Role of fiberoptic endoscopic evaluation of swallowing (FEES) in children with suspected dysphagia

Abstract Objective To assess FEES findings in defining oral feeding safety in children with suspected dysphagia, comparing them with clinical feeding evaluation results. Methods This study comprised a case series involving children with suspected dysphagia, referred for evaluation by otolaryngologists and speech-language pathologists (SLPs) at a Brazilian quaternary public university hospital. These children underwent both clinical evaluations and fiberoptic endoscopic evaluation of swallowing (FEES), with a comprehensive collection of demographic and clinical data. Subsequently, the authors performed a comparative analysis of findings from both assessments. Results Most patients successfully completed the FEES procedure (93.7%), resulting in a final number of 60 cases included in the study. The prevalence of dysphagia was confirmed in a significant 88% of these cases. Suspected aspiration on clinical SLP evaluation was present in 34 patients. Of these, FEES confirmed aspiration or penetration in 28 patients. Among the 35 patients with aspiration or penetration on FEES, 7 (20%) had no suspicion on SLP clinical assessment. All seven patients in whom clinical SLP evaluation failed to predict penetration/aspiration had neurological disorders. The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders, while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%). Conclusion FEES can diagnose structural anomalies of the upper aerodigestive tract and significantly contribute to the detection of aspiration and penetration in this group of patients with suspected dysphagia, identifying moderate and severe dysphagia even in cases where clinical assessment had no suspicion.

Model based on clinical characteristics to identify patients with neurogenic oropharyngeal dysphagia

Introduction: Neurogenic oropharyngeal dysphagia is a form of functional dysphagia usually caused by neurological and neuromuscular diseases, which produces several secondary complications. To improve its detection and characterization, models are emerging that integrate clinical variables to complement the physical examination of swallowing. Objective: Develop an explanatory model to differentiate patients with neurogenic oropharyngeal dysphagia. Materials and Methods: Case-control study based on a set of data derived from the clinical examination of swallowing with neurological emphasis carried out in a sample of patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes (cases), and in healthy people (controls). Results: 158 clinical variables were compared between both groups, where those with the greatest classification capacity were identified, integrated into an explanatory binary logistic regression model made up of nine variables: two history, two symptoms, three physical examination signs and two signs after consistency/volume test with food. The dependent variable was the category of being healthy or patient and the covariates were the clinical variables. Parameters reached by the model: Akaike information criterion 102 and Nagelkerke R2 0.78. Discussion: The nine variables that entered the model, together, largely explain the presence of neurogenic oropharyngeal dysphagia, and are accessible by physical examination of swallowing. Conclusions: The model obtained can improve and/or complement the evaluation process carried out in patients with dysphagia of functional causes, neurological and neuromuscular diseases, in screening and diagnostic characterization processes.

Introducción: La disfagia orofaríngea neurogénica es una forma de disfagia funcional causada habitualmente por enfermedades neurológicas y neuromusculares, que produce varias complicaciones secundarias. En pro de mejorar su detección y caracterización surgen modelos que integren variables clínicas para complementar el examen físico de la deglución. Objetivo: Desarrollar un modelo explicativo para diferenciar pacientes con disfagia orofaríngea neurogénica. Materiales y Métodos: Estudio de casos y controles basado en un conjunto de datos derivados del examen clínico de la deglución con énfasis neurológico realizado en una muestra de pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares (casos), y en personas sanas (controles). Resultados: Se compararon 158 variables clínicas entre ambos grupos, donde se identificaron aquellas con mayor capacidad de clasificación, integradas en un modelo explicativo de regresión logística binaria conformada por nueve variables: dos antecedentes, dos síntomas, tres signos de examen físico y dos signos tras prueba de consistencia/volumen con alimentos. La variable dependiente fue la categoría de ser sano o paciente y las covariables fueron las variables clínicas. Parámetros que alcanzó el modelo: criterio de información de Akaike 102 y R2 de Nagelkerke 0,78. Discusión: Las nueve variables que ingresaron al modelo, en conjunto, logran explicar en gran medida la presencia de disfagia orofaríngea neurogénica, y son accesibles por examen físico de la deglución. Conclusiones: El modelo obtenido puede mejorar y/o complementar el proceso evaluativo que se realiza en pacientes con disfagia de causas funcionales, enfermedades neurológicas y neuromusculares, en procesos de tamizaje y caracterización diagnóstica.

Introdução: A disfagia orofaríngea neurogênica é uma forma de disfagia funcional geralmente causada por doenças neurológicas e neuromusculares, que produz diversas complicações secundárias. Com o objetivo de melhorar a sua detecção e caracterização, estão surgindo modelos que integram variáveis clínicas para complementar o exame físico da deglutição. Objetivo: Desenvolver um modelo explicativo para diferenciar pacientes com disfagia orofaríngea neurogênica. Materiais e Métodos: Estudo caso-controle baseado em um conjunto de dados derivados do exame clínico da deglutição com ênfase neurológica realizado em uma amostra de pacientes com disfagia orofaríngea neurogênica de causas neurológicas e neuromusculares (casos) e em pessoas saudáveis (controles). Resultados: Foram comparadas 158 variáveis clínicas entre os dois grupos, onde foram identificadas aquelas com maior capacidade de classificação, integradas em um modelo explicativo de regressão logística binária composto por nove variáveis: dois antecedentes, dois sintomas, três sinais de exame físico e dois sinais após consistência /volume teste com alimentos. A variável dependente foi a categoria de ser saudável ou paciente e as covariáveis foram as variáveis clínicas. Parâmetros alcançados pelo modelo: critério de informação de Akaike 102 e Nagelkerke R2 0,78. Discussão: As nove variáveis que entraram no modelo, juntas, explicam em grande parte a presença de disfagia orofaríngea neurogênica, e são acessíveis pelo exame físico da deglutição. Conclusões: O modelo obtido pode melhorar e/ou complementar o processo de avaliação realizado em pacientes com disfagia de causas funcionais, doenças neurológicas e neuromusculares, em processos de triagem e caracterização diagnóstica.

Risco de transtorno de deglutição em Doença Pulmonar Obstrutiva Crônica / Risk of swallowing disorder in Chronic Obstructive Pulmonary Disease / Riesgo de trastorno de la deglución en la Enfermedad Pulmonar Obstructiva Crónica

Introdução: O enfisema pulmonar e a bronquite crônica são condições pulmonares conhecidas como Doença Pulmonar Obstrutiva Crônica (DPOC). Dentre os sintomas tem-se a dispneia e a tosse, o que pode impactar na coordenação entre a respiração e a deglutição, com provável comprometimento na alimentação. Objetivo: Relatar a associação do risco de transtorno de deglutição (RTD) em pacientes com DPOC sem acompanhamento fonoaudiológico. Método: Estudo transversal, retrospectivo (2001-2011) com análise de dados secundários de pacientes do ambulatório de pneumologia. As variáveis analisadas foram sexo, idade, tempo de diagnóstico da doença e comorbidades. Foi considerada como RTD a presença de pelo menos um dos critérios: modificação na consistência do alimento ingerido, alteração no volume da ingestão por via oral, uso de via alternativa de alimentação e oxigênio domiciliar. Resultados: Verificou-se RTD em 60% dos prontuários analisados. O RTD foi associado à idade (p=0,009) e ao comprometimento pulmonar relacionado ao enfisema (p = 0,041). Paciente com RTD apresentaram prevalência de utilização de oxigênio domiciliar (46,7%; p<0,001) comparados àqueles sem RTD. Conclusão: Pacientes com DPOC em seguimento ambulatorial apresentaram alta prevalência de risco para transtorno de deglutição, estando estes riscos associados a pacientes com maior idade e com comprometimento relacionado ao enfisema pulmonar. Sabemos que há publicações relacionando DPOC e disfagia, sobre a importância da avaliação fonoaudiológica, mas ainda há necessidade de mais publicações sobre o tema, para aumentar o alerta dos profissionais de saúde, da necessidade dos atendimentos desses pacientes. (AU)

Introduction: Pulmonary emphysema and chronic bronchitis are lung conditions known as chronic obstructive pulmonary disease (COPD). Symptoms include dyspnea and coughing, which can impact the breathing/swallowing coordination, possibly impairing eating. Objective: To report the association of the risk of swallowing disorders (RSD) in patients with COPD without speech-language-hearing follow-up. Method: Cross-sectional, retrospective study (2001-2011) with secondary data analysis from patients at a pulmonology outpatient clinic. The variables analyzed were sex, age, time since disease diagnosis, and comorbidities. Having at least one of the following criteria was considered as RSD: change in the food consistency, change in the oral intake volume, use of an alternative feeding route, and home oxygen. Results: RSD was found in 60% of the analyzed medical records. It was associated with age (p=0.009) and pulmonary involvement due to emphysema (p=0.041). Patients with RSD had a prevalence of home oxygen use (46.7%; p<0.001) compared to those without RSD. Conclusion: Patients with COPD in outpatient follow-up had a high prevalence of risk of swallowing disorders, associated with older patients and impairment due to pulmonary emphysema. Some publications relating COPD to dysphagia have addressed the importance of speech-language-hearing assessment. However, more publications on the subject are needed to raise health professionals' awareness of these patients' care needs. (AU)

Introducción: El enfisema pulmonar y la bronquitis crónica son afecciones pulmonares conocidas como enfermedad pulmonar obstructiva crónica (EPOC). Los síntomas incluyen disnea y tos, que pueden repercutir en la coordinación entre la respiración y la deglución, con probable afectación de la alimentación. Objetivo: Informar sobre la asociación entre el riesgo de trastornos de la deglución (RTD) en pacientes con EPOC sin seguimiento logopédico. Método: Estudio transversal, retrospectivo (2001-2011) analizando datos secundarios de pacientes de la consulta externa de neumología. Las variables analizadas fueron sexo, edad, tiempo desde el diagnóstico y comorbilidades. Se consideró RTD la presencia de al menos uno de los siguientes criterios: cambio en la consistencia de los alimentos ingeridos, cambio en el volumen de ingesta oral, uso de una vía de alimentación alternativa y oxígeno domiciliario. Resultados: Se encontró RTD en el 60% de los pacientes. El RTD se asoció con la edad (p=0,009) y con el deterioro pulmonar relacionado con el enfisema (p=0,041). Los pacientes con RTD presentaban una mayor prevalencia de uso de oxígeno domiciliario (46,7%; p<0,001) en comparación con aquellos sin RTD. Conclusión: Los pacientes con EPOC en seguimiento ambulatorio presentaron una alta prevalencia de RTD, y estos riesgos se asociaron a pacientes de mayor edad y a alteraciones relacionadas con el enfisema pulmonar. Sabemos que existen publicaciones que relacionan EPOC y disfagia, sobre la importancia de la valoración logopédica, pero aún son necesarias más publicaciones sobre el tema, para concienciar a los profesionales sanitarios de la necesidad de atender a estos pacientes. (AU)

Disfagia no Transtorno do Espectro Autista (TEA): uma revisão integrativa / Dysphagia in Autism Spectrum Disorder (ASD): An integrative review / Disfagia en el trastorno del espectro autista (TEA): una revisión integradora

Introdução: O Transtorno do Espectro Autista (TEA) é um distúrbio do neurodesenvolvimento caracterizado por déficits na comunicação social, alterações de sensibilidade e dificuldades alimentares.Objetivo: Realizar uma revisão integrativa das alterações de deglutição em indivíduos com TEA.Métodos: A pesquisa foi realizada por meio de uma busca por artigos nacionais e internacionais, utilizando descritores para a pesquisa, bem como critérios de inclusão e exclusão para a seleção da amostra final. A estratégia PPOT foi utilizada para definir critérios de elegibilidade, incluindo população (crianças e adultos), preditor (diagnóstico de TEA), desfecho (relato ou diagnóstico de disfagia oral, faríngea ou esofágica) e tipo de estudo (estudos observatórios). A busca foi realizada no período de junho a agosto de 2023, nas bases de dados: Pubmed, Scopus, Embase e Google Scholar. Resultados: Foram selecionados dez estudos com pacientes diagnosticados com TEA que relataram sintomas de disfagia orofaríngea e esofágica, além de queixas sobre ingestão alimentar. Os estudos sugerem que crianças com TEA podem apresentar algum problema de disfunções motoras orais, frequência alimentar inadequada, padrões alimentares obsessivos, apresentação específica de determinados alimentos, seletividade alimentar e dificuldades de processamento sensorial. Conclusão: Conclui-se que não há evidências científicas robustas sobre a presença de disfagia em pacientes com TEA. (AU)

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication, changes in sensitivity and eating difficulties. Objective: To carry out an integrative review of swallowing changes in individuals with ASD. Methods: The research was carried out through a search for national and international articles, using descriptors for the research, as well as inclusion and exclusion criteria for selecting the final sample. The PPOT strategy was used to define eligibility criteria, including population (children and adults), predictor (ASD diagnosis), outcome (report or diagnosis of dysphagia oral, pharyngeal or esophageal), and study type (observatory studies). The search was carried out from June to August 2023, in the databases: Pubmed, Scopus, Embase and Google Scholar. Results: Ten studies were selected with patients diagnosed with ASD who reported symptoms of oropharyngeal and esophageal dysphagia, in addition to complaints about food intake. Studies suggest that children with ASD may present problems with oral motor dysfunction, inadequate eating frequency, obsessive eating patterns, specific presentation of certain foods, food selectivity and sensory processing difficulties. Conclusion: It is concluded that there is no robust scientific evidence about the presence of dysphagia in patients with ASD. (AU)

Introducción: El Trastorno del Espectro Autista (TEA) es un trastorno del neurodesarrollo caracterizado por déficits en la comunicación social, cambios en la sensibilidad y dificultades alimentarias. Objetivo: Realizar una revisión integradora de los cambios en la deglución en individuos con TEA. Métodos: La investigación se realizó mediante una búsqueda de artículos nacionales e internacionales, utilizando descriptores para la investigación, así como criterios de inclusión y exclusión para la selección de la muestra final. La estrategia PPOT se utilizó para definir los criterios de elegibilidad, incluida la población (niños y adultos), el predictor (diagnóstico de TEA), el resultado (informe o diagnóstico de enfermedad oral, faríngea o esofágica) y el tipo de estudio (estudios observatorios). La búsqueda se realizó de junio a agosto de 2023, en las bases de datos: Pubmed, Scopus, Embase y Google Scholar. Resultados: Se seleccionaron diez estudios con pacientes diagnosticados de TEA que refirieron síntomas de disfagia orofaríngea y esofágica, además de quejas sobre la ingesta de alimentos. Los estudios sugieren que los niños con TEA pueden presentar problemas de disfunción motora oral, frecuencia inadecuada de alimentación, patrones alimentarios obsesivos, presentación específica de ciertos alimentos, selectividad alimentaria y dificultades en el procesamiento sensorial. Conclusión: Se concluye que no existe evidencia científica robusta sobre la presencia de disfagia en pacientes con TEA. (AU)

Evaluación del valor clínico del reflejo nauseoso en la disfagia orofaríngea neurogénica / Apraisal of the diagnostic value of the gag reflex in patients with neurogenic oropharyngeal dysphagia

Introducción. El reflejo nauseoso es un mecanismo de protección que impide que alimentos y agentes no deseados penetren en la vía aérea inferior. Usualmente, hace parte del examen físico de la deglución para detectar la disfagia orofaríngea, pero es un signo potencialmente ambiguo. Objetivo. Evaluar el valor diagnóstico del reflejo nauseoso en pacientes con disfagia orofaríngea neurogénica y en pacientes sin ella. Materiales y métodos. Se trata de un estudio observacional, analítico, en pacientes con disfagia orofaríngea neurogénica (casos) y en personas sin disfagia (controles), en el cual se evaluó por visualización directa la ausencia o la presencia del reflejo nauseoso de forma bilateral. Este resultado se ajustó por sexo, edad y otras variables de interacción. Resultados. Se evaluaron 86 pacientes con disfagia orofaríngea neurogénica y 80 personas sin ella. En el examen físico de la deglución, la presencia del reflejo mostró una relación positiva con los pacientes (lado derecho: OR = 3,97; IC95%: 2,01-7,84; lado izquierdo: OR = 4,84; IC95%: 2,41-9,72), pero una asociación negativa con los controles. En ambos grupos, ni el sexo ni la edad, ni otras variables de interacción modificaron el reflejo nauseoso. Conclusiones. La ausencia o la presencia del reflejo nauseoso no confirma ni excluye la existencia de una disfagia orofaríngea por causas neurológicas o neuromusculares; por lo tanto, no es recomendable que los profesionales de la salud se fíen del resultado de este reflejo. Los médicos tratantes deben ir más allá de una simple revisión del reflejo nauseoso, incluso en pacientes neurológicos en quienes se supone que debería estar ausente.

Introduction. The gag reflex is a protection mechanism that prevents food and unwanted agents from entering the lower airways. It is usually part of the physical examination of swallowing to detect oropharyngeal dysphagia, but it is a potentially ambiguous sign. Objective. To evaluate the diagnostic value of the gag reflex in patients with neurogenic oropharyngeal dysphagia and adults without it. Materials and methods. We conducted an analytical observational study in patients with neurogenic oropharyngeal dysphagia (cases) and patients without dysphagia (controls). We evaluated the absence or presence of the reflex bilaterally, by direct visualization, and adjusted it according to sex, age, and other interaction variables. Results. We included 86 patients with neurogenic oropharyngeal dysphagia and 80 control subjects. The gag reflex on swallowing physical examination showed a positive relationship with the patients (right side: OR = 3.97; 95 % CI: 2.01-7.84; left side: OR = 4.84; 95 % CI: 2.41-9.72), but a negative association with the control group. In both groups, neither sex, nor age, nor other interaction variables modified the gag reflex. Conclusions. The gag reflex absence or presence does not confirm or exclude the existence of oropharyngeal dysphagia due to neurological and neuromuscular causes. Therefore, health professionals must not rely on this reflex. Clinicians must go beyond a simple reflex revision, even in neurological patients where it is supposed to be absent.

Insuficiencias en la atención estomatológica integral del nivel primario ante trastornos de la deglución en niños

Introducción: La deglución es una actividad compleja y de carácter evolutivo, que requiere de una atención estomatológica adecuada para mantener el equilibrio del sistema estomatognático. Objetivo: Identificar las insuficiencias en la atención estomatológica integral del nivel primario ante trastornos de la deglución en niños. Métodos: Se realizó un estudio descriptivo y transversal, con enfoque mixto, de 24 estomatólogos generales integrales de la Clínica Estomatológica Victoria de Santa Clara, provincia de Villa Clara, que se encontraban laborando durante enero-marzo del 2023 y tenían más de 3 años de experiencia profesional, para lo cual se utilizaron métodos teóricos y empíricos. Se efectuó el análisis cualitativo y cuantitativo de los datos mediante el empleo de frecuencias absolutas y relativas. Resultados: En los documentos normativos-metodológicos revisados no están reflejadas de forma explícita todas las actividades de promoción y prevención, así como los aspectos necesarios para el diagnóstico y tratamiento adecuados de pacientes con alteraciones de la deglución. La mayoría de los encuestados (83,3 %) identificó la deglución como un hábito; en tanto, entre los factores medioambientales condicionantes, hubo poco reconocimiento de la posición del niño al comer (20,8 %), del uso de la cuchara y el vaso (29,1 %) y de la respiración nasal (33,3 %). Igualmente, 50,0 % de la muestra presentó un nivel medio de conocimientos. Conclusiones: Existen insuficiencias en la atención estomatológica integral en el nivel primario ante trastornos de la deglución en niños.

Introduction: Deglutition is a complex activity of evolutionary character that requires of an appropriate stomatologic care to maintain the balance of the stomatognathic system. Objective: To identify inadequacies in the comprehensive stomatologic care to children with deglutition disorders in primary health care. Methods: A descriptive and cross-sectional study was carried out, with mixed approach, of 24 comprehensive general stomatologists from Victoria Stomatologic Clinic in Santa Clara, Villa Clara province that were working during January-March, 2023 and had more than 3 years of professional experience, for which theoretical and empiric methods were used. The qualitative and quantitative analysis of the data was carried out by means of the absolute and relative frequencies. Results: In the revised normative-methodological documents are not explicitly reflected all the promotion and prevention activities, as well as the necessary aspects for the diagnosis and treatment of patients with deglutition disorders. Most of those interviewed (83.3%) identified deglutition as a habit; as long as, among the determining environmental factors there was little recognition of the kid position when eating (20.8 %), the use of tablespoon and glass (29.1 %) and nasal respiration (33.3 %). Equally, 50.0 % of the sample presented a medium level of knowledge. Conclusions: There are inadequacies in the comprehensive stomatologic care to children with deglutition disorders in primary health care.

Prevalence of self-reported swallowing difficulties and associated factors among older Colombians / Prevalência de dificuldades de deglutição autorreferidas e fatores associados entre idosos colombianos

Objective: We aimed to determine the prevalence of self-reported swallowing difficulty (dysphagia) among older Colombians and to explore the factors associated with this condition. Methods: This study presents a secondary analysis of the SABE-Colombia survey, a crosssectional study of community-dwelling older adults. The dependent variable was self reported swallowing difficulty, assessed through the question: "How often do you have difficulty or discomfort swallowing?" Descriptive and bivariate analyses of the sample were performed, followed by multivariate analysis, adjusting for confounding variables. Results: The final sample included 19 004 older Colombians, whose mean age was 69 years (56% women). The overall prevalence of swallowing difficulty was 12.2%. In the multivariate analysis, significant associations were observed between swallowing difficulty and several factors, including male sex (OR 1.14, 95%CI 1.03 ­ 1.26), age > 80 years (OR 1.26, 95%CI 1.08 ­ 1.47), dependence in activities of daily living (OR 1.62, 95%CI 1.23 ­ 2.13), cognitive impairment (OR 1.49, 95%CI 1.30 ­ 1.70), depressive symptoms (OR 1.38, 95%CI 1.15 ­ 1.65), sarcopenia (OR 1.32, 95%CI 1.02 ­ 1.69), malnutrition (OR 1.35, 95%CI 1.23 ­ 1.49), and osteoarticular disease (OR 1.18, 95%CI 1.07 ­ 1.38). Conclusion: There was a high prevalence of swallowing difficulty among older community-dwelling Colombians. Our results showed a strong correlation between swallowing difficulty and risk factors such as cognitive impairment, depressive symptoms, osteoarticular disease, and dependence in activities of daily living, but not with malnutrition or sarcopenia. (AU)

The Thyrohyoid Muscle: A Crucial Player in Deglutition and Vocalization / El Músculo Tirohioideo: Un Actor Crucial en la Deglución y la Vocalización

SUMMARY: The thyrohyoid muscle is one of the four infrahyoid muscles. Its role in vocalization and deglutition could be often overlooked, despite its crucial participation in these processes. Unlike other infrahyoid muscles, the thyrohyoid muscle receives innervation from the first cervical spinal nerves which contributes to its unique function. Its primary action involves hyolaryngeal elevation during swallowing, contributing to the opening of the upper esophageal sphincter. In conjunction with other muscles, it also protects the airway and facilitates the passage of food into the esophagus. Variations in the muscle's thickness may exist, and its function can be influenced by chewing habits. Weakened muscles involved in swallowing are often associated with dysphagia, a common complication in stroke and brain-injured patients. Advanced imaging techniques and sleep studies have provided insights into the dynamics and frequency of swallowing. This review explores the anatomic structures, function in action, diagnosis and clinical implications of this muscle. Overall, understanding the significance of the thyrohyoid muscle enhances our comprehension of the intricate interplay of laryngeal muscles during vocalization and deglutition.

El músculo tirohioideo es uno de los cuatro músculos infrahioideos. A menudo podría pasarse por alto su papel en la vocalización y la deglución, a pesar de su participación crucial en estos procesos. A diferencia de otros músculos infrahioideos, el músculo tirohioideo recibe inervación de los primeros nervios espinales cervicales, lo que contribuye a su función única. Su acción principal implica la elevación hiolaríngea durante la deglución, contribuyendo a la apertura del esfínter esofágico superior. Junto con otros músculos, también protege las vías respiratorias y facilita el paso de los alimentos al esófago. Pueden existir variaciones en el grosor del músculo y su función puede verse influenciada por los hábitos de masticación. Los músculos debilitados involucrados en la deglución a menudo se asocian con disfagia, una complicación común en pacientes con accidente cerebrovascular y lesión cerebral. Las técnicas de imagen avanzadas y los estudios del sueño han proporcionado información sobre la dinámica y la frecuencia de la deglución. Esta revisión explora las estructuras anatómicas, la función en acción, el diagnóstico y las implicaciones clínicas de este músculo. En general, comprender la importancia del músculo tirohioideo mejora nuestra comprensión de la intrincada interacción de los músculos laríngeos durante la vocalización y la deglución.

Progress in the treatment of malignant stenosis of advanced esophageal cancer with 125I radioactive stents / 中华放射肿瘤学杂志

Esophageal cancer is one of the most common malignant tumors in China and dysphagia caused by malignant stenosis is the most common symptom of advanced esophageal cancer. The inability to eat orally seriously affects the quality of life of patients with advanced esophageal cancer, and poor nutritional status caused by dysphagia limits the implementation of standard treatment programs such as radiotherapy and chemotherapy, resulting in a decline in survival. The 125I radioactive stent is a novel treatment for malignant stenosis. Studies have shown that it can relieve dysphagia and prolong patients' survival compared to traditional esophageal stents. In this article, the treatment of malignant stenosis in advanced esophageal cancer and the clinical application progress of 125I radioactive stents were reviewed.

Research progress on evaluation and prediction methods of dysphagia after occipitocervical fusion / 中华骨科杂志

Occipitocervical fusion (OCF) is used to treat the instability of the cranio-cervical junction due to various reasons (such as trauma, rheumatoid arthritis, infection, tumor, congenital malformations and degeneration). A satisfactory fusion rate can be obtained and the stability of the occipital neck can be reconstructed by OCF. Dysphagia is one of the most common complications after OCF, which seriously affects the quality of life of patients after surgery. This article mainly focuses on the evaluation and prediction methods of dysphagia after OCF, and summarizes related research in the past 16 years, and provides guidance and direction for how to predict the occurrence of dysphagia during OCF and the evaluation of postoperative dysphagia. The evaluation of dysphagia is mainly conducted using the Bazaz dysphagia score, swallowing quality of life scale (SWAL-QOL) and eating assessment tool-10 (EAT-10) score. However, the clinical prediction of dysphagia is mainly based on the changes of cervical curvature parameters (O-C 2 angle, O-EA angle, Oc-Ax angle, PI angle). At present, there are many methods for clinical evaluation and prediction of dysphagia, but the best evaluation method is still uncertain. We reviews the evaluation and prediction methods of postoperative dysphagia of OCF, showing that the Bazaz dysphagia score, SWAL-QOL score and EAT-10 score scale are suitable for evaluating postoperative dysphagia of OCF. During OCF operation, adjustment of O-C 2 Angle >-5°, O-EA Angle >100°, Oc-Ax Angle >65°, and increase of postoperative PI Angle from preoperative PI Angle (that is, dPI Angle) ≥0° can reduce the probability of dysphagia to a certain extent.

Effect of electroacupuncture at Lianquan point on nerve function deficit in rats after stroke / 中华老年心脑血管病杂志

Objective To investigate the effect of electroacupuncture at Lianquan point on nerve function deficit in post-stroke dysphagia(PSD)rats and its potential effect on regulating of transi-ent receptor potential vanilic acid subtype 1(TRPV1)signaling pathway.Methods A total of 60 male SD rats with SPF grade were randomly divided into a normal group of 12(only mild inser-tion of the thread,which did not lead to intracerebral artery occlusion),and the remaining 48 rats were established into PSD models.The 36 rats successfully made were randomly divided into mod-el group,treatment group and treatment+caffeic acid group,with 12 rats in each group.The la-tency and frequency of swallowing were recorded.Biological signal collector was applied to detect hypoglossal nerve discharge,lingual muscle threshold intensity,and contraction amplitude.ELISA was employed to detect the content of substance P in serum,toluidine blue staining was conducted to count the number of Nissl bodies in the hypoglossal nucleus,and immunohistochemistry was applied to measure the expression levels of TRPV1,serotonin(5-HT),phosphorylation(p)-p38,and neuronal nitric oxide synthase(nNOS)in the hypoglossal nucleus.Results Compared with the normal group,the model group had shorter swallowing latency,less swallowing frequency,and decreased integrated area of hypoglossal nerve discharge,amplitude of tongue muscle contrac-tion,serum substance P content,threshold strength of tongue muscle,number of Nissl bodies,and the expression levels of TRPV1 and 5-HT,but increased threshold intensity of tongue muscles and expression levels of p-p38 and nNOS in the hypoglossal nucleus(P＜0.05).Compared with the model group,the amplitude of tongue muscle contraction,serum substance P content,number of Nissl bodies,and the expression levels of TRPV1 and 5-HT proteins in rats in the treatment group were increased[2.36±0.26 vs 1.77±0.22,3.46±0.36 vs 2.15±0.18,(3.92±0.38)ng/ml vs(1.69±0.17)ng/ml,(33.60±3.65)vs(24.60±2.34),(19.85±2.11)％vs(9.79±1.07)％,(22.43± 2.34)％vs(10.85±1.13)％,P＜0.05].Conclusion Electroacupuncture at Lianquan point may improve neurological deficits in PSD rats by activating the TRPV1 signaling pathway.

A study of the correlation between oral insufficiency and mild cognitive impairment in community-dwelling older adults / 中华老年医学杂志

Objective:To investigate the relationship between oral health and mild cognitive impairment(MCI)by using indicators that evaluate oral hypofunction.Methods:The study was conducted using a cross-sectional design.Participants were recruited from three communities(Shizi Ling, Wenyi Xincun, and Yaoling in Furong District)in Changsha in July 2021, using convenience sampling.Cognitive and oral functions were evaluated using the simple mental state examination, version 2(MMSE-2)and seven indicators of oral hypofunction, which included oral hygiene, oral dryness, occlusal force, tongue and lip movement, tongue pressure, mastication, and swallowing function.Results:A total of 144 subjects were included in this study, with 72 males.Except for education level, there were no statistically significant differences between the MCI group and the normal cognitive group in terms of demographic information and self-reported and measured oral functions(all P>0.05).There was a correlation between the subjects' self-reported oral function and the actual measured oral function.Multiple linear regression analysis revealed no significant correlation between the MMSE score and the seven indicators used to measure oral hypofunction(all P>0.05).The MMSE score of the female group showed a negative correlation with mastication( β=-0.003, P=0.043), while the MMSE score of subjects with elementary school education also showed a negative correlation with mastication( β=-0.022, P=0.016).Additionally, the MMSE score of subjects with middle school education showed a positive correlation with the number of residual teeth( β=0.090, P=0.030). Conclusions:The self-reported oral function can serve as an initial assessment of overall oral function.However, among elderly individuals who do not show significant decline in oral function, there was no significant correlation between oral function and MCI.To accurately identify individuals with MCI, a more detailed sub-analysis with a larger sample size is required.

Acupuncture plus tongue pressure resistance feedback training for post-stroke deglutition disorders:a randomized controlled trial / 针灸推拿医学（英文版）

Objective:To observe the effect of Tongguan Liqiao(opening orifices)needling plus tongue pressure resistance feedback training in treating post-stroke deglutition disorders. Methods:A prospective randomized controlled trial was conducted.A total of 120 patients with post-stroke deglutition disorders were divided into a control group and an observation group using the random number table method,with 60 cases in each group.Both groups were treated with routine treatments.The control group was treated with additional tongue pressure resistance feedback training,and the observation group was treated with additional Tongguan Liqiao needling based on the same intervention in the control group.After 4 weeks of treatment,the clinical efficacy was evaluated,and the complications that occurred during treatment were summarized.The FUJISHIMA Ichiro food intake level scale(FILS)and the swallowing quality of life questionnaire(SWAL-QOL)were scored before treatment and after 4 weeks of treatment. Results:The total effective rate of the observation group was higher than that of the control group(P<0.05).After 4 weeks of treatment,the FILS and SWAL-QOL scores in both groups were higher than those before treatment,and the scores in the observation group were higher than those in the control group(P<0.05).There was no statistical difference in the complication occurrence between the two groups(P>0.05). Conclusion:On the basis of routine treatments,Tongguan Liqiao needling plus tongue pressure resistance feedback training has a better effect in the treatment of post-stroke deglutition disorders.This method can effectively improve the swallowing function of patients,improve the quality of life,and is safe.

The application of family empowerment model on the primary caregivers of first-episode stroke dysphagia patients / 中国实用护理杂志

Objective:To explore the effect of family empowerment model on the improvement of swallowing care ability and care preparedness of primary caregivers of first-episode stroke dysphagia patients, further to explore its impact on patients′s wallowing function and life quality.Methods:This study was a randomized controlled study. From January 2021 to December 2022, 80 main caregivers of patients with dysphagia caused by manual stroke admitted to the Department of Acupuncture and Moxibustion, Shenzhen Hospital of Traditional Chinese Medicine were selected as the research objects, and 40 cases in the control group and 40 cases in the observation group were selected by random number table method. The control group were treated with conventional nursing care of first-episode stroke dysphagia patients in the acupuncture and moxibustion Department. On the basis of the conventional care in the control group, the observation group were treated with family empowerment model intervention for 14 days and was followed up for 28 days. Primary caregivers′ swallowing care ability, Caregiver Preparedness Scale (CPS), patients′ swallowing function rate, Swallowing Related Quality of Life (SWALQOL) were used to evaluate the effects before intervention and at the end of intervention.Results:There were 18 males and 19 females primary caregivers in the control group, aged (55.61 ± 7.43) years old. There were 18 males and 21 females primary caregivers in the observation group, aged (58.23 ± 8.22) years old. The swallowing care ability score showed a statistically significant difference between the observation group (143.47 ± 3.96) and the control group (107.74 ± 1.43) ( t=-26.76, P<0.05). After intervention, the caregiver preparedness scale was (26.11 ± 3.81) in the observation group, and (18.35 ± 4.54) in the control group, and the difference was statistically significant ( t=-4.11, P<0.05).The patients′ swallowing function rate and SWALQOL score were respectively 97.44% (38/39) and (91.41 ± 8.08) points in the observation group, and 72.97% (27/37) and (80.33 ± 4.21) points in the control group, and the difference was both statistically significant ( χ2=10.76, t=-2.54, both P<0.05). Conclusions:The implementation of family empowerment model could enhance the swallowing care ability and care preparedness of primary caregivers of the first-episode stroke dysphagia patients, which could further improve patients′ swallowing function and life quality.

Best evidence audit and analysis to the medication management for patients with dysphagia / 中国实用护理杂志

Objective:To review the clinical status based on the best evidence of drug administration in patients with dysphagia, systematically analyze the obstacle factors and promoting factors in the process of evidence transformation, and formulate reform strategies.Methods:Based on the evidence-based nursing research method and the guidance of the Ottawa Model of Research Use (OMRU), the review indicators were developed based on the best evidence. The current status of clinical practice behaviors of 223 patients and 75 nurses in the Neurology, Neurosurgery and Geriatric departments of the Affiliated Hospital of Jiangsu University were reviewed from July to December 2021.Based on the results of the review, qualitative interviews were conducted with 32 potential adopters, and content analysis was used to assess the barriers and contributing factors to the clinical translation of evidence in three aspects: evidence-based change, potential adopters and practice environment, so as to develop effective strategies.Results:Based on the 22 best evidence selected, the evidence-based team developed 25 review indicators to carry out clinical review, showing that the compliance rate of 16 indicators were less than 60%. By analyzing and summarizing the interview results of potential adopters, the main obstacles leading to the low compliance rate of nurses were analyzed as follows: evidence-based reform changed the traditional work mode, and the application of evidence was not convenient; at the level of potential adopters, nurses had poor knowledge and practice, heavy work burden, and low awareness of patients and caregivers; at the level of practice environment, there was lack of nursing norms and procedures for clinical transformation of evidence, and the channels of multi-disciplinary collaboration and communication were not smooth. The main promoting factors were the perfect supervision mechanism of evidence-based nursing projects, the evidence-based group had rich experience in evidence transformation, the management was willing to change, and the practitioners were good at innovation.Conclusions:There is still a large gap between the clinical practice and the best evidence of drug administration in patients with dysphagia. The promoting factors should be fully utilized to overcome the obstacles and implement improvements to promote the effective transformation of evidence into clinical practice.

Avaliação videofluoroscópica do impacto do tamanho da cápsula, idade e gênero dos indivíduos na ingestão de cápsulas / Videofluoroscopic evaluation of the impact of capsule size and subject's age and gender on capsule swallowing

ABSTRACT Background: People recurrently have difficulties swallowing solid medications, which can be associated with the size of the medication and the age and gender of individuals. Objective: To evaluate the impact of capsule size and adults' age and gender on oral and pharyngeal capsule transit during capsule swallows. Methods: Videofluoroscopy was used to measure capsule oral and pharyngeal transit during swallows in 49 healthy individuals (17 men and 32 women), with a mean age of 46 years (ranging from 23 to 88 years). Smaller capsules were filled with 0.50 mL of barium sulfate, and larger capsules were filled with 0.95 mL of barium sulfate; the volume of liquid ingested with the capsules was also quantified in each ingestion. The measurements included the oral preparation time, oral transit time, swallowing reaction time, time to laryngeal vestibule closure, laryngeal vestibule closure duration, pharyngeal transit time, and upper esophageal sphincter opening duration. Results: The capsule size did not influence either the oral or pharyngeal transit time. Increased liquid volume was ingested with larger capsules and by people older than 40 years. The oral transit time was shorter in older adults (60-88 years), and the time to laryngeal vestibule closure was longer in women. Conclusion: The size of large capsules did not make a difference in oral or pharyngeal transit when compared with smaller capsules. The capsule size and the participant's age influenced the volume of liquid ingested - larger capsules and older individuals required a larger volume. The capsule oral transit was faster in individuals older than 60 years.

RESUMO Contexto: Algumas pessoas apresentam recorrentemente dificuldades para engolir medicamentos sólidos, o que pode estar associado ao tamanho do medicamento, à idade e ao gênero dos indivíduos. Objetivo: Avaliar, em adultos, o impacto do tamanho da cápsula, da idade e do gênero no trânsito oral e faríngeo de cápsulas. Métodos: Videofluoroscopia foi utilizada para medir o trânsito oral e faríngeo de cápsulas em 49 indivíduos saudáveis (17 homens e 32 mulheres), com idade média de 46 anos (limites de 23 e 88 anos). Cápsulas menores foram preenchidas com 0,50 mL e cápsulas maiores foram preenchidas com 0,95 mL de sulfato de bário; o volume de líquido ingerido com as cápsulas foi quantificado em cada ingestão. Foram medidos o tempo de preparo oral, tempo de trânsito oral, tempo de reação da deglutição, tempo para fechamento do vestíbulo laríngeo, tempo de fechamento do vestíbulo laríngeo, tempo de trânsito faríngeo e tempo de abertura do esfíncter superior do esôfago. Resultados: O tamanho da cápsula não influenciou o tempo de trânsito oral ou faríngeo. Mais líquido foi ingerido com cápsulas maiores e por pessoas com mais de 40 anos. O tempo de trânsito oral foi menor em idosos (60-88 anos) e o tempo de fechamento do vestíbulo laríngeo foi maior em mulheres. Conclusão: O tamanho da cápsula não influenciou o trânsito oral e faríngeo, porém houve maior volume de líquido ingerido com a cápsula maior e nos mais idosos. O trânsito oral da cápsula foi mais rápido em indivíduos com mais de 60 anos.

Análise ultrassonográfica da distância do osso hioide em indivíduos com disfagia orofaríngea neurogênica / Ultrasonographic analysis of the hyoid bone distance in individuals with neurogenic oropharyngeal dysphagia

RESUMO Comparar a medida ultrassonográfica de distância da aproximação do osso hioide no momento do pico máximo da deglutição entre indivíduos saudáveis e disfágicos neurogênicos e verificar o efeito das consistências do alimento no deslocamento do osso hioide. Estudo clínico prospectivo controlado. Foram realizadas avaliações ultrassonográficas da deglutição orofaríngea em 10 adultos com diagnóstico de disfagia orofaríngea e 10 adultos saudáveis, pareados por sexo e faixa etária. Para tanto, foi utilizado ultrassom portátil com transdutor microconvex 5-10 MHz, além de estabilizador de cabeça. As imagens ultrassonográficas foram gravadas pelo software Articulate Assistant Advanced a uma taxa de 120 quadros/segundo. Foram utilizadas as consistências de alimentos nível 0 (volume livre e 5 mL) e nível 4 (5 mL), conforme as recomendações do International Dysphagia Diet Standardisation Initiative. A distância foi mensurada no momento do pico máximo da deglutição entre a parte inferior do osso hioide e a inserção do músculo milo-hioideo. Cálculos de média e o desvio padrão foram utilizados na análise descritiva, enquanto o teste ANOVA de medidas repetidas foi aplicado na análise inferencial.Resultados evidenciaram que indivíduos disfágicos apresentaram menor elevação do osso hioide, marcada por maior distância da aproximação do osso hioide no momento do pico máximo da deglutição quando comparados aos indivíduos saudáveis, independentemente da consistência alimentar ofertada. Concluiu-se que a medida ultrassonográfica de distância da aproximação do osso hioide no momento do pico máximo da deglutição mostrou menor elevação laríngea em indivíduos com disfagia orofaríngea neurogênica quando comparados aos indivíduos saudáveis para todas as consistências alimentares ofertadas.

ABSTRACT To compare the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak between healthy individuals and neurogenic dysphagic individuals and to verify the effect of food consistencies on the displacement of the hyoid bone. Prospective, controlled clinical study. Ultrasound recordings of the oropharyngeal deglutition were conducted in 10 adults diagnosed with oropharyngeal dysphagia and in 10 healthy adults, matched by sex and age group. A portable ultrasound model Micro ultrasound system with a microconvex transducer 5-10 MHz, coupled to a computer as well as the head stabilizer were used. The ultrasound images were recorded using the AAA software (Articulate Assistant Advanced) at a rate of 120 frames/second. Food consistencies level 0 (free volume and 5 mL) and level 4 (5 mL) were used, based on the International Dysphagia Diet Standardisation Initiative (IDSSI). The calculation of the mean and standard deviation was used for the descriptive analysis, while the repeated measures ANOVA test was used for the inferential analysis. Results showed dysphagic individuals had lower elevation of the hyoid bone marked by a longer distance from the approximation of the hyoid bone during of the maximum deglutition peak when compared to healthy individuals, regardless of the food consistency offered. It was concluded that the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak showed less laryngeal elevation in individuals with neurogenic oropharyngeal dysphagia when compared to healthy individuals for all food consistencies offered.

Desempenho de deglutição de idosos e seus fatores sociodemográficos, cognitivos e de linguagem / Swallowing performance of elderly people and sociodemographic, cognitive and language factors

RESUMO Objetivo Analisar a correlação entre o desempenho de deglutição, linguagem e cognição e descrever os dados sociodemográficos de idosos sem alterações neurológicas prévias. Método Estudo transversal analítico, com amostra não-probabilística por conveniência e coleta de dados por telechamada. Foi aplicado o teste de triagem de broncoaspiração (Yale Swallow Protocol) para identificação e exclusão dos idosos com risco de broncoaspiração. Em seguida, realizou-se coleta de dados sociodemográficos e aplicação dos instrumentos de: atividade de vida diária (AIVDs), risco de disfagia (EAT-10), rastreio cognitivo (Mini Exame do Estado Mental - MEEM) e linguagem (Bateria Montreal-Toulouse de Linguagem - MTL-Brasil). Resultados A amostra foi composta por 32 idosos do Distrito Federal, com média de idade de 69,00±7,73 anos e de escolaridade de 10,00±5,60 anos. Os escores nos instrumentos EAT-10, MEEM e Bateria MTL apresentaram-se alterados em quatro, 22 e 26 idosos, respectivamente, indicando, nesse caso, risco de disfagia, sugestão de alteração cognitiva e alteração da linguagem. Sobre a alimentação, do total da amostra, 13 idosos (40%) apresentaram queixa de necessidade de comida modificada, bem como 10 desses também obtiveram escore no MEEM sugestivo de alteração cognitiva. Ao comparar os grupos com e sem queixa e/ou risco de disfagia, não houve diferença estatisticamente significante em relação às variáveis sociodemográficas, cognitivas e de linguagem. Os modelos de regressão logística binária também evidenciaram resultados sem significância estatística. Conclusão O presente estudo, ao correlacionar os achados de deglutição, linguagem e cognição, não obteve resultados estatisticamente significantes. Observou-se que os idosos com queixa de deglutição também apresentaram resultados sugestivos de alteração cognitiva e de linguagem nos testes realizados, mas não houve diferença estatisticamente significante em relação aos idosos sem queixa ou alteração de deglutição.

ABSTRACT Purpose To analyze the correlation between swallowing, language and cognition performance and describe the sociodemographic data of elderly people without previous neurological disorders. Methods Analytical cross-sectional study, with non-probabilistic sample for convenience and data collection by telecall. The aspiration screening test (Yale Swallow Protocol) was used to identify and exclude elderly people at risk of aspiration. Then, sociodemographic data were collected, and instruments were applied: activity of daily living (IADLs), risk of dysphagia (EAT-10), cognitive screening (Mini Mental State Examination - MMSE) and language (Montreal-Toulouse Language Battery - MTL-Brazil). Results The sample consisted of 32 elderly people from the Federal District, with a mean age of 69.00±7.73 years and schooling of 10.00±5.60 years. The scores on the EAT-10, MMSE and MTL Battery instruments were altered in four, 22 and 26 elderly, respectively, indicating, in this case, risk of dysphagia, suggestion of cognitive alteration and language alteration. Regarding food, of the total sample, 13 seniors (40%) complained of needing modified food, as well as 10 of these also obtained MMSE scores suggestive of cognitive alteration. When comparing the groups with and without complaints and/or risk of dysphagia, there was no statistically significant difference in relation to sociodemographic, cognitive and language variables. Binary logistic regression models also showed no statistically significant results. Conclusion The present study, when correlating the swallowing, language and cognition findings, did not obtain statistically significant results. It was observed that the elderly with swallowing complaints also showed results suggestive of cognitive and language changes in the tests performed, but there was no statistically significant difference in relation to the elderly without complaints or swallowing changes.

The Prevalence of Dysphagia in Children with Laryngomalacia Pre and Postsupraglottoplasty: A Systematic Review with Meta-Analysis

Abstract 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. Objectives To identify the prevalence of oropharyngeal dysphagia in children with pre and postsupraglottoplasty laryngomalacia. Data Synthesis A search strategy was developed with terms and entreterms to designate a population pediatric with laryngomalacia, exposure supraglottoplasty, and outcome frequency of dysphagia, adapted to the requirements of the main databases in the health area. The analysis of the records found was performed by two independent examiners and, in the end, 6 articles were included in the study. The articles found enabled a sample of 330 children with laryngomalacia, 311 of whom underwent supraglottoplasty. Among the included studies, 5 were grouped and meta-analyzed. After supraglottoplasty surgery, a 59% reduction in the prevalence of oropharyngeal dysphagia was identified, with high heterogeneity I2 = 93%. Conclusion Despite the heterogeneity of the sample, the supraglottoplasty procedure significantly reduces the prevalence of dysphagia in children with laryngomalacia.

A longitudinal study of the progression of Huntington's disease and oropharyngeal dysphagia: A four-case follow-up

ABSTRACT Huntington's disease (HD) is a neurodegenerative disorder, with dysphagia being a common symptom of the disease. Few studies established a relationship between neuromotor impairment and dysphagia. There is also a lack of described therapeutic approaches for dysphagia in HD. This study aimed to better understand the progression of neurological clinical aspects, instrumental swallowing and dysphagia management in four patients presented with HD in an outpatient follow-up setting. The longitudinal follow-up period was 36 to 43 months through neuroclinical assessments (Unified Huntington's Disease Rating Scale) and fiberoptic endoscopic swallowing evaluations. Case 1 - a moderate decline of independence with safe swallowing. Case 2 - a moderate motor impairment, safe swallowing and moderate dysphagia during follow-up. Case 3 - a longer disease duration and increased motor impairment associated with moderate/severe dysphagia. Case 4 - a longer disease duration, need of assistance to perform daily activities, severe dysphagia and palliative care, considering the family decision of exclusive oral feeding. This longitudinal study revealed that the progression of neuromotor damage was not directly related to dysphagia development. This case series demonstrates the importance of follow-up settings with instrumental swallowing evaluations and careful consideration of early palliative care for HD patients.