[Recurrent aspiration, vomiting and coordination disorders. Neurogenic deglutition disorder in Fahr disease. HP-positive gastritis].
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Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs of these causes. An 8-week-old infant was referred because of suspicion of cricopharyngeal achalasia causing persistent swallowing problems and failure to thrive. Manometry results showed normal resting tone and relaxation but premature closure of the upper esophageal sphincter. The infant was treated with balloon dilatation of the upper esophageal sphincter and expectance. A maturation process of the swallowing sequence was noted over time and documented by repeated manometric procedures.
A 67-year old man consulted for dysphagia to solid food and weight loss. Four years earlier he had developed Lyme disease with severe neurological involvement. Magnetic resonance imaging showed, on T2-weighted sequences, multifocal high-intensity signals located in the periventricular white matter and the brain stem. The disorders of deglutition were evaluated by cineradiography and manometry which showed deficient relaxation of the superior esophageal sphincter and delayed initiation of the pharyngeal phase; intrapharyngeal propulsion was preserved. On the basis of these findings cricopharyngeal myotomy was performed with subsequent improvement of the disorders. Treatment with doxycycline was prescribed. The significance of these deglutition disorders as regards infection and neurology is discussed and it should have therapeutic implications.
The tongue is as an organ of speech and articulation not as indispensable as the soft palate. The recovery of speech after extirpation of the tongue is usually satisfactory, and the intelligibility of patients with microglossia compares favourably with the speech of an untreated cleft palate patient. Hypernasality and nasal escape of air are typical also for the congenital short palate (in the absence of a cleft); syndromes with a congenital short palate are often misdiagnosed as suprabulbar paralysis. The function and involuntary usage of the tongue e.g. in swallowing, influence the growth and development of the surrounding bony structures and the teeth. A frontal open bite due to the tongue thrust habit is a popular example. A case if made for the notion that the mouth-breathing habit has grave consequences such as nasal obstruction, adenoids and glue ears. Mouth breathing should not be looked upon as a trivial accessory phenomenon, but as a behaviour that needs systematic reeducation treatment. Rehabilitative procedures are pointed out for patients with respiratory problems due to two-sides laryngeal nerve paralysis and patients with swallowing problems after partial extirpation of the base of the tongue.
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OBJECTIVE: To observe clinical therapeutic effect of acupuncture on poststroke deglutition disorders. METHODS: Sixty-eight inpatients of moderate and severe deglutition disorders were treated by the activating brain function to cause resuscitation needling method. RESULTS: Twenty-six cases were cured, 24 were remarkedly effective, 16 were effective, with a total effective rate of 97.06%. CONCLUSION: This needling method has a markedly therapeutic effect on poststroke moderate and severe deglutition disorders.
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THE PREVALENCE: The exact prevalence of deglutition disorders in the elderly is not known. It appears frequent in very old patients and in those suffering from polypathological symptoms, affecting 50% of the populations in long-term care units. THE EFFECTS OF AGING: Physiological aging alters various parameters of swallowing, however it seems that these modifications related to age have little effect on healthy subjects. However, they may increase vulnerability in those presenting with intercurrent pathologies. CONCOMITANT DISORDERS: Other than the decrease in efficient mastication and the existence of xerostomia, frequently observed contributing factors, many diseases may be responsible for dysphagia in the elderly. Neurological disorders, particularly cerebral vascular diseases, central nervous system degenerative disorders and neuro-motor diseases predominate. In the aging, muscular disorders and after effects of various diseases can set-in. Modifications in oropharyngeal anatomy generally results from cancerous lesions of the aero-digestive junction, but also, occasionally from extrinsic compression that does not necessarily reflect a neoplastic etiology. Zenker's diverticulitis represents a cause of dysphagia specific to the elderly. Problems in swallowing of iatrogenic origin are also frequent, following cervical radiotherapy or after oropharyngeal surgery, during tracheal intubation or when using feeding tubes and also during various medical treatments. UNDERRATED CONSEQUENCES: Dysphagia leads to multiple morbid after effects, primarily alteration in quality of life, dehydration, undernutrition, asphyxia and congestion and recurrent infections of the respiratory tract. The responsibility of deglutition disorders in the occurrence of these complications is difficult to assess in weak elderly subjects because of the frequent concomitance with multiple deficiencies and incapacities.