ABSTRACT
OBJECTIVES/HYPOTHESIS: To determine the incidence of abnormal fiberoptic endoscopic evaluation of swallowing (FEES) findings in patients with progressive neurologic disorders and identify the most commonly implemented dysphagia management strategies. STUDY DESIGN: Retrospective Review. METHODS: A retrospective review was performed of patients with neurodegenerative disease who underwent FEES at a tertiary-care center between 2008 and 2019. Patient demographics, diagnosis, and Eating Assessment Tool-10 (EAT-10) scores were recorded. Rates of penetration, aspiration, and functional change in management (FCIM) to include dietary modifications, home exercises, swallow therapy, surgical intervention (injection augmentation or esophageal dilation), or alternative means of nutrition (i.e., percutaneous enteral gastrostomy [PEG] tube) were calculated. RESULTS: Two hundred nine FEES assessments were performed in 178 patients with a mean age of 64.8 years (standard deviation = ±14). The most common diagnoses were amyotrophic lateral sclerosis (32%) followed by Parkinson's disease or Parkinsonism (26%). FEES demonstrated penetration in 72.5% of patients and aspiration in 14.6%. Mean EAT-10 scores differed between patients with aspiration versus penetration versus normal FEES (24.7 vs. 14.9 vs. 13.9, respectively, P < .001). An FCIM was recommended in 88% of patients and most commonly included self-directed modifications (43%). Overall, 4.5% of patients underwent surgical intervention. A PEG tube was recommended for either supplemental or sole form of nutrition in 19% of the entire cohort. CONCLUSIONS: Most patients with neurodegenerative diseases presenting with dysphagia demonstrated abnormal FEES findings necessitating an FCIM, suggesting early dysphagia evaluation may be warranted in this cohort. These findings correlate with worsened EAT-10 scores in patients with aspiration or penetration on FEES. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:726-730, 2021.
Subject(s)
Deglutition Disorders/physiopathology , Deglutition Disorders/therapy , Esophagoscopy/methods , Neurodegenerative Diseases/physiopathology , Aged , Disease Progression , Female , Fiber Optic Technology , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
INTRODUCTION: In a discussion of the risks and benefits of pediatric cochlear implantation, device failure and the need for revision surgery is often overlooked. The failure rate has not been investigated extensively for this population of patients. Hearing results are under-reported following revision surgery as well. We will review our experience with cochlear implant failure, revision, and hearing results when available to better guide the preoperative counseling of families considering cochlear implantation. METHODS: Retrospective chart review of all children undergoing cochlear implantation from 2004 to 2014. RESULTS: In this review of 579 cases of pediatric cochlear implantation, a 4.7% device failure rate was identified. Additionally, there was a 0.3% device infection rate, as well as a 0.3% electrode extrusion rate. 10 patients had audiometric data prior to and following revision surgery. These data demonstrate similar pre-failure and post revision surgery pure tone average. CONCLUSION: Cochlear implant device failure is the most common long-term complication of surgery; fortunately, hearing outcomes following revision surgery, evaluated with pure tone average, revealed no decline in auditory performance.
Subject(s)
Cochlear Implantation/instrumentation , Cochlear Implants , Equipment Failure/statistics & numerical data , Reoperation/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Hearing Tests , Humans , Infant , Male , Outcome and Process Assessment, Health Care , Preoperative Care , Retrospective StudiesABSTRACT
The infusion of a source of endothelial progenitors (EPCs) to limb ischemia (LB) patients has been used to increase angiogenesis. Because the formation of new blood vessels involves, in addition to EPCs, other cells and angiogenic regulators, we postulate that a combination cell therapy including EPCs and mesenchymal stem cells (a source of pericytes progenitors and angiogenic regulators) may represent a preferential stimuli for the development of blood vessels. In this phase I clinical trial, patients with LI were infused with a cell product consisting of autologous bone marrow-derived mononuclear and mesenchymal stem cells. After 10 2 months of follow-up, efficacy assessment demonstrated improvements in walking time, ankle brachial pressure, and quality of life. Concomitantly, angiographic and 99mTc-TF perfusion scintigraphy scores confirmed increased perfusion in the treated limbs. These results show that the use of a combination cell therapy is safe, feasible, and appears effective in patients with LI.
