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Post-ICU Syndrome (PICS) is a complex disease with multiple aspects, including physical, cognitive, and psychological health problems. Dysphagia persists in patients with PICS and is independently associated with adverse clinical outcomes after discharge. With the development of the level of intensive care, dysphagia of PICS needs more attention. Although several risk factors related to dysphagia in PICS have been proposed, the exact mechanism is still unclear. Respiratory rehabilitation is an important non-pharmacological therapy, which offers short-and long-term rehabilitation in critical patients, but its application is insufficient in dysphagia of PICS. In view of the lack of consensus on the rehabilitation treatment of dysphagia after PICS currently, the article elaborates on the related concepts, epidemiology, potential mechanisms and the application of respiratory rehabilitation in patients with dysphagia of PICS, in order to provide a reference for the clinical development of respiratory rehabilitation in patients with dysphagia of PICS.

Introduction: Chiari Malformation Type I (CM-I) involves the descent of the cerebellar tonsils 5 mm through the foramen magnum. This case report discusses a patient with dysphagia and glossopharyngeal neuralgia as unusual symptoms of CM-I. Case Presentation: A 59-year-old Afro-Colombian housewife presented with a clinical picture that began three years ago with dysphagia for solids and liquids, coughing when swallowing, recurrent cervical pain, and xerostomia. A neurological examination revealed deviation of the uvula to the right and absence of the gag reflex. A cerebral nuclear magnetic resonance (NMR) was performed, showing the descent of the cerebellar tonsils through the foramen magnum, compressing the medulla oblongata. CM-I was diagnosed, and the anomaly was corrected. The patient reported complete improvement of dysphagia and associated symptoms. Conclusions: CM-I poses a diagnostic challenge when presenting with dysphagia and glossopharyngeal neuralgia; however, timely diagnosis defines its proper management and prognosis.

Objective To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study. Methods This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters. Results Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types. Conclusion Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.

Unilateral laryngeal paresis can lead to dysphonia as well as respiratory and swallowing deficits. The pathomechanism of swallowing dysfunction in unilateral laryngeal paresis is decreased sensitivity of supraglottic structures, impaired protective function of reflexive cough and weakening of the upper oesophageal sphincter muscles. The subject of this case report is an 85-year-old man with unilateral laryngeal paresis, developed after gastrofibroscopy, with signs of severe oropharyngeal dysphagia leading to aspiration pneumonia. The patient was managed by a dysphagiology team leading the diagnostic and therapeutic process. This case study describes the pathomechanism of deglutition disorder in unilateral laryngeal paresis, its possible causes (iatrogenic or postinfectious) and the therapeutic process utilising compensatory and restitution techniques and expiratory muscle strength training in restoring peroral intake.

Background Although the relationship between medication status, symptomatology, and outcomes has been evaluated, data on the prevalence of polypharmacy and potentially inappropriate medications (PIMs) and the association of polypharmacy and PIMs with swallowing function during follow-up are limited among hospitalized patients aged ≥65 years with dysphagia. Methods In this 19‐center cohort study, we registered 467 inpatients aged ≥65 years and evaluated those with the Food Intake LEVEL Scale (FILS) scores ≤8 between November 2019 and March 2021. Polypharmacy was defined as prescribing ≥5 medications and PIMs were identified based on the 2023 Updated Beers Criteria. We applied a generalized linear regression model to examine the association of polypharmacy and PIMs with FILS score at discharge. Results We analyzed 399 participants (median age, 83.0 years; males, 49.8%). The median follow‐up was 51.0 days (interquartile range, 22.0–84.0 days). Polypharmacy and PIMs were present in 67.7% of and 56.1% of patients, respectively. After adjusting for covariates, neither polypharmacy (β = 0.05; 95% confidence interval [CI], -0.04–0.13, p=0.30) nor non‐steroidal anti‐inflammatory medications (β = 0.09; 95% CI, -0.02–0.19; p=0.10) were significantly associated with FILS score at discharge. Conclusions The results of this study indicated a high proportion of polypharmacy and PIMs among inpatients aged ≥65 years with dysphagia. Although these prescribed conditions were not significantly associated with swallowing function at discharge, our findings suggest the importance of regularly reviewing medications to ensure the appropriateness of prescriptions when managing older inpatients.

ABSTRACT BACKGROUND: The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE: Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING: A retrospective study. METHODS: The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS: In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74–0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61–0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87–−0.96; OR: 0.24; 95% CI: 0.80–−0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70–3.17, P < 0.001; β: −1.24, 95% CI: −1.55–−0.92; P < 0.001). CONCLUSION: Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.

Background Esophageal cancer is one of the most aggressive gastrointestinal tumors. Advanced esophageal carcinoma is mainly associated with dysphagia. Most elderly patients with severe obstruction esophageal carcinomacannot tolerate anesthesia and invasive treatment due to comorbidities, while the failure to improve dysphagia in the short term will seriously affect the nutritional status, life quality and prognosis of patients. Objective To explore the safety and efficacy of image-guided photodynamic therapy (IGPDT) under local anesthesia for short-term improvement of obstruction and nutritional status in elderly patients with severe obstruction esophageal carcinoma. Methods A total of 24 elderly patients with severe obstruction esophageal carcinoma admitted to Hebei General Hospital from March 2020 to December 2021 were selected for IGPDT in the prospective, single-arm, self-control study. The upper boundary of the lesion was located by endoscopy and marked with metal tissue clips, the lower boundary of the lesion was located by CT and esophagography before treatment. During the treatment, the fiber of laser treatment was delivered to the lesion site under the guidance of X-ray fluoroscopy during treatment. The Stooler dysphagia score was evaluated before, 1 week and 1 month after operation. The nutritional status of patients was evaluated by nutritional risk screening 2002 (NRS 2002) score, hemoglobin, BMI, albumin and prealbumin before and 2 months after operation. The swallowing quality of life scale (SWAL-QOL) was used to evaluate the quality of life in patients. Results All patients achieved partial response (PR) at 1 month postoperative efficacy evaluation. The Stooler dysphagia scores at 1 week and 1 month after IGPDT were significantly lower than that before operation (P

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient’s pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.

Botulinum neurotoxin (BNT) injection into the cricopharyngeus muscle (CPM) under ultrasound (US) guidance is a minimally invasive technique performed to relieve cricopharyngeal dysphagia by reducing CPM spasticity. This technique is basically accessible only to both lateral sides of the CPM. This cadaveric study aimed to evaluate whether US-guided injection could effectively deliver BNT to abundant areas of gross nerve endings within the CPM. We utilized a newly modified Sihler’s staining method to identify regions with abundant neural endings within the CPM while preserving the three-dimensional morphology of the muscle in 10 sides of 5 fresh cadavers. A mixture of 0.2 mL dye was injected into the 16 sides of CPM under US guidance in 8 cadavers. Nerve endings were abundant in posterolateral areas of the CPM; the injected dye was identified at the posterolateral area on 12 sides (12/16 side, 75%) without diffusion into the posterior cricoarytenoid muscle. The injection failed on four sides (two sides of the prevertebral fascia and two sides of the esophagus below the CPM). These results suggest that US-guided injection could be a feasible technique as it can deliver BNT to the most abundant nerve distribution areas within the CPM in most cases.

Background Dysphagia incidence after cardiac surgery is increasing due to increased complexity of the surgery and number of older patients, which has become one of the most severe complications of cardiac surgery, affecting patients' physical health and recovery. Objective To perform a review of available evidence on the incidence of dysphagia after cardiac surgery. Methods Databases of PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CBM, CNKI, Wanfang Data, and VIP were searched from inception to May 2022 for published studies on the incidence of dysphagia after cardiac surgery. Two researchers independently conducted a literature enrollment, quality assessment, and data extraction. Meta-analysis was conducted using Stata 15.0. Results Fifteen studies with 7 880 patients were included. The meta-analysis revealed that the overall incidence of dysphagia after cardiac surgery was 13.3%〔95%CI (10.1%, 16.5%) 〕. Further region-specific analysis indicated that, the incidence of dysphagia following cardiac surgery in Asia, North America, and Oceania was 16.6%〔95%CI (10.4%, 22.8%) 〕, 10.0%〔95%CI (6.1%, 13.8%) 〕, and 17.4%〔95%CI (12.3%, 23.5%) 〕, respectively. According to sex-specific analysis, the incidence of dysphagia following cardiac surgery was 16.9%〔95%CI (11.8%, 21.9%) 〕, and 16.4%〔95%CI (11.1%, 21.8%) 〕 in male and female patients, respectively. The analysis based on age group indicated that the dysphagia incidence following cardiac surgery in patients aged 48 hours was 1.0%〔95%CI (0.3%, 1.8%) 〕, 6.4%〔95%CI (4.4%, 8.3%) 〕, 16.8%〔95%CI (9.5%, 24.1%) 〕, and 55.0%〔95%CI (28.0%, 82.0%) 〕, respectively. In addition, chronic kidney disease, chronic lung disease, previous history of cerebrovascular accident, atrial fibrillation, heart failure, intraoperative transesophageal echocardiography, perioperative stroke and sepsis were associated with a higher incidence of dysphagia after cardiac surgery. The results of the meta-analysis were robust, as shown by sensitivity analysis. Both Begg's and Egger's tests yielded P-value

Objective To determine correlations of alternation motor rate (AMR), sequential motor rate (SMR), and maximum phonation time (MPT) with the severity of dysphagia in subacute stroke patients. Methods This was a retrospective chart review study. Data of 171 subacute stroke patients were analyzed. Patient’s AMR, SMR, and MPT data were collected from their language evaluations. Video fluoroscopic swallowing study (VFSS) was done. Data of dysphagia scales including penetration-aspiration scale (PAS), American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, clinical dysphagia scale (CDS), and videofluoroscopic dysphagia scale (VDS) were obtained. AMR, SMR, and MPT were compared between a non-aspirator group and an aspirator group. Correlations of AMR, SMR, and MPT with dysphagia scales were analyzed. Results AMR ("ka"), SMR, and modified Rankin Scale were significant associated factors between non-aspirator group and aspirator group, while AMR ("pa"), AMR ("ta"), and MPT were not. AMR, SMR, and MPT showed significant correlations with PAS score, ASHA-NOMS scale, CDS, VDS oral, and VDS pharyngeal scores. The cut-off value for distinguishing non-aspirator group and aspiration group was 18.5 for AMR ("ka") (sensitivity of 74.4%, specificity of 70.8%) and 7.5 for SMR (sensitivity of 89.9%, specificity of 61.0%). AMR and SMR were significantly lower in before-swallow aspiration group. Conclusion Articulatory diadochokinetic tasks that can be easily performed at the bedside would be particularly helpful in determining the oral feeding possibility of subacute stroke patients who cannot undergo VFSS, which is the gold standard for dysphagia assessment.

Introduction Laryngomalacia is the most common congenital laryngeal alteration, with spontaneous resolution in most cases. However, in the face of more severe presentations of the disease, it is necessary to perform supraglottoplasty surgery. Studies have been dedicated to researching changes in swallowing in children with laryngomalacia before and after surgical intervention.

Background Considering that our country has entered an aging society, the health problems of the older people has evolved into a concern due to the association with a variety of diseases. In recent years, Chinese households and society have suffered a serious economic burden due to the increasing prevalence of dysphagia among the elderly. Objective The purpose of this study is to evaluate the prevalence of dysphagia in the elderly in China systematically. Methods PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, Wanfang Data, and China Biomedical Literature Database were searched for epidemiological studies related to the prevalence of dysphagia in the elderly in China. Searches were conducted from database inception to May 2022. Two researchers were responsible for screening literature and extracting data according to the inclusion and exclusion criteria. The AHRQ scale was used to evaluate the quality of cross-sectional studies. Meta-analysis was performed with Stata 15.0 software. Results A total of 22 articles were analyzed, containing 308 289 patients, including 47 940 patients with dysphagia. Meta-analysis revealed that the prevalence of dysphagia in the elderly in China was 66.0%〔95%CI (58.0%, 73.0%) 〕. According to subgroup analysis, among elderly Chinese males and females dysphagia was prevalent in 38.0%〔95%CI (31.0%, 45.0%) 〕 and 38.0%〔95%CI (29.0%, 46.0%) 〕 of cases, respectively. The prevalence of dysphagia was 21.0%〔95 %CI (13.0%, 29.0%) 〕 in 60-69 years old, 28.0%〔95%CI (18.0%, 37.0%) 〕 in those aged 70-79, and 41.0%〔95%CI (31.0%, 50.0%) 〕 in those aged more than 80. In primary, secondary, and technical secondary school, and college and up, dysphagia was observed in 28.0%〔95%CI (20.0%, 35.0%) 〕, 32.0%〔95%CI (17.0%, 53.0%) 〕, 30.0%〔95%CI (18.0%, 42.0%) 〕 of the elderly. The prevalence of elderly dysphagia was 68.0% in the hospital〔95%CI (52.0%, 85.0%) 〕, 56.0%〔95%CI (41.0%, 71.0%) 〕 in the nursing home and 76.0%〔95%CI (56.0%, 97.0%) 〕 in the community. According to the Kubota Drinking Test, 32.0%〔95%CI (21.0%, 43.0%) 〕 of the elderly suffer from dysphagia, 41.0%〔95%CI (16.0%, 66.0%) 〕 exprience it according to the EAT-10 scale, and 35.0%〔95%CI (14.0%, 56.0%) 〕 suffer from it according to the Water Swallowing Test scale. Conclusion The prevalence of dysphagia among the elderly in China is 66.0%〔95%CI (58.0%, 73.0%) 〕. The prevalence of dysphagia among those≥80 years old, those with secondary school and technical secondary school education, elderly care in community, and those with dysphagia diagnosed by the EAT-10 scale is high. In order to improve the quality of life and reduce the prevalence of dysphagia among the elderly, we must pay more attention to and understand elderly dysphagia early.

Objective To investigate the clinical and swallowing characteristics related to respiratory infection in patients with parkinsonism. Methods One hundred and forty-two patients with parkinsonism who underwent videofluoroscopic swallowing studies (VFSS) were enrolled in this study. The initial clinical and VFSS characteristics were compared between patients with and without a history of respiratory infection in the past year. A multivariate logistic regression model was applied to identify clinical and swallowing characteristics related to respiratory infections. Results Patients with respiratory infections were older (74.75±10.20 years vs. 70.70±8.83 years, p=0.037), had a higher Hoehn and Yahr (H&Y) stage (stage IV–V, 67.9% vs. 49.1%; p=0.047), and were more likely to have a diagnosis of idiopathic Parkinson’s disease (IPD) (67.9% vs. 41.2%, p=0.011) than those without respiratory infections. Among VFSS findings, bolus formation, premature bolus loss, oral transit time, pyriform sinus residues, pharyngeal wall coatings, and penetration/aspiration were significantly worse in patients with respiratory infections (p

Eosinophilic esophagitis is now one of the most common conditions diagnosed during the assessment of feeding problems in children and during the evaluation of dysphagia and food impaction in adults. We report a case of a 20-year-old male, with a history of asthma, who developed solid dysphagia and food impaction symptoms over a 10-year course. A late diagnosis led to incapacitating symptoms, advanced endoscopic findings, and riskier therapeutic options. Primary care providers are pivotal for timely and accurate detection of symptoms and proper referral to specialists.

Psychogenic dysphagia is a deglutition disorder characterized by a fear of swallowing, with no structural or functional causes. This report presents the case of a young male patient who had severe malnutrition due to psychogenic dysphagia and was provided visual biofeedback using fiberoptic endoscopic evaluation of swallowing (FEES). A healthy 25-year-old man presented to our clinic with a complaint of throat discomfort when swallowing that had started 6 months prior. As the symptoms worsened, he became fearful of food spreading to his lungs after swallowing and the development of respiratory difficulties. His food intake gradually decreased, resulting in a weight loss of 20 kg within 2 months. Evaluation of organic and other functional causes of dysphagia was performed, but no abnormalities were detected. The sensation of a lump in his throat, fear of swallowing, and anxiety were transformed into somatic symptoms. The patient was diagnosed with psychogenic dysphagia. After visual biofeedback by a physician who performed FEES, the patient resumed eating normally and increased his food intake. If routine tests do not reveal structural or functional causes of dysphagia, assessment of a psychogenic swallowing disorder should be considered. FEES can help in the diagnosis and management of psychogenic dysphagia.

Objective To investigate esophageal motility disorders in patients with esophageal residual barium on chest x-rays after videofluoroscopic swallowing studies (VFSS) through high-resolution esophageal manometry (HREM). Methods We reviewed the records of 432 patients who underwent VFSS from September 2019 to May 2021, and 85 patients (19.7%) with large residual barium (diameter ≥1 cm) were included. As a result of HREM, motility disorders were classified as major or minor motility disorders according. Esophagogastroduodenoscopy and chest computed tomography results available were also reviewed. Results Among 85 patients with large residual barium in the esophagus, 16 patients (18.8%) underwent HREM. Abnormal esophageal motilities were identified in 68.8% patient: three patients (18.8%) had major motility disorders—achalasia (n=1), esophagogastric junction (EGJ) outflow obstruction (n=2)—and eight patients (50%) had minor motility disorders—ineffective esophageal motility (n=7), fragmented peristalsis (n=1). In those with normal esophageal motility, three patients of esophageal structure disorders (18.8%)—esophageal cancer (n=1), cardiogenic dysphagia (n=1), slight narrowing without obstruction of EGJ (n=1)—and two patients (12.5%) with chronic atrophic gastritis (n=2) were confirmed. Conclusion Esophageal motility disorders were identified in 68.8% of 16 patients with large esophageal residual barium with three patients in the major and eight patients in the minor categories. Residual barium in the esophagus was not rare and can be a sign of significant esophageal motility disorders.

Objective:This study aimed to investigate the current dysphagia practices and their defined awareness in the intensive care units (ICUs) in Turkey.Materials and Methods:The study was part of an international, multi-center survey, called Dysphagia in Intensive Care Evaluation. The survey included questions related to the descriptive information and questions under three subgroups, including current practice, awareness, and perceived best practice, and was sent to ICU department managers via Google forms for them to answer on behalf of their ICU.Results:A total of 39 responses were received, which revealed no standard protocol in all ICUs that indicates which patients should be screened for dysphagia. Cough reflex testing and water swallow tests were the most common methods to confirm dysphagia. Oral hygiene, postural adjustments, modifications, and delay feeding and retry the next day were reported as the most common preventions for aspiration, and repetitive swallowing exercises/maneuvers, muscle strengthening exercises, and respiratory exercises were most common for dysphagia treatment. The awarenessrelated survey items revealed a mean score of >5 on a 7-level Likert scale.Conclusion:Dysphagia practice in the ICUs in Turkey needs improvement, with established standardized management protocol.

Objective Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Objective: Direct swallowing rehabilitation assessment in patients with highly infectious diseases, such as COVID-19, is not recommended. We aimed to explore the feasibility of using telerehabilitation for managing dysphagia in patients with COVID-19 in isolated hospital rooms. Design: Open-label trial. Subjects/patients: We examined 7 enrolled patients with COVID-19 who presented with dysphagia and were treated with telerehabilitation. Methods: Telerehabilitation was performed for 20 min daily and included indirect and direct swallowing training. Dysphagia was assessed before and after telerehabilitation using the 10-item Eating Assessment Tool, the Mann Assessment of Swallowing Ability and graphical evaluation using tablet device cameras. Results: All patients showed significant improvement in swallowing ability, evaluated by the range of the upward movement of their larynxes and the Eating Assessment Tool and Mann Assessment of Swallowing Ability scores. The change in swallowing evaluation scores was correlated with the number of telerehabilitation sessions. There was no infection spread to the medical staff treating these patients. Dysphagia in patients with COVID-19 was improved using telerehabilitation while ensuring a high degree of safety for clinicians. Conclusion: Telerehabilitation might eliminate the risks associated with patient contact and has the advantage of infection control. Its feasibility needs further exploration. LAY ABSTRACT We explored the feasibility of using telerehabilitation for managing dysphagia in patients with COVID-19 in isolated hospital rooms. We enrolled 7 patients with dysphagia. Telerehabilitation was performed for 20 min per day and included indirect and direct swallowing training. All patients showed significant improvement in their swallowing ability, evaluated by the range of the upward movement of their larynxes and the Eating Assessment Tool and Mann Assessment of Swallowing Ability scores. The change in swallowing evaluation scores was correlated with the number of telerehabilitation sessions. There was no spread of infection to the medical staff who treated these patients. Dysphagia in patients with COVID-19 was improved using telerehabilitation while ensuring a high degree of safety for clinicians. Telerehabilitation might eliminate the risks associated with patient contact and has the advantage of infection control. Its feasibility should be explored further.

Introduction: Dysphagia is a frequent disorder throughout the life cycle, which has different etiolo-gies in relation to its clinical type in oropharyngeal or esophageal.Objective: Clinical and etiological characterization of a sample with dysphagia attended in two health care centers in the city of Medellín (Colombia), showing the etiology and clinical type of dysphagia according to age groups. Methods: Observational, descriptive, and retrospective study, through the review and analysis of and clinical records of patients with a diagnosis of dysphagia, treated between 2012 and 2018 in a university hospital and a speech therapy center in swallowing. Results: Sample of 527 patients. Distributed in tho-se under 18 years 45.4% (239/527); 18 to 59: 20.1% (106/527) and over 60: 34.5% (182/527). Clinical type, etiology, and most frequent health condition in the entire sample: oropharyngeal dysphagia, functional etiology, and neurological diseases. The most frequent conditions causing dysphagia in children under 18 years of age were childhood development disorders; group 18 to 59 years, cancer and, in those over 60 years of age, neurodegenerative processes. Conclusion: Oropharyngeal dysphagia due to functional etiology is common throughout the life cycle, and neurological diseases seem to largely explain its pathophysiology. In older adults it is associated with neurodegenerative disorders, and in those under 60 years of age (including children) the etiology is diverse. Its causes and clinical characteristics must be considered for promotion, diagnosis, treatment, and rehabilitation processes.

Introduction: Dysphagia is a prevalent condition (20%), and occurs more frequently in women and in older people. It negatively impacts innumerous aspects of patient’s personal and professional lives. Patient-reported outcomes allow patients to directly quantify their experience regarding dysphagia and evaluate its true impact on quality of life. Among the scales available, Patient-Reported Outcomes Measurement Information System Gastrointestinal (PROMIS GI) Disrupted Swallowing stands out because it is a robust instrument that can be applied regardless of the type and etiology of dysphagia. The aim of this study was to translate, culturally adapt and validate PROMIS GI Disrupted Swallowing scale for the Portuguese-speaking population. Material and Methods: Firstly, the seven items of the scale were translated and transculturally reviewed following the systematic method proposed by the Functional Assessment of Chronic Illness Therapy (FACIT). Afterwards, the pre-test version of the questionnaire was administered to a convenience sample (n = 6) for semantic evaluation, with the aim of detection and subsequent correction of possible problems in the translation. The final translated and certified version of the scale was administered to 200 voluntary adult participants (n = 123 healthy; n = 77 dysphagia) in Portugal, for evaluation of reliability and validity. Results: The Portuguese version of PROMIS GI Disrupted Swallowing presented acceptable internal consistency (coefficient of Cronbach’s α of 0.919) and adequate test-retest reliability (intraclass correlation coefficient of 0.941). The translated version of the scale revealed a strong correlation with both Eckardt score (p < 0.001; ρ = 0.782) and the quality-of-life questionnaire EuroQol-5D (p < 0.001; ρ = -0.551), demonstrating evidence of convergent validity. Conclusion: The Portuguese version of PROMIS GI Disrupted Swallowing scale presented conceptual, semantic, cultural and measurement equivalence relatively to the original items. The results attained demonstrated that the translation of this scale to Portuguese is reliable and valid for use both in clinical practice and for research purposes.

Abstract Background and purpose Oropharyngeal dysphagia (OD) affects 40–81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD. Methods A systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Discussion The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. Trial registration PROSPERO CRD42020136245

BackgroundDysphagia is a common non-motor symptom of Parkinson's disease (PD), which may cause pneumonia, malnutrition, and declined quality of life. However, risk factors of dysphagia in PD are still unclear.ObjectiveTo explore the risk factors of dysphagiain PD.MethodsOne hundred and seven consecutive PD patients were recruited in Henan Provincial People's Hospital from June 2018 to December 2019, and general demographic data, incidence of dysphagia and sialorrhea, disease stage and illness severity, severity of anxiety and depression, cognitive function, as well as uric acid and homocsteine were retrospectively analyzed. Risk factors of dysphagia in PD were explored using multivariate Logistic regression analysis. ROC curve analysis was used for evaluating the predictive value of independent risk factors for dysphagia in PD.ResultsOf the 107 PD patients, 45 with dysphagia and 62 without were assigned to an observation group and a control group, respectively, with an incidence of dysphagia of 42.1% (45/107). There were significant difference in terms of age, Hoehn-Yahr classification, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅰ, Ⅱ and Ⅲ scores, incidence of sialorrhea, the 14-item Hamilton Anxiety Scale (HAMA-14) score, the 24-item Hamilton Depression Scale (HAMD-24) score, Mini-mental State Examination (MMSE) score and uric acid between these two groups (P≤0.05). Multivariate Logistic regression analysis showed that, UPDRSⅢ score≥35〔OR=7.639, 95%CI (2.750, 21.219) 〕, sialorrhea〔OR=3.336, 95%CI (1.178, 9.447) 〕, HAMA-14 score≥13〔OR=2.847, 95%CI (1.027, 7.894) 〕and uric acid

Post-tracheal extubation swallowing dysfunction in critically ill patients may negatively affect patient prognosis, and cause significant increases in relevant medical and social burden as well as care burden. We reviewed the epidemiology, causes, associated factors and interventions regarding post-tracheal extubation swallowing dysfunction in critically ill patients, aiming at providing evidence for the management of post-tracheal extubation swallowing dysfunctionin this group.

This review introduces the updated Chicago Classification ver. 4.0 for esophageal motility disorders using metrics from high-resolution manometry (HRM). The Chicago Classification ver. 4.0 was developed by 52 diverse international experts using validated methodologies over 2 years. Key updates in Chicago Classification ver. 4.0 include: 1) a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, 2) a refined definition of esophagogastric junction outflow obstruction, and 3) emphasis on supportive testing with barium esophagogram with tablet and/or functional lumen imaging probe.

Abstract Background Dysphagia (swallowing difficulty) is one of the most common and debilitating sequelae of head and neck cancer (HNC). Patient-reported outcome measures (PROMs) are a fundamental component of dysphagia outcomes evaluation, as they inform treatment consequences that cannot be captured by objective clinician measures. Many PROMs for dysphagia in HNC are available, but their validity is unclear. As a consequence, the selection of the most appropriate PROM for dysphagia in HNC is complex and often based on the clinician’s personal preferences, rather than on valid psychometric properties. This protocol describes a systematic review aiming at (1) identifying PROMs specific to dysphagia symptoms, swallowing functional status, swallowing-related health status, and swallowing-related quality of life in HNC, (2) mapping them to our conceptual framework of dysphagia-related PROs, and (3) appraising their psychometric properties using the Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology. Methods Six electronic databases will be searched from inception to December 2020 for all primary studies in any language and design detailing PROM development, reliability, validity, feasibility, interpretability, and/or cross-cultural adaptation. Eligibility criteria will target PROMs for patients with HNC (≥ 90% of the study sample) with ≥ 20% of their items pertaining to swallowing. Two independent raters will screen abstract and full texts and a third rater will resolve discrepancies. Data will be extracted on study, sample and PROM characteristics, and results of psychometric testing. PROMs will be mapped to our conceptual framework. The methodological quality of included PROMs and their psychometric properties will be appraised using the COSMIN risk of bias checklist and evidence will be summarized using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Discussion This systematic review will provide a summary of existing dysphagia-related PROMs for people with HNC and a comprehensive account of their psychometric properties. We will provide recommendations on PROMs selection which will aid healthcare professionals to the most appropriate PROM based on its validity, reliability, feasibility, interpretability and suitability for clinical and research settings. Further recommendations will be made on areas of measurement property requiring further testing. Systematic review registration PROSPERO registration ID: CRD42021237877

Objective To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients. Methods Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS). Results The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p

Objective To utilize pulmonary function parameters as predictive factors for dysphagia in individuals with cervical spinal cord injuries (CSCIs). Methods Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2–8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group. Results The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively. Conclusion Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.

Objective To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS). Methods Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (

Cerebral infarction (CI) is also known as ischemic stroke. It is one of the most common cerebrovascular diseases, with high mortality and disability rate, which has seriously threatened human health. To better apply the diagnosis and treatment plan of integrated traditional Chinese and Western medicine to the treatment of patients with CI, the Chinese Association of Integrative Medicine issued the Expert Consensus on the Diagnosis and Treatment of Cerebral Infarction with the Integrated Traditional Chinese and Western Medicine in 2021. It involves etiology and pathogenesis of CI, diagnosis and treatment standards of Traditional Chinese Medicine (TCM) and Western Medicine, syndrome elements of TCM, as well as rehabilitation nursing of CI with integrated traditional Chinese and Western medicine during acute period and recovery period. This study interprets the consensus from routine nursing, dietary nursing, emotional nursing, complication nursing, rehabilitation nursing, and continuous nursing, aiming to provide evidence-based support for clinical TCM nursing practice. [ABSTRACT FROM AUTHOR]

Background: The influence of changes in body composition on swallowing in patients with Amyotrophic Lateral Sclerosis (ALS) is unknown. Understanding the interrelation between body compartments and dysphagia may establish specific treatments related to both nutritional aspects as to myofunctional ones designed to delay swallowing loss. Aim: The aim of the study was to evaluate the relationship between body composition and dysphagia during the course of the disease. Methods: The protocol of this study included assessments carried out quarterly for one year and included: analysis of body composition by multi-frequency segmental bioimpedance, nutritional diagnosis, maximum strength test of the tongue and lips, analysis of swallowing using the Functional Oral Intake Score (FOIS) and Swallowing Rating Scale of the American Speech-Language-Hearing Association (ASHA), speech intelligibility and analysis of disease severity. To measure the degree of relationship between quantitative variables, Spearman’s correlation was used. Results: Thirty-four patients were evaluated, 28 Spinal Group and 6 Bulbar Group. The results did not show any significant differences in the analysis of body composition between the groups. Positive associations were found between body compartments and swallowing analysis. The phase angle showed a strong correlation between the FOIS scales (r = 0.74, p < 0.01), ASHA (r = 0.77, p < 0.01) and tongue (r = 0.66, p < 0.01). Conclusions: Changes in body compartments were related to swallowing functionality and speech intelligibility in ALS patients, emphasizing the importance of analyzing body compartments for decision making by the interdisciplinary team. Although these preliminary data were collected in a small sample size, they serve to motivate future studies in this area.

Abstract Dysphagia or difficulty swallowing in childhood necessitates multi‐disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work‐up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.

Introduction Supracricoid laryngectomy (SCL CHEP) removes ∼ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global (p

Objective: Swallowing disorders are systematically present in patients with severe brain injury, disorders of consciousness, and subsequently poor quality of life. The study hypothesis was that taste and smell could improve swallowing function and quality of life in such patients, who are fed by gastrostomy tube. Methods: Eight patients with unresponsive wakefulness syndrome were included in this study. All patients had been in a stable state for at least 2 years, and the delay between the neurological event and the study was always more than 2 years. Strong tastes and smells were selected using the Pfister olfactory classification. Taste and smell stimulations were performed every weekday, Monday to Friday, for 1 week (5 sessions) by a speech and language therapist. Evaluation of swallowing was performed before the first session and after the fifth session, and included the number of spontaneous swallows during 10 min, the presence of drooling, and spontaneous tongue and velum mobility. Results: The number of spontaneous swallows at the initial evaluation was 6.8 ± 5.1 n/min. At the final evaluation there was a significant increase in the number of spontaneous swallows (9.1 ± 4.1 n/min, p < 0.01). Conclusion: This clinical observation has shown that taste and smell stimulations are relevant in clinical practice to improve spontaneous swallowing.

Background : : Percutaneous radiologic gastrostomy (PRG) was considered as an alternative technique for long-term enteral nutrition, and the current study is aimed to evaluate the feasibility and safety of this technique in patients with amyotrophic lateral sclerosis (ALS) at a single medical center. Methods : : From July 2017 to October 2020, a total of 14 patients underwent PRG with ALS were included in this retrospective study with a median age of 64.0 years, and 78.6% were male. The procedure comprised a dilation of the stomach via a nasogastric catheter, followed by puncture and gastrostomy tube placement under fluoroscopic guidance. The technical success rate and clinical outcomes were recorded over 3 months following the procedure. Results : : The technical success rate was 100%. During the follow-up period, minor complications were reported in 2 of patients (14.3%) including superficial skin infection and early tube block. Neither major complications nor mortality were observed. Body mass index of the patients increased significantly from 16.4 ± 2.1 kg/m2 to 17.1 ± 2.0 kg/m2 (t = –13.77; P < 0.001), and the albumin level increased significantly from 37.5 ± 2.3 g/L to 41.8 ± 1.6 g/L (t = –8.82, P < 0.001). Conclusion : : PRG is a relatively safe and effective method for ALS patients, and deserves widespread clinical acceptance.

Objective To identify the variables of videofluoroscopic swallowing study (VFSS) that are useful for predicting the risk of aspiration pneumonia in elderly patients with dysphagia. Methods A total of 251 patients (aged 65 years or more) were included and divided into a pneumonia group (n=133) and a non-pneumonia group (n=118). The pneumonia group included patients who had been diagnosed with aspiration pneumonia, and individuals in the non-pneumonia group did not have pneumonia but were referred for VFSS. The medical records and results of VFSS were reviewed and compared between the groups retrospectively. Results The pneumonia group exhibited a male preponderance and a higher 8-point Penetration-Aspiration Scale (8PPAS) score. The mean values of 8PPAS score for swallowing thick liquid and rice porridge was significantly higher in the pneumonia group. The pharyngeal delay time (PDT) and pharyngeal transit time (PTT) were significantly longer in the pneumonia group. The amounts of vallecular and pyriform sinus residue were increased in the pneumonia group. The delay in swallowing reflex and the decrease in laryngeal elevation were more frequently observed in the pneumonia group. Among those variables, PDT and PTT were identified as significant predictors of aspiration pneumonia based on logistic regression analysis. Conclusion The present study delineated the findings of VFSS, suggesting an increased risk of aspiration pneumonia in elderly patients with dysphagia. The results demonstrate that prolonged PDT and PTT are significant predictors of aspiration pneumonia.

Background: The free water protocol (FWP) is an alternate management strategy for patients with dysphagia, who would otherwise be nil by mouth or prescribed thickened fluids, allowing them to drink and potentially aspirate water under strict guidelines to minimize the risk of adverse consequences. The FWP is not widely implemented in acute settings, and it is unclear whether this is due to the complexity of patient presentations, clinician decision‐making or barriers related to the setting. Aims: To explore the perceptions and decision‐making process of clinicians about using FWPs to manage dysphagia for patients admitted to acute stroke and general medicine. Methods & Procedures: A qualitative, critical realist approach was adopted to allow for in‐depth exploration of the perspectives of four dietitians, seven medical officers, eight registered nurses and 17 speech and language pathologists (SLPs) from three hospitals in a capital city of Australia. Data from semi‐structured interviews were analysed using the Situated Clinical Decision‐Making Framework (CDF). Outcomes & Results: Participants were cautious about FWP for patients with neurological conditions, head and neck cancer, dementia, poor immunity, chronic or recurrent respiratory illness, and certain types of stroke. Medical status and the implications for aspiration were paramount, particularly respiratory status, oxygen supplementation, cognitive status, fatigue and mobility. Participants considered patient quality of life, preferences and choices for care, but indicated that factors influencing safety often outweighed patient preference for water. Indirect factors affecting decision‐making included the roles of the multidisciplinary team, individual clinical experience and attitude to risk, and availability of supervision. Conclusions & Implications: Despite the benefits of FWPs in other settings, in acute stroke and general medicine, clinicians erred on the side of safety and, in most cases, would not implement an FWP. Future clinical research is needed to systematically design high‐quality and feasible clinical trials to determine the benefits and safety of FWPs for patients with dysphagia in these settings. This would lay the foundations for guidelines to support the complex clinical decision‐making regarding patient suitability for FWPs. WHAT THIS PAPER ADDS: What is already known on the subject: FWPs are an alternate management strategy for patients with dysphagia, with systematic reviews recommending their use for adults in inpatient rehabilitation with a low risk of pneumonia. However, evidence from the acute setting is sparse, leaving clinicians unsure about which patients might benefit and which may inadvertently be exposed to increased risk by an FWP. What this paper adds to existing knowledge: Participants from all interviewed disciplines agreed that SLPs lead the decision‐making process and as such act as 'gatekeepers' for access to an FWP. The decision‐making process is complex, and participants acknowledged that disease conditions and illnesses were often used as exclusionary criteria. Although participants reported favourably on the benefits of FWPs, their decision‐making privileged risk aversion over patient preference in most settings, except for palliative care. Lack of clinical guidelines and research evidence in acute care settings, as well as the focus on risk aversion, appear to perpetually reinforce the avoidance of FWP in these settings. Of note, more senior clinicians acknowledged being more deliberately guided by patient preference; hence, leadership by senior clinicians appears critical for change in practice in this space. What are the potential or actual clinical implications of this work?: If evidence about the safety of FWP in the acute settings is to be collected, a systematic approach to addressing the present barriers is warranted. This may allow rigorous clinical trials to proceed and potentially lead to best‐practice guidelines for dysphagia management options for wider populations of patients. [ABSTRACT FROM AUTHOR]

High-riding right brachiocephalic and subclavian arteries are often asymptomatic and rare vascular variations. We present a patient with high-riding right brachiocephalic and subclavian arteries that caused compressive pharyngeal and cervical esophageal dysphagia. An 82-year-old woman presented to our hospital with dysphagia that worsened with solid food. A pulsatile lump was observed on the right neck side. A videofluoroscopic swallowing study showed a deviated food bolus movement anterolaterally from the normal vertical pharyngoesophageal transition, with a filling defect in the lower pharynx through the upper esophagus. Neck computed tomography (CT) showed high-riding right brachiocephalic and subclavian arteries and a tortuous right common carotid artery located adjacent to the trachea in the cervical area. The cervical midline structures were deviated to the left neck side. A neck mass with vascular variation should be considered as a cause of dysphagia that worsens with solid food; CT should be considered to determine its cause.

Patients with esophageal dysphagia need a step-by-step approach for diagnosis and treatment. Endoscopic with biopsy and barium esophagogram are the essential tests evaluating anatomical abnormality and esophageal bolus stasis. Further imaging or esophageal function tests such as high-resolution esophageal manometry, functional endoluminal imaging probe, CT or endoscopic ultrasound are required. In the case of dysphagia due to esophageal motility disorder, whether it is the major motility disorder or minor motility disorder should be identified in high resolution manometry. Major motility disorders show esophagogastric junction obstruction or major peristaltic defects. In this case, the severity of the symptoms should be assessed and patients who need endoscopic or surgical treatment targeting lower esophageal sphincter should be screened. Impaired lower esophageal sphincter relaxation (achalasia, esophagogastric junction outflow obstruction, esophageal spasm or abnormal hypercontraction (jackhammer esophagus), hypotensive contraction (ineffective esophageal motility, failed peristalsis), esophageal hypersensitivity (noncardiac chest pain), gastroesophageal reflux disease and esophageal bolus stasis are the possible mechanisms causing dysphagia symptoms. The proper medical treatment depends on underlying mechanisms

Dysphagia is difficulty in swallowing that can be caused by a number of disorders that involve either the oropharynx or the esophagus. Specific endoscopic treatment for dysphagia depends on its etiology, whether the dysphagia is caused by mechanical narrowing or a motor disorder. Variable endoscopic treatment strategies can be used to manage dysphagia. Patient with dysfunction of the upper esophageal sphincter may benefit from esophageal dilationor injection of botulinum toxin. Pneumatic balloon dilation, injection of botulinum toxin, peroral endoscopic myotomy can be considered as treatment options for esophageal motility disorders. Endoscopic dilation is the treatment choice of esophageal stricture, while intraluminal steroid injection and temporary stent can be considered in refractory benign esophageal stricture. Self-expandable metal stent insertion can be considered for dysphagia with malignant cause.

Objective To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM). Methods HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration. Results Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited. Conclusion This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.

ABSTRACT Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.

A 54-year-old woman with a past history of breast and uterine cancer, appeared at the Emergency Room with a six-month history of fatigue, weight loss (> 12 kg), lower limbs swelling and dysphagia due to progressive tongue enlargement. ENT examination demonstrated macroglossia (Fig. 1-A), that was confirmed by computed tomography (CT) scan (Fig. 1-B). Laboratory tests complemented with image findings showed the presence of a restrictive cardiomyopathy and a nephrotic syndrome. The abdominal fat biopsy with immunofixation electrophoresis was positive for light-chain amyloidosis. The patient began chemotherapy treatment with bortezomib, dexamethasone and cyclophosphamide, completing four cycles of treatment with frank tongue reduction. The patient died 5 months after the diagnosis.[...]

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Objective To evaluate the prevalence rate, types, characteristics, and associated factors of esophageal dysphagia detected on chest X-ray images after videofluoroscopic swallowing study (VFSS). Methods The medical records of 535 adults were reviewed retrospectively. Chest X-ray images taken after barium swallow study were analyzed and presence of any residual barium in the esophagus was considered as esophageal dysphagia. Esophageal dysphagia was classified based on the largest width of barium deposit (mild,

Background/Aims This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs). Methods This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS. Results The Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score. Conclusions The severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

A 43-year-old woman suffered from drooling and dysphagia after a stroke in the left posterior inferior cerebellar artery territory. Videofluoroscopic swallowing study showed compatible findings of cricopharyngeal dysphagia. Despite the injection of botulinum neurotoxin, no symptom improvement was achieved and pharyngeal dystonia was considered as the cause. Medications for dystonia dramatically helped with saliva control and resulted in a small improvement in the progression of food from the pharyngeal to esophageal phase. After adjusting the drug dose, the patient was able to perform social activities without drooling. Moreover, she could consume food orally; however, this was limited to small amounts of liquid, and the main method of nutrition support was via an orogastric tube. Therefore, we suggest that physicians should make a differential diagnosis of combined dystonia in patients complaining of dysphagia by esophageal manometry and electromyography.

OBJECTIVE: To find out about the disease characteristics of primary thyroid lymphoma in Pakistani patients. METHODS: In this retrospective study of 20 years duration, we reviewed five diagnosed and/or treated cases of primary thyroid lymphoma at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. Each patient’s medical records were reviewed and studied. RESULTS: Mean age of the participants was 62.8±10.2 years with 3 males and 2 females. Two patients presented at the age of 69 and 70 years, and two patients presented at ages of 47 and 58 years. All our patients presented with a rapidly progressing neck mass and dysphagia. Other common presenting complaints in our study subjects included dyspnea, hoarseness of voice, stridor and feeling of globus in the throat. Average duration of presentation of our cases was 3 months, with 2 patient’s presenting after a month of development of symptoms, while the remaining two participants presented at four and six months after onset of signs and symptoms. All patient’s histopathology was consistent with Diffuse B cell Lymphoma subtype. Out of the five patients, one patient died as a result of complications, one patient opted out of treatment at AKUH due to financial constraints and three patients are doing well with no active complaints and followed-up regularly. CONCLUSION: Primary thyroid lymphoma is a rare condition and can present with neck swelling and compressive symptoms. Diagnosis is based on the histological findings. Larger studies are needed to study the prognosis of the patients.