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1.
Auris Nasus Larynx ; 50(2): 247-253, 2023 Apr.
Article in English | MEDLINE | ID: mdl-35973890

ABSTRACT

OBJECTIVE: Aspiration pneumonia is one of the leading causes of death in patients with muscular dystrophy; therefore, it is important to predict its occurrence in the clincal setting. We aimed to examine the usefulness of repeated saliva swallowing test (RSST), modified water swallowing test (MWST), and flexible endoscopic evaluation of swallowing (FEES) for evaluating the Hyodo score at the bedside, to predict the risk of aspiration pneumonia in patients with Duchenne muscular dystrophy (DMD). METHODS: In this retrospective cohort study involving 43 patients, we evaluated the swallowing function using the RSST, MWST, and FEES, and predicted the likelihood of aspiration pneumonia within 2 years after the assessment. The Hyodo score, a scoring system for evaluating the swallowing function determined by the FEES, was used. RESULTS: Pneumonia was observed in 14 patients (32.6%). The RSST was not significantly useful for predicting the onset of pneumonia. The MWST was reported to have a cutoff value of < 4 points. Significantly more patients in the pneumonia group had an MWST score of < 4 points. The results revealed that the occurrence of pneumonia could be predicted based on a Hyodo cutoff score of ≥ 6. Significantly more patients in the pneumonia group had an MWST score of < 4 or a Hyodo score of ≥ 6. CONCLUSIONS: Combining MWST and FEES is useful for evaluating the bedside swallowing function and predicting the onset of pneumonia.


Subject(s)
Deglutition Disorders , Muscular Dystrophy, Duchenne , Pneumonia, Aspiration , Pneumonia , Humans , Deglutition , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Deglutition Disorders/epidemiology , Muscular Dystrophy, Duchenne/complications , Retrospective Studies , Pneumonia, Aspiration/complications
2.
BMC Neurol ; 22(1): 94, 2022 Mar 16.
Article in English | MEDLINE | ID: mdl-35296264

ABSTRACT

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons selectively. In particular, weakness in respiratory and swallowing muscles occasionally causes aspiration pneumonia and choking, which can be lethal. Surgery to prevent aspiration, which separates the trachea and esophagus, can reduce the associated risks. Central-part laryngectomy (CPL) is a relatively minimally invasive surgery to prevent aspiration. No studies have been conducted on the long-term outcomes of surgery to prevent aspiration in patients with ALS. This case series aimed to determine the long-term outcomes of surgery to prevent aspiration and the use of a continuous low-pressure aspirator in patients with ALS by evaluating the frequency of intratracheal sputum suctions performed per day, intra- and postoperative complications, oral intake data, and satisfaction of patients and their primary caregiver to predict improvement in patients' quality of life (QOL). METHODS: We report a case series of six patients with ALS who underwent CPL along with tracheostomy to prevent aspiration between January 2015 and November 2018. We evaluated their pre- and postoperative status and administered questionnaires at the time of last admission to the patients and their primary caregivers. RESULTS: The mean follow-up period after CPL was 33.5 months. Aerophagia was a common postoperative complication. The use of a continuous low-pressure aspirator resulted in reduced frequency of intratracheal sputum suctions. All cases avoided aspiration pneumonia. Oral intake was continued for 2-4 years after the tracheostomy and CPL. The satisfaction levels of the patient and primary caregiver were high. CONCLUSION: Our case series suggests that the use of a continuous low-pressure aspirator in patients undergoing CPL improves oral intake and reduces the frequency of intratracheal sputum suctions, which improves the QOL of patients with ALS and their families and caregivers. CPL and continuous low-pressure aspiration should be considered as a management option for ALS with significant bulbar and respiratory muscle weakness/dysfunction.


Subject(s)
Amyotrophic Lateral Sclerosis , Neurodegenerative Diseases , Pneumonia, Aspiration , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/surgery , Deglutition , Humans , Neurodegenerative Diseases/complications , Pneumonia, Aspiration/complications , Pneumonia, Aspiration/prevention & control , Quality of Life
3.
J Voice ; 34(4): 649.e1-649.e6, 2020 Jul.
Article in English | MEDLINE | ID: mdl-30616964

ABSTRACT

PURPOSE: This study was performed to evaluate the characteristics of the Voice Handicap Index (VHI), a self-assessment measure, for patients with unilateral vocal fold paralysis (UVFP) who underwent arytenoid adduction (AA), in comparison with postoperative vocal function examinations. METHODS: A retrospective chart review was conducted for patients who underwent AA at Tohoku University Hospital during the period between 2014 and 2017. VHI was compared before and after surgery; moreover, correlations were assessed between the VHI and other voice measurements, including perceptual assessment of voice, as well as aerodynamic and acoustic measures. Factors involved in the VHI score were explored by multivariate analysis. RESULTS: Forty-three UVFP patients (28 males, age 32-81 years; 15 females, age 34-80 years) were enrolled in the study; the average age of all patients was 61.5 years (32-81 years). Among the enrolled patients, 33 (76.7%) left and 10 (23.3%) right vocal folds were impaired. After surgery, nearly all of the patients exhibited significantly improved VHI score; each of the three subscales (functional, physical, and emotional) was also improved. The postoperative VHI correlated mildly with several values of the other voice measurements, with the exception of the mean flow rate. Multivariate analysis showed that the sole variable associated with postoperative VHI score was preoperative VHI. CONCLUSIONS: The postoperative VHI likely reflects improvement in the voices of the patients with UVFP. Although there were weak correlations with other voice measures, postoperative VHI is a relatively independent measurement parameter for patients with UVFP who underwent AA.


Subject(s)
Arytenoid Cartilage/surgery , Disability Evaluation , Dysphonia/surgery , Laryngoplasty , Self-Assessment , Vocal Cord Paralysis/surgery , Voice Quality , Adult , Aged , Aged, 80 and over , Arytenoid Cartilage/physiopathology , Dysphonia/diagnosis , Dysphonia/physiopathology , Dysphonia/psychology , Emotions , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Quality of Life , Recovery of Function , Retrospective Studies , Treatment Outcome , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/physiopathology , Vocal Cord Paralysis/psychology
4.
Eur Arch Otorhinolaryngol ; 275(6): 1607-1611, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29610959

ABSTRACT

PURPOSE: To identify precipitating factors responsible for enteral nutrition (EN) dependency after concomitant chemoradiotherapy (CCRT) of head and neck cancers and to examine their statistical correlations. METHODS: Factors related to feeding condition, nutritional status, disease, and treatment of 26 oropharyngeal and hypopharyngeal cancer patients who received definitive CCRT were retrospectively investigated by examining their medical records. The days of no oral intake (NOI) during hospitalization and the months using enteral nutrition after CCRT were counted as representing the feeding condition, and the changes in body weight (BW) were examined as reflecting nutritional status. The factors related to EN dependency after CCRT were analyzed. RESULTS: Long duration of total NOI (≥ 30 days) and maximum NOI ≥ 14 days were significant predictors of EN dependency. Decreased BW (≥ 7.5 kg) was the next predictor identified, but it was not significant. Multivariate analysis showed that the total duration of NOI was more correlated with EN dependency than changes in BW. CONCLUSIONS: A long duration of NOI was more strongly related to EN dependency than nutritional factors.


Subject(s)
Chemoradiotherapy , Enteral Nutrition , Hypopharyngeal Neoplasms/therapy , Nutritional Status , Oropharyngeal Neoplasms/therapy , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
5.
Okajimas Folia Anat Jpn ; 94(3): 101-108, 2017.
Article in English | MEDLINE | ID: mdl-29681587

ABSTRACT

The purpose of this study is to describe the Hasner's membrane which is the main factor of congenital nasolacrimal duct obstruction. Hasner's membrane at the nasal end of the fetal nasolacrimal duct (NLD) is considered to rupture at and after birth. However, topographical anatomy around the membrane as well as a mechanism of rupture seems to be still obscure. We observed frontal or sagittal sections of 20 late-stage fetuses (28-33 weeks) and found the on-going rupture in 2 specimens. The present sections demonstrated that 1) the nasal dilation was not a simple ball-like structure but extended posteriorly and laterally; 2) dilation of the NLD consistently involved the lacrimal sac; 3) Hasner's membrane and ductal mucosal layer contained no macrophages and no or few arteries and nerves. The posterior extension of the NLD end ranged from 1-2 mm, while the lateral extension 3-5 mm although a site of the thinnest membrane varied in location between specimens. Moreover, the thickest NLD due to dilation was in the slightly orbital or upper side of the nasal end. Therefore, before surgical treatment of Hasner's membrane, evaluation using medical images seems to be necessary. Since the nasal epithelium on Hasner's membrane was most likely to destroy earlier than the NLD mucosal lining, observations of the membrane from the nasal cavity seemed helpful for diagnosis at which site would be broken and when.


Subject(s)
Nasolacrimal Duct/embryology , Humans , Lacrimal Duct Obstruction/congenital , Nasal Mucosa/embryology , Nasolacrimal Duct/immunology
6.
Dysphagia ; 31(5): 635-43, 2016 10.
Article in English | MEDLINE | ID: mdl-27435248

ABSTRACT

Although the pharyngeal wall is well known to have high elasticity, the distribution of submucosal elastic fibers has not been described. Observations of histological sections of the mid and lower pharyngeal walls from 15 elderly donated cadavers were made. We found two distinct submucosal tissue layers with a high content of elastic fibers (tentatively termed the "submucosal elastic laminae"). The inferolateral elastic lamina was restricted to the level from the upper part of the arytenoid to the lower end of the inferior cornu of the thyroid cartilage. It originated from the pharyngeal submucosa, extended laterally along the inner aspect of the thyropharyngeal muscle, and inserted into the posterior margin of the thyroid cartilage including the cornu. The posteromedial lamina extended along the supero-inferior axis from a level above the greater horn of the hyoid bone to reach the muscularis mucosae of the cervical esophagus. The inferolateral and posteromedial laminae were connected at levels below the cricoarytenoid joint. Individual variations were evident in their thicknesses (ranging from almost absent to 0.3 mm) as well as the extent of connection between them. In association with striated muscle function, the inferolateral lamina seemed to suspend the lower pharyngeal mucosa, while the posteromedial lamina seemed to provide mucosal fold forcing smoothly peristaltic conveyance of a bolus during swallowing.


Subject(s)
Deglutition/physiology , Elastic Tissue/physiology , Mucous Membrane/physiology , Pharynx/physiology , Aged , Aged, 80 and over , Cadaver , Esophagus/physiology , Female , Humans , Hyoid Bone/physiology , Laryngeal Cartilages/physiology , Male
7.
Ann Otol Rhinol Laryngol ; 125(3): 219-27, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26391093

ABSTRACT

OBJECTIVE: To clarify composite fibers and cells in the synovial tissues of the cricoarytenoid joint (CA joint). METHODS: Routine histology and immunohistrochemistry using sagittal or nearly sagittal sections obtained from 18 elderly cadaveric specimens. RESULTS: The CA joint capsule was thin and contained few elastic fibers. A limited supportive ligament, namely, a thickened fascia of the posterior cricoarytenoid muscles, was sometimes evident on the lateral aspect of the CA joint. However, even in the weaker medial aspect of the joint, no marked destruction of the synovial tissues was found. The CA joint always contained synovial folds--a short medial fold and long lateral folds--but these contained no or few macrophages, lymphocytes, and blood capillaries. In 2 exceptional specimens showing inflammatory cell infiltration in the submucosal tissue of the larynx, the macrophage-rich area extended toward the capsule and medial synovial fold. CONCLUSIONS: The lateral aspect of the CA joint was likely to be supported mechanically by the muscle-associated tissues. Strong support of the arytenoid by muscles might reduce the degree of CA joint injury with age. However, some patients with hoarseness due to mucosal inflammation of the larynx might have accompanying synovitis and subsequent cartilage injury in the CA joint.


Subject(s)
Arytenoid Cartilage/anatomy & histology , Cricoid Cartilage/anatomy & histology , Synovial Membrane/anatomy & histology , Aged , Aged, 80 and over , Arytenoid Cartilage/blood supply , Arytenoid Cartilage/cytology , Cadaver , Capillaries/anatomy & histology , Cricoid Cartilage/blood supply , Cricoid Cartilage/cytology , Elastic Tissue/anatomy & histology , Humans , Immunoenzyme Techniques , Ligaments/anatomy & histology , Lymphocytes/cytology , Macrophages/cytology , Male , Middle Aged , Synovial Membrane/blood supply , Synovial Membrane/cytology
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