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PubMed1997

Videofluoroscopic evaluation of dysphagia in motor neurone disease with modified barium swallow.

The role of videofluoroscopy with the modified barium swallow in the assessment and management of motor neurone disease (MND) is discussed. Nine patients (age range 40-82) with dysphagia secondary to MND were assessed over a four-year period. The examinations were carried out by a multiprofessional team of radiologist, speech and language therapist and dietitian assessing the preoral, oral and pharyngeal phases of swallowing. Preoral feeding abnormalities were present in four out of nine patients, oral phase abnormalities in eight out of nine patients, while 33% of patients demonstrated abnormality in all three phases. Where aspiration occurred (four out of nine cases), no cough reflex was noted. On the basis of these examinations management changes were introduced in all patients. Nonoral feeding was continued or introduced in three patients. Videofluoroscopic examination with the modified barium swallow may be helpful in planning suitable feeding regimes for dysphagia in MND.

Adult↗
PubMedDate not supplied

Barium and meat. A comparison between pharyngeal swallow of fluid and solid boluses.

The influence of bolus consistency on pharyngeal swallow was radiologically studied in 24 individuals by comparing liquid barium and solid meat after chewing. Pharyngeal function was apparently performed synchronously and symmetrically on both boluses. No definite conclusion about the influence on epiglottic mobility, closure of the laryngeal vestibule and relaxation of the cricopharyngeal muscle could be drawn from this study. There was no difference in the elevation of the pharynx and larynx. The transit time for a solid bolus was shorter compared with that of a fluid bolus. The transit time for the apex of the bolus was shorter than for the tail. A more marked elevation of the pharynx and larynx was followed by a shorter transit time. The width of the pharyngo-esophageal segment was larger in the transverse than in the sagittal diameter during the passage of the bolus and larger on solid compared with fluid swallow. Our results reflect the ability of pharyngeal swallow to be executed with precision and with few alterations due to variable bolus consistency.

Adult↗
PubMed1998

Lessons to be learned: a case study approach. An unusual case of alveolar deposition from swallowing metallic mercury in an attempt at self-poisoning.

The authors report a case of deliberate self-poisoning in a drug addict who swallowed elemental mercury: in so doing he inadvertently acquired a permanent diffuse deposition of mercury particles throughout both lung fields. Swallowed mercury should be relatively harmless in small quantity but the high specific gravity and free flowing properties of elemental mercury allowed it to overcome the normal swallowing pathways--such that some of it passed into the bronchial tree instead of passing harmlessly through the gut. In that site its significant vapour pressure, together with its potential for oxidation to inorganic mercury--which may, in turn, be absorbed across the alveolar membrane, gives high potential for mercury poisoning.

Adult↗
PubMedDate not supplied

Training in swallowing prevents aspiration pneumonia in stroke patients with dysphagia.

This study investigated the frequency of aspiration pneumonia in conscious stroke patients fed by a family member and examined the effect of introducing training in swallowing techniques by nurses. A total of 96 consecutive patients presenting with dysphagia due to acute stroke were included in the study. Patients presenting between January 2000 and July 2003 (n = 48) were fed orally by a family member given general nursing information (group A), whereas those presenting between August 2003 and March 2005 (n = 48) were fed orally by an experienced nurse trained in specific swallowing techniques (group B). All patients were examined daily for the presence of aspiration pneumonia. The incidence of aspiration pneumonia was 33.3% in group A and 6.3% in group B (P < 0.05). The incidence of aspiration pneumonia in dysphagic stroke patients who are orally fed is still high. Training in swallowing during oral feeding offers clear protection against pneumonia in conscious stroke patients.

Deglutition↗
PubMed1990

Swallowing function in patients with spasmodic torticollis.

We examined the oropharyngeal swallowing ability of 43 patients with spasmodic torticollis using a videofluoroscopic procedure. Twenty-two (51.2%) demonstrated objective evidence of swallowing abnormalities; 15 (34.9%) had subjective complaints. Delayed swallowing reflex and vallecular residue were more frequent (p less than 0.0046) than any other abnormality. The constellations of abnormalities were consistent with neurogenic, postural, and mixed neurogenic-postural types of dysphagia.

Adult↗
PubMed1994

Swallowing assessment in primary brain tumor patients with dysphagia.

Dysphagia is a common problem in patients with neurologic disease and is often associated with significant morbidity and mortality. To evaluate primary brain tumor patients who complained of dysphagia, we adapted grading scales for severity of complaint and level of alertness (scale of 1 to 4) and bedside swallowing assessment and videofluoroscopic examination (scales of 1 to 5). Over 13 months, we prospectively screened 117 patients for dysphagia. Seventeen of these (14.5%) complained of dysphagia (mean age, 50.2 years; range, 20 to 75); an additional six control patients were studied from a group with no dysphagic complaints. Scoring for severity of complaint (mean, 2.3) and level of alertness (mean, 2.2) was mild-moderate in the majority of patients. Eleven of 17 patients scored > or = grade 3 (mean 3.2, moderate impairment, requiring supervision) on bedside testing, and six of seven scored > or = grade 3 (mean 3.8, moderate-moderately severe abnormality, trace or frequent aspiration) during videofluoroscopic evaluation. Bedside testing scores of the study group differed significantly (p < 0.001) from those of the control group. Level of alertness correlated strongly with bedside (r = 0.794) and videofluoroscopic (r = 0.780) scoring. Primary brain tumor patients with dysphagia are likely to have impairment of swallowing out of proportion to their complaints and therefore are at risk for aspiration and nutritional compromise. We recommend that these patients undergo formal swallowing assessment followed by rehabilitation or implementation of alternative feeding methods.

Adult↗
PubMed1997

The kinematics of swallowing in the buccal mass of Aplysia californica.

Changes in the positions, shapes and movements of the feeding apparatus (buccal mass) of the marine mollusc Aplysia californica were studied in intact, transilluminated juveniles. The buccal mass assumes characteristic shapes as its internal structure, the radula/odontophore, moves anteriorly (protracts) or posteriorly (retracts). These shapes are especially distinctive when the radula/odontophore has protracted forwards fully, is close to its resting or neutral position, or has retracted backwards fully. We refer to the shapes that occur at full protraction, transition and full retraction as shape 1 (spherical), shape 2 (ovoid) and shape 3 (gamma-shaped), respectively. We introduce this shape nomenclature in order to avoid confusion with the existing terms protraction and retraction, which we reserve exclusively to describe the direction of movement of the radula/odontophore. The observed shape changes do not agree with those predicted on the basis of in vitro observations of a feeding head preparation, but are similar to shapes observed in vitro in the snail Lymnaea stagnalis. The buccal mass also rotates approximately 10 degrees dorsally during retraction, pivoting on the attachment to the mouth, before the subsequent protraction and return of the buccal mass to the transition shape. This rotation may be due to activation of the extrinsic muscles of the buccal mass. Plots of the buccal mass shape parameters eccentricity versus ellipticity create a two-dimensional shape space, which accurately quantifies the subtle transitions of shape between the different phases of the feeding cycle. Quantitative differences are observed between pure swallows and swallows with tearing behavior, but the qualitative shapes are similar. Hysteresis in the shape space plots of most swallows provides evidence for the hypothesis that protraction and retraction each have distinct 'active' and 'return' phases. The observed kinematic pattern imposes constraints on the internal structures of the buccal mass and may be used to infer the shape and positions of the radula and odontophore.

Animals↗
PubMed2001

Flexibility in flight behaviour of barn swallows (Hirundo rustica) and house martins (Delichon urbica) tested in a wind tunnel.

The flight behaviour of barn swallows (Hirundo rustica) and house martins (Delichon urbica) was tested in a wind tunnel at 15 combinations of flight angles and speeds. In contrast to that of most other small passerines, the intermittent flight of hirundines rarely consists of regular patterns of flapping and rest phases. To vary mechanical power output, both species used intermittent flight, controlling the number of single, pulse-like wingbeats per unit time. House martins in descent tended to concentrate their wingbeats into bursts and performed true gliding flight during rest phases. Barn swallows mainly performed partial bounds during brief interruptions of upstrokes, which they progressively prolonged with decreasing flight angle. Thus, identification of distinct flapping phases to calculate wingbeat frequencies was not feasible. Instead, an effective wingbeat frequency for flight intervals of 20 s, including partial bounds, was introduced. The effective wingbeat frequencies of house martins (N=3) ranged from 2 to 10.5 s(-1), those of barn swallows (N=4) from 2.5 to 8.5 s(-1). In both hirundine species, effective wingbeat frequency was found to decrease almost linearly with decreasing flight angle. With changes in air speed, wingbeat frequency varied according to a U-shaped curve, suggesting a minimum power speed of roughly 9 m s(-1). The duration of the down- and upstrokes varied systematically depending on flight angle and air speed.

Animals↗
PubMed2002

Wingbeat frequency of barn swallows and house martins: a comparison between free flight and wind tunnel experiments.

The flight paths and wingbeat patterns of 39 barn swallows (Hirundo rustica) and 26 house martins (Delichon urbica) were recorded by tracking radar during the spring migration. Depending mostly on flight angle, hirundines performed anything from continuous flapping flight during climbing to single pulse-like wing beats during descent. Unlike most other passerines, hirundines rarely showed regular flapping and rest phases, allowing them to be distinguished from other bird migrants by radar echo signatures. Effective wingbeat frequency (F(eff)) was calculated as the mean number of wing beats per second, including non-flapping phases. Under comparable flight conditions, F(eff) was higher in house martins than in barn swallows. Within species, F(eff) values were higher during climbing and slow flying than during descent. Of the variance in F(eff), 71% could be explained by climb rate, air speed and species; similar results were obtained in the wind tunnel. Under comparable flight conditions, barn swallows and house martins in free flight had significantly lower values of F(eff) than individuals in wind tunnel experiments (by 40% and 32%, respectively). This difference may at least partly be due to the shorter wings of the juveniles tested in the wind tunnel during autumn. However, it seems unlikely that this can account for all of the large difference. It is suggested that wind tunnel experiments might overestimate birds' flight costs compared with free flight.

Animals↗
PubMed1996

A case of swallowing-induced atrioventricular block after myocardial infarction.

We report a patient with transient atrioventricular (AV) block induced by swallowing. He complained of recurrent dizziness during meals and had suffered from inferior myocardial infarction 1 year before the onset of these symptoms. Radiologic examination showed no apparent esophageal abnormalities. Swallowing a piece of solid food or hot liquid repeatedly provoked advanced AV block. Administration of intravenous atropine sulfate prevented AV block. An electrophysiologic study revealed that this swallowing-induced AV block was an intranodal (A-H) block. We did not implant a cardiac pacemaker because his symptoms were not very serious and could be prevented by eating carefully. The patient has been symptom-free for the past 12 months. The previous myocardial infarction may be related to the appearance of this vagal-related AV block.

Deglutition↗
PubMed1993

Oesophageal varices: how reliable is a barium swallow?

Although barium swallow is a quick and easy method for diagnosing oesophageal varices, there is considerable variation between observers because objective quantitative radiological criteria have so far not been defined. In order to define these criteria, a blind radiological/endoscopic comparative study using endoscopy as the gold standard was retrospectively carried out in 72 patients. A prospective study was then carried out in 47 patients to define the validity of the radiological criteria found by the first study. The results of both studies showed that the length and the width of the mucosal folds representing varices as measured on barium swallow radiographs have a significant relationship with the grade of the varices as determined by endoscopy. We conclude that barium swallow is a quick and reliable method for quantitative assessment of oesophageal varices.

Barium Sulfate↗
PubMed1988

Analysis of pressure generation and bolus transit during pharyngeal swallowing.

Current pharyngeal deglutition theory has stressed the role of the pharyngeal constrictors as producing a peristaltic wave responsible for bolus propulsion through the pharynx. This thesis presents data obtained using manofluorography which supports the significance of tongue and laryngeal motion in swallowing. The usage of the term peristalsis to describe the constrictor contraction is challenged. The results of this quantitative study of swallowing in normal subjects, laryngectomized patients, and patients with restricted tongue motion show that tongue driving pressure and the negative pressure developed in the pharyngeal esophageal segment appear more important than the peristaltic-like pressure of the constrictors. Bolus transit is really dependent upon these two pressures. This model for analysis has clinical significance because it permits quantification of the pharyngeal swallowing mechanism.

Deglutition↗
PubMed1994

Activation and coordination patterns of the suprahyoid muscles during swallowing.

This study was undertaken to determine the activation and coordination patterns of the three suprahyoid muscles--geniohyoid, mylohyoid, and anterior belly of the digastric muscle--in elevating the larynx during swallowing. Electromyographic activity was also recorded from two intrinsic laryngeal muscles (vocalis and lateral cricoarytenoid) and the anterior genioglossus. Ten adults served as participants. Each participant produced 15 swallows of 15 mL of tap water both normally and with a 12-mm bite block placed between the molars. The electromyographic data were ensemble-averaged with a laboratory computer. Analyses showed that the three suprahyoid muscles were used selectively by different participants. Some participants used all three muscles for hyoid elevation, while others used different pairs of two of the muscles. The activation patterns of the suprahyoid muscles during swallowing also varied with respect to each other and the onset of the laryngeal constrictor muscles; however, use of at least one suprahyoid muscle always preceded the onset of the laryngeal adductors, indicating that larynx elevation consistently preceded glottal adduction. The way in which the muscles responded to the bite block varied considerably both within and among participants. Some maintained temporal stability but increased overall muscle activity; others reorganized temporal relations either with or without corresponding muscle activity adjustments. These findings suggest that the laryngeal elevation system is an adaptive function rather than an immutable action.

Adaptation, Physiological↗
PubMed2006

Improving oral medicine administration in patients with swallowing problems and feeding tubes.

BACKGROUND: Correct administration of oral medicines in patients with swallowing problems and feeding tubes remains a challenge. OBJECTIVE: To improve drug administration in patients with swallowing problems and feeding tubes in a 1600 bed tertiary referral center in the State of Qatar. METHODS: A questionnaire was used to evaluate the knowledge and practice of nursing staff from 6 different intensive care units (ICU). Questions assessed the respondents' knowledge of the purpose of controlled-release (CR) preparations, codes used for CR medication, the consequences of crushing these preparations, and their interactions with enteral feeds and feeding tubes. Based on the results of the questionnaire, a 2 day training program was conducted for a core group of 34 staff nurses from all units (ICU and non-ICU) and 3 nursing instructors. Following the principle of "training the trainers," the core group and the nursing instructors would widen the scope of education by running programs in the future. Lecture sessions for pharmacy staff and a monitoring tool to evaluate the practice were also developed. RESULTS: Overall knowledge of CR codes increased from 0% to 40%, correct crushing of solid preparations from 35% to 90%, and knowledge of possible interactions with the enteral feed or feeding tubes from 51% to 88%. Correct administration of medication in patients with feeding tubes improved from 32% to 83%. The quality and value of the 2 day training course received a mean score of 96%. CONCLUSIONS: While most nurses were aware of the purpose of CR formulations, little was known about the different codes used by drug companies and the consequences of crushing these preparations. Interactions with enteral feeds and feeding tubes were mostly overlooked. A 2 day training course followed by continuous in-service training, a lecture to pharmacy staff, and provision of supportive educational material greatly improved the overall medicine administration process in patients with swallowing problems and feeding tubes.

Administration, Oral↗
PubMedDate not supplied

How many pins? A case report of a girl who swallowed more than 50 straight pins in a suicide attempt.

A 14-year-old girl was admitted after attempting suicide by swallowing over 50 pins. On admission, she complained of abdominal pain. A flat abdominal X-ray revealed numerous needle-like objects in the large intestine. After a period of observation we were able to diagnose her as suffering from a major depressive episode with psychotic features, post-traumatic stress disorder, physical abuse, neglect and inhalant abuse. Medically, the pins were spontaneously evacuated with her stools without any intervention. The mode of the suicide attempt was an important clue to raise suspicion of a psychotic episode. Two issues are discussed: 1) A "psychiatric" issue: the way in which an attempt is made should be considered as a factor not just for the evaluation of the suicidal risk, but also for the psychopathology. This case demonstrates that a bizarre attempt should raise the suspicion of a psychotic disorder. 2) A "general medical" issue: our experience with this patient was in accordance with common medical expectant management for patients who have swallowed multiple sharp objects once they have reached the large intestine. We conclude: 1) In the preliminary psychiatric evaluation, more emphasis should be placed on how bizarre the means of the suicide attempt as a possible sign of a psychotic psychopathology. 2) Treatment for adolescents who swallow numerous sharp objects should consist of expectant management once those objects reach the large intestine.

Adolescent↗
PubMed1989

Swallowing induced supraventricular ectopics in a patient with straight back syndrome.

A 45 year old man presented with the complaint of palpitations on swallowing. Clinical and radiological examination showed features of straight back syndrome and pectus excavatum. Electrocardiogram revealed supraventricular ectopics each time the patient swallowed. This illustrates a unique case of swallowing-related rhythm disturbance.

Deglutition↗
PubMed1993

Clinical and videofluoroscopic evaluation of swallowing disorders.

Swallowing and feeding problems are common, particularly in elderly persons, and will be an increasing cause of disability as the geriatric population expands. Consequently, the need for clinical and radiologic examinations of patients who have swallowing problems will likely become commonplace. In this review, we define the problem confronting these patients, discuss the clinical and videofluoroscopic procedures used to examine patients with swallowing difficulty, and integrate the results of these examinations and their impact on feeding recommendations.

Deglutition↗
PubMedDate not supplied

Electromyogram of the tensor tympani muscle in man during swallowing.

Experiments were carried out on 2 patients who underwent an operation for chronic otitis media, whereupon the tensor tympani muscle was visualized. A unipolar platinum electrode was inserted into the muscle belly. EMG recordings were made during swallowing and other motor activity. Distinct, pronounced EMG activity was recorded from both patients every time they swallowed. It was concluded that the tensor tympani muscle participates in the act of swallowing and thereby probably contributes to the ventilation of the middle ear.

Deglutition↗