The Comparison of Dysphagia between COVID-19 Pneumonia and Aspiration Pneumonia / 대한연하장애학회지

Objective@#Patients recovering from moderate-to-severe coronavirus disease 2019 (COVID-19) reportedly have dysphagia or difficulty in swallowing. The current study compares the differences in dysphagia characteristics arising from COVID-19 pneumonia and aspiration pneumonia. We further identify factors affecting the severity of dysphagia. @*Methods@#Fifty-four patients diagnosed with COVID-19 pneumonia with dysphagia and 44 patients with aspiration pneumonia were referred for a videofluoroscopic swallowing study (VFSS) since they presented with signs and symptoms of dysphagia. The electronic medical records were reviewed to compare the dysphagia characteristics of the patients. @*Results@#Intensive care unit (ICU) admission, intubation, tracheostomy, and a diagnosis of Acute Respiratory Distress Syndrome (ARDS) after admission were more common in patients with COVID-19 pneumonia (P＜0.001 for other variables and P=0.007 for tracheostomy) than in patients with aspiration pneumonia. Compared to patients with aspiration pneumonia, the COVID-19 patients had a significantly higher total modified videofluoroscopic dysphagia scale (mVDS) score, indicating more severe dysphagia (P=0.038). Among the mVDS sub-scores, tracheal aspiration was significantly higher in the COVID-19 pneumonia group (P＜0.001). In logistic regression analysis, age (P=0.034), COVID-19 (P=0.001), ICU admission (P=0.012), tracheostomy (P=0.029), and ARDS diagnosis after admission (P=0.036) were significantly associated with tracheal aspiration. After adjusting for age, sex, comorbidities, and clinical variables, COVID-19 was still significantly associated with worse tracheal aspiration scores (P=0.042). @*Conclusion@#Patients with COVID-19 pneumonia showed more severe dysphagia than subjects with aspiration pneumonia. This is particularly related to tracheal aspiration, as revealed by the VFSS. The dysphagia also correlated with a greater incidence of ICU admission, intubation, tracheostomy, and ARDS diagnosis in the COVID-19 pneumonia group.

Dysphagia Due to Bilateral Facial Palsy in B-Cell Acute Lymphoblastic Leukemia: A Case Report / 대한연하장애학회지

Dysphagia can cause aspiration pneumonia, a critical condition that increases the risk of morbidity and mortality in immunosuppressed patients. The facial nerve plays an important role in oropharyngeal swallowing. Here, we present a rare case of a leukemia patient with bilateral facial palsy and dysphagia, detected by a videofluoroscopic swallowing study (VFSS), which revealed oropharyngeal phase dysfunction. Severe drooling was observed due to poor lip sealing in the oral phase. The tongue movement was normal, but the patient had difficulty controlling dense food between his teeth and tongue, and under the tongue. In the pharyngeal phase, decreased elevation and closure of the larynx were observed. Penetration and aspiration were observed during liquid tests, however there was no cough. This case highlights the fact that the facial nerve plays an important role in the oropharyngeal phase of swallowing. VFSS should be preferentially considered to rule out aspiration pneumonia in bilateral facial palsy with suspected dysphagia.