|
1
|
Dai M, Qiao J, Chen H, Shi Z, Liu B, Dou ZL. Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome. Dysphagia 2024; 39:255-266. [PMID: 37584721 DOI: 10.1007/s00455-023-10607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Abstract
To assess the severity and timing of penetration and aspiration (PA) of severe dysphagia after lateral medullary syndrome (LMS) and its association with temporal characteristics. We performed videofluoroscopic swallowing studies (VFSS) in 48 patients with LMS and severe dysphagia and 26 sex- and age-matched healthy subjects. The following temporal measures were compared between groups: velopharyngeal closure duration (VCD); hyoid bone movement duration (HMD); laryngeal vestibular closure duration (LCD); upper esophageal sphincter (UES) opening duration (UOD); stage transition duration (STD) and the interval between laryngeal vestibular closure and UES opening (LC-UESop). The association between temporal measures and Penetration-Aspiration Scale (PAS) scores was analyzed. Differences in timing measures were compared between subgroups (safe swallows, and swallows with PA events during and after the swallow). PAS scores ≥ 3 were seen in 48% of swallows (4% occuring before, 35% occurred during and 61% after the swallow) from the LMS patients. Significantly longer STD and LC-UESop were found in the patients compared to the healthy subjects (p < 0.05). Significant negative correlations with PA severity were found for HMD, LCD, and UOD. Short UOD was the strongest predictor with an area under the receiver-operating-characteristic curve of 0.66. UOD was also significantly shorter in cases of PA after the swallow (p < 0.01). Patients with LMS involving severe dysphagia exhibit a high frequency of PA (mostly during and after swallowing). PA events were associated with shorter UOD, HMD, and LCD. Notably, shortened UOD appears to be strongly associated with PA.
Collapse
Affiliation(s)
- Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Jiao Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Huayu Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Zhonghui Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Binbin Liu
- Mingxin Rehabilitation Center, No. 1, Wushan Road, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Zu-Lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China.
| |
Collapse
|
|
2
|
Evaluation of chronological changes in videofluorographic findings after transoral videolaryngoscopic surgery to reveal mechanism of dysphagia. Auris Nasus Larynx 2022; 50:374-382. [PMID: 36075789 DOI: 10.1016/j.anl.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Transoral surgery preserves good swallowing function in most cases, however, postoperative dysphagia sometimes leads to fatal complication such as aspiration pneumonia. We investigated the chronological changes in swallowing function have not been revealed relationship with dysphagia. The primary aim of this study was to reveal the mechanism of dysphagia following transoral surgery by analyzing chronological videofluorography (VF) findings. Moreover, the secondary aim of this study was to evaluate the relationship between mechanism of dysphagia and risk factors of patients to clarify the risk for dysphagia lead to prevention of postoperative complications. METHODS 22 patients who underwent transoral videolaryngoscopic surgery (TOVS) for either supraglottic or hypopharyngeal cancer were evaluated swallowing function. We performed VF during the preoperative, postoperative acute, and stable phases and investigated the chronological changes in the VF findings. The following parameters were evaluated by VF: horizontal distance of laryngeal movement, vertical distance of laryngeal elevation, laryngeal elevation delay time (LEDT), Bolus Residue Scale (BRS) scores, and Penetration Aspiration Scale (PAS) scores. Additionally, we evaluated risk factors for postoperative aspiration by investigating relationships between preoperative VF parameters, age of patients, history of radiation therapy, resection area, tumor (T) stage, postoperative Numeric Rating Scale (NRS), and PAS and BRS scores. RESULTS The median time at which oral feeding was resumed in this study was 9 (2-200) days. The patients who had postoperative acute PAS scores of 4 and above exhibited delays in resuming oral ingestion after surgery. TOVS did not impair laryngeal elevation and LEDT; however, the BRS and PAS scores temporarily worsened in the acute phase compared to the preoperative scores. These scores almost recovered to their preoperative states in the stable phase, and both the BRS and PAS scores worsened and recovered concurrently. Patients who exhibited poor vertical distance in laryngeal elevation as observed via preoperative VF or who had histories of radiation therapy had worse PAS scores in postoperative acute phase VF. Patients with broad resection areas had worse BRS scores in postoperative acute phase VF. CONCLUSION TOVS didn't impair the function of laryngeal elevation and elicitation of the swallowing reflex whereas pharyngeal bolus clearance, laryngeal penetration, and aspiration temporarily deteriorated concurrently but eventually almost recovered to their baseline values. Patients with histories of radiotherapy, poor laryngeal elevation, and broad resection areas are at the risk of postoperative dysphagia after TOVS. Patients with these risk factors need appropriate evaluation before resuming postoperative oral intake.
Collapse
|
|
3
|
Zhang D, Li Y, Li H, Fu W, Zeng J, Zeng X. Analysis of Factors That Influence the Prognosis of Swallowing Function Rehabilitation Therapy in Patients with Dysphagia After Medullary Infarction. Neuropsychiatr Dis Treat 2022; 18:97-107. [PMID: 35079218 PMCID: PMC8776725 DOI: 10.2147/ndt.s341353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study investigated the factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. PATIENTS AND METHODS This retrospective study was conducted using the clinical data of 51 patients who were diagnosed with dysphagia after medullary infarction and hospitalized at our institution between January 2019 and January 2021. As per the water swallow test (WST) grade at 1 month after rehabilitation treatment, patients were classified into the good prognosis group and the poor prognosis group. Univariate analysis as well as univariate and multivariate logistic regression analysis were used to analyze factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. Receiver operating characteristic (ROC) curves were then used to test the predictive ability of the significant parameters to predict the prognosis of the rehabilitation therapy in these patients. RESULTS Univariate analysis and univariate logistic regression analysis showed that previous stroke (odds ratio [OR] = 1.361), dysarthria (OR = 3.771), disease course (OR = 1.112), National Institutes of Health Stroke Scale (NIHSS) score at admission (OR = 2.596), and infarct site (OR = 11.071) were all significantly correlated with the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction (P < 0.05). Multivariate logistic regression analysis showed that dysarthria (OR = 5.519, 95% confidence interval (CI) 1.413-21.566), infarct site (OR = 18.634, 95% CI 1.696-204.73), and the NIHSS score (OR = 1.001, 95% CI 1.536-4.820) were independent influencing factors of the prognosis of swallowing function rehabilitation therapy in these patients. The ROC curve showed that the area under the curve for the combined prediction of the three indicators was 0.943. CONCLUSION The NIHSS score, dysarthria, and infarct site are independent influencing factors for the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction.
Collapse
Affiliation(s)
- Di Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yi Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Heping Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Weifeng Fu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Jing Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Xi Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| |
Collapse
|
|
4
|
Hamzic S, Schramm P, Khilan H, Gerriets T, Juenemann M. Isolated Dysphagia in a Patient with Medial Medullary Infarction - Effects of Evidence-Based Dysphagia Therapy: A Case Report. Case Rep Neurol 2021; 13:190-199. [PMID: 33976655 PMCID: PMC8077515 DOI: 10.1159/000513676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Medial medullary infarction (MMI) is a vascular occlusion in the medulla oblongata leading to certain constellations of neurological symptoms and seriously affecting the patient. Effective evidence-based treatment of severe dysphagia as sole symptom of MMI has not yet been reported. This case study aims to report successful effects of evidence-based therapy based on findings of dysphagia symptoms and pathophysiology of swallowing by flexible endoscopic evaluation of swallowing (FEES) in severe isolated dysphagia after MMI. FEES was performed to evaluate swallowing pathophysiology and dysphagia symptoms in a 57-year-old male with severe dysphagia after MMI. On the basis of FEES findings, simple and high-frequent evidence-based exercises for improvement of swallowing were implemented: thermal stimulation of faucial arches, Jaw Opening Exercise, and Jaw Opening Against Resistance. After 7 weeks of high-frequent evidence-based therapy and regular FEES evaluation the patient was set on full oral diet with no evidence of aspiration risk. In a first case report of isolated dysphagia in MMI our case illustrates that high-frequent evidence-based dysphagia therapy in combination with FEES as the method to evaluate and monitor swallowing pathophysiology can lead to successful and quick rehabilitation of severely affected dysphagic patients.
Collapse
Affiliation(s)
- Samra Hamzic
- Department of Neurology, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany.,Heart and Brain Research Group, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Patrick Schramm
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Heart and Brain Research Group, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Hassan Khilan
- Stroke Unit, Department of Neurology, Gesundheitszentrum Wetterau, Friedberg, Germany
| | - Tibo Gerriets
- Department of Neurology, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany.,Heart and Brain Research Group, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.,Stroke Unit, Department of Neurology, Gesundheitszentrum Wetterau, Friedberg, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany.,Heart and Brain Research Group, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| |
Collapse
|
|
5
|
Crary MA. Adult Neurologic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
6
|
Jones CA, Colletti CM, Ding MC. Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep 2020; 20:61. [PMID: 33136216 PMCID: PMC7604228 DOI: 10.1007/s11910-020-01081-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? RECENT FINDINGS There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.
Collapse
Affiliation(s)
- Corinne A Jones
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA. .,Speech, Language, & Hearing Sciences; Moody College of Communication, The University of Texas, Austin, TX, USA.
| | - Christina M Colletti
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| | - Ming-Chieh Ding
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| |
Collapse
|
|
7
|
Frederick M, Rajpal A, Kircher C, Faryar KA. The Trouble with Swallowing: Dysphagia as the Presenting Symptom in Lateral Medullary Syndrome. J Emerg Med 2020; 59:392-395. [PMID: 32682639 DOI: 10.1016/j.jemermed.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Posterior circulation strokes account for approximately one-fourth of all ischemic strokes, but are frequently misdiagnosed by emergency providers. Current standard stroke screening tools such as the National Institutes of Health Stroke Scale and the Cincinnati Prehospital Stroke Scale are weighted toward anterior circulation stroke diagnosis. Lateral medullary syndrome, a type of posterior circulation stroke, can be particularly challenging to diagnose due to nonspecific presenting symptoms, such as dysphagia. CASE REPORT This report describes a 65-year-old man who presented with dysphagia, dizziness, and hoarseness. An initial neurological examination did not reveal any gross deficits, and imaging to evaluate for posterior circulation stroke was not obtained. The patient presented the following day with worsening symptoms, prompting imaging that revealed a large cerebellar ischemic infarction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although dysphagia frequently occurs in lateral medullary syndrome, it is rarely the presenting symptom in the emergency department. In patients with cerebrovascular risk factors who present with dysphagia, a complete neurological examination should be performed and noncontrast computed tomography (CT) of the head should be obtained if a neurological deficit is appreciated. Due to their poor sensitivity, CT scans can frequently miss posterior circulation strokes, therefore magnetic resonance imaging should be considered if provider suspicion remains high. Emergency providers are encouraged to have a high level of suspicion for this rare but debilitating stroke syndrome to avoid misdiagnosis and delayed care.
Collapse
Affiliation(s)
- Meaghan Frederick
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Abhinav Rajpal
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Charles Kircher
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio; University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
| | - Kiran A Faryar
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|
|
8
|
Nakao M, Oshima F, Izumi S. Comment on "Which Factors Affect the Severity of Dysphagia in Lateral Medullary Infarction?". Dysphagia 2020; 35:872-873. [PMID: 32221673 DOI: 10.1007/s00455-020-10109-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mari Nakao
- Rehabilitation Department, Niigata Rehabilitation Hospital, 761 Kizaki, Kita-ku, Niigata, 950-3304, Japan. .,Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Fumiko Oshima
- Rehabilitation Department, Suwa Red Cross Hospital, Suwa, Japan
| | - Shinichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
|
9
|
Jiang YE, Lyu QQ, Lin F, You XT, Jiang ZL. Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports. World J Clin Cases 2020; 8:1142-1149. [PMID: 32258085 PMCID: PMC7103971 DOI: 10.12998/wjcc.v8.i6.1142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A swallowing disorder may occur following a brainstem stroke, especially one that occurs in the swallowing centers. Lateral medullary syndrome (referred to as LMS), a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery, has been reported to lead to more severe and longer lasting dysphagia.
CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique (known as HEST). The two patients had no other functional incapacity back into life, but nasogastric feeding was the only possible way for nutrition because of severe aspirations. Swallowing function was evaluated by functional oral intake scale, modified water swallow test, surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration, pharyngeal residue, pharyngeal peristalsis, upper esophageal opening and the ability of deglutition. Both patients were treated with the HEST method for dysphagia and recovered quickly.
CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.
Collapse
Affiliation(s)
- Yu-Er Jiang
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Qian-Qian Lyu
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xue-Ting You
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhong-Li Jiang
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| |
Collapse
|