations and Inuit, in whom aspiration during swallowing was detected in the course of investigating associations with recurrent lower respiratory tract infections. None of the children had any of the known risk factors for aspiration during swallowing such as developmental variation, prematurity, neuromotor problems, or anatomic abnormalities of the upper aerodigestive tract. We speculate that aspiration during swallowing in typically developing children may be an important, previously unrecognized co-factor in the occurrence of lower respiratory tract infections, particularly in the communities of the Canadian First Nations and Inuit. Further prospective studies will be needed to determine whether aspiration during swallowing represents an independent risk factor for the occurrence of lower respiratory tract infections in these children.

Canada↗
PubMed2005

Repeatability of the sonographic assessment of fetal sucking and swallowing movements.

OBJECTIVE: To test the repeatability of sonography in the assessment of fetal sucking and swallowing movements. METHODS: Eighty normal fetuses of pregnant women with no systemic abnormalities were examined sonographically at 30-38 weeks of gestation. Sucking and swallowing movements were observed for 15 min and the face was visualized in frontal and lateral views. The examinations were recorded for later analysis by two independent observers and the 95% limits of agreement (Bland and Altman) method was used for inter- and intraobserver comparison. RESULTS: The mean +/- SD number of swallowing movements, sucking bursts and total sucking movements recorded by Observer 1 were 8.3 +/- 4.7, 9.9 +/- 9.3 and 35.8 +/- 48.0 and the equivalent values for Observer 2 were 8.2 +/- 4.8, 9.8 +/- 9.3 and 36.4 +/- 49.0, respectively. The mean (95% limits of agreement) interobserver difference was 0.1 (-1.4; 1.6), 0.1 (-2.2; 2.3) and -0.6 (-9.0; 7.9), and the mean (95% limits of agreement) intraobserver difference was 0.4 (-3.1; 3.9), 0.1 (-2.0; 2.2) and 1.0 (-10.7; 12.7) for swallowing movements, sucking bursts and total sucking movements, respectively. CONCLUSIONS: The high degree of intra- and interobserver repeatability disclosed in the sonographic analysis of fetal sucking and swallowing movements supports the applicability of sonographic assessment in normal fetuses.

Cross-Sectional Studies↗
PubMed1999

Sexual selection for white tail spots in the barn swallow in relation to habitat choice by feather lice.

Many bird species have white spots in their tails or wing feathers, and such characters have been hypothesized to be either reliable signals (handicaps) or amplifiers that facilitate the message of a signal. In barn swallows, Hirundo rustica, the size of the white spots in the tail feathers is sexually dimorphic and positively correlated with feather length. We tested whether such spots act as handicaps or amplifiers. These white spots affect sexual selection in barn swallows, as shown by an experiment in which we randomly subjected males to (1) a considerable reduction of the size of all the spots by the use of a black permanent marker pen, (2) a small reduction of the size of the spots, or (3) no reduction. There was a positive association between spot size and the number of offspring produced per season. The white tail spots were preferred by feather-eating Mallophaga as a feeding site: holes made by Mallophaga were more abundant in the white spots than expected by chance. A habitat choice experiment with Mallophaga on barn swallow tail feathers revealed that they preferred white spots over black parts of the tail feathers. We therefore expected long-tailed male barn swallows to have more Mallophaga than short-tailed males. However, the opposite relationship was observed, indicating that long-tailed males may reliably signal their quality by the presence of large white tail spots without parasite damage. Thus white tail spots in barn swallows appear to be a reliable signal of phenotypic quality. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1996

Activity of dorsal respiratory group inspiratory neurons during laryngeal-induced fictive coughing and swallowing in decerebrate cats.

Membrane potential changes and/or discharges from 36 inspiratory neurons were recorded intracellularly in the dorsal respiratory group (DRG; i.e., the ventrolateral subdivision of the nucleus tractus solitarii) in decerebrate, paralyzed, and ventilated cats. Electrical activities were recorded from both somata (n = 10) and axons (n = 26). Activities during quiet breathing were compared with those observed during fictive coughing and swallowing evoked by repetitive electrical stimulation of afferent fibers of the superior laryngeal nerve (SLN). These nonrespiratory behaviors were evident in paralyzed animals as characteristic discharge patterns of the phrenic, abdominal, and hypoglossal nerves. Twenty-six neurons exhibiting antidromic action potentials in response to electrical stimuli applied to the cervical (C3-5) spinal cord were classified as inspiratory bulbospinal neurons (IBSNs). These neurons were considered as premotoneurons. The remaining 10 inspiratory neurons (I-NAA) were not antidromically activated by electrical stimuli applied to either cervical spinal cord or ipsilateral cervical vagus. These neurons are thought to be propriobulbar neurons. We recorded the activity of 31 DRG inspiratory neurons (24 IBSNs and 7 I-NAA) during coughing. All but one (a late-recruited IBSN) discharged a burst of action potentials during the coughing-related phrenic nerve activity. Typically, ramp-like membrane depolarization trajectories and discharge frequencies during coughing were similar to those observed during inspiration. We recorded the activity of 33 DRG inspiratory neurons (23 IBSNs and 10 I-NAA) during swallowing. Most (28/33) neurons were briefly activated, i.e., discharged a burst of action potentials during swallowing, but peak discharge frequency decreased compared with that measured during inspiration. The membrane potentials of nine somata exhibited a brief bell-shaped depolarization during swallowing, the amplitude of which was similar to that observed during inspiration. These results suggest that some inspiratory premotoneurons and propriobulbar neurons of the DRG might be involved in nonrespiratory motor activities, even if clearly antagonistic to breathing (e.g., swallowing). We postulate the existence in the medulla oblongata of adult mammals of neurons exhibiting a "functional flexibility".

Action Potentials↗
PubMed1996

A new application for electropalatography: swallowing.

Electropalatography (EPG) has been applied to linguistic research and speech pathology. This study evaluated whether EPG could provide useful information on swallow-related tongue action. Specifically, the investigation focused on the quantification of tongue-palate contact patterns for swallowing and on the effects of bolus volume and consistency. Five normal subjects were tested during swallows of 5 and 30 ml of water, 5 and 30 ml of gelatin, and saliva. By segmenting the EPG time-motion sequences into four stages (prepropulsion, propulsion, full contact, withdrawal) and compartmentalizing the palate into six bins (front, central, back, lateral, medial, midline), temporal and spatial characteristics of deglutitive tongue-palate contact were revealed. Significant differences (p < 0.01) were found in contact timing across bolus sizes and consistencies for the propulsion and full contact stages. Water was propelled faster than gelatin. and 30-ml gelatin faster than 5-ml gelatin. Dry swallows had a longer full contact stage than water. Contact patterns, though not statistically analyzed at this time, appeared to vary little as a function of bolus properties. Our findings suggest potential value in using EPG to investigate the timing and patterning of abnormal tongue movements associated with disordered swallowing.

Adult↗
PubMed1996

An electronic device measuring the frequency of spontaneous swallowing: digital phagometer.

A new and portable electronic device called the "Digital Phagometer" is described for the time based counting of spontaneous swallowing. This device is composed of a piezoelectric sensor and a digital event counter/ recorder which can be downloaded to any IBM-compatible PC. The sensor of Digital Phagometer is placed and fixed on the coniotomy region between the cricoid and thyroid cartilage. In this way, it is capable of sensing each upward and downward movement of the larynx produced by spontaneous movement as a function of time. Spontaneous swallowing was measured 1-4 h after lunch in 21 normal subjects and 21 patients with Parkinson's disease (PD). The mean frequency of spontaneous swallowing was 0.8 counts/min in PD patients and 1.18 counts/ min in normal subjects (p < 0.05). During the intake of 200 ml water, the mean frequency of voluntary swallowing did not differ significantly between the two groups (24.6 counts/min in normals vs. 22.3 counts/min in PD patients), but the time necessary to swallow the same volume of water was longer in the PD group.

Adult↗
PubMed1996

Modified barium swallow: clinical and radiographic correlation and relation to feeding recommendations.

Clinical and videofluoroscopic evaluation of swallowing were correlated to determine their agreement and relationship to feeding recommendations. We reviewed a total of 148 patients with swallowing difficulties, of which 93 (45 women, 48 men; mean age 62 years) were evaluated by both clinical and radiographic examinations. A variety of materials were used for clinical bedside evaluation of oral and pharyngeal function. Radiographic examination was done with variable viscosity materials and videotape recording of the oral cavity and pharynx. The severity of oral and pharyngeal abnormalities was graded and findings of the examinations were compared. The combined results of both evaluations generated an index of swallowing difficulty which was correlated to the type of diet used if oral feeding was recommended or to a nonoral route of nutrition. In the assessment of oral and pharyngeal dysfunction, clinical evaluation and radiographic examination correlated closely in 94% of patients; however, the status of pharyngeal function was not determined in 61 (66%) of the 93 patients by clinical examination alone. The combined swallowing index was calculated in 89 patients and its severity correlated significantly with the type of feeding recommended; 64 patients were placed on one of three types of diets and 25 had enteral feedings. In conclusion, combined clinical and radiographic examinations correlated well, but clinical evaluation alone was limited by failure to evaluate the pharynx in many patients. The swallowing severity correlated well with final feeding recommendations.

Barium↗
PubMed1996

The effects of cold, touch, and chemical stimulation of the anterior faucial pillar on human swallowing.

Cold stimulation of the oropharyngeal mucosa, including the faucial pillar region, is used a specific technique for the treatment of swallowing disorders. The physiological mechanisms underpinning this clinical technique are unclear. Thermal (cold), chemical (saline, glucose and water), mechanical (light touch) and feigned stimulation of the faucial pillar were assessed for their effects on the latency to swallow and the repetitive frequency of swallowing. There was no significant difference between these variables following light stimulation of the faucial pillar with a metal probe warmed to body temperature compared with feigned stimulation. However, cold touch stimulation evoked a significant increase in swallowing latency and repetitive frequency compared to feigned stimulation. The results suggest the existence of thermo-sensitive receptors in the faucial pillars that evoke swallowing when stimulated by cold touch. The clinical and physiological importance of these findings are discussed.

Adult↗
PubMed1996

Influence of cold stimulation on the normal pharyngeal swallow response.

We examined the potential influence of cold stimulation of the anterior tonsillar pillars, before and after topical anesthesia, on the temporal linkage between the oral and pharyngeal components of the swallow. We hypothesized that if elicitation of the pharyngeal swallow were dependent upon stimulation of faucial mucosal receptors this response would be facilitated by cold tactile stimulation and inhibited by topical anesthesia. In 14 healthy volunteers undergoing simultaneous videoradiography and manometry we measured and compared regional transit and clearance times, and the timing of hyoid motion, upper esophageal sphincter relaxation, and opening within the swallow sequence. There was a significant, volume-dependent forward shift in timings of hyoid motion, upper esophageal sphincter (UES) relaxation profile, and opening which were influenced neither by cold stimulation nor topical anesthesia. Regional transit and clearance times and UES coordination were not influenced by cold stimulation. Pharyngeal clearance time was prolonged by tonsillar pillar anesthesia due to earlier arrival of the bolus head at this region (p = 0.002). We conclude that the normal pharyngeal swallow response is neither facilitated nor inhibited by prior cold tactile stimulation or topical anesthesia to the tonsillar pillars, respectively. These observations do not support the hypothesis that elicitation of the pharyngeal swallow response is dependent upon stimulation of mucosal receptors in the tonsillar arches.

Adenoids↗