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PubMed1999

Swallowing and speech in infants following tracheotomy.

Tracheotomy in children has been associated with significant operative and post-operative complications and disabilities. In this study, special attention was given to the post-operative effects on the ability to swallow and the development of speech in infants following tracheotomy. In 36 infants (19 boys, 17 girls) a tracheotomy was performed before the age of one year. Indications were: 1 severe upper airway obstruction (n = 25), 2. the requirement of prolonged mechanical ventilation (n = 10) and 3. intensive tracheal-broncheal suction (n = 1). In contrast of the absence of peri-operative complications, in the post-operative follow-up period we observed many complications and disabilities, partially attributable to several underlying disorders and to the tracheotomy itself. The swallowing ability was deteriorated in nearly all infants and the speech-development was seriously delayed in 38% of all infants. Infants following tracheotomy require intensive care to minimize complications and to stimulate the ability to swallow and the development of speech. Some proposals for treatment of swallowing disorders and rehabilitation are proposed.

Airway Obstruction↗
PubMed1999

[Kinematic MRI using short TR single shot fast spin echo (SSFSE) in evaluating swallowing].

PURPOSE: To determine the utility of short TR single shot fast spin echo (SSFSE) MR imaging for evaluating swallowing. MATERIALS AND METHODS: Five healthy volunteers underwent kinematic MR imaging of swallowing with a 1.5T MR scanner using the short TR (300 ms) SSFSE sequence. Twenty phases of sagittal sections were acquired within 6 sec, where the temporal resolution was 300 ms. For oral contrast medium, we used prune yogurt juice with Fe added. RESULTS: The image contrast of short TR SSFSE was found to be somewhere like that of T1-weighted images. In all cases, both the buccal and pharyngeal stages of swallowing were successfully depicted. The Fe-added prune yogurt juice performed as a positive contrast medium and helped determine anatomical structures in the buccal stage. CONCLUSION: Short TR (300 ms) SSFSE was useful in evaluating swallowing. The combined use of Fe-added prune yogurt juice was helpful in enhancing the surface of the oropharynx.

Contrast Media↗
PubMed1999

Scintigraphic assessment of swallowing after horizontal supraglottic laryngectomy.

OBJECTIVE: Oral-pharyngo-esophageal scintigraphy (OPES) proved to be able to demonstrate the pharyngeal residue of the radioactive bolus after deglutition and the presence and amount of tracheobronchial aspiration, and to calculate exactly the transit time of the various swallowing phases. The aim of this study was to evaluate the real objective effectiveness of OPES in order to assess the degree of swallowing recovery after horizontal supraglottic laryngectomy (HSL). METHODS: Nineteen patients entered the study, and 17 healthy subjects were included as control group (group 1). Nineteen patients in whom HSL had been performed at least 1 year before underwent OPES. They were divided into two groups: 13 patients (group 2) in whom the tracheal cannula had been removed and swallowing, phonatory, and respiratory functions were satisfactory and 6 patients (group 3) in whom the tracheostomy tube was still in situ for aspiration of liquids and scarring of the laryngeal vestibule. RESULTS: Our results showed that in the patients who underwent HSL, all scintigraphic semiquantitative parameters and particularly aspiration percentage values and Pharyngeal Ritention Index (PRI) at 10 and 60 seconds were able to pinpoint some residual "subclinical" alteration and/or minimal surgical sequelae frequently observed after this kind of functional surgery, even though a substantially satisfactory recovery was achieved clinically (group 2 versus group 1). In addition, aspiration amounts in group 3 were markedly higher than those in group 2 (p < .0002), and mean PRI values at 10 and 60 seconds were significantly different (p < .0001) from normal mean control values (group 1). CONCLUSION: Oral-pharyngo-esophageal scintigraphy may be regarded as a noninvasive, well-tolerated technique, with a radiation body burden within satisfactory limits of radioprotection. It appeared to be also sensitive in assessing the swallowing recovery after HSL.

Adult↗
PubMed2000

[Swallowing disorders in unilateral recurrent laryngeal nerve paralysis].

Swallowing difficulties in isolated recurrent laryngeal nerve paralysis are rarely reported in the literature, although it is frequently mentioned in lesions of both recurrent laryngeal and superior laryngeal nerves. The aim of this prospective study was to evaluate the incidence of aspiration in patients with unilateral recurrent laryngeal nerve paralysis after head and neck or thoracic surgery. Eighteen patients were included and evaluated within the first week and eleven two months postoperatively. Position, tone and tension of the vocal fold as well as assessment of the glottic axis, arytenoid position and mobility, laryngeal sensibility, status of the pyriform sinus and salivary stasis were studied. Swallowing evaluation was performed using flexible fiberoptic videolaryngoscopy during dry swallowing, thick cream and methylene blue liquid swallowing. Five patients had symptomatic aspiration, one silent aspiration and twelve patients had no aspiration. The type of regimen feeding used was classified as a normal, mixed, or blended diet. Added specific treatment performed was also described. We conclude that aspiration may occur in unilateral recurrent laryngeal nerve paralysis and have to be systematically evaluated after pneumomectomy, because adequate treatment can be proposed.

Adult↗
PubMedDate not supplied

Intractable wheezing and swallowing problem in an infant: report of one case.

A 9-month-old female infant with intractable wheezing and frequent aspiration pneumonia was poor response to the usual treatment for respiratory disease. The barium swallow test revealed barium aspirating into trachea directly. Because of the high-risk nature for aspiration in the swallowing disorder infant, a nasogastric tube feeding therapy was prescribed. Fortunately, her symptoms were greatly reduced. One month later, the clinical and roentgenographic findings strongly support a causal relationship between swallowing problem and wheezing. Therefore, swallowing problem should be considered when a young infant has refractory wheezing, even when there is no developmental problem.

Deglutition Disorders↗
PubMed1998

Nutritional implications of dental and swallowing issues in head and neck cancer.

Tumors of the head and neck account for 4% of cancers in the United States. Both the disease process itself and side effects of cancer treatment, such as xerostomia, dysphagia, and malnutrition, compromise oral health, swallowing ability, and nutritional status. Optimal treatment of dental, swallowing, and nutritional problems of head and neck cancer patients requires practical strategies that address these problems. These strategies should include appropriate referrals to the dentist, speech/language pathologist, and registered dietitian to enhance patient comfort, prevent secondary malnutrition and dental disease, and improve treatment outcomes. Since dental, swallowing, and nutritional issues are interrelated, appropriate therapeutic strategies hinge on timely, integrated input from each discipline. A better understanding of the dental and swallowing therapies used in patients with head and neck cancer by health professionals will help promote the comprehensive care of these patients.

Deglutition↗
PubMed2002

It's tough to swallow: a practical approach to nutritional care of dysphagia.

Have you ever swallowed a food or liquid only to have it "go down the wrong way"? If you have, then you have an idea of what it might be like to have a swallowing problem. Now multiply that experience times the more than 600 times a day that we normally swallow! Imagine how difficult it would be to deal with that on a daily basis. Approximately 6-15 million Americans are affected by dysplagia (chewing and swallowing problems). About 53-74% of nursing home residents, 14% of hospital patients and 33% of rehabilitation center patients have some form of dysphagia, which can have a dramatic impact on nutritional status.

Aged↗
PubMed2003

[Swallowing study with kinetic MRI using a single shot fast spin echo sequence in healthy volunteers and patients treated for head and neck cancer].

PURPOSE: To evaluate the single shot fast spin echo sequence (SSFSE) rapid MRI sequence for swallowing study, to describe the swallowing phases analyzable by kinetic MR Imaging and to show the advantages and the limits of the method in patients treated for head and neck cancer. METHODS AND MATERIALS: A preliminary study was conducted in 8 healthy volunteers and 11 patients treated for a head and neck cancer between June 1999 and April 2001. Examinations were obtained on a 1.5 T machine using a multi-slice SSFSE sequence with an acquisition time of 1 second/slice. The different phases of swallowing were analyzed. Examinations were done with and without water ingestion. RESULTS: Kinetic MRI allows to clearly analyze the anatomy and the dynamic of the tongue, the soft palate, the hyoid bone, the larynx and the posterior pharyngeal wall. The hypopharyngeal and esophageal phases were suboptimally assessed. CONCLUSION: Kinetic MRI allows to clearly analyze the oral and early pharyngeal phases of swallowing, which can be correlated with normal and surgically reconstructed areas in spite of the low temporal resolution and the non-physiologic position. It is simple and rapid to perform and may be useful in treated patients with head and neck cancer.

Adult↗
PubMedDate not supplied

[Fiberoptic endoscopic swallowing disorders in chronic encephalopathy]

OBJECTIVE: To evaluate the results of fiberoptic endoscopic examination of swallowing safety in children with cerebral encephalopathy in order to identify patients with oropharyngeal dysphagia. METHODS: 68 children from the Association for the Care of Disabled Children (Associação de Assistência à Criança Deficiente -AACD), São Paulo, were submitted to fiberoptic endoscopic examination of swallowing safety from March 1999 to March 2000. RESULTS: We observed premature spillage (53%), penetration in a pureed consistency (5.9%), penetration in a liquid consistency (4.4%), tracheal aspiration in a pureed consistency (14.7%), tracheal aspiration in a liquid consistency (32.3%), residue (7.4%), cough effectiveness (44.1%). CONCLUSIONS: Children showed a high incidence of pharyngeal swallowing disorders. Tracheal aspiration was the most important disorder because it is related with high morbidity in children with cerebral encephalopathy. The texture and consistency of the patientacute;s diet may be modified to decrease the risk of aspiration and improve swallowing examination.

Journal Article↗
PubMed2003

Using left atrial esophagus impression after a barium swallow to determine the optimal septal puncture site during percutaneous balloon mitral valvuloplasty.

BACKGROUND: Transseptal catheterization is the key to a successful percutaneous balloon mitral valvuloplasty (PBMV). The primary aim of the study was to investigate new methods of transseptal catheterization for PBMV. METHODS: Eighty-four patients with rheumatic mitral stenosis were randomized into two groups for PBMV. In the study group, the left atrial (LA) impression on the esophagus after a barium swallow was used as a reference of LA silhouette to determine the septal puncture site. In the control group, the LA silhouette under a normal fluoroscopic view was used for the determination of septal puncture site. RESULTS: In the study group, the average length of esophagus impression after a barium swallow was similar to the size of the left atrium measured by angiography (43.8+/-0.6 mm versus 44.1+/-0.7 mm, n=42, P>0.05). The success rate of atrial septum puncture in the study and control groups were 100% and 64.3%, respectively (P<0.01). Transseptal catheterization was subsequently achieved using the barium swallow approach in the 15 initially unsuccessful patients from the control group. PBMV was successful in the 84 patients with significant reduction in LA pressure and improvement of clinical symptoms. CONCLUSIONS: Transseptal catheterization in patients undergoing PBMV can be safely and effectively performed using the barium swallow approach.

Adult↗
PubMed2003

[Evaluation and treatment of swallowing disorders after tracheal intubation and tracheotomy].

Swallowing and respiration are well-coordinated and interdependent functions. When one of these processes is impaired, the consequence may be negative for the other. This article describes the mechanisms of the disorders of swallowing, the effects of tracheotomy or intubation and mechanical ventilation on swallowing, and the procedures used to assess and treat perturbation of swallowing. Combining a basic understanding of these concepts with practical management can increase safe and efficient oral intake in patients after artificial ventilation.

Deglutition Disorders↗
PubMedDate not supplied

Barium swallow.

After completing this article, the reader should be able to: Describe the functional phases and anatomy of swallowing. Detail common underlying causes of dysphagia and their radiographic signs and clinical correlates. List the risk factors for gastroesophageal reflux disease. Differentiate the procedures and goals of barium swallow from those of modified barium swallow. Predict future trends in demand for barium contrast imaging exams related to swallowing dysfunction.

Barium Sulfate↗
PubMed2005

[Multidisciplinary approach to patients with persistent swallowing problems; the first experiences, 1996/'02 in Louvain].

OBJECTIVE: To inventory the experiences of a multidisciplinary team for the treatment of patients with chronic swallowing problems. DESIGN: Descriptive, retrospective. METHOD: Data were collected on the cause, treatment and course in 400 consecutive ambulatory patients who had had swallowing problems for at least several months. During the period from 1 October 1996 to 30 April 2002 they had been referred to a multidisciplinary team consisting of a radiologist, an otorhinolaryngologist, a thoracic surgeon, a logopaedician, a neurologist and an internist-geriatrician in the University Hospitals of the Catholic University of Louvain (Belgium). RESULTS: The group of 4oo patients consisted of 236 men and 164 women, one-third of whom were 70 years of age or older. Half of the patients had problems swallowing solid food and more than 10% were unable to take any food by mouth. Most of the underlying conditions were neurological. The most commonly prescribed treatments were adjustments to the diet and posture (41%) and logopaedic guidance (36%). The safety and comfort of swallowing were improved in 44% of the patients, 13% were able to feed themselves orally once more after the intervention and in 11% there was still an indication for a percutaneous endoscopic gastrostomy (PEG) catheter.

Adolescent↗
PubMed2005

[Role of gastro-esophageal reflux (GER) and swallowing latency in aspiration pulmonary diseases].

We evaluated the role of gastro-esophageal reflux (GER) in aspiration pulmonary disease. To explore swallowing function, we measured the latent time (LT) on the swallowing provocation test in patient with non-aspiration pneumonia (PN, n=5), aspiration pneumonia (AP, n=8), post-gastrectomy aspiration pneumonia (PGAP, n=8), gastro-esophageal reflux disease (GERD, n=12) and normal group (NR, n=7). LT was prolonged in the AP (2.83 +/- 1.66 sec p < 0.01), PGAP (2.58 +/- 1.40 sec p < 0.05) and GERD (2.40 +/- 1.70 sec p < 0.05) groups compared with NR (1.04 +/- 0.56 sec) group, but not prolonged in PN (1.46 +/- 0.75 sec) group. LT was also prolonged when swallowing was provoked during inspiration both in AP (3.61 +/- 2.60 sec vs. 2.73 +/- 2.19 sec, p < 0.05) and NR (2.13 -/+ 1.12 sec vs. 1.49 +/- 1.30 sec, p < 0.01). Protected specimen brushing (PSB) was employed to detect pathogenic organisms in the PN (n=70), AP (AP, n=27) and PGAP (n=15) groups. Gram-negative rods were most frequently detected in the PGAP (p=0.008) group. We conclude that GER plays an important role in aspiration pulmonary disease not only as a source of aspirating agent but also as a disturbing factor of swallowing function.

Adult↗
PubMed2006

Videofluoroscopic kinesiologic analysis of swallowing: defining a standard plane.

PURPOSE: The Videofluorographic Swallowing Study (VFSS) has become the routine method for assessing swallowing dysfunction and accordingly, much research has been conducted on this procedure. However, due to a lack of standardization of the method of analysis of VFSS, it is often difficult to compare the results of such studies. Therefore, we conducted a comparative study of VFSS's spatial measurement using different standard planes used in the past study and Camper's plane and examined which plane was the most preferable. METHOD: VFSS was performed on 20 healthy young volunteers (26.9 +/- 3 years) and 9 healthy elderly (77.3 +/- 3 years). Each subject swallowed 4ml of thin liquid barium. We measured hyoid displacement and opening of the upper esophageal sphincter (UES) by using four different standard planes. RESULTS: In the young group, the correlation between anterior hyoid displacement and UES opening was significant in all standard planes. In the elderly group, the correlation between anterior hyoid displacement and UES opening was significant only in Camper's plane. Moreover, this plane is hard to be affected by morphological change as ageing. CONCLUSIONS: Camper's plane was found to be as the most preferable plane for analyzing swallowing function.

Adult↗
PubMed1991

Teaching developmentally disabled children with chronic illness to swallow prescribed capsules.

Child noncompliance with prescribed medical regimens, including nonacceptance of oral medication, frequently impedes medical treatment and achievement of clinical aims. During this study, we used a single-subject experimental design to evaluate the effectiveness of a capsule-swallowing training curriculum specifically developed to promote acceptance of oral medication by multihandicapped children. Four such children participated, each diagnosed with a chronic pediatric illness requiring daily intake of oral medication. Training consisted of verbal instruction, demonstration, reinforcement for swallowing candies/capsules progressively larger in size, ignoring mild inappropriate behavior, and gradually providing less guidance and structure. In each case, the curriculum produced routine independent swallowing of prescribed capsules/tablets. Follow-up assessments, coupled with parent satisfaction ratings, suggest that skill acquisition was both enduring and clinically significant. This study validates a brief, readily exportable, and effective approach to teaching handicapped children to swallow capsules.

Adolescent↗
PubMed1991

Multiple swallow test for the quantitative and qualitative evaluation of esophageal motility disorders.

Esophageal motility was evaluated from the analysis of six consecutive swallows. A sum image was generated comprising the representative information of an entire study. Calculation of emptying rates and characterization of the bolus behavior was performed from the sum image and the single swallow data. In 86 patients investigated, liquid and solid-phase studies showed a remarkable variation of single swallow data in normals (relative variation coefficient for liquid: 10%, solid: 14%), which were even higher (p less than 0.001) in patients with disorders (liquid: 31%, solid: 25%). As sum images compensate for this intra-individual variation, false-positive (liquid: 16%, solid: 25%) or negative single swallow findings (liquid: 36%, solid: 27%) are reduced. Qualitative analysis of condensed sum images provided characteristic image patterns representing different pathophysiologic aspects. Since the method introduced better discriminates between normal and pathologic function, it may enhance diagnostic accuracy.

Deglutition↗
PubMed1990

[The rehabilitation of swallowing after a supraglottic laryngectomy].

We report the swallowing rehabilitation experience of two patients submitted to supraglottic laryngectomy. Rehabilitation was obtained by training of specific swallowing movements to increase hypertrophy of the true vocal cords, which avoid pulmonary aspiration of foods. The first patient failed owing to unfavorable factors. The second patient was able to swallow pastes after eleven days of training, and the swallowing was normal forty days after the surgery. Success in this case was the result of patient's motivation and persistent efforts of the nursing personnel.

Deglutition Disorders↗