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1.
Curr Opin Otolaryngol Head Neck Surg ; 30(6): 393-399, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2152252

ABSTRACT

PURPOSE OF REVIEW: Dysphagia and dysphonia are common presentations of both acute and long coronavirus disease 2019 (COVID-19). The majority of peer-reviewed publications in 2020 and early 2021 were expert guidance and consensus statements to support dysphagia management in multidisciplinary teams while protecting clinicians and patients from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This review discusses dysphagia and dysphonia primary data published in 2021-2022, focusing on patient presentations, pathophysiology, and evidence for interventions. RECENT FINDINGS: Clinicians and researchers amassed knowledge of the cross-system presentation of dysphagia and dysphonia in patients with COVID-19, from severe disease requiring ICU stays to those with mild-to-moderate disease presenting to outpatient clinics. Pre-COVID-19 health status, hospitalization experience, presence of neurological symptoms, and impact of the virus to the upper aerodigestive and respiratory system need consideration in patient management. Long-term dysphagia and dysphonia manifested from COVID-19 require otolaryngologist and speech-language pathologist input. SUMMARY: Changes in immunity through population vaccination and variations in COVID-19 from SARS-CoV-2 mutations means prevalence data are challenging to interpret. However, there is no doubt of the presence of long-term dysphagia and dysphonia in our clinics. Long-term dysphagia and dysphonia are complex and a multidisciplinary team with a tailored approach for each patient is required.


Subject(s)
COVID-19 , Deglutition Disorders , Dysphonia , Humans , COVID-19/complications , Dysphonia/diagnosis , Dysphonia/etiology , Dysphonia/epidemiology , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Deglutition Disorders/epidemiology , SARS-CoV-2 , Hospitalization
2.
JAMA Otolaryngol Head Neck Surg ; 148(11): 1073-1074, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2119055

ABSTRACT

A 6-month-old girl presented to the emergency department for evaluation of fever and was noted to have mild inspiratory stridor, which began acutely at 4 months of age without any inciting illness or event. What is your diagnosis?


Subject(s)
Deglutition Disorders , Respiratory Sounds , Humans , Child , Respiratory Sounds/etiology , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Neck , Diagnosis, Differential
3.
Eur Arch Otorhinolaryngol ; 279(12): 5929-5937, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1982144

ABSTRACT

PURPOSE: COVID-19 is known to present with a wide range of clinical symptoms. COVID-19-related dysphagia has been frequently investigated in patients who were critically ill and mechanically ventilated, but not in those with less severe presentations. This study aims to identify the frequency, characteristics, and severity of self-perceived oropharyngeal dysphagia in non-intubated COVID-19 patients. METHODS: In this cross-sectional study, data were collected from patients using a self-administered questionnaire that included the Eating Assessment Tool (EAT-10). RESULTS: The study included 359 participants with a median age of 34 (range: 18-65) years. Self-perceived dysphagia (EAT-10 total score > 2) was identified in 64.62%, and their median EAT-10 total score was 13 (range 3-40). The most prevalent symptoms were painful swallowing, affected pleasure of eating, stressful swallowing, and coughing while eating. Age, gender, and hospitalization were not statistically significantly associated with the presence of dysphagia, while re-infection, duration, and severity of COVID-19 diagnosis were. The EAT-10 total score was higher in moderate and severe COVID-19 cases as compared to mild cases, and showed a statistically significant inverse correlation with the duration of COVID-19 (r = - 0.267). CONCLUSION: Self-perceived dysphagia was prevalent in non-intubated COVID-19 patients. Its severity was related to that of COVID-19 and its duration.


Subject(s)
COVID-19 , Deglutition Disorders , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Deglutition Disorders/etiology , Cross-Sectional Studies , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Deglutition , Surveys and Questionnaires
4.
J Laryngol Otol ; 136(12): 1278-1283, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1972483

ABSTRACT

OBJECTIVE: Post-extubation dysphagia in critically ill patients is known to affect about 18 per cent of mixed medical-surgical intensive care unit patients. This study investigated the incidence of post-extubation dysphagia in adult intensive care unit patients with coronavirus disease 2019. METHOD: This study was a retrospective analysis of consecutive intensive care unit patients prospectively screened for dysphagia. Systematic screening of all extubated intensive care unit patients at our tertiary centre was performed using the Bernese intensive care unit dysphagia algorithm. The primary outcome measure was the incidence of post-extubation dysphagia. RESULTS: A total of 231 critically ill adult coronavirus disease 2019 positive patients were included, and 81 patients remained in the final analysis after exclusion criteria were applied (e.g. patients transferred). Dysphagia screening positivity was 25 of 81 (30.9 per cent), with 28.2 per cent (22 of 78) having confirmed dysphagia by specialist examination within 24 hours (n = 3 lost to follow up). CONCLUSION: In this observational study, it was observed that the incidence of dysphagia in adult critically ill coronavirus disease 2019 patients was about 31 per cent (i.e. increased when compared with a historical pre-pandemic non-coronavirus disease 2019 intensive care unit cohort).


Subject(s)
COVID-19 , Deglutition Disorders , Humans , Adult , Critical Illness/epidemiology , Retrospective Studies , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Deglutition Disorders/etiology , COVID-19/complications , COVID-19/epidemiology , Incidence , Critical Care , Intensive Care Units
5.
Aliment Pharmacol Ther ; 55(9): 1160-1168, 2022 05.
Article in English | MEDLINE | ID: covidwho-1731089

ABSTRACT

BACKGROUND: The British Society of Gastroenterology has recommended the Edinburgh Dysphagia Score (EDS) to risk-stratify dysphagia referrals during the endoscopy COVID recovery phase. AIMS: External validation of the diagnostic accuracy of EDS and exploration of potential changes to improve its diagnostic performance. METHODS: A prospective multicentre study of consecutive patients referred with dysphagia on an urgent suspected upper gastrointestinal (UGI) cancer pathway between May 2020 and February 2021. The sensitivity and negative predictive value (NPV) of EDS were calculated. Variables associated with UGI cancer were identified by forward stepwise logistic regression and a modified Cancer Dysphagia Score (CDS) developed. RESULTS: 1301 patients were included from 19 endoscopy providers; 43% male; median age 62 (IQR 51-73) years. 91 (7%) UGI cancers were diagnosed, including 80 oesophageal, 10 gastric and one duodenal cancer. An EDS ≥3.5 had a sensitivity of 96.7 (95% CI 90.7-99.3)% and an NPV of 99.3 (97.8-99.8)%. Age, male sex, progressive dysphagia and unintentional weight loss >3 kg were positively associated and acid reflux and localisation to the neck were negatively associated with UGI cancer. Dysphagia duration <6 months utilised in EDS was replaced with progressive dysphagia in CDS. CDS ≥5.5 had a sensitivity of 97.8 (92.3-99.7)% and NPV of 99.5 (98.1-99.9)%. Area under receiver operating curve was 0.83 for CDS, compared to 0.81 for EDS. CONCLUSIONS: In a national cohort, the EDS has high sensitivity and NPV as a triage tool for UGI cancer. The CDS offers even higher diagnostic accuracy. The EDS or CDS should be incorporated into the urgent suspected UGI cancer pathway.


Subject(s)
COVID-19 , Deglutition Disorders , Gastrointestinal Neoplasms , Aged , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Endoscopy, Gastrointestinal , Female , Gastrointestinal Neoplasms/complications , Gastrointestinal Neoplasms/diagnosis , Humans , Male , Middle Aged , Prospective Studies , Referral and Consultation , Triage
6.
Dysphagia ; 37(6): 1633-1650, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1712242

ABSTRACT

The purpose of this systematic review was to examine the application of event-related potentials (ERPs) to investigate neural processes of swallowing functions in adults with and without dysphagia. Computerized literature searches were performed from three search engines. Studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2009). A total of 759 studies were initially retrieved, of which 12 studies met inclusion criteria. Electrophysiological measures assessing swallowing functions were identified in two major ERP categories: (1) sensory potentials and (2) pre-motor potentials. Approximately 80% of eligible studies demonstrated strong methodological quality, although most employed a case series or case-control study design. Pharyngeal sensory-evoked potentials (PSEPs) were used to assess pharyngeal afferent cortical processing. The temporal sequence of the PSEP waveforms varied based on the sensory stimuli. PSEPs were delayed with localized scalp maps in patients with dysphagia as compared to healthy controls. The pre-motor ERPs assessed the cortical substrates involved in motor planning for swallowing, with the following major neural substrates identified: pre-motor cortex, supplementary motor area, and primary sensorimotor cortex. The pre-motor ERPs differed in amplitude for the swallow task (saliva versus liquid swallow), and the neural networks differed for cued versus non-cued task of swallowing suggesting differences in cognitive processes. This systematic review describes the application of electrophysiological measures to assess swallowing function and the promising application for furthering understanding of the neural substrates of swallowing. Standardization of protocols for use of electrophysiological measures to examine swallowing would allow for aggregation of study data to inform clinical practice for dysphagia rehabilitation.


Subject(s)
Deglutition Disorders , Motor Cortex , Adult , Humans , Deglutition/physiology , Deglutition Disorders/diagnosis , Case-Control Studies , Motor Cortex/physiology , Pharynx/physiology
7.
Nervenarzt ; 93(2): 167-174, 2022 Feb.
Article in German | MEDLINE | ID: covidwho-1669765

ABSTRACT

Coronavirus disease 2019 (COVID-19) can lead to severe disease courses with multiple organ involvement, respiratory and neurological functional impairments. Swallowing disorders (dysphagia) in this patient group can result from primary damage to the central and peripheral neuronal swallowing network but also from the frequently prolonged intensive care treatment and mechanical ventilation. Clinical observations indicate persistence of dysphagia in post-acute COVID-19 syndrome (long COVID), so that these patients probably also need long-term interventions for rehabilitation of safe and sufficient oral feeding. Therefore, structured disease-specific monitoring of dysphagia symptoms should be integrated into the treatment of COVID-19 patients and respiratory therapy should be an essential part of dysphagia management to re-establish cough effectiveness and breathing-swallowing coordination. Challenges arise from necessary adjustments to established treatment standards to prevent infections. Furthermore, the selection and intensity of therapeutic measures have to be adapted to the capacities and the specific pathophysiology of COVID-19 and long COVID patients to prevent further functional deterioration.


Subject(s)
COVID-19 , Deglutition Disorders , Respiration, Artificial/adverse effects , COVID-19/complications , Deglutition Disorders/diagnosis , Deglutition Disorders/therapy , Humans , SARS-CoV-2
8.
BMC Pulm Med ; 21(1): 403, 2021 Dec 06.
Article in English | MEDLINE | ID: covidwho-1556106

ABSTRACT

BACKGROUND: To meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dysphagia predicting feeding-tube dependence persisting for 72 h after extubation. METHODS: This study examined the predictive validity of a two-item swallowing screen on feeding-tube dependence over 72 h in patients following endotracheal extubation. Intensive-care-unit (ICU) patients (≥ 20 years) successfully extubated after ≥ 48 h endotracheal intubation were screened by trained nurses using the swallowing screen (comprising oral stereognosis and cough-reflex tests) 24 h postextubation. Feeding-tube dependence persisting for 72 h postextubation was abstracted from the medical record by an independent rater. To verify the results and cross-check whether the screen predicted penetration and/or aspiration during fiberoptic endoscopic evaluation of swallowing (FEES), participants agreeing to receive FEES were analyzed within 30 min of screening. RESULTS: The results showed that 95/123 participants (77.2%) failed the screen, which predicted ICU patients' prolonged (> 72 h) feeding-tube dependence, yielding sensitivity of 0.83, specificity of 0.35, and accuracy of 0.68. Failed-screen participants had 2.96-fold higher odds of feeding-tube dependence (95% CI, 1.13-7.76). For the 38 participants receiving FEES, the swallowing screen had 0.89 sensitivity to detect feeding-tube dependence and 0.86 sensitivity to predict penetration/aspiration, although specificity had room for improvement (0.36 and 0.21, respectively). CONCLUSION: This ultra-brief swallowing screen is sufficiently sensitive to identify high-risk patients for feeding-tube dependence persisting over 72 h after extubation. Once identified, a further assessment and care are indicated to ensure the prompt return of patients' oral feeding. TRIAL REGISTRATION: NCT03284892, registered on September 15, 2017.


Subject(s)
Airway Extubation/adverse effects , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Enteral Nutrition , Intubation, Intratracheal/adverse effects , Aged , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Critical Care , Deglutition Disorders/therapy , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Risk Factors , Time Factors
9.
Am J Speech Lang Pathol ; 30(2): 532-550, 2021 03 26.
Article in English | MEDLINE | ID: covidwho-1545666

ABSTRACT

Purpose Our aim was to critically review recent literature on the use of telehealth for dysphagia during the COVID-19 pandemic and enhance this information in order to provide evidence- and practice-based clinical guidance during and after the pandemic. Method We conducted a rapid systematized review to identify telehealth adaptations during COVID-19, according to peer-reviewed articles published from January to August 2020. Of the 40 articles identified, 11 met the inclusion criteria. Full-text reviews were completed by three raters, followed by qualitative synthesis of the results and description of practical recommendations for the use of telehealth for dysphagia. Results Seven articles were guidelines articles, three were editorials, and one was a narrative review. One article focused on telehealth and dysphagia during COVID-19. The remaining 10 mentioned telehealth in varying degrees while focusing on dysphagia management during the pandemic. No articles discussed pediatrics in depth. The most common procedure for which telehealth was recommended was the clinical swallowing assessment (8/11), followed by therapy (7/11). Six articles characterized telehealth as a second-tier service delivery option. Only one article included brief guidance on telehealth-specific factors, such as legal safeguards, safety, privacy, infrastructure, and facilitators. Conclusions Literature published during the pandemic on telehealth for dysphagia is extremely limited and guarded in endorsing telehealth as an equivalent service delivery model. We have presented prepandemic and emerging current evidence for the safety and reliability of dysphagia telemanagement, in combination with practical guidelines to facilitate the safe adoption of telehealth during and after the pandemic.


Subject(s)
Deglutition Disorders/therapy , Speech-Language Pathology/methods , Telemedicine/methods , Adult , COVID-19/epidemiology , Child, Preschool , Deglutition Disorders/diagnosis , Deglutition Disorders/rehabilitation , Humans , Pandemics , Pediatrics/methods , SARS-CoV-2
10.
Arch Phys Med Rehabil ; 103(2): 336-341, 2022 02.
Article in English | MEDLINE | ID: covidwho-1544760

ABSTRACT

OBJECTIVE: To investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DESIGN: Retrospective cohort study. SETTING: Urban inpatient rehabilitation hospital. PARTICIPANTS: The first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. RESULTS: Twenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. CONCLUSIONS: Instrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.


Subject(s)
COVID-19/rehabilitation , Cineradiography/methods , Deglutition Disorders/epidemiology , Intubation, Intratracheal/adverse effects , Aged , Deglutition , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Female , Humans , Inpatients/statistics & numerical data , Male , Middle Aged , Odds Ratio , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
11.
Sleep Breath ; 24(3): 791-799, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1453831

ABSTRACT

OBJECTIVES: The purpose of this systematic review was to summarize and qualitatively analyze published evidence elucidating the prevalence of dysphagia and detail alterations in swallowing function in patients with OSAS. METHODS: Computerized literature searches were performed from four search engines. The studies were selected based on the inclusion and exclusion criteria. The studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2009). A total 2645 studies were initially retrieved, of which a total of 17 studies met inclusion criteria. Two reviewers, blinded to each other, evaluated level and strength of evidence using the Oxford Centre for Evidence-based Medicine Levels of Evidence and QualSyst, respectively. RESULTS: Dysphagia prevalence ranged from 16 to 78% among the eligible studies. Studies varied in operational definitions defining swallowing dysfunction (dysphagia) and method used to assess swallowing function. Approximately 70% of eligible studies demonstrated strong methodological quality. The majority of studies (n = 11; 65%) reported pharyngeal swallowing impairments in patients with OSAS, including delayed initiation of pharyngeal swallow and penetration/aspiration. CONCLUSION: This systematic review describes swallowing function in patients with OSAS. However, due to the variability in defining OSAS and dysphagia, in the assessment method used to determine dysphagia, and heterogeneity of study designs, true prevalence is difficult to determine. Clinicians involved in the management of OSAS patients should employ validated assessment measures to determine if swallow dysfunction is present.


Subject(s)
Deglutition Disorders/etiology , Deglutition/physiology , Oropharynx/physiopathology , Severity of Illness Index , Sleep Apnea, Obstructive/complications , Deglutition Disorders/diagnosis , Humans , Sleep Apnea, Obstructive/physiopathology
12.
Eur J Phys Rehabil Med ; 58(2): 179-189, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1451034

ABSTRACT

INTRODUCTION: Telerehabilitation is the provision of rehabilitation remotely through Information and Communication Technologies (ICT). Recently, there has been an increase of interest in its application thanks to increasing a new technology. The aim of this systematic review was to examine the evidence of the literature regarding the management of neurogenic dysphagia via telerehabilitation, compared to face-to-face rehabilitation treatment. The secondary aim was to create recommendations on telerehabilitation sessions for patients diagnosed with neurogenic dysphagia. EVIDENCE ACQUISITION: The databases were: Medline, Embase, CINAHL, Scopus. A total of 235 records emerged from bibliographic research, manual search of full text and from gray literature, published until January 2021. Two blinded authors carried out titles and abstract screening and followed by full-text analysis. Sixteen articles were included in the systematic review and assessed through critical appraisal tools. EVIDENCE SYNTHESIS: The research shows that the majority of the studies on neurogenic dysphagia involved the Clinical Swallow Examination via telerehabilitation, compared with the in-person modality. Significant levels of agreement and high satisfaction from clinicians and patients are reported to support the use of telerehabilitation. Based on the results of this systematic review and qualitative analysis, the authors developed practical recommendations for the management of telerehabilitation sessions for patients with neurogenic dysphagia. CONCLUSIONS: Despite the presence of barriers, telerehabilitation allowed healthcare provision and increasing access to care and services with specialized professionals, remote rehabilitation can be a valid resource during the health emergency due to COVID-19.


Subject(s)
COVID-19 , Deglutition Disorders , Telemedicine , Telerehabilitation , COVID-19/complications , Deglutition Disorders/diagnosis , Delivery of Health Care , Humans , Telerehabilitation/methods
14.
Int J Pediatr Otorhinolaryngol ; 148: 110823, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1293856

ABSTRACT

IMPORTANCE: Paediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) is a novel disease first identified in 2020. Recent cohort studies have described the complex presentation and symptomatology. This paper provides detailed description of the dysphagia and dysphonia symptoms, management, and outcome. OBJECTIVE: To describe dysphagia and dysphonia in PIMS-TS. DESIGN: Retrospective cohort study. SETTING: Single tertiary and quaternary children's hospital. PARTICIPANTS: All 50 children treated for paediatric multisystem inflammatory disease between April and June 2020 were included in this study. MAIN OUTCOME(S) AND MEASURE(S): Dysphonia: GRBAS Perceptual Severity Scores, Vocal Handicap Index scores and the Vocal Tract Discomfort Scale. Dysphagia: Functional Oral Intake Scale. RESULTS: Fifty children met the diagnostic criteria for PIMS-TS. 33 (66%) were male. Median age was 10 years (range: 1-17). 36 (72%) were of Black, Asian or minority ethnic background. Nine (18%) required specialist assessment and management of dysphagia and/or dysphonia. Five (55%) were male with a median age of 9 years 7 months (range: 1-15 years). Symptoms typically resolved within three months. Two children presented with persisting dysphonia three months post-presentation. Neurological, inflammatory, and iatrogenic causes of dysphagia and dysphonia were identified. CONCLUSIONS AND RELEVANCE: Dysphonia and dysphagia are present in children with PIMS-TS. Further data is required to understand pathophysiology, estimate incidence, and determine prognostic factors. This preliminary data highlights the need for dysphagia and dysphonia screening and timely referral for specialist, multidisciplinary assessment and treatment to ensure short-term aspiration risk is managed and long-term, functional outcomes are optimised.


Subject(s)
COVID-19 , Deglutition Disorders , Dysphonia , Child , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Deglutition Disorders/etiology , Dysphonia/diagnosis , Dysphonia/etiology , Humans , Infant , Male , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
15.
Dysphagia ; 37(2): 447-453, 2022 04.
Article in English | MEDLINE | ID: covidwho-1283782

ABSTRACT

A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease-2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score > 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score > 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the "time of meals" (mean score 65) following by the "sleep" (mean score 66) and "eating desire" (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology.


Subject(s)
COVID-19 , Deglutition Disorders , COVID-19/complications , COVID-19/epidemiology , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Deglutition Disorders/etiology , Hospitalization , Humans , Quality of Life , SARS-CoV-2
16.
Curr Opin Otolaryngol Head Neck Surg ; 29(3): 187-193, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1197059

ABSTRACT

PURPOSE OF REVIEW: Coronavirus Disease-19, (COVID-19) has challenged the customary practice of speech language pathologists (SLPs) in the acute care hospital arena, particularly in patients with swallowing disorders. RECENT FINDINGS: In this article, we present themes that emerged from qualitative interviews in which 15 SLPs in a tertiary academic medical center in Boston share their clinical experience caring for over 500 patients with COVID-19: triumphs, concerns, and fears. SUMMARY: The broad themes addressed include adapting to practice laced with fear and uncertainty about safety for themselves and their decision making, coming to terms with disparate and unpredictable clinical presentation, teamwork and collaboration and relationships with their patients despite physical and language barriers.


Subject(s)
COVID-19/epidemiology , Deglutition Disorders/therapy , Delivery of Health Care/organization & administration , Infection Control/organization & administration , Otolaryngology/organization & administration , Attitude of Health Personnel , Boston , COVID-19/prevention & control , COVID-19/transmission , Clinical Decision-Making , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Fear , Humans
17.
Am J Phys Med Rehabil ; 100(5): 424-431, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1114926

ABSTRACT

ABSTRACT: Dysphagia is the difficulty in swallowing because of the presence of certain diseases; it particularly compromises the oral and/or pharyngeal stages. In severe acute respiratory syndrome coronavirus 2 infection, neuromuscular complications, prolonged bed rest, and endotracheal intubation target different levels of the swallowing network. Thus, critically ill patients are prone to dysphagia and aspiration pneumonia. In this review, we first discuss the possible cause and pathophysiology underlying dysphagia associated with coronavirus disease 2019, including cerebrovascular events, such as stroke, encephalomyelitis, encephalopathy, peripheral neuropathy, and myositis, that may lead to the dysphagia reported as a complication associated with the coronavirus disease 2019. Next, we present some recommendations for dysphagia evaluation with modifications that would allow a safe and comprehensive assessment based on available evidence to date, including critical considerations of the appropriate use of personal protective equipment and optimization individual's noninstrumental swallowing tasks evaluation, while preserving instrumental assessments for urgent cases only. Finally, we discuss a practical managing strategy for dysphagia rehabilitation to ensure safe and efficient practice in the risks of severe acute respiratory syndrome coronavirus 2 exposure, in which swallowing therapy using newer technology, such as telerehabilitation system or wearable device, would be considered as a useful option.


Subject(s)
COVID-19/complications , Deglutition Disorders/diagnosis , Deglutition Disorders/rehabilitation , COVID-19/rehabilitation , Deglutition Disorders/virology , Humans , Telerehabilitation
18.
Laryngoscope ; 131(6): E1918-E1925, 2021 06.
Article in English | MEDLINE | ID: covidwho-986314

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has led to unprecedented demands on healthcare with many requiring intubation. Tracheostomy insertion has often been delayed and the enduring effects of this on voice, swallow, and airway outcomes in COVID-19 tracheostomy patients are unknown. The aim of this study was to prospectively assess these outcomes in this patient cohort following hospital discharge. METHODS: All COVID-19 patients who had undergone tracheostomy insertion, and were subsequently decannulated, were identified at our institution and followed up 2 months post-discharge. Patient-reported (PROMS) and clinician-reported outcome measures, endoscopic examination, and spirometry were used to assess voice, swallow, and airway outcomes. RESULTS: Forty-one patients were included in the study with a mean age of 56 years and male:female ratio of 28:13. Average duration of endotracheal intubation was 24 days and 63.4% of tracheostomies were performed at day 21 to 35 of intubation. 53.7% had an abnormal GRBAS score and 30% reported abnormal swallow on EAT-10 questionnaire. 81.1% had normal endoscopic examination of the larynx, however, positive endoscopic findings correlated with the patient self-reported VHI-10 (P = .036) and EAT-10 scores (P = .027). 22.5% had spirometric evidence of fixed upper airway obstruction using the Expiratory-Disproportion Index (EDI) and Spearman correlation analysis showed a positive trend between abnormal endoscopic findings and EDI scores over 50 (P < .0001). CONCLUSION: The preliminary results of this study reveal a high incidence of laryngeal injury among patients who underwent intubation and tracheostomy insertion during the COVID-19 pandemic. As these patients continue to be followed up, the evolution of these complications will be studied. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1918-E1925, 2021.


Subject(s)
COVID-19/surgery , Deglutition/physiology , Postoperative Complications/physiopathology , Pulmonary Ventilation/physiology , Tracheostomy , Voice Quality/physiology , Adult , Aged , Aged, 80 and over , Airway Obstruction/diagnosis , Airway Obstruction/physiopathology , COVID-19/physiopathology , Correlation of Data , Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Female , Follow-Up Studies , Humans , Intubation, Intratracheal , Larynx/injuries , Larynx/physiopathology , Male , Middle Aged , Prospective Studies , Spirometry , Treatment Outcome , Young Adult
19.
Dysphagia ; 36(5): 910-918, 2021 10.
Article in English | MEDLINE | ID: covidwho-938568

ABSTRACT

PURPOSE: Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18-65 years. METHODS: The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were e-mailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann-Whitney U) and Spearman's rho correlation. RESULTS: From March 2014 to October 2017: 2054 responses (32 reported ages outside of 18-65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18-65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0-36, mean 1.57, SD 3.49). EAT-10 score ≥ 3 (337) median 5 (range 3-36, mean 7.02 SD 5.91). Median age 36 (range 19-65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p = 0.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale = 1648, Nmale = 364) = 275,420.000, z = - 2.677, p = 0.007. Age and EAT-10 score were not associated: females rs = - 0.043, p = 0.079, N = 1648, males rs = - 0.003, p = 0.952, N = 364. Considerable impact on people: "I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry." (no diagnosis, EAT-10 = 17). CONCLUSION: Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.


Subject(s)
COVID-19 , Deglutition Disorders , Adolescent , Adult , Aged , Deglutition , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Female , Humans , Male , Middle Aged , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
20.
Dysphagia ; 36(4): 764-767, 2021 08.
Article in English | MEDLINE | ID: covidwho-893277

ABSTRACT

Since the World Health Organization declared the COVID-19 pandemic a Global Public Health Emergency, experts in swallowing are seeking guidance on service delivery and clinical procedures. The European Society for Swallowing Disorders provides considerations to support experts in swallowing disorders in clinical practice. During the COVID-19 pandemic, assessment and treatment of patients with oropharyngeal dysphagia should be provided, while at the same time balancing risk of oropharyngeal complications with that of infection of patients and healthcare professionals involved in their management. Elective, non-urgent assessment may be temporarily postponed and patients are triaged to decide whether dysphagia assessment is necessary; instrumental assessment of swallowing is performed only if processing of the instruments can be guaranteed and clinical assessment has not provided enough diagnostic information for treatment prescription. Assessment and management of oropharyngeal dysphagia is a high-risk situation as it must be considered an aerosol-generating procedure. Personal protective equipment (PPE) should be used. Telepractice is encouraged and compensatory treatments are recommended.


Subject(s)
COVID-19 , Deglutition Disorders , Infection Control , Practice Guidelines as Topic , Practice Patterns, Physicians'/organization & administration , Risk Management/organization & administration , COVID-19/epidemiology , COVID-19/prevention & control , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Deglutition Disorders/therapy , Delivery of Health Care/standards , Delivery of Health Care/trends , Europe/epidemiology , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/standards , Organizational Innovation , SARS-CoV-2 , Telemedicine/methods
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