ABSTRACT
IMPORTANCE: Magnetic resonance imaging (MRI) has the advantage of imaging swallow function at any anatomical level without changing the position of patient, which can provide detailed information than modified barium swallow, by far the gold standard of swallow evaluation. OBJECTIVE: To investigate the use of real-time MRI in the evaluation of swallow function of patients with tongue cancer. DESIGN, SETTING, AND PARTICIPANTS: Real-time MRI experiments were performed on a Signa Excite HD 1.5-T scanner (GE Healthcare), with gradients capable of 40-mT/m (milli-Tesla per meter) amplitudes and 150-mT/m/ms (mT/m per millisecond) slew rates. The sequence used was spiral fast gradient echo sequence. Four men with base of tongue or oral tongue squamous cell carcinoma and 3 age-matched healthy men with normal swallowing participated in the experiment. INTERVENTIONS: Real-time MRI of the midsagittal plane was collected during swallowing. Coronal planes between the oral tongue and base of tongue and through the middle of the larynx were collected from 1 of the patients. MAIN OUTCOMES AND MEASURES: Oral transit time, pharyngeal transit time, submental muscle length change, and the distance change between the hyoid bone and anterior boundary of the thyroid cartilage were measured frame by frame during swallowing. RESULTS: All the measurable oral transit and pharyngeal transit times of the patients with cancer were significantly longer than the ones of the healthy participants. The changes in submental muscle length and the distance between the hyoid bone and thyroid cartilage happened in concert for all 60 normal swallows; however, the pattern differed for each patient with cancer. To our knowledge, the coronal view of the tongue and larynx revealed information that has not been previously reported. CONCLUSIONS AND RELEVANCE: This study has demonstrated the potential of real-time MRI to reveal critical information beyond the capacity of traditional videofluoroscopy. Further investigation is needed to fully consider the technique, procedure, and standard scope of applying MRI to evaluate swallow function of patients with cancer in research and clinic practice.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Deglutition Disorders/diagnosis , Echo-Planar Imaging/methods , Image Interpretation, Computer-Assisted , Tongue Neoplasms/diagnosis , Aged , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Case-Control Studies , Deglutition/physiology , Deglutition Disorders/etiology , Follow-Up Studies , Humans , Male , Middle Aged , Pilot Projects , Postoperative Complications/diagnosis , Reference Values , Risk Assessment , Tongue Neoplasms/radiotherapy , Tongue Neoplasms/surgeryABSTRACT
The primary aim of this study was to investigate the outcomes of two different modes (active and passive) of balloon dilatation therapy on cricopharyngeal dysfunction (CPD). Thirty-eight CPD patients with neurological disorders were recruited between 2006 and 2010. Twenty-one of them received active balloon dilatation therapy, and the remaining 17 received passive dilatation therapy for an average of 4 weeks. The patients' swallowing function before and after the intervention was evaluated using the Functional Oral Intake Scale (FOIS) and the upper esophageal sphincter (UES) opening was studied with the videofluoroscopic swallow study. Both modes of balloon dilatation therapy yielded improvements in the FOIS (active group: z = -3.767, p < 0.001; passive group: z = -3.472, p < 0.001) and the UES opening (both groups: p < 0.01). Active dilatation showed a significantly better FOIS result (p = 0.028) than passive dilatation for CPD. Both active and passive balloon dilatation benefits patients with neurological disorders but active balloon dilatation is better.
Subject(s)
Catheters , Cricoid Cartilage/physiopathology , Deglutition Disorders/physiopathology , Deglutition/physiology , Dilatation/instrumentation , Esophageal Sphincter, Upper/physiopathology , Pharyngeal Muscles/physiopathology , Deglutition Disorders/therapy , Equipment Design , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: Dysphagia after head and neck cancer treatment is a health care issue; in some cases, the cause of death is not cancer but, rather, the passage of food or liquid into the lungs. Hyoid displacement is known to be important to safe swallowing function. The purpose of this study was to evaluate hyoid displacement after cancer treatment. METHOD: Hyoid displacement was measured in healthy persons with normal swallowing function, head and neck cancer patients postradiation only, and head and neck cancer patients postsurgery only. Three bolus conditions (5 ml and 10 ml liquid and 5 ml paste) were examined. The influence of 2 different measurement algorithms on the extent of hyoid movement was also explored. RESULTS: Radiation-therapy patients in this study had greater hyoid displacement than did surgery patients. Bolus viscosity and measurement method significantly influenced displacement results, whereas bolus volume did not. However, more multiple swallows occurred with 10 ml liquid; this may account for the apparent insignificance of bolus volume. CONCLUSIONS: These findings can be used to assist head and neck cancer treatment planning and counseling. Because hyoid measurement methods influence research conclusions, this aspect of design should be considered when interpreting research findings.
Subject(s)
Deglutition Disorders/diagnostic imaging , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/surgery , Hyoid Bone/diagnostic imaging , Postoperative Complications/diagnostic imaging , Adult , Aged , Aged, 80 and over , Algorithms , Deglutition/physiology , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Fluoroscopy , Humans , Hyoid Bone/physiology , Hyoid Bone/surgery , Male , Middle Aged , Models, Biological , Pilot Projects , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Radiotherapy/adverse effects , Reproducibility of Results , ViscosityABSTRACT
OBJECTIVE: To explore and assess the use of NiTi shape memory alloys in the eustachian tube to prevent and treat adhesive middle ear. METHODS: All preliminary study cases were divided into three groups (A: 56 cases of adhesive otitis media, B: 27 cases of otitis media with effusion, C: 52 cases without ear disease as control). The eustachian orifice in all cases was observed by endoscopy. Autopsy of Eustachian tube was done in two specimens. The NiTi shape memory alloys were then installed into the Eustachian tube to prevent and treat adhesive middle ear in 4 cases. The installer of NiTi shape memory alloys was designed by ourselves. RESULTS: The Eustachian orifice can be classified into three types: wide, narrow and fissured. They comprised of 20, 31 and 5 cases in group A, 9, 13 and 5 cases in group B and 45, 7 and 0 cases in group C, respectively. The differences among three groups were statistically significant (A, B vs C, chi 2 = 29.66, 25.44 respectively, P < 0.001), but the difference between A and B was not statistically significant (chi 2 = 1.59, P > 0.05). Two cases with adhesive otitis media gained good ventilation with Valsalva method and the audiometric improvement of 15-30 dB after the NiTi shape memory alloys installation. One of the two cases with otitis media with effusion gained A-B gap closure over 8 months, and the other still improved with ventilative tube removed. In all 4 cases, there was no any side-effect or signs of patulous Eustachian tube. CONCLUSION: Adhesive otitis media can be prevented and treated by using NiTi shape memory alloys without any side-effect, but more study is necessary.
