Manejo de la disfagia en pacientes con antecedente de infección severa por COVID-19 / Manejo de la disfagia en pacientes con antecedente de infección severa por COVID-19

de la deglución, los cuales representan todas las alteraciones del proceso fisiológico encargado de llevar el alimento desde la boca al esófago y después al estómago, salvaguardando siempre la protección de las vías respiratorias. OBJETIVO. Definir el manejo óptimo, de la disfagia en pacientes con antecedente de infección severa por COVID-19. METODOLOGÍA. Se realizó una revisión de la literatura científica en las bases de datos PubMed y Elsevier que relacionan el manejo de la disfagia y pacientes con antecedente de infección severa por SARS-CoV-2. Se obtuvo un universo de 134 artículos que cumplieron los criterios de búsqueda. Se seleccionaron 24 documentos, para ser considerados en este estudio. RESULTADOS. La incidencia de disfagia posterior a infección severa por SARS-CoV-2 fue del 23,14%, siendo la disfagia leve la más frecuente 48,0%. Los tratamientos clínicos más empleados en el manejo de la disfagia fueron rehabilitación oral y cambio de textura en la dieta en el 77,23% de los casos, mientras que el único tratamiento quirúrgico empleado fue la traqueotomía 37,31%. Un 12,68% de pacientes recuperó su función deglutoria sin un tratamiento específico. La eficacia de los tratamientos clínicos y quirúrgicos en los pacientes sobrevivientes de la infección severa por SARS-CoV-2 fue del 80,68%, con una media en el tiempo de resolución de 58 días. CONCLUSIÓN. La anamnesis es clave para el diagnóstico de disfagia post COVID-19. El tratamiento puede variar, desde un manejo conservador como cambios en la textura de la dieta hasta tratamientos más invasivos como traqueotomía para mejorar la función deglutoria.

INTRODUCTION. The difficulty to swallow or dysphagia is included within the problems of swallowing, which represent all the alterations of the physiological process in charge of carrying the food from the mouth to the esophagus, and then to the stomach, always taking into account the protection of the airways. OBJECTIVE. To define the optimal management, both clinical and surgical, for the adequate treatment of dysphagia produced as a consequence of severe SARS-CoV-2 infection. METHODOLOGY. A review of the scientific literature was carried out using both PubMed and Elsevier databases, which relate the management of dysphagia and patients with a history of severe SARS-CoV-2 infection. RESULTS. The incidence of dysphagia following severe SARS-CoV-2 infection was of 23,14%, with mild dysphagia being the most frequent 48,00%. The most frequently used clinical treatments for dysphagia management were oral rehabilitation and change in dietary texture in 77,23% of cases, while tracheotomy was the only surgical treatment used 37,31%. A total of 12,68% of patients recovered their swallowing function without specific treatment. The efficacy of clinical and surgical treatments in survivors of severe SARS-CoV-2 infection was 80,68%, with a mean resolution time of 58 days. CONCLUSION. An adequate medical history is key to the diagnosis of post-COVID-19 dysphagia. Treatment can range from conservative management such as changes in diet texture to more invasive treatments such as tracheotomy to improve swallowing function.

Manejo hospitalario de la persona mayor con disfagia / Clinical management of elderly with dysphagia

La disfagia es la alteración de la seguridad y eficacia del proceso deglutorio que dificulta el correcto paso del alimento/saliva desde la boca hacia el estómago, lo que aumenta la probabilidad de desnutrición, deshidratación y aspiración pulmonar con un consiguiente empeoramiento del pronóstico[1]. Los cambios en el acto de tragar relacionados con la edad se llaman presbifagia[6], un cuadro altamente prevalente afectando entre 13-30% de las personas mayores autovalentes, e incrementando considerablemente, en contexto de hospitalización, al 30-47% por causas adicionales[7]: mecánicas, neurológicas o iatrogénicas, que potencian las complicaciones o desestabilizan el equilibrio deglutorio. Recientemente la disfagia se considera un síndrome geriátrico[6], lo que conlleva desafíos para el equipo multidisciplinario respecto de prevenir y disminuir efectos adversos[8]. El conflicto principal, es que para el equipo hospitalario resulta un desafío detectar a personas mayores con riesgo aspirativo, por lo que no son identificados a tiempo[6­8]. El objetivo de este artículo es exponer un esquema multidisciplinario de detección de riesgo aspirativo en contexto de hospitalización de la "Unidad Especializada de Cuidado en persona Mayor" (UCAM) de Clínica Las Condes, para lo cual, primero se revisa literatura asociada a disfagia, clasificación reciente, consecuencias, métodos de evaluación recomendados y condiciones específicas, asociadas a riesgo aspirativo y segundo, se definen dos vías junto con Geriatría, Enfermería y Nutrición: 1) Se definen criterios de derivación fonoaudiológica oportunos para evaluación clínica de la deglución, y 2) Método precoz de pesquizaje y evaluación multidisciplinario de disfagia orofaríngea y riesgo aspiratorio.

Dysphagia is the alteration of the safety and efficacy of the swallowing process that prevents the correct transit of food/saliva from the mouth to the stomach, which increases malnutrition, dehydration and pulmonary aspiration and patient's bad prognosis[1]. The changes in the act of swallowing related to age are called presbyophagy[6]. A highly prevalent affect of self-worthy elderly people (between 13-30%), and increasing considerably in hospitalization context (30-47%) for additional causes[7]: mechanical, neurological or iatrogenic, which increases complications or destabilizes swallowing balance. Recently dysphagia it is considered a geriatric syndrome[6], that challenges the multidisciplinary team regarding prevention and reduction of adverse effects related to hospitalization units of elderly people[8]. One of the main tasks of the healthcare team is the early detection of elderly people with aspiration risk. The objective of this article is present a multidisciplinary protocol of EP with dysphagia in the context of hospitalization in the "Specialized care unit for the elderly" (SCUE) of Clínica Las Condes. Initially, literature associated with oropharyngeal dysphagia (OD), recent classification, consequences, recommended evaluation methods and specific conditions associated with were reviewed. Accordingly, two routes are defined with SCUE'team, Speech language pathologist, Geriatrics, Nursing and Nutrition. 1) opportune referral criteria of Speech language pathologist for clinical swallowing evaluation and 2) Early multidisciplinary screening and evaluation method of OD and aspiration risk.

Evaluación Fonoaudiológica de la disfagia: Encuentros y disonancias / Assessment phonoaudiological dysphagia: Meetings and disonancias

El presente artículo surge del proceso de investigación titulado"Identificación de las pruebas objeti-vas y subjetivas utilizadas por fonoaudiólogos para la evaluación y diagnóstico de la disfagia", realizado en Universidad Santiago de Cali. Se propone debatir sobre los encuentros y disonancias en torno a la evaluación fonoaudiológica de la disfagia para lo cual se realizó un estudio cuantitativo, ob-servacional descriptivo transversal, con el uso de encuesta estructurada. La población de estudio correspondió a fonoaudiólogos que laboraban en el área de alimentación, específicamente en la disfagia, en la ciudad de Santiago de Cali (Colombia), entre enero de 2014 y junio de 2015. Los resultados obtenidos permiten visualizar cómo se encuentra la Fonoaudiología frente al hacer profesional en la evaluación de la disfagia, los modelos conceptuales que cimentan la praxis; pero también posibilitan llegar al análisis del quehacer Fonoaudiológico en relación a su experti-cia y formación. Los resultados que se presentan, desde los encuentros y las disonancias, abren el camino a repensar posiciones conceptuales y gremiales en pro de la visibilización de la profesión en el área de la salud

This article arises from the research process called "Identification of the objective and subjective tests used by speech therapists for evaluation and diagnosis of dysphagia" held in Santiago de Cali University. To answer the problem question a quantitative, descriptive observational cross-sectional study was conducted using structured survey. The study population corresponded to speech therapists who work in the food area, specifically in dysphagia, in the city of Santiago de Cali (Colombia) during second half, 2014 - first half, 2015.The results allow to visualize how the Fonoaudiología is facing the professional make the evalua-tion of dysphagia, conceptual models that underpin the practice; but also enable analysis pho-noaudiological reach actions related to their expertise and training. The results presented from encounters and dissonances, open the way to rethink conceptual and union positions towards the visibility of the profession in the world of health

Utilização de protocolos de qualidade de vida em disfagia: revisão de literatura / Use of protocols for quality of life in dysphagia: literature review

Resumo:O objetivo deste estudo foi identificar os protocolos existentes sobre qualidade de vida (QV) em disfagia e verificar a utilização dos mesmos no tratamento fonoaudiológico. Realizou-se pesquisa teórica e exploratória com a técnica de revisão da literatura nas bases de dados SCOPUS, Trip Database, LILACS, PubMed, SciELO, Google Schoolar, periódicos Capes e MedLine. O período de busca compreendeu os anos entre 2004 e 2014 e foram utilizados os seguintes descritores: deglutição; transtornos da deglutição; qualidade de vida; questionários e os seus respectivos termos em inglês deglutition; deglutition disorders; quality of Life; questionnaires. Foram encontrados na literatura o protocolo Quality of life in Swallowing Disorders-SWAL-QOL, o qual estabelece o comprometimento da deglutição independente da etiologia; o MD Anderson Dysphagia Inventory, que é específico para sujeitos submetidos à tratamento de câncer de cabeça e pescoço e o Dysphagia Handicap Index,que avalia os efeitos da disfagia sobre a qualidade de vida (QV) em sujeitos com diferentes patologias de base e pode ser utilizado em níveis mais baixos de escolaridade. A literatura propõe diferentes protocolos que avaliam a QV em disfagia, sendo que os mais utilizados avaliam a QV de forma geral, relacionada ao câncer de cabeça e pescoço e de sujeitos com diferentes diagnósticos médicos. A utilização desses protocolos pode auxiliar e complementar a avaliação clínica e objetiva da deglutição, uma vez que, retratam a autoavaliação referida pelo sujeito, sendo este ponto de vista de extrema importância para o tratamento fonoaudiológico.

Abstract:The purpose of this study was to identify the use of protocols on quality of life (QoL) in dysphagia and verify their use in reahbilitation. A theoretical and exploratory research with the review of the literature technical, on the basis of SCOPUS data, Trip Database, LILACS, PubMed, SciELO, Google Scholar, Capes journals and MedLine. The search time comprised the years between 2004 and 2014 and the following keywords were used: deglution; deglution disorders; quality of life; questionnaires. The protocols found in the literature was the Quality of life in Deglution Disorders-SWAL-QOL, which establishes the impairment of swallowing independent of the etiology; the MD Anderson Dysphagia Inventory, which is specific for subjects submitted treatment for head and neck cancer and the Dysphagia Handicap Index, which evaluates the effects of dysphagia on quality of life (QoL) in subjects with different pathologies and it can be used at lower levels of education.The literature proposes different protocols that assess QoL in dysphagia, the most used to assess QoL in general, related to head and neck cancer and subjects with different medical diagnoses . The use of these protocols can support and complement the clinical and objective evaluation of deglution since they portray the self-assessment by the subject, and this view is extremely important for speech and language therapy.

Algoritmo para la transformación de consistencia como estrategia de abordaje fonoaudiológico / Algorithm for transforming consistency as strategy approach phonoaudiological

El trabajo objetiva presentar un algoritmo de atención para transformación de consistencia como estrategia de abordaje del paciente con déficit motor a partir de caracterizaciones realizadas a procesos de abordaje fonoaudiológico, fruto del trabajo proyectado desde las prácticas profesio-nales de la Universidad de Pamplona. Luego de un estudio detallado de procedimientos asisten-ciales en deglución, y de la triangulación de datos referentes a diagnóstico y abordaje, se elaboró un algoritmo de atención para transformación de consistencia que se articuló en escenarios for-mativos durante un año; al cual se adhirieron profesionales de la salud, como el nutricionista, personal administrativo y de apoyo. La funcionalidad del algoritmo permitió su ingreso a orga-nigramas de acción institucionales. Después de un año de pruebas y adhesión a organigramas laborales en instituciones de salud, se da origen a un algoritmo de atención que detalla los pasos necesarios desde la Fonoaudiología para abordar a través de estrategias de transformación de consistencias al paciente con déficit motor. Este algoritmo permitirá a profesionales del área esta-blecer mecanismos de atención funcionales que puedan replicarse a casos similares que ameriten como estrategia terapéutica la transformación de consistencia.

The work aims to present an attentiveness algorithm for processing consistency as a strategy for addressing patient with motor deficit from characterizations carried out to phonoaudiological approach processes, resulting from work projected in the professional practices of the University of Pamplona. After a detailed study on assistance procedures in swallowing, and triangulation of data referring to diagnosis and approach, an attentiveness algorithm for transformation of consistency was made, articulated in training scenarios for a year; which was joined by health professionals, as the nutritionist, administrative and support staff. The functionality of the algo-rithm allowed admission to institutional organizational action. After a year of testing and adhe-rence to organizational work in health institutions, it was originated an attentiveness algorithm that details the steps from the phonoaudiology to address through consistencies transformation strategies for patients with motor deficits. This algorithm will allow professionals to establish mechanisms of functional area that can be replicated to similar cases that require therapeutic strategy and the transformation of consistency

Diferenças entre homens e mulheres da mesma altura corporal no teste de ingestão de água / Differences between men and women with the same height in the water swallow test

Introdução: há trabalhos que demonstram que a dinâmica da deglutição é influenciada pelo gênero, o que poderia ser consequente a diferenças anatômicas entre homens e mulheres. Entretanto, estes trabalhos não consideraram o possível efeito da altura corporal dos indivíduos. Nossa hipótese é que as diferenças previamente observadas não devem acontecer quando os indivíduos tiverem idades e alturas semelhantes. Objetivo: avaliar a dinâmica da deglutição de água em homens e mulheres com idades e alturas corporais semelhantes. Método: utilizando o teste de ingestão de água, estudamos 60 voluntários saudáveis, 30 homens [idade: 40,7 (12,9) anos, altura: 1,69 (0,05)m] e 30 mulheres [idade: 37,3 (11,4) anos, altura: 1,68 (0.05)m]. O teste foi realizado com o voluntário sentado, com a ingestão contínua de 50 ml de água, e a medida do tempo de ingestão e contagem do número de deglutições para ingerir todo volume. Com estes resultados, calculamos o intervalo entre deglutições, o fluxo de ingestão e o volume por deglutição. Resultados: o número de deglutições para ingerir todo volume foi, em média, maior nas mulheres [4,3 (1,6)] do que nos homens [3,9 (1,8); p=0,04]. Sendo assim, o volume por deglutição foi menor nas mulheres [13,4 (5,0) ml] do que o volume por deglutição observado nos homens [17,3 (12,5) ml; p=0,04]. Não houve diferença entre os gêneros no tempo de ingestão, no intervalo entre deglutições e no fluxo de ingestão. Conclusão: mulheres ingerem água em menor volume em cada deglutição quando comparadas com homens com idades e alturas corporais semelhantes.

Introduction: there are results reporting that there are differences between men and women in the dynamics of swallowing, which may be consequence of anatomic differences between genders. Objective: to evaluate the dynamics of water ingestion in men and women with similar heights and ages. Our hypothesis was that the differences previously found might not be seen if they have similar age and similar height. Method: we evaluated by the water swallow test the dynamics of water ingestion in 60 healthy volunteers, 30 men [age: 40.7 (12.9) years; height: 1.69 (0.05)m] and 30 women (age: 37.3 (11.4) years; height: 1.68 (0.05) m]. The test was performed with the volunteers in the sitting position. They ingested continuously and confortably 50 ml of water while precisely timed and counted the number of swallows needed to ingest all the volume. Results: The number of swallows to ingest all the volume was greater in women [4.3 (1.6)] than in men [3.9 (1.8); p=0.04]. The volume capacity in each swallow was smaller in women [13.4 (5.0) ml] than in men [17.3 (12.5) ml; p=0.04]. There was no difference in the duration of ingestion, in the time between swallows and in the flux of ingestion. Conclusion: even with similar ages and height women ingest water in smaller volume in each swallow than men.

Tiroides lingual como causa de disfagia: Caso clínico / Disphagia caused by a lingual thyroid: Report of one case

We report all year-old boy who presented with difficulty in swallowing without symptoms of hypothyroidism. The physical examination revealed a mass at the base of the tongue. The thyroid hormone profile showed a primary hypothyroidism (a serum TSH of 10.8 IU/mL with normal-low thyroxin of 6.0 fig/dL and low triiodothyronine of 57.8 ng/ dL). Antithyroid antibodies were negative. The fiberoptic endoscopy showed a reddish mass, without evidence of haemorrhage or ulceration, confirmed as a well circumscribed, hypodense mass in the base of the tongue by computed tomography of the oropharynx and neck. Tc-99-pertechnetate scanning showed an abnormal area of uptake at the base of the tongue and no uptake in the normal thyroid location, concordant with an ectopic lingual thyroid gland. Levothyroxine in a suppressive dose was started that resulted in a reduction of the size of the mass and disappearance of dysphagia.