Effects of Cervical Bracing on Elderly Patients With Dysphagia.

PURPOSE: This study aimed to determine if cervical bracing with a PMT collar increases risk of airway invasion and pharyngeal residue in elderly patients with dysphagia. Additionally, it aimed to identify patient preference for cervical bracing during deglutition. METHOD: Twenty-one patients underwent a videofluoroscopic swallow study. Thin liquid, nectar thick liquid, pudding, and cracker were administered with cervical collar on and off with order of condition randomized. The Penetration-Aspiration Scale (PAS) was used to grade swallows, with McNemar's test of symmetry used to determine whether the categorical PAS score was similar between conditions. Pharyngeal residue was measured following swallows. Patients were asked which condition they preferred, and which was more comfortable with "no difference" being a selection. RESULTS: No significant difference in PAS categorization score was measured for any consistency (p = .317-.919). Significantly more pyriform sinus residue was measured in the collar off condition (p = .003), albeit amounts were within normative range, with no difference measured in vallecula residue between conditions (p = .939). Forty-five percent of participants preferred to swallow with the collar off, while 55% indicated no preference. Forty-one percent of participants indicated increased comfort with collar off, while 59% indicated no difference in comfort. No participant preferred swallowing or indicated increased comfort with the collar on. CONCLUSIONS: Presence of a cervical collar in elderly patients with dysphagia did not result in a significant difference in airway invasion or total pharyngeal residue. There was significantly more residue in the pyriform sinuses when cervical bracing was removed. The majority of patients did not indicate a difference in preference or comfort between collar on/off conditions.

Effect of Lidocaine on Comfort and Swallowing Pressures During Pharyngeal High-Resolution Manometry.

The purpose of this study is to determine the level of patient comfort during pharyngeal high-resolution manometry (HRM) with and without the use of atomized lidocaine. A secondary aim of the study was to explore whether differences in pharyngeal pressure measurements exist between HRM conducted with the use of atomized lidocaine verses HRM conducted without. Twenty-nine participants underwent two HRM procedures under two conditions, 5-7 days apart: 2% viscous lidocaine to nares or 0.4 mL 4% atomized and 2% viscous lidocaine to nares. During each procedure, participants received six boluses of water. Following catheter removal, participants were asked to rate comfort using a visual analog scale (VAS) and upon completion of both conditions, participants indicated which procedure they preferred. A paired t-test was used to compare pharyngeal pressure measurements at the velopharynx, tongue base region and during upper esophageal sphincter opening. Pharyngeal pressures were categorized as normal or outside of normal limits and compared using a McNemar's test. Twenty-eight of the 29 participants indicated they preferred the use of atomized lidocaine. VAS ratings yielded a significant difference (p = 0.001). No significant difference in pharyngeal pressures were detected between the two groups. Patients prefer atomized lidocaine when undergoing HRM. The use of atomized lidocaine did not affect measurement outcomes.

Preliminary Evaluation of Functional Swallow After Total Laryngectomy Using High-Resolution Manometry.

INTRODUCTION: Understanding of swallowing pressures after total laryngectomy (TL) and what constitutes a "functional" swallow are limited. Mobile structures are altered or removed after TL, with consequent effects on pressure profiles. High-resolution manometry (HRM) can characterize these pressures. METHODS: Six TL subjects without dysphagia and 6 controls underwent pharyngeal HRM. Timing and pressure variables for the velopharynx, mesopharynx, and upper esophageal sphincter (UES) were compared. Changes in variables due to bolus volume were evaluated in TL subjects. RESULTS: The TL subjects had increased duration of velopharyngeal pressure (P = .012). Maximum mesopharyngeal pressure was lower versus controls (P = .003). Maximal and total pre-opening (P = .002, P = .002) and post-closure (P = .001, P = .002) UES pressures were lower. Maximum mesopharyngeal pressure (P = .032) decreased with increasing bolus volume. CONCLUSIONS: Increased velopharyngeal pressure duration and total swallow duration reflect separation of the pharynx into distinct conduits for air and food, thus ensuring successful bolus passage without the need for respiration. Decreased UES pressure highlights the effects of disrupting the cricopharyngeal and rostral esophageal muscle fibers from their attachments to the larynx and performing a cricopharyngeal myotomy. Additional studies including subjects with dysphagia could further characterize the functional TL swallow and identify aspects susceptible to dysfunction.