Application of quantification of food thickness in patients with swallowing difficulty after thyroidectomy / 中国实用护理杂志

Objective:To explore the effect of quantifying food thickness in patients with swallowing difficulty after thyroidectomy.Methods:A total of 70 patients with swallowing difficulty after thyroidectomy in Department of Thyroid and Neck Oncology, Tianjin Medical University Cancer Institute & Hospital, during April 2019 to March 2020, randomly divided into intervention group(35cases) and control group(35cases). The patients in the control group were treated with conventional dietary nursing measures after thyroidectomy. The patients in the intervention group were treated with dietary guidance according to the results of quantifying food thickness and conventional dietary nursing. The incidence of aspiration was compared during hospitalization, the swallowing function were evaluated in the two groups pre intervention and on discharge, and relationship was evaluated between Kubota drinking test level and food consistency grade of safe eating in intervention group.Results:The incidence of aspiration in the intervention group (0) was lower than that in the control group 28.57% (10/35) and the difference was statistically significant ( χ2 value was 11.667, P<0.01). Before intervention the difference in the degrees of Kubota drinking test had no statistical significance between two groups before intervention ( Z value was -0.283, P>0.05). After interventions the degrees of Kubota drinking test was graded as gradeⅠ(1 example), gradeⅡ(4 examples), gradeⅢ(20 examples), grade Ⅳ(9 examples), gradeⅤ(1 example) respectively, meanwhile the degrees of control group was graded as gradeⅠ(0 example), gradeⅡ(1 example), gradeⅢ(16 examples), grade Ⅳ(17 examples), gradeⅤ(1 example) respectively. The difference between two groups was statistically significant ( Z value was -2.170, P<0.05). Moreover, the improvement of swallowing function in the intervention group was larger than that of the control group and the difference in the degree of the swallowing function was statistically significant between two groups ( Z value was -2.029, P<0.05). Before intervention the difference of the score of Eating Assessment Tool-10 had no statistical significance between two groups ( t value was 0.168, P>0.05). After intervention the score of Eating Assessment Tool-10 in the intervention group was 8.43±2.21, the score of Eating Assessment Tool-10 in the control group was 10.06±2.45, the difference had statistical significance between two groups( t value was -2.919, P<0.01). Conclusion:Quantification of fluid food thickness can more accurately and objectively judge the grade of food consistency that patients can eat safely, and it can effectively reduce the incidence of aspiration and contribute to improving the swallowing function in patients with swallowing difficulty after thyroidectomy and can also help them to recovery.

Gelfoam-induced Swallowing Difficulty after Anterior Cervical Spine Surgery

Symptomatic diffuse idiopathic skeletal hyperostosis (DISH) is not common. Gelfoam is one of the most commonly used topical hemostatic agents. But, in the partially moistened state, air retained in its pores may result in excessive expansion on contact with liquid. The onset of swallowing difficulty after anterior cervical spine surgery due to appling gelfoam is a rare complication. A 77-year-old man with swallowing difficulty was admitted to our hospital and we diagnosed him as DISH confirmed by radiological study. After removing the DISH, patient's symptom was relieved gradually. However, on postoperative day (POD) 7, the symptom recurred but lesser than the preoperative state. We confirmed no hematoma and esophageal perforation on the operation site. We observed him closely and controlled the diet. Three months later, he had no symptom of swallowing difficulty, and was able to be back on a regular diet, including solid foods. We present a complication case of swallowing difficulty occurring by gelfoam application.

Long Term Improvement of Dysphagia in Lateral Medullary Infarction: A Case Report / 이화의대지

This report concerns a male patient suffered from refractory dysphagia after subarachnoid hemorrhage. A 49-year-old man admitted with severe headache followed by mental change. Imaging studies revealed that subarachnoid hemorrhage was located in basal cistern, and demonstrated ruptured vertebral dissecting aneurysm. After operation, the patient recovered well except severe dysphagia. Initial VFSS showed aspiration in fluid trial, penetration in semisolid bolus, and large amount of pharyngeal residue with poor relaxation of upper esophageal sphincter. For about 5 months, his symptom and several follow-up VFSS findings did not show marked improvement by various treatments. On magnetic resonance imaging for further evaluation of his brain lesion, an old infarction in right lateral side of medulla was found. He kept dysphagia rehabilitation more than one year, and his symptom improved to the level of oral feeding at last.

Swallowing Difficulties in Polio Survivors

OBJECTIVE: In patients with a history of acute paralytic poliomyelitis, late progressive muscle weakness, fatigue, pain may arise, a symptom complex of known as post-poliomyelitis syndrome (PPS). Dysphagia may also develop in some PPS patients. The purpose of this study was to assess the presence of is swallowing difficulty in polio survivors and to describe the nature of the swallowing difficulty. METHOD: Polio survivors answered the questionnaire pertaining to swallowing function and received a videofluroscopic evaluation of the oral and pharyngeal phases using 3 consistencies of material: liquid barium; semisolid barium paste; boiled yolk of an egg coated with barium. RESULTS: Of the 16 subjects, 8 had subjective symptoms of swallowing difficulties. All of the 6 PPS patients, regardless of whether they had symptoms of swallowing difficulties, had some abnormal oropharyngeal function through video fluoroscopic swallowing study. CONCLUSION: In patients with post-polio syndrome, there is progressive deterioration of swallowing functions similar to that in the muscles of the limbs. This swallowing dysfunction is not related with their subjective symptoms.

Manometric Characteristics of the Pharynx and upper Esophageal Sphincter in theTotal Laryngectomized Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Total laryngectomy is usually used for patients with advanced laryngeal cancer, and causes injuries to hypopharyngeal mucosa, cricopharyngeal muscle, pharyngeal constrictor muscle. These damages induce postoperative swallowing difficulties, although accurate and objective data have not been reported. The purpose of this study is to evaluate the changes and functional difficulties of swallowing mechanism in patients with total laryngectomy by manometric analysis. MATERIALS AND METHODS: We used station pull-through technique in two groups. The study group consisted of 11 total laryngectomized patients, and the control group consisted of 10 cases. We measured resting pressure, length, pressure after relaxation of UES (upper esophageal sphincter), and pharyngeal pressure. And 5 parameters were analyzed for coordination of hypopharynx and UES during swallowing. RESULTS: In the study group, the resting pressure, the maximal pressure after relaxation, and the length of UES was 36.3+/-10.5 mmHg, 149.8+/-14.6 mmHg, and 3.4+/-0.8 cm respectively. In the control group, the results was 34.9+/-9.6 mmHg, 85.5+/-12.3 mmHg, 2.2+/-0.6 cm respectively. The pharyngeal pressure was 81.8+/-10.1 mmHg in the study group, and 67.1+/-12.3 mmHg in the control group. The interval of pharyngeal constriction was 3.0+/-0.23 sec in the study group and 0.49+/-0.04 sec in the control group. The interval of UES relaxation was 2.43+/-0.14 sec in the study group and 0.99+/-0.03 sec in the control group. CONCLUSION: Manometric analysis showed higher pressure of the pharynx and UES in the total laryngectomized patients than in the normal adults. And there was a failure in the coordination between pharyngeal constriction and UES relaxation.