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While oropharyngeal cancer treatment regimens, including surgical resection, irradiation, and chemotherapy, are effective at removing tumors, they lead to muscle atrophy, denervation, and fibrosis, contributing to the pathogenesis of oropharyngeal dysphagia - difficulty swallowing. Current standard of care of rehabilitative tongue strengthening and swallowing exercises is ineffective. Here, we evaluate an alternative approach utilizing an acellular and injectable biomaterial to preserve muscle content and reduce fibrosis of the tongue after injury. Skeletal muscle extracellular matrix (SKM) hydrogel is fabricated from decellularized porcine skeletal muscle tissue. A partial glossectomy injury in the rat is used to induce tongue fibrosis, and SKM hydrogels along with saline controls are injected into the site of scarring two weeks after injury. Tissues are harvested at 3 and 7 days post-injection for gene expression and immunohistochemical analyses, and at 4 weeks post-injection to evaluate histomorphological properties. SKM hydrogel reduces scar formation and improves muscle regeneration at the site of injury compared to saline. SKM additionally modulates the immune response towards an anti-inflammatory phenotype. This study demonstrates the immunomodulatory and tissue-regenerative capacity of an acellular and minimally invasive ECM hydrogel in a rodent model of tongue injury.

Laryngeal carcinoma represents one-third of all head and neck cancers and is burdened by significant morbidity and mortality for advanced-stage disease. Surgical treatments, including Open Partial Horizontal Laryngectomy (OPHL), are often followed by long-lasting swallowing rehabilitation and more rarely, persistent dysphagia. Some authors reported single cases, successfully treated with fat injection of the base of tongue, but nowadays, a standardized technique has never been described so far. We provide a step-by-step technique description of the trans-cervical lipofilling of the base of the tongue (BOT) under local anaesthesia in a case series of three patients. The functional results have been evaluated with a videofluoroscopic study of deglutition and Penetration-Aspiration Score. The procedure was well tolerated; all patients were discharged after 24 hours without any majorcomplications. After six months, all patients had a steady improvement in swallowing. During follow-up, the videofluoroscopic study of deglutition confirmed a sensitive amelioration of the Penetration-Aspiration Score and an empowered base of tongue retropulsion. Finally, the lipofilling of the BOT under local anaesthesia showed to be a feasible, and reproducible procedure, for dysphagia after OPHLs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate and compare the swallow-related muscles and bones movement patterns during swallowing quantitatively by B+M-mode ultrasound, and to investigate its application value in dysphagia. Sixty elderly stroke patients with dysphagia (patient group) and sixty healthy elderly individuals (control group) were enrolled in this study. M-mode ultrasound was utilized to measure the radial displacement and duration of tongue and geniohyoid muscle movements. B-mode ultrasound was employed to assess hyoid bone displacement and the distance of hyoid-larynx approximation. Ultrasound parameters were compared between the two groups. Logistic regression was used to identify the optimal parameters with independent predictive value. The predictive efficacy of each parameter for dysphagia was evaluated using ROC curve analysis. Both intraindividual and interindividual variations were observed in the B+M-mode imaging traces during the three swallows. Significant differences were found in the average radial displacement and duration of tongue and geniohyoid muscle movements, hyoid bone displacement, and hyoid-larynx approximation distance between the two groups (all p < 0.001). The radial displacement of the tongue and geniohyoid muscle, hyoid bone displacement, and hyoid-larynx approximation distance were lower in the patient group compared to the control group, while the duration of tongue and geniohyoid muscle movements was higher in the patient group. Logistic regression selected the radial displacement of the tongue, the duration of geniohyoid muscle movement, and the hyoid-larynx approximation distance as significant predictors. The combined model demonstrated excellent predictive performance with an AUC of 0.994 and good model fit (p < 0.001). The B+M-mode ultrasound offers a rapid and safe technique for the preliminary evaluation of swallowing movements. It can serve as a quantitative and noninvasive method for the clinical screening of dysphagia. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis (ALS) is a rare multisystem neurodegenerative disease leading to death due to respiratory failure. Riluzole was the first disease modifying treatment approved in ALS. Randomized clinical trials showed a significant benefit of riluzole on survival in the months following randomization, with a good safety profile. 'Real-world' studies suggested that the survival benefit of riluzole is substantially greater, with an extended survival ranging between 6 and 19 months. The main limiting associated adverse effects of riluzole are non-severe gastrointestinal complications and an elevation of liver enzymes, observed in 10% of patients. While different classes of drugs have been approved in some countries, riluzole remains the gold standard of therapy. Dysphagia induced by ALS is a major challenge for food intake and riluzole administration. Tablet crushing is associated with a loss of drug intake and a risk of powder aspiration, which jeopardizes the benefits of riluzole. Riluzole oral suspension (ROS) and oral film (ROF) allow riluzole intake in patients with dysphagia. Both formulations are bioequivalent to riluzole tablets with a good safety profile albeit transient oral hypoaesthesia. In case of severe dysphagia, ROS can be used with percutaneous endoscopic gastrostomy. ROF, the last approved formulation, requires low swallowing capacities and may contribute to maintain the efficacy of riluzole when tablets are inadequate according to patient's status and/or preferences. To optimize treatment continuity in newly diagnosed patients, the expected psychological impact of formulation switching that may be perceived as the sign of disease progression should be anticipated. [ABSTRACT FROM AUTHOR]

Summary: Complications associated with nasogastric tube placement are infrequent and usually not severe. This article details a case of a pharyngo‐oesophageal fistula in a 6‐year‐old Arabian racing gelding initially presenting with recurrent oesophageal obstruction and dysphagia 5 months after recovering from a medically treated colic. Initially, a suspected diverticulum was diagnosed using a combination of endoscopic examinations and barium‐contrast radiography. Its occurrence was believed to be secondary to a pharyngeal abscess occurring as a consequence of repeated or long‐term nasogastric tube placement during the previous treatment for colic. Continuing, and unresolvable, oesophageal obstruction and dysphagia resulted in the gelding being euthanised. Post‐mortem examination revealed the presence of a pharyngo‐oesophageal fistula. [ABSTRACT FROM AUTHOR]

Dysphagia is the most common serious complication after stroke, with an incidence of about 37–78%, which seriously affects the independence of patients in daily life and clinical recovery. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuromodulation technique, is an emerging option for post-stroke dysphagia. Theta burst stimulation (TBS) is a new mode of transcranial magnetic stimulation that simulates the frequency of pulses released in the hippocampus.Intermittent theta burst stimulation (iTBS) has been shown to increase cortical excitability and improve swallowing function in patients. Our study sought to summarize existing clinical randomized controlled trials to provide evidence-based medical evidence for the clinical use of iTBS. A computer search was conducted on 4 Chinese (Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science) and 4 English (including Cochrane Library, Embase, PubMed, Web of Science) databases to retrieve all randomized controlled trials in Chinese and English that explored the effects of Intermittent Theta Burst Stimulation for post-stroke dysphagia. The retrieval years are from database construction to 23 November 2023. The primary outcome measure was a change in Penetration/Aspiration Scale (PAS), Standardized Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS), Secondary outcomes included Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), water-swallowing test (WST) etc. A meta-analysis by Standardized Mean Difference (SMD) and 95% confidence interval (CI) was performed with RevMan 5.3. we appraise risk of bias(RoB) of each study with the Cochrane RoB tool. Detailed instructions for using the Cochrane RoB tool are provided in the Cochrane Handbook for Systematic Reviews of Interventions (The Cochrane Handbook). Nine studies were obtained from eight databases after screening by inclusion and exclusion criteria, 567 patients from 9 studies were included in the meta-analysis, and one study was included in the qualitative analysis due to different control groups. Two of the nine studies had an unclear risk of bias, and four studies were at low risk. The results showed that iTBS significantly improved SSA, PAS, FOIS, and PAS scores in stroke patients compared to the control group(P < 0.05), and promoted swallowing function recovery. Our systematic review provides the first evidence of the efficacy of iTBS in improving dysphagia in stroke patients. However, the number of available studies limits the persuasiveness of the evidence and further validation by additional randomized controlled trials is needed. [ABSTRACT FROM AUTHOR]

Around 80% of persons with Parkinson's disease (PD) present symptoms of dysphagia. Although cognitive impairment may contribute to dysphagia, few studies have investigated the association between the PD neuropsychological profile and objective measures of swallowing dysfunction. Since the swallowing function comprises involuntary but also voluntary actions, we hypothesize that specific measures of attention and executive functions can be underlined in PD-related dysphagia. Therefore, the aim of this study was to extensively investigate the correlation and the relationship between attentive and executive functions and safety/efficiency of pharyngeal phase of swallowing in people with PD. All participants received a fiberoptic endoscopic evaluation of swallowing and were evaluated using the Penetration Aspiration Scale (PAS); the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and the Functional Oral Intake Scale (FOIS-IT). Participants also underwent a neuropsychological assessment covering global cognitive status, attention, and frontal executive functions. Correlations and associations between neuropsychological measures and swallowing components were calculated. Twenty-one participants with PD (mean age 69.38 ± 6.58 years, mean disease duration 8.38 ± 5.31 years; mean MDS-UPDRS III 43.95 ± 24.18) completed all evaluations. The most significant correlations were found between attentive functions (i.e., Stroop Time), and executive functions (i.e., Raven's Progressive Matrices, Digit Backward and Semantic Fluency), and FOIS-IT, PAS, and IT-YPRSRS sinuses and valleculae. These associations were not influenced by disease duration. These results suggest that a dysfunction to attentional processes and/or to executive functions can contribute to penetration and the presence of pharyngeal residue in participants with middle-stage PD. [ABSTRACT FROM AUTHOR]

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50–14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34–18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58–15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia. [ABSTRACT FROM AUTHOR]

While functional endoscopic evaluation of swallowing (FEES) is the most useful diagnostic test for the evaluation of dysphagia, it cannot evaluate the esophageal phase of swallowing. To evaluate if a modification for the FEES exam by swallowing an empty capsule and screening of the upper esophagus could be used for early detection of esophageal dysphagia. A prospective, single-center, pilot study. At the end of a standard FEES exam, the patients were asked to swallow an empty capsule. Fifteen seconds later, the endoscope was inserted into the upper esophagus. A pathological capsule test was defined when the capsule was seen in the esophagus. In such cases, the patient was advised to undergo a gastroscopy, MBS, or esophageal manometry, which were compared to the results of the capsule test. The capsule test was utilized in 109 patients. A pathological capsule test was found in 55 patients (57.8%). In 48 patients (87.3%), an isolated or combined esophageal dysphagia was seen. The accuracy value of the capsule test compared to gastroenterology tests was 83.3%, sensitivity 88.46%, specificity 75%, PPV 85%, and NPV 80%. A modification of the standard FEES exam by including an empty capsule swallow test with an upper esophagus examination may provide a useful screening tool for esophageal dysphagia. [ABSTRACT FROM AUTHOR]

Although the psychosocial sequelae of living with dysphagia secondary to Parkinson disease (PD) are described in the literature as challenging, there has been little focus on using this information to influence the design of dysphagia treatment. A more nuanced understanding of the psychosocial experiences of this population may assist clinicians in providing a patient-centered approach to care. Our study was designed to gather insight into the common psychosocial experiences associated with dysphagia in the context of PD. A semi-structured interview consisting of open- and closed items was conducted with 25 individuals from regions across the country with self-reported oropharyngeal dysphagia secondary to PD. Questions were developed using comprehensive stress and coping frameworks that emphasized psychosocial predictors of specific affective reactions (e.g., grief, anxiety, depression), including self-evaluation (e.g., self-identity), coping strategies, social support, personal expectations (including perceived control over symptoms and prognosis), positive experiences, and perceptions of personal growth. Interview responses were subjected to a qualitative analysis and revealed three dominant themes: (1) Recalibration of a PD Diagnosis, (2) Vigilant Caution to Swallowing, and (3) Grieving the Loss of the Communal Meal. Using these data interpretations, we discuss three concepts for speech-language pathologists working with individuals with dysphagia and PD to consider during clinical interactions; these are reframing swallowing vigilance to engagement with mindful eating, using biofeedback to align patient perceptions and swallow physiology, and understanding the consequences of loss (of their former swallowing ability) through grief and growth reactions. [ABSTRACT FROM AUTHOR]

In dysphagia assessment, along with well-defined measurements and signs, voice parameters can potentially support clinical decision as a marker, but more evidence is needed. This study aims to determine the voice parameters that can predict the risk of dysphagia and to determine optimal cutoff values in individuals with multiple sclerosis (IwMS). Seventy-six adults participated in the study, including 39 IwMS and 37 healthy individuals (HI). The study used the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS), Gugging Swallowing Screen (GUSS), and Voice Handicap Index (VHI-10) and recorded voice samples using Praat programme. Voice recordings were taken pre- and post-swallowing. The voice parameters analysed are fundamental frequency (F0), standard deviation F0 (SD F0), jitter (local), shimmer (local), and harmonic-to-noise ratio (HNR). Roc analysis was performed to examine the diagnostic accuracy performance of the risk for dysphagia/penetration. The parameters of IwMS pre-swallowing differed significantly from those of HI on the VHI-10, DYMUS, GUSS scores, and jitter (local), shimmer (local), and HNR. IwMS but not HI exhibited significant differences in shimmer (local) and HNR between the pre- and post-swallowing measurements. In IwMS, GUSS revealed significant differences in shimmer (local) pre- and post-swallowing between the groups with and without dysphagia/penetration. In the ROC analysis results, the area under the curve (AUC) for shimmer (local) pre-swallowing was 73.1% (cutoff = 1.69); post-swallowing, it was 78.6% (cutoff = 1.57). In conclusion, IwMS can be associated with differences in shimmer (local) and HNR parameters, low quality of life-related to voice, and dysphagia/penetration risk. The AUC values for shimmer (local) in IwMS pre- and post-swallowing may help to strengthen diagnostic decisions of dysphagia risk. [ABSTRACT FROM AUTHOR]

Background: The radiation dose to dysphagia and aspiration-related structures (DARS) for patients undergoing transoral robotic surgery (TORS) and post-operative radiation therapy (PORT) for primary oropharyngeal carcinoma is unknown. Methods: This prospective study measured swallowing using the MD Anderson Dysphagia Inventory at baseline and then 12-months after PORT. Dosimetric parameters were collected. Results: 19 patients were recruited between 2017 and 2019. Worse swallow function at 12-months after PORT was associated with dose-parameters to the oesophageal inlet muscle, superior pharyngeal constrictor muscle and cervical oesophagus. Mean dose, V50Gy, and V60Gy to the base of tongue and pharyngeal constrictors was significantly lower in those receiving PORT to the neck alone. Conclusion: Dose to DARS was lower in patients who received PORT to the neck alone. In patients treated with TORS and PORT, poorer swallowing outcomes at 12 months post-treatment were associated with increased dose to oesophageal inlet muscle, superior constrictor muscle, and cervical oesophagus. [ABSTRACT FROM AUTHOR]

Dysphagia is known to present a social and psychological burden with negative effects on quality of life. However, the psychosocial effect of an individual's dysphagia on those that care for them is less known. The purpose of this study was to develop a clinically efficient, statistically robust companion-reported outcomes measure to the Dysphagia Handicap Index (DHI) to better understand the impact of a patient's dysphagia on their companions as related to physical, emotional and functional domains of health-related quality of life. Seventy-seven initial statements describing companion perceptions of dysphagia were divided into physical, emotional and functional subscales. The statements were administered to 75 consecutive companions of individuals with dysphagia. Respondents replied never, almost never, sometimes, almost always and always to each statement and rated their companion's dysphagia severity on a 7-point equal appearing interval scale. Cronbach's α was performed to assess the internal consistency validation of the statements. The final questionnaire was reduced to 25 items and administered to 317 companions of individuals with dysphagia and 31 controls. Test–retest was performed on 29 companions of individuals with dysphagia. Cronbach's α was strong for the initial and final versions at r = 0.96 and r = 0.97 respectively. Significant differences occurred between companion responses of subjects with dysphagia and the control group. Test–retest reliability was strong (all ICC > 0.85). We present a statistically robust companion-reported outcomes measure to assess the handicapping effects of dysphagia on companions to further our understanding of the global effect of dysphagia and to guide treatment for successful swallowing outcomes. [ABSTRACT FROM AUTHOR]

Background: COVID-19 can lead to impairment of neural networks involved in swallowing, since the act of swallowing is coordinated and performed by a diffuse brain network involving peripheral nerves and muscles. Dysphagia has been identified as a risk and predictive factor for the severest form of SARS-CoV-2 infection. Objectives: To investigate the association between swallowing disorders and COVID-19 in patients hospitalized for COVID-19. Methods: We collected demographic data, medical information specific to dysphagia and data on medical treatments of patients with COVID-19. Results: A total of 43 hospitalized COVID-19 patients were enrolled in the study. Twenty (46%) were evaluated positive for dysphagia and 23 (54%) were evaluated negative. Neurocognitive disorders and diabetes were mostly associated with patients who resulted positive for dysphagia. Respiratory impairment caused by COVID-19 seems to be a cause of dysphagia, since all patients who needed oxygen-therapy developed symptoms of dysphagia, unlike patients who did not. In the dysphagic group, alteration of the swallowing trigger resulted in the severest form of dysphagia. An association was found between the severest form of COVID-19 and dysphagia. This group consisted predominantly of males with longer hospitalization. Conclusions: Identification of COVID-19 patients at risk for dysphagia is crucial for better patient management. [ABSTRACT FROM AUTHOR]

Patients with chronic obstructive pulmonary disease (COPD) in pulmonary rehabilitation programs (PRPs) are not routinely screened for dysphagia. An Australian regional health service audit revealed that patients with COPD are frequently referred to speech pathology during acute admissions, rather than proactively to mitigate the risk of dysphagia-related consequences. Referral patterns to speech pathology using a novel transdisciplinary approach for identifying at risk for dysphagia patients in a PRP were explored. The aim of this study was to investigate the impact of a transdisciplinary dysphagia screening questionnaire on speech pathology referrals within a cohort of patients with COPD enrolled in a PRP. This quasi-experimental study introduced a dysphagia screening questionnaire in a PRP using a transdisciplinary approach. A retrospective audit of PRP patients (n = 563) between 01/01/2014 and 31/12/2018 was conducted to identify the frequency of referrals to speech pathology for dysphagia. Data was compared to a cohort of patients (n = 50) enrolled in the PRP (from 01/02/21 to 30/11/21) after introduction of the questionnaire using Fisher's exact test. Less than 1% (n = 4/563) of PRP patients were referred to speech pathology prior to implementation of the questionnaire. Following the implementation, referrals to speech pathology significantly increased to 16% (8/50) (X2 = 7.72, P < 0.05; odds ratio = 7.89 95% CI [1.94, 32.1]). Introducing a dysphagia screening questionnaire increased referrals to speech pathology from a PRP. This study demonstrated the potential for a transdisciplinary approach in early screening for patients at risk of dysphagia for patients with COPD. Further research is encouraged to explore patient motivation towards speech pathology input with COPD-related dysphagia and clinicians' perceived self-efficacy in using the questionnaire. [ABSTRACT FROM AUTHOR]

This investigation assessed the impact of temporal resolution during a videofluoroscopic evaluation of swallowing (VFSS) on measures of duration and kinematics. Thirty adult and ten infant swallow studies, all acquired at 30 frames and 30 pulses per second, were obtained from a New Mexico hospital. All swallow studies were altered to simulate 15 and 5 pulses per second. Duration measures included pharyngeal response time, duration of upper esophageal sphincter (UES) opening, velopharyngeal closure duration and total swallow duration. Kinematic measures were assessed in adults only and included peak hyoid position and extent of UES opening during the swallow. Analysis of outcome measures was performed and compared across the three temporal resolutions (30, 15, and 5 pulses per second). For data points where normative values are available, we evaluated the impact of temporal resolution on clinical determination (i.e., did a change in pulse rate alter the clinical classification). Kinematic and duration measures were altered with changes in pulse rate and these changes increased as temporal resolution decreased. For outcome measures where normative values are available, accuracy of clinical determination decreased with decreased pulse rate. Temporal resolution impacts duration and kinematic measures. However, the direction of these changes is unpredictable, indicating sensitivity and specificity are both affected. Without a predictable impact, the use of lower pulse rates may alter clinical impressions and treatment recommendations yielding inappropriate treatment goals and treatment duration. [ABSTRACT FROM AUTHOR]

The objective of this study was to create a Turkish language adaptation of the Boston Residue and Clearance Scale (BRACS), a validated and reliable tool. The BRACS scale was first translated into Turkish and a Turkish version was subsequently developed. Fiberoptic endoscopic examination of swallowing (FEES) was administered to collect data from 25 dysphagic patients who were hospitalized after a stroke. The recorded films were subjected to editing procedures to ensure their appropriateness for the assessment of swallowing disorders and were then dispatched to a panel of five speech and language therapists for evaluation using the adaptation of the BRACS instrument. The scoring by the experts was evaluated using both explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity, item reliability, and construct (composite) reliability were measured by calculating the average variance extracted (AVE) values. For the 12 location items, EFA revealed 3 main latent factors: the laryngeal vestibule and the oropharynx and hypopharynx. The Turkish BRACS had excellent inter-rater reliability (Krippendorff's alpha coefficient values ranged from 0.93 to 0.95) and high internal consistency (Cronbach's alpha values ranged from 0.88 to 0.93). Inter-rater ICCs for the first and second sessions were 0.83 and 0.85, respectively. CFA showed that all fitted criteria reached acceptable or perfect fit levels. The findings indicated that the proposed factor structure was validated. The AVE values are between 0.61 and 0.73 which was taken as evidence of convergent validity. The Turkish adaptation of the BRACS tool demonstrates both reliablity and validity, rendering it a useful and credible tool for assessing residual severity, particularly in clinical settings. [ABSTRACT FROM AUTHOR]

The goal of this study was to identify which anatomical and dosimetric changes correlated with late patient-reported dysphagia throughout the course of head and neck chemo-radiotherapy treatment. The patient cohort (n = 64) considered oropharyngeal and nasopharyngeal patients treated with curative intent, exhibiting no baseline dysphagia with a follow-up time greater than one year. Patients completed the MD Anderson Dysphagia Inventory during a follow-up visit. A composite score was measured ranging from 20 to 100, with a low score indicating a high symptom burden; a score ≤60 indicated patient-reported dysphagia. The pharyngeal (PCM) and cricopharyngeal constrictor muscles (CPM) were contoured on a planning CT image and adapted to weekly cone-beam CT anatomy using deformable image registration and dose was accumulated using weighted dose-volume histogram curves. The PCM and CPM were examined for volume, thickness, and dosimetric changes across treatment with the results correlated to symptom group. Anatomical evaluation indicated the PCM thickness increased more during treatment for patients with dysphagia, with base of C2 vertebrae (p = 0.04) and superior-inferior middle PCM (p = 0.01) thicknesses indicating a 1.0–1.5 mm increase. The planned and delivered mean dose and DVH metrics to PCM and CPM were found to be within random error measured for the dose accumulation, indicating delivered and planned dose are equivalent. The PCM and CPM organs were found to lie approximately 5 mm closer to high dose gradients in patients exhibiting dysphagia. The volume, thickness, and high dose gradient metrics may be useful metrics to identify patients at risk of late patient-reported dysphagia. [ABSTRACT FROM AUTHOR]

Thickening agents effectively prevent liquid aspiration, but their impact on the ease of discharging aspirated liquids from the trachea remains unclear due to alterations in the physical properties of liquids. This study clarifies the effects of thickening agents, comprising various raw materials, on mucociliary transport function, focusing on the viscosities of thickened waters. The subjects were 23 healthy adults. Five types of saccharin solution were prepared: a solution without a thickening agent, a starch-based nectar-like solution, a starch-based honey-like solution, a xanthan-gum-based nectar-like solution, and a xanthan-gum-based honey-like solution. Using these five types of saccharin solutions randomly, each subject underwent five trials of the saccharine dye test to evaluate the mucociliary transport function of the respiratory tract. The saccharin time was defined as the time from the placement of the saccharin solution on the nasal vestibule of the subject to when the subject reported that they became aware of the sweetness. The saccharin transit times for all samples of thickened water were longer compared to those of water without a thickening agent (p < 0.01). A comparison between thickened water samples with different viscosities showed that the saccharin transit time was longer when thickened water samples with high viscosity were prepared using the same thickening agent (p < 0.01). This suggests that while thickening reduces aspiration, the use of thickening agents may increase the difficulty in discharging aspirated fluids from the trachea. [ABSTRACT FROM AUTHOR]

Purpose: Optimising dysphagia service delivery is crucial to minimise personal and service impacts associated with dysphagia. However, limited data exist on how to achieve this in Singapore. This study aimed to develop prioritised enhancements that the speech-language pathology workforce perceived as needed to improve dysphagia services in Singapore. Method: Using a concept mapping approach, 19 speech-language pathologists (SLPs) and 10 managers listed suggestions for dysphagia service optimisation. Within their groups, the collated suggestions were sorted based on similarity, and individually rated on a 5-point scale based on importance and changeability. Using cluster and bivariate analysis, clusters of similar suggestions and prioritised suggestions for service optimisation were identified. Result: The SLPs and managers proposed 73 and 51 unique suggestions respectively. Six clusters were identified for each group, with similar themes suggesting agreement of service improvements. All clusters were rated as more important than changeable. The managers perceived services as easier to change. The SLPs and managers rated 37% (27/73) and 43% (22/51) of suggestions, respectively, as high priority, with similarities relating to workforce capacity and capability, support and services access, care transitions, and telehealth services. Conclusion: Prioritised enhancements identified by SLPs and managers provide direction for dysphagia service optimisation in Singapore. [ABSTRACT FROM AUTHOR]

Purpose: The efficacy of thickened fluids for individuals with dysphagia has come under increasing scrutiny among healthcare professionals. This commentary provides a critical appraisal of the research evidence and presents a balanced argument on the benefits and limitations of thickened fluids in dysphagia management. By doing so, we aim to engage the readership to think critically about this controversial topic and make informed, patient-centered decisions regarding the use of thickened fluids in dysphagia management. Result/Conclusion: We argue that, while the research evidence for the use of thickened fluids in dysphagia management continues to grow, perhaps our problem lies in trying to find one pure answer—to thicken or not to thicken. We encourage clinicians to move past arguments about the controversies of thickened fluids and, rather, use the current evidence base, including research evidence, clinical expertise, and patient preferences to support individuals with dysphagia to make informed choices about their oral intake, in the short and long term. [ABSTRACT FROM AUTHOR]

Objective To investigate the characteristics of nutritional indexes (hemoglobin, serum protein, prealbumin),brain-derived neurotrophic factor (BDNF) and visinin-like protein 1 (VILIP-1) in elderly patients with mild cognitive impairment (MCI) complicated with dysphagia. Methods A total of 218 elderly patients with MCI admitted to the hospital from January 2020 to January 2024 were selected as the study objects. Patients with concurrent dysphagia were set as the study group, and those without dysphagia were set as the control group, with 109 cases in each group. The clinical data, BDNF level, VILIP-1 level, serum nutritional indexes [hemoglobin (Hb), blood albumin (ALB), prealbumin (PAB) ],and scores of related scales [Fried Frailty Assessment Scale, Barthel index (BI), Micro-nutrition Rating Scale (MNA) ] were compared between the two groups. Results There were significant differences in age, swallowing training, visual and auditory impairment, number of damaged teeth and number of drug types between the two groups (P＜0. 05) . The level of BDNF in the study group was significantly lower than that in the control group, and the level of VILIP-1 was significantly higher than that in the control group (P＜0. 05) . The levels of Hb, ALB and PAB in the study group were significantly lower than those in the control group (P＜0. 05) . FRIED score and BI score of the study group had significant differences, and MNA score of the study group was significantly lower than that of the control group (P＜0. 05) . Conclusion There are significant differences in age, swallowing training and tooth damage between elderly MCI patients with dysphagia and those without dysphagia. Patients with dysphagia have lower BDNF level, higher VILIP-1 level, worse nutritional status and higher frailty degree. [ABSTRACT FROM AUTHOR]

Introduction: Dysphagia and cognitive impairment are prevalent in older individuals. This study aimed to understand the characteristics of dysphagia through fluoroscopy in older adults with mild cognitive impairment (MCI) and dementia. Methods: A cross-sectional study was conducted at a memory clinic in a tertiary hospital in Mexico City. A total of 158 patients were included, of whom 86 (54.4%) showed a risk of dysphagia, and 84 underwent barium swallow fluoroscopy. Results: An association was observed between MCI and alteration in the oral phase (OR 0.33, 95% CI 0.12, 0.92, p = 0.034). Compared to patients with dementia, patients with MCI showed greater alteration in protection against regurgitation (OR 3.19, 95% CI: 1.05 to 9.72, p = 0.042) and in the contraction of the laryngeal muscles (OR 3.54, 95% CI: 1.30 to 9.62, p = 0.013). Discussion: Our findings highlight the altered phases of swallowing in patients with dementia. Additionally, we found a high prevalence of dysphagia in older adults with MCI, underscoring the importance of early detection and intervention. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the positive predictive value of our NMD Suspicion Criteria in the diagnosis of NMDs. Other clinical factors routinely examined in our voice and swallowing examinations were also investigated to see if they had a significant association with the diagnosis of NMDs. Methods: This study retrospectively investigated the medical charts of patients who visited our Voice and Swallowing outpatient clinic between 2013 and 2022. Patients with previously diagnosed NMDs were excluded from the analysis. Among the remaining patients, we included those that were referred to neurologists for further evaluation due to suspicion of having an NMD based on the NMD Suspicion Criteria. The patients were then divided into groups according to the status of their diagnosis within 2 years of referral as "diagnosed", "denied", or "observed". These three groups of patients were then compared according to the following clinical findings; velopharyngeal insufficiency (VPI), tongue atrophy, impaired tongue movement, dysarthria, vocal fold mobility impairment, dysphagia, involuntary movement, gait disturbances, weight loss, and a sense of fatigue in order to see if they were significantly associated with the diagnosis of NMDs. Results: Of 3769 outpatients without a confirmed diagnosis of NMDs, 37 were referred to neurologists for suspected NMDs, and 19 (51%) were diagnosed with NMDs. VPI and impaired tongue movement were significant diagnostic factors for NMDs (p = 0.014, 0.033). VPI during speech (p = 0.045) was more strongly associated with the diagnosis of NMDs than VPI during swallowing (p = 0.076). Fatigue was a significant related factor for other diseases (non-NMDs) causing Voice and Swallowing problems (p = 0.049). Conclusions: In the outpatient clinic setting, suspicion of NMD should be raised, particularly when VPI and impaired tongue movement are observed, prompting a thorough assessment of velopharyngeal closure during both speech and swallowing. [ABSTRACT FROM AUTHOR]

Objectives: Poststroke dysphagia (PSD) is a common complication after stroke but there is limited information on its global prevalence and influencing factors, such as spatial, temporal, demographic characteristics, and stroke-related factors. Our study seeks to fill this knowledge gap by exploring the overall prevalence of PSD and its influencing factors. Methods: A search of English-language literature from database inception from 2005 until May 2022 was performed using PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We used the Joanna Briggs Institute Critical Appraisal Instrument to estimate study quality and calculated the pooled prevalence of PSD with a 95% confidence interval (CI) using an inverse-variance weighted random-effects meta-analysis. A subgroup analysis was performed to identify sources of heterogeneity, and the relationship between PSD and various clinical features was examined using binary logistic regression. Results: Among 95 studies of 1,059,969 patients, the overall pooled estimated prevalence of PSD was 38.57% (95% CI 35.45–41.69%). Subgroup analysis reveals that South America has the highest prevalence of PSD at 52.30% (95% CI 41.15–63.46%). In rehabilitation units, this rate is 42.42% (95% CI 34.20–50.64%). Women are notably affected, with a prevalence of 41.17% (95% CI 36.97–45.36%) and a higher risk (OR: 1.376, 95% CI 1.315–1.439) than men. Individuals over 65 years exhibit a higher prevalence of 40.26% (95% CI 35.68–44.84%). Fiberoptic endoscopic evaluation of swallowing test shows a striking prevalence of 64.27% (95% CI 55.72–72.81%), and Video fluoroscopic Swallowing Study is 46.93% (95% CI 41.99–51.87%). The the Speech Language Physiotherapist group accounts for 41.36% (95% CI 36.61–46.11%), and a positive correlation between the prevalence of PSD and the NIHSS score. The prevalence of PSD is higher in non-acute strokes, the hemorrhagic strokes, right hemisphere strokes, as well as in the cardioembolism group and the total anterior circulation syndrome (TACS) group. Hemorrhagic strokes [OR: 2.111 (95% CI 1.781–2.503)], the CARDIOEMBOLISM GROUP [OR: 1.531 (95% CI 1.381–1.698)], and TACS group [OR: 2.895 (95% CI 1.495–5.607)] were associated with higher risk of PSD. Conclusions: We found that various factors, including spatial, temporal, demographic characteristics, and stroke-related factors, all influence the prevalence of PSD. More high-quality epidemiological research is needed to explore the links between PSD, demographic characteristics, and stroke-related factors. Caution is advised when interpreting our study results due to the included studies' heterogeneity. [ABSTRACT FROM AUTHOR]

Disorders and diseases present considerable challenges to human society, and among them, dysphagia stands out as a frequently observed disorder, notably affecting both the elderly and pediatric populations. Addressing this issue has been the focus of numerous clinical and medical research efforts. However, a comprehensive approach that investigates both the mechanical and biological aspects of dysphagia holds promise for proposing and implementing more effective solutions. By exploring the mechanobiology of the human digestive system, particularly focusing on swallowing and esophageal peristalsis, a deeper understanding of dysphagia can be gained. Studying the rheological behavior of food during the digestion process becomes crucial, allowing for the customization of food diets for individuals affected by this disorder. This review provides an overview of various mathematical and finite element analysis (FEA) models that have been proposed to address dysphagia. Additionally, it explores the rheological properties of the food bolus, offering acumens that can contribute to a more nuanced understanding of the disorder. This multidimensional approach holds the potential to improve both the diagnosis and treatment of dysphagia, ultimately enhancing the quality of life for individuals affected by this condition. [ABSTRACT FROM AUTHOR]

Introduction: Esophageal cancer impairs basic functions such as eating and drinking frequently resulting in difficulty swallowing (dysphagia) and other problems such as weight loss, pain, fatigue, and taste alterations. There is still a research gap in understanding the impact of dysphagia on quality of life, as patients continue to bear significant physical and psychological burdens despite advances in treatment. This study attempted to address this gap by examining the lived experiences of dysphagia-related quality of life among esophageal cancer patients. Methods: A phenomenological study was employed to analyze the data provided by 14 patients with esophageal cancer at the Oncology Center of the University of Gondar Comprehensive Specialized Hospital from March to April 2023. An interview guide was employed to carry out in-depth interviews with purposively selected patients. The interviews were audio-taped, translated, transcribed, and analysed using thematic analysis. Results: Three main themes emerged from the analysis of the participant interviews: physical challenges related to difficulty swallowing, altered dietary habits, and struggle to maintain weight; psychosocial strain, including emotional distress and social isolation; and reliance on assistance, encompassing both dependency and financial burden. Conclusion and recommendations: This study underscores the significant physical, emotional, and social challenges experienced by esophageal cancer patients with dysphagia. To enhance support, healthcare providers should develop personalized care plans that address both the physical and emotional aspects of dysphagia, with sensitivity to cultural practices. Efforts should also be made to alleviate feelings of dependency and promote public awareness to reduce stigma and build a more supportive community. [ABSTRACT FROM AUTHOR]

In December 2023, the Chinese Research Hospital Association officially released the association standard of Nursing Practice for Dysphagia in Stroke Patients (T/CRHA 027-2023), setting forth the fundamental requirements of nursing care for dysphagia in stroke patients. The operation of feeding nursing, oral nursing, airway nursing, medication nursing, rehabilitation nursing, psychological nursing, health education, continuous nursing, and complication prevention and treatment were standardized. This paper interprets the core points of the standard to facilitate users to understand, in order to promote the standardized practice of nursing care for dysphagia in stroke patients. [ABSTRACT FROM AUTHOR]

Background: Internationally adopted Chicago Classification (CC) criteria based on adult normative data have been used to diagnose children with esophageal motility disorders undergoing high‐resolution esophageal manometry (HREM). The aim of this study was to compare HREM parameters of children without dysphagia and children with dysphagia and normal findings according to CC. Methods: HREM metrics of 41 children (13.2 (9–18) years; 20 female) without dysphagia and 41 children (13.7 (8–18) years; 30 female) with dysphagia and normal diagnosis according to CC were compared. Analyzed data included resting and integrated relaxation pressures (IRP) of upper (UES) and lower (LES) esophageal sphincters, esophageal peristaltic contractile integrals, transition zone (TZ) gaps, distal latency (DL), and manometric esophageal length to height ratio (MELH). 95%ile normative cutoffs were calculated from the cohort without dysphagia. Key Results: Proximal contractile integral (PCI), UES and LES mean resting and IRP were not significantly different between the cohorts (p > 0.3). On the contrary, distal contractile integral (DCI), TZ gap and MELH were notably different with p = 0.0002, p = 0.027, and p = 0.033 respectively. According to 95%ile normative cutoffs of DCI, TZ gap and MELH, in cohort with dysphagia 27%, 15%, and 22% of patients respectively were not normal. Conclusion & Inferences: First study ever to compare HREM parameters of children without dysphagia to children with dysphagia. Considerable proportion of children with dysphagia may be underdiagnosed according to the adult criteria. This emphasizes the need for universally accepted child‐specific diagnostic protocols and norms. [ABSTRACT FROM AUTHOR]

Background: Post‐stroke dysphagia can lead to serious complications and appropriate rehabilitation can significantly improve swallowing function. However, the best rehabilitation method for post‐stroke dysphagia patients is not clear at the present stage, so it is necessary to conduct a comprehensive network meta‐analysis and systematic review of different interventions for dysphagia. Objective: To compare the effectiveness and ranking of different interventions for improving swallowing function, and feeding and daily function in patients with post‐stroke dysphagia. Methods: Seven databases were searched from the date of inception to September 1, 2022. Two investigators independently conducted literature searches, selected randomized controlled trials on dysphagia interventions, and assessed study quality. Network meta‐analysis was conducted by using Stata software. Results: A total of 33 studies involving 1,341 patients were included. According to the ranking probabilities, acupuncture was rated as the most effective of all interventions to enhance patients' swallowing function (surface under cumulative ranking curve values [SUCRCV]: 99.0%, standardized mean difference [SMD]: −2.40, 95% confidence interval [CI]: −3.38 to −1.43), followed by the chin tuck against resistance exercise (CTAR, SUCRA: 89.9%, SMD: −1.83, 95% CI: −2.69 to −0.97). Among all the interventions, acupuncture was the most effective for feeding and daily function (SUCRCV: 88.4%, SMD: −1.62, 95% CI: −2.94 to −0.30). Conclusions: The results showed that acupuncture was the most effective in the rehabilitation of patients with post‐stroke dysphagia, followed by CTAR. Considering that CTAR is a low‐cost and highly feasible intervention, we suggest that CTAR should be selected as a rehabilitation measure for patients with post‐stroke dysphagia to improve their swallowing function. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effects of early swallowing rehabilitation on safe oral feeding in dysphagia patients following traumatic brain injury. Methods: Sixty-nine patients were divided into intervention and control groups, with the intervention group receiving swallowing rehabilitation therapy. The severity of swallowing disorders, cognitive function, and level of consciousness were assessed using the Mann Assessment of Swallowing Ability (MASA), Rancho Los Amigos (RLA), and Glasgow Coma Scale (GCS) before and after the intervention. Additionally, data on ventilator use duration and hospital stay length were collected. Result: The intervention group exhibited a significant improvement in MASA scores (68.58) compared to the control group (38.10). No significant differences were observed in GCS and RLA scores post-intervention, indicating similar levels of consciousness and cognitive function between groups. While the duration of ventilator use was comparable, the intervention group achieved safe oral swallowing 12.12 days earlier than the control group. Discussion: The findings demonstrate that early swallowing rehabilitation significantly enhances recovery dysphagia post-brain injury, as evidenced by improved MASA scores and earlier achievement of safe oral feeding, despite no notable changes in cognition or consciousness. This underscores the importance of implementing early rehabilitation strategies in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Dysphagia is most prevalent among post stroke aging adults. This systematic review was conducted to collect evidence-based data regarding assessment and therapeutic techniques used to rehabilitate post stroke dysphagia patients. Methods: Four major databases including PubMed, Cochrane Library, Science direct and Google scholar were searched systematically using the defined search strategy to target Randomized Controlled Trials conducted from January 2018 to 2023 using the pre-defined search strategy by three independent reviewers. Results: After following PRISMA guidelines, fifteen articles matched the inclusion criteria. Several evidence based therapies like Neuromuscular Electrical Stimulation Therapy, Effortful Swallowing Training, Tongue Pressure Strength and Accuracy Training, Electrical Stimulation of Hyoid Muscles, Modified Chin Tuck Against Resistance exercise, Oral Neuromuscular Training, and Conventional Speech Therapy with Functional Electrical Stimulation were used frequently for the treatment of old age post stroke dysphagia in different rehabilitation centers. Along with this, a list of different assessment methodologies and tools was made that were used including Functional Oral Intake Scale, Fiber optic Endoscopic Evaluation of Swallowing, Penetration Aspiration Scale, Pooling Scale, Video fluoroscopic Dysphagia Scale, Iowa Oral Performance Instrument, Mann Assessment of Swallowing Ability, and Repetitive Saliva Swallowing Test. Conclusion: Dysphagia is known to be serious complication of stroke. This systematic review shows a significant impact of therapeutic techniques on post stroke dysphagia patients and demonstrates that neuromuscular electrical stimulation therapy is one of the most effective therapeutic techniques used to rehabilitate post stroke dysphagia patients. [ABSTRACT FROM AUTHOR]

Background/Aims Functional lumen imaging probe (FLIP) Panometry has demonstrated utility in the assessment of esophageal motility as a complement to existing methodologies like high-resolution manometry. However, as FLIP is typically performed with sedation during routine endoscopy, there is potential for impact of sedation agents on esophageal motility. We aim to examine the effects of conscious sedation with midazolam and fentanyl on FLIP Panometry metrics and classification. Methods A cross-over study was conducted on 12 healthy, asymptomatic volunteers that completed FLIP while sedated with intravenous fentanyl and midazolam and while awake on a separate day. FLIP was performed in the same manner in both conditions with transoral placement of the FLIP and stepwise FLIP filling. During awake FLIP, subjects also rated the presence and intensity of esophageal perception. Results In both experimental conditions, all subjects demonstrated normal motility. The esophagogastric junction distensibility index was lower (median [interquartile range]: 5.8 [5.15-6.85] vs 8.9 [7.68-9.38] mm2/mmHg; P = 0.025), and the FLIP pressure was higher (46.5 [38.125-52.5] vs 33 [26-36.8] mmHg; P = 0.010) in the sedated condition compared to the awake condition. Maximum esophagogastric junction diameter and body distensibility plateau were no different between conditions (P = 0.999 and P = 0.098, respectively). Perception of esophageal sensation during awake FLIP was reported in 7/12 (58%) subjects. Conclusions While numeric differences in FLIP Panometry metrics were observed between sedated and awake FLIP in healthy subjects, these differences did not change the FLIP Panometry diagnosis. Sedated FLIP offers a well-tolerated method to assess esophageal motility during endoscopy. [ABSTRACT FROM AUTHOR]

Background: Our study aims to assess the association between chemotherapy-induced oral ulcerative mucositis (CT-UM) or radiotherapy-induced oral ulcerative mucositis (RT-UM) and the burden of illness (BOI), dysphagia, and disparities among patients with cancers of the oral cavity, lip, and pharynx (CLOP) and hematopoietic stem cell transplant patients (HSCT). Methods: The study used US national data to investigate the association between UM and the BOI—length of stay (LOS) and dysphagia. The BOI was measured by length of stay (LOS), dysphagia, and associated disparities in these outcomes. This investigation was conducted using generalized linear models (glm). Results: An analysis was conducted on a sample of 820 patients with CT-UM and 1010 patients with RT-UM, out of a total of 59,710 hospitalized CLOP patients, and 1380 patients with CT-UM from 10,885 total hospitalized HSCT patients. Among, CLOP patients, CT-UM status was associated with increased LOS (Coeff,1.54; 95% CI 1.36 to 1.74) and also associated with a greater likelihood of dysphagia (aOR, 2.11; 95% CI 1.52–2.95). However, among CLOP, RT-UM status was also associated with increased LOS (Coeff, 1.33; 95% CI 1.14–1.55), but there was no association of d RT-UM status and dysphagia (aOR = 1.21; 95% CI 0.84–1.77). Among HSCT patients, CT-UM status was associated with increased LOS and greater likelihood of dysphagia (Coeff, 1.09; 95% CI 1.02–1.16 and aOR = 2.08; 95% CI 1.11–3.9, respectively). Further, UM outcomes disproportionately affect females, Blacks, Hispanics, Medicaid recipients, and those with lower incomes. Conclusion: The findings highlight the need for more effective methods of screening for and preventing UM in order to decrease BOI, especially in the context of systemic treatments. Additionally, new computational methods including artificial intelligence for mucositis prediction should be the center of future studies. [ABSTRACT FROM AUTHOR]

Background: This study presents a comprehensive investigation into the correlation between Rare Diseases and Syndromes (RDS) and the dysphagic disorders manifested during childhood and adulthood in affected patients. Dysphagia is characterized by difficulty or an inability to swallow food of any consistency, as well as saliva or medications, from the oral cavity to the stomach. RDS often present with complex and heterogeneous clinical manifestations, making it challenging to develop standardized diagnostic and therapeutic approaches. Dysphagia can arise from various etiologies, including those related to the central nervous system, inflammatory and neoplastic processes, anatomical or structural disorders, and neuromuscular conditions. These diverse etiologies can result in both structural and functional deficits or neurological impairments that compromise swallowing function. While RDS frequently leads to uncommon conditions, dysphagia remains an underrecognized complication. Objectives: The primary objective of this review is to illuminate the latest knowledge concerning the management of dysphagia in both pediatric and adult populations within the context of RDS, with a particular focus on current therapeutic approaches. To achieve this, the study provides a comprehensive analysis of existing strategies for managing dysphagia in RDS, highlighting recent advancements in therapy while identifying critical gaps in clinical knowledge and practice. By synthesizing available evidence, the review aims to deepen understanding of the unique challenges associated with dysphagia in these conditions and explore innovative interventions to enhance patient care and outcomes. Results: The integration of innovative therapeutic techniques into the speech-language pathology treatment of dysphagia augments traditional strategies, offering updated knowledge that can be applied to prognosis and therapeutic interventions across various ages and racial groups. This review also provides an overview of symptomatology, assessment techniques, and the specific characteristics of dysphagia associated with various genetic and acquired RDS. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a significant concern for head and neck cancer (HNC) patients, as treatment often impairs mastication, causes dysphagia, and alters taste and smell, leading to reduced food intake and a diminished quality of life. Thus, this study aims to compare nutritional intake in HNC survivors using maxillofacial prostheses (MFPs) to healthy reference values and identify the factors influencing their dietary intake. Methods: The study included 56 patients treated for HNC undergoing rehabilitation with comfortable definitive dentures for over a month at the Maxillofacial Prosthetics Clinic of Tokyo Medical and Dental University Hospital. Data were gathered on the demographics, clinical characteristics, malnutrition risk using a malnutrition universal screening tool, dietary intake consistency via a functional oral intake scale, swallowing difficulties with eating assessment tool-10, and nutrient intake through a Brief-type Self-administered Dietary History Questionnaire. Patients' nutrient intakes were compared to the reference values from the BDHQ ad hoc computer algorithm based on the 2015 National Health and Nutrition Survey in Japan. Factors such as maximum mouth opening and the number of functional teeth were also assessed together with the aforementioned factors. Results: There were significant differences between the patient values and reference values, with lower intakes of total dietary fiber, carbohydrates, and β-carotene, while higher intakes of calcium, fats, and certain vitamins were noted in the patients. Food intake consistency, swallowing difficulties, and mouth opening significantly influenced green vegetable intake, whereas sex and the number of functional teeth impacted cereal intake. Conclusions: The HNC survivors were rehabilitated with MFP; however, their nutritional intake differed from that of healthy subjects. The significance of swallowing rehabilitation, appropriate food preparation, exercises to enhance mouth opening, and the preservation of functional teeth has been emphasized as critical factors influencing diet in head and neck cancer (HNC) survivors. Additionally, the importance of a multidisciplinary approach to nutritional care for these individuals is underscored. [ABSTRACT FROM AUTHOR]

A dysphagia diet is a special dietary programme. The development and design of foods for dysphagia should consider both swallowing safety and food nutritional quality. In this study, we investigated the rheological properties (viscosity, thixotropy, and viscoelasticity), textural properties, and swallowing behaviour of commercially available natural, pregelatinised, acetylated, and phosphorylated maize starch and tapioca starch. The results showed that all the samples belonged to food grade 3 in the framework of the International Dysphagia Dietary Standardization Initiative (IDDSI) and exhibited shear-thinning behaviour in favour of dysphagia patients, except for the sample containing pregelatinised starch, which was grade 2. Rheological tests showed that the samples had good structural recovery properties. At the same starch concentration, the elastic modulus of phosphorylated cassava starch FSMP was significantly greater than that of the starch solution, whereas that of acetylated starch was significantly less than that of the starch solution, and the combination of acetylated starch and protein led to a significant viscosity reduction phenomenon, resulting in FSMPs with good stability and fluidity; this may provide an opportunity for the incorporation of more high-energy substructures. The textural results showed that all the samples possessed textural properties of low hardness, low adhesion, and high cohesion, all of which could be used as food for dysphagia patients. This study may provide a theoretical basis for the creation and design of novel nutritional foods for dysphagia. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a common neurodegenerative condition that can lead to problems swallowing. Individuals living with PD may be unable to take medications orally for various reasons including acute or chronic dysphagia, non-PD related causes and being placed nil-by-mouth for elective reasons. This article outlines a five-step approach to managing an individual living with PD who is unable to take oral medication acutely. This includes assessment for the appropriateness of nasogastric tube insertion and the conversion of an individual's usual medication regimen to either a dispersible one or to a topical patch if a nasogastric tube is not possible. A patient-centred multidisciplinary approach is important, with shared decision-making involving the individual and their next of kin with key members including the Speech and Language Therapy and dietetic teams. The patient should be reviewed daily with their medication titrated according to clinical response, aiming to restart their usual regimen as soon as possible. [ABSTRACT FROM AUTHOR]

An 80-year-old lady had a history of progressive swallowing difficulty over several years with significant weight loss, but prior investigations in several medical departments proved negative. Neurological assessment noted her complaint of impaired feeling for food in her mouth and examination showed impaired corneal reflexes and facial sensory function. Blink reflex electrodiagnostic testing was consistent with a diagnosis of facial onset sensory and motor neuronopathy (FOSMN). This article raises awareness of the diagnosis, investigation and treatment of FOSMN. [ABSTRACT FROM AUTHOR]