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At least 631 records · Page 35Linked to original sources
PubMed1999

Feeding difficulties in the first days of life: findings on upper gastrointestinal series and the role of the videofluoroscopic swallowing study.

BACKGROUND: Feeding difficulties in the newborn period are a common indication for an upper gastrointestinal (UGI) series. OBJECTIVE: To review the radiological findings in infants with feeding-related difficulties, with no other medical problems, and to evaluate the role, if any, of the videofluoroscopic swallowing study (modified barium swallow, MBSW). MATERIALS AND METHODS: We retrospectively reviewed all the UGI and MBSW studies performed at our institution over a 5-year period in infants under 1 month of age. We found a total of 77 patients referred for feeding-related problems. RESULTS: All patients had at least one UGI study performed at our institution, and 17 patients had at least one additional MBSW. The most frequently found abnormality that could directly account for the patients' symptoms was swallowing dysfunction. This was detected in 19 patients; in 10 of these patients the swallowing dysfunction was seen only on the MBSW. CONCLUSION: Swallowing dysfunction with aspiration is a common cause of feeding-related difficulties in childhood. In infants with feeding difficulties, a MBSW may demonstrate aspiration when the UGI is negative.

Deglutition↗
PubMed2004

Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging--initial clinical experience in healthy volunteers and patients with acromegaly.

This study assessed both two-dimensional (2D) TrueFISP imaging for quantifying tongue volume and real-time TrueFISP imaging for evaluating chewing and swallowing in healthy volunteers and patients with acromegaly. In 50 healthy volunteers, tongue volumes were measured using a 2D TrueFISP sequence. Chewing and swallowing were visualized using a real-time TrueFISP sequence. Ten patients with acromegaly were examined twice with the same magnetic resonance imaging protocol: once prior to therapy and a second time 6 months after therapy. Prior to therapy, healthy volunteers had an average tongue volume of 140 ml for men and 90 ml for women, and patients with acromegaly had an average tongue volume of 180 ml for men and 145 ml for women. However, 6 months after therapy the mean tongue volumes in patients with acromegaly had decreased to 154 ml in the men and to 125 ml in the women. The chewing and swallowing process was normal in all volunteers. Prior to therapy, just two patients showed a chewing and swallowing pathology, which disappeared after therapy. Patients with acromegaly had larger tongue volumes than healthy volunteers, and TrueFISP imaging proved feasible for visualizing chewing and swallowing in real time and is capable of detecting possible pathologies. Furthermore, TrueFISP imaging can be used to monitor therapeutic approaches in patients with acromegaly.

Acromegaly↗
PubMed2002

Videofluoroscopy of the swallowing act after partial supraglottic laryngectomy by CO(2) laser.

The evaluation of functional deglutition in patients after partial supraglottic laryngectomy by CO(2) laser was performed by videofluoroscopy of the swallowing act. We studied 20 patients in PA and LL projections, and the swallowing act, at 25 frames per s, was captured on videotape. Aspiration was found in six patients, four of whom had manifest clinical symptoms of aspiration. Four patients had post-deglutitive, one intra-deglutitive and one both intra- and post-deglutitive aspiration. Other swallowing disturbances or structural deformities were not detected. Dynamic radiological studies of swallowing, such as videofluoroscopy of the swallowing act, can provide valuable information regarding functional results after surgical procedures in the upper aerodigestive tract. Our encouraging results prove the validity of partial supraglottic laryngectomy by CO(2) laser as a method of treatment for carcinoma of the larynx.

Aged↗
PubMed2001

Perceptual ratings for pureed and molded peaches for individuals with and without impaired swallowing.

Food molds have been created to alter the appearance of pureed foods by making the pureed consistencies look more like typically prepared foods. This study examined the perceptions of 15 adults with impaired swallowing and 15 adults with nonimpaired swallowing for three different types of pureed peach: a typically prepared pureed peach, a pureed peach with a thickening agent added, and a pureed peach with a thickening agent added and molded to look like peach slices. Results are presented for the attribute ratings of overall liking: liking of taste, texture, and appearance; and ease of chewing and swallowing. The results showed that the adults with impaired swallowing rated the attributes of chewing and swallowing significantly lower (i.e.. more difficult) for each type of puree. Significant differences within samples also were found for the attributes of overall liking and liking of taste. Overall, the pureed peach molds were not perceived favorably for any of the examined attributes. In addition, the molded peach was rated lower (more difficult) in its ease of chewing. The implications of these findings and ideas for further research are discussed.

Adult↗
PubMed2002

Cardiovascular effects of the supraglottic and super-supraglottic swallowing maneuvers in stroke patients with dysphagia.

The prolonged voluntary closure of the glottis during the supraglottic and super-supraglottic swallowing techniques may create the Valsalva maneuver. The Valsalva maneuver has been associated with sudden cardiac death and cardiac arrhythmias. This study describes the effects of the supraglottic and super-supraglottic swallowing techniques on the cardiovascular system. Subjects included 23 patients from an acute inpatient rehabilitation hospital. Subject groups included recent stroke, dysphagia. and a history of coronary artery disease (Group 1, N = 11). recent stroke and dysphagia with no known coronary artery disease (Group 2, N = 4), and orthopedic diagnosis with no known dysphagia or coronary artery disease (Group 3, N = 8). Cardiac status was monitored for 4 hours during swallowing training, regular therapy sessions, and a meal. For Groups I and 2, 86.6% (13 out of 15) of the subjects demonstrated abnormal cardiac findings during the swallowing session including supraventricular tachycardia, premature atrial contractions, and premature ventricular contractions. Arrhythmia subsided within a few minutes after the session and did not occur during other activities. In Group 3 (control group), none of the subjects demonstrated abnormal cardiac findings except for bradycardia in one subject. It is suggested that the supraglottic and super-supraglottic swallow maneuvers may be contraindicated for patients with a history of stroke or coronary artery disease.

Adult↗
PubMed2002

Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing.

Aspiration is an important variable related to increased morbidity, mortality, and cost of care for acute stroke patients. This prospective systematic replication study compared a clinical swallowing examination consisting of six clinical identifiers of aspiration risk, i.e., dysphonia, dysarthria, abnormal gag reflex, abnormal volitional cough, cough after swallow, and voice change after swallow, with an instrumental fiberoptic endoscopic evaluation of swallowing (FEES) to determine reliability in identifying aspiration risk following acute stroke. A referred consecutive sample of 49 first-time stroke patients was evaluated within 24 hours poststroke, first with the clinical examination followed immediately by FEES. The endoscopist was blinded to results of clinical testing. The clinical examination correctly identified 19 subjects with aspiration risk, when compared with the criterion standard FEES, but incorrectly identified 3 patients as having no aspiration risk when they did. The clinical examination incorrectly identified 19 subjects with aspiration risk but determined correctly no aspiration risk in 8 patients who did not exhibit aspiration risk on FEES. Clinical examination sensitivity = 86%; specificity = 30%; false negative rate = 14%; false positive rate = 70%; positive predictive value = 50%; and negative predictive value = 73%. It was concluded that the clinical examination, when compared with FEES, underestimated aspiration risk in patients with aspiration risk and overestimated aspiration risk in patients who did not exhibit aspiration risk. Careful consideration of the limitations of clinical testing leads us to believe that a reliable, timely, and cost-effective instrumental swallow evaluation should be available for the majority of patients following acute stroke.

Aged↗
PubMed2003

Laryngeal paralysis: distinguishing Xth nerve from recurrent nerve paralysis through videoendoscopic swallowing study (VESS).

Distinction between unilateral recurrent laryngeal nerve paralysis and Xth nerve paralysis is a rarely addressed issue in the literature. However, it may be crucial to examine the cause of the paralysis and to perform the appropriate investigation. The videoendoscopic swallowing study has been demonstrated to be a useful tool in assessing pharyngeal function. Since in unilateral Xth nerve paralysis the pharynx is impaired on the same side as the vocal fold immobility, it may be easily detected by videoendoscopic swallowing study. The rotation of the posterolateral pharyngeal wall toward the opposite side during swallowing is a sign of impaired motor pharyngeal branches. To demonstrate the usefulness of the videoendoscopic swallowing study in distinguishing unilateral Xth nerve from isolated recurrent nerve paralysis, a series of six patients were studied prospectively. Diagnosis of Xth nerve paralysis focused the investigation toward the high neck or the skull base area. Paralysis of the Xth nerve was suspected in all cases and diagnosis was achieved in five cases by the workup performed. Videoendoscopic swallowing study is a cost-effective and easily available tool which should be performed in all cases of vocal fold paralysis.

Aged↗
PubMed2007

Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal Dysphagia.

We tested two hypotheses using surface electrical stimulation in chronic pharyngeal dysphagia: that stimulation (1) lowered the hyoid bone and/or larynx when applied at rest, and (2) increased aspiration, penetration, or pharyngeal pooling during swallowing. Bipolar surface electrodes were placed on the skin overlying the submandibular and laryngeal regions. Maximum tolerated levels of stimulation were applied while patients held their mouth closed at rest. Videofluoroscopic recordings were used to measure hyoid movements in the superior-inferior and anterior-posterior dimensions and the subglottic air column position while stimulation was on or off. Patients swallowed 5 ml liquid when stimulation was off, at low sensory stimulation levels, and at maximum tolerated levels (motor). Speech pathologists, blinded to condition, tallied the frequency of aspiration, penetration, pooling, and esophageal entry from videofluorographic recordings of swallows. Only significant (p = 0.0175) hyoid depression occurred during stimulation at rest. Aspiration and pooling were significantly reduced only with low sensory threshold levels of stimulation (p = 0.025) and not during maximum levels of surface electrical stimulation. Those patients who had reduced aspiration and penetration during swallowing with stimulation had greater hyoid depression during stimulation at rest (p = 0.006). Stimulation may have acted to resist patients' hyoid elevation during swallowing.

Adult↗
PubMed2006

Coordinative organization of lingual propulsion during the normal adult swallow.

Lingual propulsion during swallowing is characterized by the sequential elevation of the anterior, middle, and dorsal regions of the tongue. Although lingual discoordination underlies many swallowing disorders, the coordinative organization of lingual propulsion during the typical and disordered swallow is poorly understood. The purpose of this investigation was to quantitatively describe the coordinative organization of lingual propulsion during the normal adult swallow. Tongue movement data were obtained from the X-Ray Microbeam Database at the University of Wisconsin. Movement of four pellets placed on specific tongue regions were tracked in 36 healthy adult participants while they swallowed 10 cc of water across five discrete trials. The propulsive action of the tongue during bolus transport was quantified using a cross-correlation analysis. Lingual transit time (LTT), which was defined as the interval (lag time) between the movements of the anterior- and posterior-most tongue regions, was determined to be approximately 168 ms. The average time interval (lag) between the movements of the posterior tongue regions was significantly shorter than the intervals between more anterior tongue regions. The results also suggest that during bolus transport movement patterns of the anterior tongue regions are distinct from those of the posterior tongue regions. Future work is needed to determine if the absence of the observed coordinative organization of lingual propulsion is indicative of oral stage dysphagia.

Adult↗
PubMed2001

Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients.

This prospective study was undertaken to determine the accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) for detecting aspiration in acute stroke patients. Fifty patients underwent an examination of their ability to swallow 50 ml of water in 10-ml aliquots. Later their oxygen saturation levels before and after swallowing 10 ml of water were measured using a pulse oximeter. Oxygen desaturation of more than 2%, was considered to be clinically significant. All patients then underwent a FEES assessment by a speech therapist and were followed up during their inpatient stay for evidence of aspiration pneumonia. The oxygen desaturation test had a sensitivity of 76.9% and specificity of 83.3% (chi2 = 18.154, p = 0.00002), while the 50-ml water swallow test had a sensitivity of 84.6% and specificity of 75.0% (chi2 = 18.001, p = 0.00002). However, when these two tests were combined into one test called "bedside aspiration," the sensitivity rose to 100% with a specificity of 70.8% (chi2 = 27.9, p = 0.000001). Five (10%) patients developed pneumonia during their inpatient stay. The relative risk (RR) of developing pneumonia, if there was evidence of aspiration on FEES, was 1.24 (1.03 < RR < 1.49). We conclude that the oxygen desaturation test combined with the 50-ml water swallow test is suitable as a screening test to identify all acute stroke patients at risk of aspiration for further evaluation and management.

Acute Disease↗
PubMed2004

Assessment of swallowing function in patients with head and neck cancer.

Difficulty in swallowing is a common complaint among patients with head and neck cancer. Preexistent dysphagia is often compounded by any of the side effects and sequelae of the current treatment modalities for malignancies of the head and neck. Surgery, radiotherapy, and chemoradiotherapy produce sensory and motor denervation and fibrosis of the upper aerodigestive tract musculature and mucosa. Clinicians must learn to anticipate and identify the various deficits of swallowing function in these patients. Flexible fiberoptic evaluation of swallowing and the modified barium swallow are critical tests for delineating the pathophysiology of these patients and establishing a protocol for their rehabilitation. Rehabilitation for patients with swallowing disorders decreases the morbidity of aspiration and allows for better nutrition, better hydration, and overall improvement in quality of life.

Deglutition↗
PubMed1991

Effects of lingual nerve and chewing cortex stimulation upon activity of the swallowing neurons located in the region of the hypoglossal motor nucleus.

This study focuses on motoneurons and interneurons in the region of the hypoglossal nucleus (XIIth) related to swallowing and chewing. In sheep anesthetized with halothane, we have used extracellular microelectrodes to study the effects of stimulation of the superior laryngeal nerve (SLN), the lingual nerve (LN) and the chewing cortex (CCx) upon activities of the swallowing neurons (SNs). Ipsilateral stimulation (1-5 pulses at 500 Hz) of the peripheral afferents or CCx did not generally induce a short latency activation of the hypoglossal swallowing motoneurons (Group I SNs) since only 4 motoneurons (69 tested) were activated by the SLN, 4 motoneurons (56 tested) by the LN and none by the CCx. In contrast, the same stimulations were more effective with swallowing interneurons (Group II SNs) located in the reticular formation close to the XIIth motor nucleus since 12 neurons (30 tested) were activated with short latencies (9 +/- 1.8 ms; mean latency +/- S.D.) by the SLN, 9 neurons (21 tested) by the LN (latency; 8 +/- 1.8 ms) and 5 neurons (18 tested) by the CCx (latency: 13 +/- 1.7 ms). Seven neurons were activated by two or three modes of stimulation indicating the existence of convergent inputs upon some Group II SNs. During chewing movements induced by a prolonged stimulation (20-40 Hz) of the CCx, 10 Group I SNs (16 tested) versus only one Group II SN (8 tested) were found to fire in association with the jaw opening. Moreover, 3 motoneurons and 4 interneurons inactive during swallowing discharged during chewing movements.(ABSTRACT TRUNCATED AT 250 WORDS)

Afferent Pathways↗
PubMed1975

The pattern of swallowing during sleep.

The pattern of swallowing during sleep was investigated by means of a study in 10 normal subjects. Sleep was staged by means of EEG, EOG and EMG, and swallowing was monitored by means of an external sensing device attached to the neck. It was found that during sleep, swallowing is episodic, with long swallow-free periods. Swallows occur almost exculusively in association with movement arousals which are most frequent during Stages REM, 1 and 2 of sleep.

Adult↗
PubMed1989

Upper esophageal sphincter opening and modulation during swallowing.

Studies were done on 8 normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of upper esophageal sphincter opening and volume-dependent modulation during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal sphincter pressure were determined at 1/30th-s intervals during swallows of 1, 5, 10, and 20 ml of liquid barium. Our analysis subdivided upper esophageal sphincter activity during swallowing into five phases: (a) relaxation, (b) opening, (c) distention, (d) collapse, and (e) closure. Sphincter relaxation occurred during laryngeal elevation and preceded opening by a mean period of 0.1 s. Opening occurred as the sphincter was pulled apart via muscular attachments to the hyoid such that the hyoid coordinates at which sphincter opening and closing occurred were constant among bolus volumes. Sphincter distention after opening was modulated by intrabolus pressures rather than graded hyoid movement. The generation of intrabolus pressure coincided with the posterior thrust of the tongue that culminated in pharyngeal wall contact and the initiation of pharyngeal peristalsis. Larger volume swallows were associated with greater intrabolus pressure and increased bolus head velocity. The duration of sphincter opening increased in conjunction with a prolongation of the anterior-superior excursion of the hyoid and a delay in the onset of pharyngeal peristalsis (the event that determined the timing of sphincter closure). We conclude that transsphincteric transport of increasing swallow bolus volumes is accomplished by modulating sphincter diameter, opening interval, and flow rate (reflected by bolus head velocity). Furthermore, upper esophageal sphincter opening is an active mechanical event rather than simply a consequence of cricopharyngeal relaxation.

Adult↗
PubMed1987

Effect of a maxillary glossectomy prosthesis on articulation and swallowing.

Swallowing was found to be substantially improved with the prosthesis. Less aspiration, less time necessary to complete the swallow, and greater variation in food consistency tolerated were all positive results of the prosthesis. In addition, videofluoroscopic studies of tongue movements during speech revealed that tip-alveolar /t-d/ and back-velar /k-g/ productions were more normal with the prosthesis. With the prosthesis, the understandibility of /t/ and /d/ was improved 20% and that of /k/ and /g/, 33%. It is clear that compromises must be effected in prosthesis design to facilitate improvement in both speech and swallowing. A large prosthetic mass in the oral cavity can also negatively change speech resonance. These issues are being investigated, as are acoustic and perceptual studies of speech articulation. Future research should address whether a combination of maxillary and mandibular prostheses would result in better speech and swallowing function. A mandibular prosthesis could replace missing teeth and alveolar contour that might influence speech and swallowing. A mandibular prosthesis might also allow construction of a smaller maxillary glossectomy prosthesis to interact with the mandibular prosthesis.

Articulation Disorders↗
PubMed1991

Noninvasive acceleration measurements to characterize the pharyngeal phase of swallowing.

Swallowing disorder (dysphagia) presents a major problem in the rehabilitation of stroke and head injured patients. In the present investigation, a new technique is developed for noninvasive assessment of the pharyngeal phase of the swallowing mechanism. Acceleration was measured with two ultra-miniature accelerometers placed on the skin over the throat. Simultaneously, the swallow suction pressure was monitored. Swallowing in normal individuals gave rise to a characteristic acceleration pattern which was quite reproducible, and was in phase with the swallow pressure. In dysphagic patients, the acceleration response was either absent or significantly delayed. The accelerometry technique provides a tool for continuing patient assessment and demonstrating the clinical improvements.

Biomechanical Phenomena↗
PubMed1986

Inhibitory influence of monoamines and brainstem monoaminergic regions on the medullary swallowing reflex.

Swallowing is a polysynaptic reflex organized by a neuronal network localized mainly within the lateral region of the nucleus tractus solitarius (NTS). Monoamine microinjections (serotonin, noradrenaline; 1 nmol, 50 nl) within the swallowing region of the NTS produced a significant decrease in the number of swallows elicited by repetitive stimulation of the superior laryngeal nerve. Stimulation, with concentric bipolar electrodes, of several brainstem structures overlapping monoaminergic regions such as the nucleus raphe magnus, the nucleus raphe pallidus, the lemniscus medialis, the ventrolateral reticular formation, the locus coeruleus and the nucleus commissuralis, induced an inhibition of the laryngeal-initiated swallowing. These results indicate the existence, within the NTS, of a monoaminergic inhibition of the swallowing reflex which might originate from monoaminergic brainstem regions.

Animals↗
PubMed1996

Fetal pharyngeal distention--is it a normal component of fetal swallowing?

Fetal swallowing is one of the main mechanisms of amniotic fluid circulation. Swallowing mechanisms were studied in 34 healthy fetuses using modern ultrasound technology. The fetal lips and mouth, as well as tongue, pharynx, larynx, trachea and esophagus were surveyed in serial sagittal planes. Fetal swallowing movements were recorded and subsequently analyzed from the videotapes. All neonates were born at term in a satisfactory condition. Twenty-nine infants were breastfed, and five were bottle fed. No feeding problems were reported in these neonates. In 85% of fetuses, swallowing activity started with suckling movements followed by wide opening of the mouth. Next, low frequency tongue movements propelled the fluid bolus into the hypopharynx. In 15% of fetuses, this activity was associated with prolonged pharyngeal dilatation. Prolonged pharyngeal dilatation does not signify fetal neurological compromise as judged by good neonatal outcome and probably represents a normal variant of fetal swallowing.

Amniotic Fluid↗