Article

The Prevalence of Dysphagia among Adults in the United States

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Abstract

Objective: To determine the prevalence of dysphagia, reported etiologies, and impact among adults in the United States. Study design: Cross-sectional analysis of a national health care survey. Subjects and methods: The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was assessed. Results: An estimated 9.44 ± 0.33 million adults (raw N = 1554; mean age, 52.1 years; 60.2% ± 1.6% female) reported a swallowing problem (4.0% ± 0.1%). Overall, 22.7% ± 1.7% saw a health care professional for their swallowing problem, and 36.9% ± 0.1.7% were given a diagnosis. Women were more likely than men to report a swallowing problem (4.7% ± 0.2% versus 3.3% ± 0.2%, P < .001). Of the patients, 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422,000 ± 77,000; 11.2% ± 1.9%), followed by other neurologic cause (269,000 ± 57,000; 7.2% ± 1.5%) and head and neck cancer (185,000 ± 40,000; 4.9% ± 1.1%). The mean number of days affected by the swallowing problem was 139 ± 7. Respondents with a swallowing problem reported 11.6 ± 2.0 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without a swallowing problem (contrast, +8.1 lost workdays, P < .001). Conclusion: Swallowing problems affect 1 in 25 adults, annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.

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... Estimates of the prevalence of dysphagia demonstrate wide variability and range from 25% to 45% in typically developing children, 33% to 80% in children with developmental disorders, between 16% and 22% among individuals older than 50 and between 14% and 40% in adults over 60 (Koidou, Kollinas, Sdravou, & Grouios, 2013). A 2014 study of self-reported health of United States residents estimates that one in 25 adults in the United States experiences dysphagia annually (Bhattacharyya, 2014). ...
... In the same study, only 51% of respondents stated they would seek a referral to a specialist if they were experiencing dysphagia. A study of adults in the United States found that only 4.0% of adults identified themselves as having experienced swallowing difficulties and of those only 22.9% sought assistance from health care professionals even though 48% of respondents rated the severity of their swallowing problem to be moderate or greater (Bhattacharyya, 2014). Unaddressed, dysphagia can lead to serious complications such as malnutrition and aspiration pneumonia (Martino, Foley, Bhogal, Diamant, Speechley, & Teasell, 2005). ...
... were highly varied and in many cases vague. Both the causes of dysphagia and the responses to this question are manifold, so two of the most common aetiologies for swallowing disorders, cancer and stroke (Bhattacharyya, 2014), were coded. Instances of both of these causes were tallied, with several respondents providing both answers. ...
Article
Purpose: Dysphagia affects a wide cross-section of society. Reports of stigma and missed diagnoses suggest limited public awareness of this prevalent condition, exacerbating the hidden disability stemming from this impairment. This study explored the public awareness of dysphagia among people both with and without occupational ties to healthcare to assess the level of awareness and identify topics where public knowledge may be deficient. Method: An online purpose-built survey was administered to determine self-assessed awareness of dysphagia, and researcher-assessed understanding of the causes, symptoms, assessment and treatment of swallowing disorders. Survey answers (n = 374) were grouped by healthcare (n = 105) and non-healthcare (n = 269) respondents. Responses were analysed using both qualitative and quantitative methods. Result: Self-assessed respondent awareness was low among 71% of non-healthcare and 29% of healthcare respondents, corroborating the limited demonstrated knowledge of the causes, symptoms, assessment and treatment of dysphagia. Self assessed and researcher-assessed awareness was more limited among non-healthcare respondents. Conclusion: Survey results confirm limited public knowledge of dysphagia and demonstrate the need for greater public awareness of this largely invisible disorder.
... The true prevalence of dysphagia in the community is uncertain, with a wide range from 2.5 to 72% [17,25,[27][28][29][30][31][32] reported. Adkins et al. reported a prevalence of 16.1% (4998/31129) across all age groups [20], whereas Battacharyya reported a 4% prevalence from a cohort of 30,000 in a household survey [33]. Kertscher et al. using EAT-10 as part of a telephone survey, found that 21.9% of those > 76 years scored ≥ 3, indicating problems swallowing [21]. ...
... Bias may be introduced by both the survey and the researcher. Those studies of dysphagia focussing on older people have tended to be small [17,26], and larger studies have relied on census data [24,33]. No studies have examined the medical data held in electronic health records (EHRs) that have been collated as part of day-to-day clinical care and explored the relationship with and age, gender, frailty and deprivation. ...
... Similarly, Adkins et al. reported that 2445 of 4998 (49%) survey participants had not consulted a health care practitioner [20]. In the USA, Bhattacharyya et al. estimated that 9.4 million adults had had dysphagia in the previous year [33]. This was extrapolated from a cohort of 1554 (4%) of the sample reporting dysphagia, where 22.7% (353) had seen a health care professional, 36.9% (130) had received a confirmed diagnosis and 56.5% reported that their swallow was a moderate/big/very big problem. ...
Article
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Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated < 1% of individuals were recorded as having a dysphagia diagnosis per year. We found dysphagia to be statistically significantly associated with older age, more severe frailty and individuals from more deprived areas. Multivariate analyses indicated increased odds ratios [OR (95% confidence intervals)] for a dysphagia diagnosis with increased age [reference 65–74: aged 75–84 OR 1.09 (1.07, 1.12), 85 + OR 1.23 (1.20, 1.27)], frailty (reference fit: mild frailty 2.45 (2.38, 2.53), moderate frailty 4.64 (4.49, 4.79) and severe frailty 7.87 (7.55, 8.21)] and individuals from most deprived areas [reference 5. Least deprived, 1. Most deprived: 1.10 (1.06, 1.14)]. The study has identified that prevalence of diagnosed dysphagia is lower than previously reported. This study has confirmed the association of dysphagia with increasing age and frailty. A previously unreported association with deprivation has been identified. Deprivation is a multifactorial problem that is known to affect health outcomes, and the association with dysphagia should not be a surprise. Research in to this relationship is indicated.
... Dysphagia has been reported in up to 8% of the world's population, or almost 600 million people (Cichero et al., 2017). In 2012, it was estimated that over 9 million adults experienced difficulty swallowing in the preceding 12 months (Bhattacharyya, 2014). Advancing age is a major risk factor for dysphagia. ...
... Oropharyngeal dysphagia can occur as a component of many different clinical conditions (see Table 2; ASHA, 2020b; Bhattacharyya, 2014;Eslick & Talley, 2008;Jaffer et al., 2015;Liu et al., 2018;Spieker, 2000). Because of the significant risk of morbidity (e.g., pneumonia), it is important to screen patients at risk for oropharyngeal dysphagia using a tool validated for dysphagia and/or aspiration (Sherman et al., 2018). ...
... Consensus recommendation no. 3: An MBSS should be considered when: Table 2. Common diseases/conditions and signs and symptoms associated with adult oropharyngeal dysphagia (ASHA, 2020b; Bhattacharyya, 2014;Eslick & Talley, 2008;Jaffer et al., 2015;Liu et al., 2018;Spieker, 2000). ...
Article
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Purpose Dysphagia occurs as a component of a wide variety of diseases and conditions. When unrecognized or poorly managed, dysphagia can result in malnutrition, volume depletion, and reduced quality of life, as well as aspiration, pneumonia, and death. This document focuses specifically on oropharyngeal dysphagia. The modified barium swallow study (MBSS) is a fluoroscopic motion study used to evaluate oropharyngeal anatomy and swallowing physiology in real time. It is typically performed by a speech-language pathologist together with a radiologist and often assisted by a radiologic technologist. Because oropharyngeal dysphagia has such a varied presentation, the guidance to diagnose and treat oropharyngeal dysphagia in the United States falls under the purview of several professional societies and organizations. However, a thorough review of available practice guidelines and appropriateness criteria issued to date reveals a deficit of up-to-date, comprehensive, evidence-based information on the diagnosis and evaluation of oropharyngeal dysphagia. Specifically, a lack of quality guidance on the ordering, performance, and reporting of the MBSS has hindered efforts to improve standardization and ensure quality continuity of care. Method In 2019, a group with expertise in oropharyngeal dysphagia (speech-language pathologists, radiologists, and referring physicians) convened with the goal of specifying a core set of expert recommendations/best practices to achieve a high-quality MBSS. Results Here, we present the results of the participants' discussions and provide consensus recommendations regarding ordering, performing, and reporting an MBSS. Conclusion The overarching goal of this summary is to emphasize the need for and encourage the development of MBSS practice guidelines to support clinicians and patients.
... Results on dysphagia prevalence differ not only depending on age and etiology but also due to methodology. Overall, epidemiological reports have indicated that dysphagia is more common (6-50%) among older adults [15,16]. In our populationbased study focused on long-term NGT placement, the prevalence rate was approximately 0.05-0.06% in the adult population, and the rate was dominant in men and increased in line with age, which is consistent with other studies [14][15][16]. ...
... Overall, epidemiological reports have indicated that dysphagia is more common (6-50%) among older adults [15,16]. In our populationbased study focused on long-term NGT placement, the prevalence rate was approximately 0.05-0.06% in the adult population, and the rate was dominant in men and increased in line with age, which is consistent with other studies [14][15][16]. This is the first longitudinal follow-up study to reveal the annual prevalence in an adult population with long-term NGT placement. ...
Article
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Tube feeding (TF) is commonly used for patients with severe swallowing disturbance, and patients with chronic dysphagia are often provided with a long-term nasogastric tube (NGT). However, nationwide epidemiological data on long-term NGT placement are limited. The present study identified the prevalence and outcomes of patients with long-term NGT placement in Taiwan. Data were obtained from the Longitudinal Health Insurance Database. Patients with NGT placement for more than 3 months between 2000 and 2012 were enrolled in this cohort study. An NGT cohort of 2754 patients was compared with 11,016 controls matched for age, sex, residential area, and comorbidities. The prevalence rate of long-term NGT reached 0.063% in 2005 and then remained stable at 0.05–0.06%. The major causes of NGT placement were stroke (44%), cancer (16%), head injury (14%), and dementia (12%). Men (63%) were more likely to have long-term NGT placement than women (37%). The adjusted hazard ratios were 28.1 (95% CI = 26.0, 30.3) for acute and chronic respiratory infections; 26.8 (95% CI = 24.1, 29.8) for pneumonia, 8.84 (95% CI = 7.87, 9.93) for diseases of the esophagus, stomach, and duodenum; and 7.5 (95% CI = 14.7, 20.8) for mortality. Patients with NGT placement for more than 6 months had a higher odds ratio (1.58, 95% CI = 1.13, 2.20) of pneumonia than those with NGT placement for less than 6 months. Only 13% and 0.62% of the patients underwent rehabilitation therapy and percutaneous endoscopic gastrostomy, respectively. Long-term NGT use was associated with a higher risk of comorbidities and mortality. Stroke was the main illness contributing to long-term NGT use. Further interventions are necessary to improve the negative effects of long-term TF.
... Dysphagia is a common problem with a prevalence of about 1 of 25 adult population in the community. 1 This problem has a signi cant impact as 25-32% of the affected non-elderly population reported the severity of the problem to be moderate to severe and associated with work abstinence. 1 In community-dwelling adults, the older population age >50 years has a higher prevalence of dysphagia (15-22%) than the younger (6-9%). 2 Moreover, the elders with dysphagia have higher morbidity from aspiration pneumonia and a higher 30-day mortality rate after admission than those without. 3 In addition to age, hospital admission from acute illness can contribute to the presence of dysphagia at approximately 30% evaluated by validated screening questionnaires and volume-viscosity swallowing tests. ...
... 1 This problem has a signi cant impact as 25-32% of the affected non-elderly population reported the severity of the problem to be moderate to severe and associated with work abstinence. 1 In community-dwelling adults, the older population age >50 years has a higher prevalence of dysphagia (15-22%) than the younger (6-9%). 2 Moreover, the elders with dysphagia have higher morbidity from aspiration pneumonia and a higher 30-day mortality rate after admission than those without. 3 In addition to age, hospital admission from acute illness can contribute to the presence of dysphagia at approximately 30% evaluated by validated screening questionnaires and volume-viscosity swallowing tests. ...
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Background and aims: Acute illness might affect the swallowing function. However, there have been limited studies regarding dysphagia awareness in hospitalized patients, factors associated with dysphagia, and its outcomes. Methods: Consecutive patients in an internal medicine ward whom primary physicians prescribed oral diet were prospectively evaluated their swallowing problems by using a water swallow test (WST) and swallowing disturbance questionnaire (SDQ) within 48 hours after admission. Patients characteristics, nutritional status, readmission, and mortality rates were evaluated and compared between patients with and without impaired swallowing. Results: Among 131 enrolled patients (61 males, mean age 58±21 years), 20 patients (15.3%) had abnormal SDQ and 38 patients (29%) had abnormal WST. 19/20 patients with abnormal SDQ had abnormal WST while 19/38 patients with abnormal WST (50.0%) had abnormal SDQ. Patients with swallowing problems by either abnormal SDQ or WST were significantly older than those without (p<0.05). After adjusting for age, underlying neurological disorders (OR 2.96, 95%CI 1.03-8.47; p=0.04), admission diagnosis of pneumonia (OR 5.29, 95%CI 1.47-19.0, p=0.01), and moderate-to-severe malnutrition (OR 4.14, 95%CI 1.67-10.3, p=0.002) were significantly associated with abnormal WST, while malnutrition (OR 9.88, 95%CI 2.36-41.4; p=0.002) was independently associated with abnormal SDQ. For the follow-up period of 14 months, five patients (26.3%) who had abnormal SDQ/WST had aspiration pneumonia and 2 of them died while one patient with normal SDQ and WST (0.9%) had aspiration pneumonia (p<0.001). Conclusion: Dysphagia is an underrecognized problem in hospitalized patients. This problem was associated with underlying neurological diseases, malnutrition, the current diagnosis, and readmission due to pneumonia. Screening for dysphagia is recommended in hospitalized patients, particularly in patients at risk.
... Dysphagia, or disordered swallowing, impacts 1 in 25 adults every year in the United States [1,2] and leads to serious health complications including malnutrition, dehydration, and aspiration pneumonia [3][4][5]. Penetration and Aspiration, characterized as varying degrees of airway invasion of ingested material, are major sequalae of a swallowing impairment that increase the likelihood of aspiration pneumonia [4,[6][7][8]. ...
Article
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A widely applied metric for identifying airway invasion events is the Penetration–Aspiration Scale (PAS). PAS scores are often included as primary outcome measures in clinical interventional studies, applied to characterize airway protection in a particular disease, used to establish a normal referent for control group comparisons without dysphagia, and as determinants or predictors of clinical outcomes. Despite the widespread use of the PAS, there is variability in scoring condition. One common method used in research studies includes rater scores applied to each single swallow that occurred during a modified barium swallow study (MBSS) of the same patient. A second common method includes raters scoring single swallow segments that have been spliced from full MBSS from different patients. These single swallow segments are then randomly distributed and the rater is blinded to all swallows that occurred during that patient MBSS. The potential effects of different scoring conditions on rater reliability and score accuracy have not been studied and may have high relevance for the conclusion drawn from the result. The primary aim of this investigation is to determine the impact of two scoring conditions on rater reliability and score accuracy: 1. Contextual, unblinded scoring condition and 2. Randomized, blinded condition. Results of the present study show that no statistically significant differences in PAS rater reliability and score accuracy were found between the two scoring conditions. If findings from this pilot study are reproduced in larger sample sizes, the time and intensity involved in splicing and randomizing MBSS for scoring may not be necessary.
... Hansen et al. demonstrated the ability of young subjects to learn to take oral dosage forms [16]. Acceptance could be further increased if the subjects were trained beforehand, by taking placebo tablets or capsules with an identical density, for example, using the EsoCap system cup [16,17,24,25]. ...
Article
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There are no methods for specific local application of active substances to the mucosa of the esophagus to treat eosinophilic esophagitis or other esophageal diseases. This publication describes the principal in vivo functionality and acceptance of a novel modular drug delivery concept, called EsoCap system, by 12 healthy volunteers. For the first time, the EsoCap system enables targeted placement on the esophageal mucosa of a mucoadhesive polymer film. Acceptance was determined by means of a standardized questionnaire after administration and functionality of the device by MRI scans. Two different setups of the EsoCap system were tested: one setup with a density of 0.4 g/cm3 and one with a density of 1.0 g/cm3. Acceptability of the dosage form was also confirmed in addition to functionality, by measuring the applied film length. It was found that acceptance of the variant with the higher density was significantly better. This novel drug delivery technology could enable a targeted, local and long-lasting therapy of the esophagus for the first time, depending on the polymer film used.
... These serious consequences, caused by dysphagia, impact both the health and the quality of patients' daily life. Annually in the United States, approximately 4% of adults have swallowing-related disorders [10]. It is estimated that 12-13% of patients in short-term acute care hospitals and around 60% of nursing home occupants have swallowing difficulties [6]. ...
Article
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Swallowing physiology includes numerous biomechanical events including displacement of the hyoid bone, which is a crucial component of airway protection and opening of the proximal esophagus. The objective of this study was to evaluate the potential relations between the trajectory of hyoid bone movement and the risk of airway penetration and aspiration during a videofluoroscopic swallowing study. Two hundred sixty-five patients were involved in this study, producing a total of 1433 swallows of various volumes consisting of thin liquid, nectar-thick liquid, and solids during a fluoroscopic exam. The anterior and posterior landmarks of the body of the hyoid bone were manually marked in each frame of each fluoroscopic video. Generalized estimation equations were applied to evaluate the relationship between penetration–aspiration scores and mathematical features extracted from the hyoid bone trajectories, while also considering the influence of other independent variables such as age, bolus volume, and viscosity. Our results indicated that penetration–aspiration scores showed a significant relation to age. The maximum anterior (horizontal) displacement of the anterior hyoid bone landmark was significantly associated with the penetration–aspiration scores. Differences in the displacement of the hyoid bone are useful observations in airway protection. Article highlights In this work, the potential relations between the trajectory of hyoid bone movement and the risk of airway penetration and aspiration during a videofluoroscopic swallowing study were evaluated. We extracted features from the hyoid bone trajectories and applied generalized estimation equations to investigate their relationship to penetration–aspiration scales. The results showed that the maximum anterior (horizontal) displacement of the anterior hyoid bone landmark was significantly associated with the penetration–aspiration scales.
... Swallowing dysfunction has devastating health implications, putting patients at high risk for aspiration of secretions, liquids or food particulates, subsequent development of aspiration pneumonia, and potential death. 1 The estimated prevalence of dysphagia ranges from 3 to 4 per cent in otherwise healthy adults in Western countries with increased rates among high-risk populations. [2][3][4] Martino et al. reported that following a stroke up to 78 per cent of patients had abnormal swallowing with increased risk for pneumonia among patients with evidence of aspiration. 5 Hospital and societal costs for patients affected by dysphagia are increasingly recognised as a major expense that will continue to increase with an aging population. ...
Article
Objective Dysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time. Method This was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities. Results This study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time ( p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time ( p = 0.57) or severity of dysphagia ( p = 0.88). Conclusion Our dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.
... Dysphagia is a frequent consequence of many neurological and anatomical conditions or diseases (e.g., stroke, cerebral palsy, Parkinson's disease, dementia, head and neck cancer, trauma, etc.), and is very common. In the US alone, four percent of adults are reported to experience dysphagia per year (Bhattacharyya, 2014). For those individuals, the impact can be profound. ...
Article
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Background: Swallowing disorders (dysphagia) can negatively impact quality of life and health. For clinicians and researchers seeking to improve outcomes for patients with dysphagia, understanding the neural control of swallowing is critical. The role of gray matter in swallowing control has been extensively documented, but knowledge is limited regarding the contributions of white matter. Our aim was to identify, evaluate, and summarize the populations, methods, and results of published articles describing the role of white matter in neural control of swallowing. Methods: We completed a systematic review with a multi-engine search following PRISMA-P 2015 standards. Two authors screened articles and completed blind full-text review and quality assessments using an adapted U.S. National Institute of Health's Quality Assessment. The senior author resolved any disagreements. Qualitative synthesis of evidence was completed. Results: The search yielded 105 non-duplicate articles, twenty-two of which met inclusion criteria. Twenty were rated as Good (5/22; 23%) or Fair (15/22; 68%) quality. Stroke was the most represented diagnosis ( n = 20; 91%). All studies were observational, and half were retrospective cohort design. The majority of studies (13/22; 59%) quantified white matter damage with lesion-based methods, whereas 7/22 (32%) described intrinsic characteristics of white matter using methods like fractional anisotropy. Fifteen studies (68%) used instrumental methods for swallowing evaluations. White matter areas commonly implicated in swallowing control included the pyramidal tract, internal capsule, corona radiata, superior longitudinal fasciculus, external capsule, and corpus callosum. Additional noteworthy themes included: severity of white matter damage is related to dysphagia severity; bilateral white matter lesions appear particularly disruptive to swallowing; and white matter adaptation can facilitate dysphagia recovery. Gaps in the literature included limited sample size and populations, lack of in-depth evaluations, and issues with research design. Conclusion: Although traditionally understudied, there is sufficient evidence to conclude that white matter is critical in the neural control of swallowing. The reviewed studies indicated that white matter damage can be directly tied to swallowing deficits, and several white matter structures were implicated across studies. Further well-designed interdisciplinary research is needed to understand white matter's role in neural control of normal swallowing and in dysphagia recovery and rehabilitation.
... Prevalence of swallowing problems is 4.0% among adults aged ≥18 years and 15.0-33.7% for those aged ≥65 years (Baijens et al., 2016;Bhattacharyya, 2014;Roden and Altman, 2013). Dysphagic patients experience higher mortality, with lengthy hospitalization periods increasing healthcare utilization and costs (Attrill et al., 2018). ...
... Swallowing is a complex process, requiring intricate coordination of nerves and muscles to move a substance (bolus) from the mouth to the stomach. Dysphagia, or difficulty swallowing, occurs when this process is compromised, such as from muscle weakness or damage to the nervous system (e.g., from a stroke), and affects approximately 1 in 25 adults annually in the USA [1]. The consequences of impaired swallowing can be dire, with significant risk of health complications and even death [2]. ...
Article
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Introduction: Difficulty swallowing (dysphagia) occurs frequently in patients with neurological disorders and can lead to aspiration, choking, and malnutrition. Dysphagia is typically diagnosed using costly, invasive imaging procedures or subjective, qualitative bedside examinations. Wearable sensors are a promising alternative to noninvasively and objectively measure physiological signals relevant to swallowing. An ongoing challenge with this approach is consolidating these complex signals into sensitive, clinically meaningful metrics of swallowing performance. To address this gap, we propose 2 novel, digital monitoring tools to evaluate swallows using wearable sensor data and machine learning. Methods: Biometric swallowing and respiration signals from wearable, mechano-acoustic sensors were compared between patients with poststroke dysphagia and nondysphagic controls while swallowing foods and liquids of different consistencies, in accordance with the Mann Assessment of Swallowing Ability (MASA). Two machine learning approaches were developed to (1) classify the severity of impairment for each swallow, with model confidence ratings for transparent clinical decision support, and (2) compute a similarity measure of each swallow to nondysphagic performance. Task-specific models were trained using swallow kinematics and respiratory features from 505 swallows (321 from patients and 184 from controls). Results: These models provide sensitive metrics to gauge impairment on a per-swallow basis. Both approaches demonstrate intrasubject swallow variability and patient-specific changes which were not captured by the MASA alone. Sensor measures encoding respiratory-swallow coordination were important features relating to dysphagia presence and severity. Puree swallows exhibited greater differences from controls than saliva swallows or liquid sips (p < 0.037). Discussion: Developing interpretable tools is critical to optimize the clinical utility of novel, sensor-based measurement techniques. The proof-of-concept models proposed here provide concrete, communicable evidence to track dysphagia recovery over time. With refined training schemes and real-world validation, these tools can be deployed to automatically measure and monitor swallowing in the clinic and community for patients across the impairment spectrum.
... Dysphagia is defined as an inability to swallow or a difficulty in the passage of food from the mouth to the stomach due to functional or mechanical obstruction of the luminal organ, including the oropharynx, esophagus, or gastric cardiac. According to the 2012 National Health Interview Survey, approximately nine million adults have reported a swallowing problem [1]. The higher incidence of dysphagia in the elderly is well documented; however, there is scarce data on its precise etiology and diagnostic workup. ...
Article
Dysphagia, which is characterized by difficulty in oro-gastric bolus transit, is a common condition. It is broadly classified into oropharyngeal or esophageal pathology. A wide array of differentials for dysphagia and initial clinical suspicion of oropharyngeal or esophagus etiology can assist in further evaluation. Fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallow study (VFSS) are the preferred modalities for assessing oropharyngeal bolus transit, residual, as well as determining the risk of laryngeal aspiration. High-resolution pharyngeal manometry (HRPM) is an emerging modality for optimal topographical and pressure assessment of pharyngeal anatomy. HRPM provides improved assistance in evaluating the strength of the pharyngeal muscular contraction. Esophagogastroduodenoscopy (EGD) is the preferred exam for patients with suspected esophageal etiology of dysphagia. Barium swallow provides luminal assessment and assists in evaluating esophageal motility; it is non-invasive, but therapeutic interventions like biopsy cannot be performed. High-resolution esophageal manometry (HREM) has added another dimension in the diagnosis of esophageal motility disorders. The purpose of this review article is to help internists and primary care providers get a better understanding of the role of various imaging modalities in diagnosing dysphagia in the elderly population. This article also provides a comprehensive review and detailed comparison of these imaging modalities based on the latest evidence.
... This study identifies a need to clarify guidelines and increase interprofessional education between both professions to improve patient care. D isordered swallowing (dysphagia) affects an estimated 4% of adults (Bhattacharyya, 2014), and the presence of dysphagia significantly contributes to health care cost (Attrill et al., 2018;Patel et al., 2018). Nearly 35% of adults aged 75 years or older have experienced dysphagia (Cho et al., 2015). ...
Article
Purpose Speech-language pathologists (SLPs) are trained to evaluate and treat dysphagia. One treatment method is to modify diet consistency or viscosity to compensate for swallowing dysfunction and promote a safer intake; this typically involves softening solids and thickening liquids. Thickening liquids is not safer for all patients, and modification of dysphagia diets without adequate training may reduce the quality of dysphagia patient care. Over 90% of SLPs working in health care report exposure to nurses who regularly downgrade dysphagia diets without an SLP consult. This study explores dysphagia diet modification practices of nursing staff with and without dysphagia training. Method Practicing nurses and student nurses ( N = 298) in the United States were surveyed regarding their dysphagia diet modification training and practice patterns. Additionally, a pre-/posttest design was used to determine the efficacy of a short general tutorial on willingness to modify diets without an SLP consult. Results Downgrading diets without an SLP consult is a common practice. Fewer than one third of nurses (31.41%) would avoid it, whereas 73.65% would avoid upgrading without SLP consult. Formal dysphagia training made little difference to this practice. The short general tutorial also had no beneficial effect, in fact slightly reducing the willingness to consult SLPs. Conclusions Dysphagia diet modification practice by nurses is pervasive in U.S. health care. This is a previously unexplored but common issue SLPs face in work settings. This study identifies a need to clarify guidelines and increase interprofessional education between both professions to improve patient care.
... H ead and neck cancer (HNC) is one of the most common etiologies of dysphagia (Bhattacharyya, 2014). Dysphagia can be managed in a number of ways, depending on the severity, underlying impairment, and prognosis. ...
Article
Purpose A large knowledge gap related to dysphagia treatment adherence was identified by a recent systematic review: Few existing studies report on adherence, and current adherence tracking relies heavily on patient self-report. This study aimed to report weekly adherence and dysphagia-specific quality of life following home-based swallowing therapy in head and neck cancer (HNC). Method This was a quasi-experimental pretest–posttest design. Patients who were at least 3 months post–HNC treatment were enrolled in swallowing therapy using a mobile health (mHealth) swallowing system equipped with surface electromyography (sEMG) biofeedback. Participants completed a home dysphagia exercise program across 6 weeks, with a target of 72 swallows per day split between three different exercise types. Adherence was calculated as percent trials completed of trials prescribed. The M. D. Anderson Dysphagia Inventory (MDADI) was administered before and after therapy. Results Twenty participants (75% male), with an average age of 61.9 years (SD = 8.5), completed the study. The majority had surgery ± adjuvant (chemo)radiation therapy for oral (10%), oropharyngeal (80%), or other (10%) cancers. Using an intention-to-treat analysis, adherence to the exercise regimen remained high from 84% in Week 1 to 72% in Week 6. Radiation therapy, time since cancer treatment, medical difficulties, and technical difficulties were all found to be predictive of poorer adherence at Week 6. A statistically significant improvement was found for composite, emotional, and physical MDADI subscales. Conclusions When using an mHealth system with sEMG biofeedback, adherence rates to home-based swallowing exercise remained at or above 72% over a 6-week treatment period. Dysphagia-specific quality of life improved following this 6-week treatment program.
... In general, compared with adults in the general population, adults with SMA have a higher burden of many of the symptoms or conditions studied here. Approximately 4% of US adults have dysphagia [16]; however, through 2 years postindex, 13.4% of SMA patients in this study had dysphagia (data not shown). In the general population, prevalence of scoliosis ranges widely, from 8.3% in a 1987 National Health and Nutrition Examination Survey (NHANES) of adults aged 25-74 years [17] and 8.9% in a study of 3185 adults aged ≥ 40 years [18] to 13.4% based on another smaller study of 500 adults aged 25-64 years reporting thoracic scoliosis [19]. ...
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Background: Spinal muscular atrophy (SMA) is a rare genetic disease characterized by progressive muscular weakness and atrophy resulting from motor neuron degeneration. Limited information is available on disease progression among older SMA patients, particularly adults. Objective: This study sought to characterize the natural history of SMA among adult patients in US hospital settings through the assessment of symptoms, complications, costs, and healthcare resource utilization (HRU) over 3 years before the availability of disease-modifying therapies. Methods: The study population included adult (≥18 years) patients with inpatient and/or hospital-based outpatient discharge records and≥2 primary or secondary SMA ICD-9 codes≥30 days apart in the Premier Healthcare Database during the main study period (2007- 2014). Index date was the date of the first SMA ICD-9 code. The frequency of SMA-related symptoms and complications was assessed 1 year preindex through 2 years postindex to characterize disease progression. Costs and HRU were also assessed across the study period. Results: A total of 446 adult patients from 337 US hospitals met inclusion criteria for these analyses. All evaluated SMA-related symptoms and complications increased steadily over time, from 1 year preindex to 2 years postindex both overall and in each age group. Adult patients with SMA had increasing total costs and HRU over the 3-year study period: total costs were $1759 preindex and $12,308 by 2 years postindex. Conclusions: Findings are consistent with increasing disease burden over time and support the progressive nature of SMA for adult patients with hospital interactions.
... Anatomically, dysphagia may result from dysfunction at oropharyngeal or esophageal levels. Dysphagia can occur at any age and affects 4% of the population; however, it is more prevalent in the elderly population [1]. At conservative estimates, dysphagia affects about 15% of the elderly [2], 30% of the elderly who are hospitalized [3] and up to 68% of the elderly who live in nursing homes [4]. ...
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Sarcopenic dysphagia (SD) is swallowing difficulty associated with loss of generalized skeletal muscles and swallowing‐related muscles. Diagnostic criteria for SD were suggested, yet there is a variability in instruments and cut-offs used. The aim of the current review is to critically evaluate tools used in diagnosis of sarcopenic dysphagia in the elderly. Comprehensive review of the literature was performed. Studies were qualitatively evaluated for the diagnostic tools used to make a diagnosis of “sarcopenic dysphagia” and compared to the known diagnostic criteria for SD and other accepted measures. Fourteen studies (N = 10,282) were selected from a search yield of 331 de-duplicated studies. Ninety-three percent of studies (13/14) were conducted in Japan. All subjects included were over the age of 65 years old (mean, 76.5 years). Various tools were used to assess sarcopenia including handgrip strength (14/14 of studies), followed by skeletal muscle mass/index (7/14), tongue pressure, gait speed, and calf circumference in 5/14 studies. The most commonly tool used for dysphagia and/or swallowing dysfunction was the food level intake scale (5/14 of studies) followed by the functional oral intake scale (3/14). The 100-mL water swallow test was used in 2 of the 14 included SD studies. Fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, EAT-10 questionnaire, and standardized swallow assessment were each used in only one SD study. Further research is required to validate SD diagnostic tools, establish cut-offs in different populations, and investigate their role in screening of dysphagia and swallowing dysfunction in the elderly.
... Dysphagia and malnutrition pose significant health threats and are financial burdens increasing health care expenditures [1][2][3][4]. Dysphagia is a symptom of disease, with an estimated 9. 44 million adults (1 in 25) reporting swallowing difficulty in the United States [5]. Careful evaluation of the swallowing process to determine the etiology of dysphagia is necessary to reduce dysphagia sequela and health care costs. ...
Article
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Oropharyngeal and esophageal dysphagia may occur simultaneously. However, symptoms are often evaluated separately. Few standardized, multi-texture esophageal screening protocols exist as an addition to the modified barium swallow study (MBSS). Given the gap in MBSS evaluation standards, providers may be lacking information needed to fully assess the swallowing process and create appropriate dysphagia management plans. The aim was to assess the diagnostic accuracy of a standardized esophageal screening protocol performed by an SLP compared to formal reference esophageal examinations. A cross-sectional analytic study was performed. Consecutively referred patients who underwent same-day consultation with the SLP and a gastroenterologist were included. MBSS with a standardized esophageal screen was performed. Same-day formal esophageal testing was completed and included timed barium emptying study or high-resolution manometry. Summary diagnostic accuracy measures were calculated. Seventy-three patients matched the inclusion criteria. Median age was 62.5 years (25–87), 55% were female. Sensitivity of the esophageal screen for the detection of esophageal abnormality was 83.7% (95% CI 70–91.9%); specificity was 73.7% (95% CI 55.6–85.8%). The positive likelihood ratio was 3.14 (95% CI 1.71–5.77), whereas the negative likelihood ratio was 0.22 (95% CI 0.11–0.45). Positive and negative predictive values were 82% and 76%, respectively. Use of a systematic, multi-texture esophageal screen protocol interpreted by SLPs accurately identifies multiphase dysphagia and should be considered in addition to standard MBSS testing. Inclusion of a cursory esophageal view may more adequately assess dysphagia symptoms and help to promote multidisciplinary care.
... The MBSS is often referred to as the gold standard for the diagnosis of swallowing impairment. Despite its critical role for more than nine million patients in the United States with swallowing impairment [15], this exam has historically been underused or used in a truncated manner due to radiation exposure concerns. One reason for this is that clinicians have not had access to data which quantify the average radiation exposure to patients undergoing MBSS when determining the risk/benefit ratio for this exam causing clinicians to err on the side of caution. ...
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Modified Barium Swallow Studies (MBSSs) are important tests to aid the diagnosis of swallowing impairment and guide treatment planning. Since MBSSs use ionizing radiation, it is important to understand the radiation exposure associated with the exam. This study reports the average radiation dose in routine clinical MBSSs, to aid the evidence-based decision-making of clinical providers and patients. We examined the MBSSs of 200 consecutive adult patients undergoing clinically indicated exams and used kilovoltage (kV) and Kerma Area Product to calculate the effective dose. While 100% of patients underwent the exam in the lateral projection, 72% were imaged in the upper posterior-anterior (PA) projection and approximately 25% were imaged in the middle and lower PA projection. Average kVs were 63 kV, 77 kV, 78.3 kV, and 94.3 kV, for the lateral, upper, middle, and lower PA projections, respectively. The average effective dose per exam was 0.32 ± 0.23 mSv. These results categorize a typical adult MBSS as a low dose examination. This value serves as a general estimate for adults undergoing MBSSs and can be used to compare other sources of radiation (environmental and medical) to help clinicians and patients assess the risks of conducting an MBSS. The distinction of MBSS as a low dose exam will assuage most clinician’s fears, allowing them to utilize this tool to gather clinically significant information about swallow function. However, as an X-ray exam that uses ionizing radiation, the principles of ALARA and radiation safety must still be applied.
... The prevalence of dysphagia is about 3% in the general population [1] and as high as 22% in individuals over the age of 50. [2] Dysphagia can be a sign of another conditions or neglected medical issues. Cervicogenic dysphagia is a cervical cause of difficulty in swallowing. ...
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Dysphagia (swallowing difficulty) is most often related to another health problems, including brain or spinal cord injury, neurological damage, neuromuscular disorders, and anatomical conditions. Dysphagia can have detrimental effects on pulmonary health and also impact nutritional intake. The right treatment depends on the cause established. Cervicogenic dysphagia is a cervical cause of difficulty in swallowing. This report describes a 53-year-old female patient with sore throat, swallowing difficulty for solids, and acid reflux for 2 years. Radiographs revealed anterior osteophytic lipping and kyphosis of the cervical spine and thoracolumbar (right convex) scoliosis. After 6 months of chiropractic treatment, her complaints and spinal deformity were obviously resolved. Our case report is unique in that the patient had an unusual presentation, i.e. cervical osteophytes, cervical kyphosis, and thoracolumbar scoliosis, which are all contributable causes of dysphagia. Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.
... The incidence of dysphagia is high (The Ontario Association of Speech-Language Pathologists and Audiologists [OSLA], 2016). The prevalence of dysphagia is generally reported to be more common among older patients compared to the general population (Bhattacharyya, 2014;Cabré et al., 2014;Roden & Altman, 2013) A few studies (Lindgren & Janzon, 1991;Tibbling & Gustafsson, 1991) have estimated that dysphagia may be as high as 22% in adults over 50 years of age and higher in elderly populations receiving inpatient medical treatment, where up to 30% of the patients may have symptoms of dysphagia (Layne et al., 1989). The numbers increase for residents in long-term care settings, where more than half of the residents there (68%) have dysphagia (Steele et al., 1997). ...
Article
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Swallowing involves 55 muscles, five cranial nerves and two cervical nerve roots. When the coordination of this reflex is disturbed, dysphagia occurs. Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow or to the sensation that the foods or the liquids are being obstructed in their passage from the mouth to the stomach. The objective of the study was to identify the diagnosis of patients attending Speech Therapy clinic, in Queen Elizabeth Hospital, Kota Kinabalu, Sabah, and to identify the demography of dysphagic patients. From the 406 patients that came during the study period, 139 patients (34.2%) were diagnosed with dysphagia, followed by developmental language disorders (33.3%). Of the 139 patients diagnosed with dysphagia, most of them are within the 41 to 60 (43.2%) and above 60 (42.2%) age groups. The majority were males (66.2%). A total of 81 (58.3%) patients with dysphagia had a history of cerebrovascular accident. Dysphagia is a common disorder among patients attending Speech Therapy Clinics at Queen Elizabeth Hospital, Kota Kinabalu. Training of Speech Therapists and early dysphagia intervention leads to a better outcome.
... Normal swallowing function requires a series of precisely timed pressure changes within the upper aerodigestive tract that are accomplished primarily by tongue muscle contractile activity, which contributes to bolus containment and propulsion through the upper esophageal segment (Logemann, 1998;Lind, 2003). However, each year, 1 in 25 adults in the United States experience swallowing disorders (dysphagia) (Bhattacharyya, 2014). Prevalence increases with aging and age-related diseases with 50-75% of nursing home residents estimated to have dysphagia (Steele et al., 1997;O'Loughlin and Shanley, 1998), more than 80% of patients with Parkinson disease (Kalf et al., 2012;Suttrup and Warnecke, 2016), and 46-60% of patients with head and neck cancer (Shune et al., 2012). ...
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Purpose: Exercise-based treatment approaches for dysphagia may improve swallow function in part by inducing adaptive changes to muscles involved in swallowing and deglutition. We have previously shown that both aging and progressive resistance tongue exercise, in a rat model, can induce biological changes in the genioglossus (GG); a muscle that elevates and protrudes the tongue. However, the impacts of progressive resistance tongue exercise on the retrusive muscles (styloglossus, SG; hyoglossus, HG) of the tongue are unknown. The purpose of this study was to examine the impact of a progressive resistance tongue exercise regimen on the retrusive tongue musculature in the context of aging. Given that aging alters retrusive tongue muscles to more slowly contracting fiber types, we hypothesized that these biological changes may be mitigated by tongue exercise. Methods: Hyoglossus (HG) and styloglossus (SG) muscles of male Fischer 344/Brown Norway rats were assayed in age groups of young (9 months old, n = 24), middle-aged (24 months old, n = 23), and old (32 months old, n = 26), after receiving an 8-week period of either progressive resistance protrusive tongue exercise, or sham exercise conditions. Following exercise, HG and SG tongue muscle contractile properties were assessed in vivo . HG and SG muscles were then isolated and assayed to determine myosin heavy chain isoform (MyHC) composition. Results: Both retrusive tongue muscle contractile properties and MyHC profiles of the HG and SG muscles were significantly impacted by age, but were not significantly impacted by tongue exercise. Old rats had significantly longer retrusive tongue contraction times and longer decay times than young rats. Additionally, HG and SG muscles showed significant MyHC profile changes with age, in that old groups had slower MyHC profiles as compared to young groups. However, the exercise condition did not induce significant effects in any of the biological outcome measures. Conclusion: In a rat model of protrusive tongue exercise, aging induced significant changes in retrusive tongue muscles, and these age-induced changes were unaffected by the tongue exercise regimen. Collectively, results are compatible with the interpretation that protrusive tongue exercise does not induce changes to retrusive tongue muscle function.
... Previous surveys have identified that approximately 9.5 million adults (mean age: 52.1 years) report swallowing problems yearly, with women being more likely to report the problem as compared to men. In USA, it is expected that more than six-million older adults experience swallowing issues [11,36]. Other reports have suggested that more than 15% of the older population suffers from dysphagia worldwide, from which only 22.7% visited their healthcare professional in order to address the condition [35]. ...
Article
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Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.
... However, linguistic processing under the command swallow condition may alter swallow behaviors and suggests that linguistic inducement could be useful as a compensatory technique for patients with difficulty initiating oropharyngeal swallows. I n the United States, over 9 million adults (approximately one in 25 adults) experience a swallowing problem each year (Bhattacharyya, 2014). Patients with dysphagia have a high risk of dehydration, malnutrition, aspiration pneumonia, and reduction in quality of life (Harrison et al., 2014;Logemann, 1998). ...
Article
Purpose During videofluoroscopic examination of swallowing, patients commonly are instructed to hold a bolus in their mouth until they hear a verbal instruction to swallow, which usually consists of the word swallow and is commonly referred to as the command swallow condition. The language-induced motor facilitation theory suggests that linguistic processes associated with the verbal command to swallow should facilitate the voluntary component of swallowing. As such, the purpose of the study was to examine the linguistic influences of the verbal command on swallowing. Method Twenty healthy young adult participants held a 5-ml liquid bolus in their mouth and swallowed the bolus after hearing one of five acoustic stimuli presented randomly: congruent action word ( swallow ), incongruent action word ( cough ), congruent pseudoword ( spallow ), incongruent pseudoword ( pough ), and nonverbal stimulus (1000-Hz pure tone). Suprahyoid muscle activity during swallowing was measured via surface electromyography (sEMG). Results The onset and peak sEMG latencies following the congruent action word swallow were shorter than latencies following the pure tone and pseudowords but were not different from the incongruent action word. The lack of difference between swallow and cough did not negate the positive impact of real words on timing. In contrast to expectations, sEMG activity duration and rise time were longer following the word swallow than the pure tone and pseudowords but were not different from cough . No differences were observed for peak suprahyoid muscle activity amplitude and fall times. Conclusions Language facilitation was observed in swallowing. The clinical utility of the information obtained in the study may depend on the purposes for using the command swallow and the type of patient being assessed. However, linguistic processing under the command swallow condition may alter swallow behaviors and suggests that linguistic inducement could be useful as a compensatory technique for patients with difficulty initiating oropharyngeal swallows.
... El patrón de la disfagia en pacientes con esófago dilatado es único (5); frecuentemente, mejoran el paso de la comida con la ingestión de líquidos o con maniobras como doblar las piernas, pararse o saltar. La pérdida de peso puede ser masiva y la regurgitación nocturna puede ser significativa y acompañarse de síntomas respiratorios como aspiración y tos crónica (6). El megaesófago, también llamado esófago sigmoide, resulta de la dilatación crónica del esófago (24). ...
Article
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El megaesófago se presenta entre el 5 % y el 20 % de pacientes con acalasia, un trastorno motor esofágico primario reconocido hace más de 300 años, a considerarse en todo paciente con disfagia no explicada por un proceso obstructivo o inflamatorio luego de un estudio endoscópico detallado. Se presenta el caso de un paciente con disfagia progresiva, en quien se documentó megaesófago como complicación de una acalasia de largo tiempo de evolución, no tratada. Se descartó la enfermedad de Chagas mediante enzimoinmunoensayo (ELISA) e inmunofluorescencia indirecta (IFI), tal como recomiendan las guías actuales. Ante la baja frecuencia de esta entidad en nuestro medio y las implicaciones terapéuticas que tiene para los pacientes con acalasia, se realizó una revisión narrativa en la literatura sobre su diagnóstico y alternativas de manejo.
... Dysphagia as a syndrome refers to symptoms related to difficulty swallowing or the passage of food from the mouth to the stomach. A 2012 cross-sectional study showed that dysphagia affects nearly 1 in 25 adults in the USA and results in significant loss of workdays [1]. In the inpatient setting, dysphagia is associated with significant increase in cost, length of stay, and mortality [2]. ...
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Non-obstructive dysphagia (NOD) is defined as symptomatic dysphagia in patients with negative endoscopic and radiographic workup. The management of NOD remains controversial as there is a discrepancy between different guidelines and clinical practice. Despite the lack of high-quality studies, empiric dilation for NOD is a common clinical practice among endoscopists and the approach varies between different clinical centers. In this review, we summarize the published literature on empiric dilation for NOD and propose a management algorithm for offering empiric dilation to patients presenting with dysphagia.
... In studies of the elderly where the participants live in the community, the definitions of elderly, the community, and dysphagia vary. This makes comparisons across studies fraught with difficulty; thus; further detail, where required, has been added to allow some comparison between studies (see Table 1) [11][12][13][14][15][16][17][18]. ...
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Purpose Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18–65 years. Methods The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were e-mailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann–Whitney U) and Spearman’s rho correlation. Results From March 2014 to October 2017: 2054 responses (32 reported ages outside of 18–65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18–65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0–36, mean 1.57, SD 3.49). EAT-10 score ≥ 3 (337) median 5 (range 3–36, mean 7.02 SD 5.91). Median age 36 (range 19–65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p = 0.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale = 1648, Nmale = 364) = 275,420.000, z = − 2.677, p = 0.007. Age and EAT-10 score were not associated: females rs = − 0.043, p = 0.079, N = 1648, males rs = − 0.003, p = 0.952, N = 364. Considerable impact on people: “I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry.” (no diagnosis, EAT-10 = 17). Conclusion Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.
Chapter
Dysphagia impacts approximately 1 in 25 adults in the United States, and this number continues to grow. Dysphagia can arise from a variety of causes, such as cerebral vascular accidents, head and neck cancer, neurologic diseases, rheumatoid disorders, and/or surgical interventions. There are many approaches to the evaluation and management of dysphagia. The last 10 years have seen an exponential rise in dysphagia-related publications, but unfortunately the majority of studies represent smaller sample sizes at single institutions. This chapter focuses on higher-level evidence behind pertinent topics within swallowing physiology, as well as diagnosis and treatment of swallowing disorders, to help guide treatment decisions.
Article
Objectives Due to the importance of providing the appropriate fluid consistency for effective management of swallowing problems (dysphagia) in infants, this project sought to determine the effect of three commercially available thickening agents on the resulting thickened consistencies of commonly prescribed, ready to feed infant formulas. Methods Nine ready‐to‐feed infant formulas were thickened with three different thickening agents to nectar and honey consistencies following manufacturer’s instructions and their resulting thickness was measured via line spread test. The nine formulas with nothing added to them (thin liquids) and the 27 target‐nectar and 27 target‐honey samples together created 63 unique samples for comparison. A series of one‐way ANOVA analyses were conducted to determine if the resulting thickness (as measured by line spread test values) for target categories of nectar and honey consistencies was significantly influenced by the type of thickening agent used. Results The achieved thickness of the formula samples as measured by line spread test values was statistically significantly different for the three different types of thickening agents used to achieve a target nectar consistency, F (2, 24) = 15.55, p < .001, partial eta squared = .709. Additionally, the achieved thickness of the formula samples was statistically significantly different for the three different types of thickening agents used to achieve a target honey consistency, F (2, 24) = 16.18, p < .001, partial eta squared = .709. Conclusions The results of this study reveal that the choice of thickening agent impacts the resulting thickness of ready to feed infant formula.
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Swallowing disorders occur more frequently in older adults. However, the effects of the aging process on neural activation when swallowing are unclear. We aimed to identify neural regions activated during swallowing and evaluate changes in neural activation and neural networks with aging. Using a general linear model (GLM) and independent component (IC) analyses, blood oxygen level-dependent (BOLD) signals were observed in the lateral precentral gyrus, postcentral gyrus, anterior insular cortices, supramarginal gyri, and medial frontal gyrus during swallowing. The right thalamus and anterior cingulate gyri were found to be active areas by GLM and IC analyses, respectively. In the correlational analyses, age was negatively correlated with BOLD signals of the lateral precentral gyri, postcentral gyri, and insular cortices in swallowing tasks. Additionally, correlation analyses between ICs of all participants and age revealed negative correlations in the right supramarginal gyrus, both anterior cingulate cortices, putamen, and cerebellum. In the network analysis, the BOLD signal positively correlated with age in the default mode network (DMN), and was negatively correlated in the lateral precentral gyri, postcentral gyri, and insular cortices. The amplitude of low-frequency fluctuations was significantly decreased in the DMN and increased in swallowing-related areas during swallowing tasks. These results suggest that aging has negative effects on the activation of swallowing-related regions and task-induced deactivation of the DMN. These changes may be used to detect early functional decline during swallowing.
Article
Purpose The purpose of this study was to investigate the perceptions of speech-language pathologists (SLPs) regarding their academic preparation and current confidence levels for providing dysphagia services, and the relationship between their perceptions of graduate school preparation and their current levels of confidence. Method This study utilized an online survey to gather information from 374 American Speech-Language-Hearing Association–certified SLPs who currently provide dysphagia services in the United States. Surveys were primarily distributed through American Speech-Language-Hearing Association Special Interest Group forums and Facebook groups. The anonymous survey gathered information regarding SLPs' perceptions of academic preparation and current confidence levels for providing dysphagia services in 11 knowledge and skill areas. Results Findings indicated that more than half of respondents did not feel prepared following their graduate academic training in five of the 11 knowledge and skill areas related to dysphagia service delivery. However, about half of respondents indicated they were currently confident about their ability to provide services in eight of the 11 knowledge and skill areas. Findings also indicated that their current confidence levels to provide dysphagia services were significantly higher than their perceptions of preparation immediately following graduate school. However, no significant relationships were found between respondents' self-reported current confidence levels and their perceptions of the adequacy of their academic preparation. Conclusions Despite SLPs' low perceptions of the adequacy of their graduate preparation for providing dysphagia services in specific knowledge and skill areas immediately following graduation, they reported high confidence levels with respect to their actual service delivery. Implications of these findings are discussed.
Chapter
Over the past decade, significant advances have been made in the diagnosis and management of esophageal motility disorders. The advent of high-resolution esophageal manometry has allowed greater specificity in diagnosis and recognition of clinically relevant phenotypes, particularly achalasia. New diagnostic modalities including impedance and the Functional Lumen Imaging Probe have provided insight into pathophysiology and further defined disease states. Therapeutic options for achalasia continue to evolve and new seminal trials have helped clarify the pros and cons of definitive achalasia therapy, including pneumatic dilatation, Heller myotomy, and peroral endoscopic myotomy. Peroral endoscopic myotomy has gone from conception to worldwide implementation in the span of a decade and provides comparable outcomes to surgical myotomy. Emerging technology has helped define non-achalasia esophageal motility disorders, including esophagogastric junction outflow obstruction, distal esophageal spasm, and the hypercontractile esophagus. These entities are distinct from achalasia, with less defined natural history and treatment algorithms, but appear to be associated with esophageal symptoms and respond to therapy directed at underlying pathogenesis. Finally, technical advances in endoscopy have resulted in increased diagnostic and therapeutic possibilities through accessibility to the submucosal space. This chapter will summarize the diagnostic and therapeutic options for esophageal motility disorders, focusing on those with endoscopic relevance.
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Swallowing is a complex sequence of highly regulated and coordinated skeletal and smooth muscle activity. Previous studies have attempted to determine the temporal relationship between the muscles to establish the activation sequence pattern, assessing functional muscle coordination with cross-correlation or coherence, which is seriously impaired by volume conduction. In the present work, we used conditional Granger causality from surface electromyography signals to analyse the directed functional coordination between different swallowing muscles in both healthy and dysphagic subjects ingesting saliva, water, and yoghurt boluses. In healthy individuals, both bilateral and ipsilateral muscles showed higher coupling strength than contralateral muscles. We also found a dominant downward direction in ipsilateral supra and infrahyoid muscles. In dysphagic subjects, we found a significantly higher right-to-left infrahyoid, right ipsilateral infra-to-suprahyoid, and left ipsilateral supra-to-infrahyoid interactions, in addition to significant differences in the left ipsilateral muscles between bolus types. Our results suggest that the functional coordination analysis of swallowing muscles contains relevant information on the swallowing process and possible dysfunctions associated with dysphagia, indicating that it could potentially be used to assess the progress of the disease or the effectiveness of rehabilitation therapies.
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Objectives: Normal older persons often experience presbyphagia due to aging. This study utilized the 18-item self-reported questionnaire of the Swallowing Monitoring & Assessment Protocol (SMAP) to identify swallowing difficulties that might appear during natural aging. Methods: After excluding those with neurological disorders, dysphagia-related disorders, and/or cognitive problems, a total of 822 healthy older adults aged 65 or older (mean age= 76.88± 5.60; men:women= 277:545) were surveyed by the self-reported swallowing function questionnaire of the SMAP. The total score of the 18-item questionnaire (5-point Likert scale: 0, 1, 2, 3, 4) was extracted and the ranking was determined based on the mean score of each item. Ranking among two age groups (aged 65-74 and aged 75≤ ) was compared with a Spearman rank correlation, and the difference in total scores by age group was examined with the Mann-Whitney test. Results: The mean total score was 7.81± 7.63 (range 0-58). Swallowing problems related to ‘dry mouth’, ‘meal volume’, ‘mealtime’, and ‘choking on water or liquid’ were regarded as chief complaints. There was a significant correlation between the ranking of questions by age group. The mean total score was significantly higher for groups aged 75 or older (n = 494; mean age = 80.46 ± 3.98) than those aged 65 to 74 (n= 328; mean age= 71.49± 2.51) (p< .01). Conclusion: The chief complaints for swallowing reported by older adults can be considered as main swallowing problems caused by aging. By identifying precise swallowing difficulties that appear during normal aging, we should be able to alleviate presbyphagia via early detection and intervention.
Article
This study examined the relationship between dysphagia and adverse outcomes across frailty conditions among surgical patients ≥50 years of age. A retrospective cohort analysis of surgical hospitalizations in the Healthcare Cost and Utilization Project's National Inpatient Sample among patients ≥50 years of age undergoing intermediate/high risk surgery not involving the larynx, pharynx, or esophagus. Of 3,298,835 weighted surgical hospitalizations, dysphagia occurred in 1.2% of all hospitalizations and was higher in frail patients ranging from 5.4% to 11.7%. Dysphagia was associated with greater length of stay, higher total costs, increased non-routine discharges, and increased medical/surgical complications among both frail and non-frail patients. Dysphagia may be an independent risk factor for poor postoperative outcomes among surgical patients ≥50 years of age across frailty conditions and is an important consideration for providers seeking to reduce risk in vulnerable surgical populations.
Article
Dysphagia, defined as impairment of the swallowing process, is a common symptom and can be a significant source of morbidity and mortality in the general population. This article summarizes the causes of the condition, its prevalence, and the consequences and costs of untreated dysphagia. The aim of this article is to provide a framework for the general internist in assessing, diagnosing, and managing dysphagia in an adult patient. Basic diagnostic screening procedures and techniques for management are emphasized. A basic treatment pathway based on cause is provided for reference.
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Oropharyngeal dysphagia (OD) is defined as difficulty in moving a food bolus from the mouth to the upper esophagus and disproportionately affects the older population. There are a multitude of potential etiologies of OD, and current diagnostic testing modalities utilized to decipher the cause of OD in an individual geriatric patient include videofluoroscopic swallow studies, nasopharyngolaryngoscopy, fiber-optic endoscopic evaluation of swallowing, high-resolution manometry, as well as functional lumen imaging probe technology. Determining the particular etiology of OD in a patient can direct appropriate treatment. Management options for OD range from noninvasive swallow exercises and rehabilitative techniques targeted to the underlying pathophysiology to invasive therapy to the upper esophageal sphincter or non-oral feeding. A careful diagnostic evaluation with meticulous attention to the underlying mechanism of OD can allow a practitioner to weigh risks and benefits of suitable treatment options for older patients affected with OD.
Article
Purpose The objective of this study was to evaluate the usability of a mobile health (mHealth) system designed for dysphagia exercise in persons with a history of stroke. Method Five participants with a history of stroke were recruited from a tertiary health center and assessed for their ability to use and interact with the system. After being introduced to the technology, participants were asked to independently complete five tasks, one at a time. Assistance was available when required or requested. Usability was evaluated with respect to effectiveness, efficiency, and user satisfaction when completing the prespecified goals. Results Four men and one woman between the ages of 50 and 83 years (M = 65.4) completed the usability testing. Time from stroke onset varied from 1 month to 2.5 years. Additional poststroke challenges related to the usability of the mHealth system included reduced range of motion or mobility, vision, and short-term memory difficulties. Independent success (system effectiveness) varied in this user subgroup, and the research clinician or the family member was required to adjust the level and type of support they provided (system efficiency). All participants reported satisfaction with the use of the system. Conclusion Usability of and satisfaction with this mHealth system and others like it can be achieved in individuals who have had a stroke, either as an independent user or as a patient–caregiver dyad.
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Objective: to survey the Brazilian participation in original and review articles published in the Dysphagia journal. Methods: original and review articles in volumes 1 to 35, quantifying all those developed in Brazil, the diseases researched, the places where the investigations were conducted, and the number of citations they received, were analyzed. The categorical variables are presented in relative and absolute frequencies. Literature Review: a total of 35 Brazilian manuscripts were published. The most researched disease was Parkinson’s, followed by Chagas disease, stroke, and the physiology of swallowing. The highest number of publications was carried out at the Universidade de São Paulo, campus at Ribeirão Preto, SP, and the Universidade Federal de São Paulo, capital city. Between 2001 and 2010, 14 manuscripts were published (3.7% of the journal), and between 2011 and 2020, 20 were published (2.9% of the journal). By 2019, the manuscripts had received 481 citations - 17 citations per article between 1998 and 2009, and 14, between 2010 and 2019. Conclusion: Brazilian manuscripts are regularly published in the Dysphagia journal and have a scientific impact. However, there has not been a progressive increase in the number of published articles.
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Objective We examined the influence of liquid thickness levels on the frequency of liquid penetration-aspiration in patients with dysphagia and evaluated the clinical risk factors for penetration-aspiration and aspiration pneumonia development. Study Design A case series. Setting Single-institution academic center. Methods We reviewed medical charts from 2018 to 2019. First, we evaluated whether liquid thickness levels influence the frequency of liquid penetration-aspiration in patients with dysphagia. Penetration-aspiration occurrence in a videofluoroscopic swallowing study was defined as Penetration-Aspiration Scale (PAS) scores ≥3. Second, the association between liquid thickness level and penetration-aspiration was analyzed, and clinical risk factors were identified. Moreover, clinical risk factors for aspiration pneumonia development within 6 months were investigated. Results Of 483 patients, 159 showed penetration-aspiration. The thickening of liquids significantly decreased the incidence of penetration-aspiration ( P < .001). Clinical risk factors for penetration-aspiration were vocal fold paralysis (odds ratio [OR], 1.99), impaired laryngeal sensation (OR, 5.01), and a history of pneumonia (OR, 2.90). Twenty-three patients developed aspiration pneumonia while undertaking advised dietary changes, including liquid thickening. Significant risk factors for aspiration pneumonia development were poor performance status (OR, 1.85), PAS score ≥3 (OR, 4.03), and a history of aspiration pneumonia (OR, 7.00). Conclusion Thickening of liquids can reduce the incidence of penetration-aspiration. Vocal fold paralysis, impaired laryngeal sensation, and history of aspiration pneumonia are significant risk factors of penetration-aspiration. Poor performance status, PAS score ≥3, and history of aspiration pneumonia are significantly associated with aspiration pneumonia development following recommendations on thickening liquids. Level of Evidence 3.
Article
This cross-sectional study aimed to analyze dysphagia-specific quality of life and its influencing factors in aged patients with neurologic disorders, and is reported according to the STROBE checklist for observational research. The study included 120 outpatients, aged ≥65 years, diagnosed with neurologic diseases at a general hospital Neurology Department in Seoul, Korea. Data collected during a one-month (March and April 2021) questionnaire survey were statistically analyzed using SPSS. Factors related to dysphagia-specific quality of life were gender, education level, neurological diagnosis, type of diet, subjective swallowing disturbance, and affectionate support—a subscale of social support. The combined explanatory power of these factors was 42.1%. It is essential to note that the factors related to the emotional, functional, and physical domains–the subscales of dysphagia-specific quality of life–are different. Therefore, each factor should be considered when planning nursing interventions to improve dysphagia-specific quality of life.
Article
Purpose The purpose of this study was to (a) examine the interprofessional relationship between radiologists and speech-language pathologists (SLPs), and (b) explore viewpoints and practice patterns of each profession regarding a videofluoroscopic swallow study (VFSS). Methods This IRB approved study utilized an online survey developed by the authors to gather information from radiologists and SLPs who currently perform videofluoroscopic swallow studies (VFSS) for the evaluation of swallow function. Surveys were primarily distributed through the American Speech-Language-Hearing Association's (ASHA) Special Interest Group 13 (Swallowing and Swallowing Disorders) forum, through LinkedIn and email networking among professional radiology-focused businesses and organizations (Bracco Diagnostics, Inc., Society of Abdominal Radiology), and via social media (e.g. Facebook). The survey consisted of 7 demographic questions and 15 practice-related items, using a modified Likert scale and multiple-choice items to assess agreement with statements regarding VFSS procedures and opinions on professional roles. Results Radiologists and SLPs differed significantly (p < 0.05) in practices regarding nearly all items surveyed, including preferences on: esophageal sweep, anteroposterior view, fluoroscopy time limitation, termination following an aspiration event, frame rate, as well as in defining the primary role of the SLP, the primary purpose of a VFSS, the most valuable piece of information obtained from a VFSS, and training requirements. Radiologists and SLPs agreed that a standardized protocol should exist for VFSS. Conclusions Radiologists and SLPs differ in their practice patterns and opinions on the roles of team members in the performance of VFSS. However, both radiologists and SLPs agree that a standardized protocol for VFSS should exist.
Article
Background and purpose Postoperative dysphagia is a known complication of anterior cervical discectomy and fusion (ACDF) with reported incidences ranging from 1 to 79%. No standardized guidelines exist for spine surgeons to evaluate postoperative dysphagia after ACDF. A systematic method may be beneficial in distinguishing transient postoperative dysphagia secondary to intubation from those with postoperative complications. This study evaluates the causes, recognition, and clinical evaluation of postoperative dysphagia following ACDF. Methods International classification of disease (ICD) and current procedural terminology (CPT) codes were used to identify ACDF patients and compared to anterior lumbar discectomy and fusion (ALDF), serving as a control group, between the years 2015–2019 and those diagnosed with dysphagia within 1 year. Demographics, operative details, and clinical evaluation were reviewed. Exclusion criteria included history of head and neck procedures, cancer, stroke, radiation, and trauma. Results One hundred thirty-one ACDF and 93 ALDF patients met inclusion criteria. Twenty-seven (20.6%) ACDF patients were diagnosed with dysphagia within 1 year. Less than half of the dysphagia patients had the word “dysphagia” documented in their 1-month spine surgeon follow up visit. Only 66% of dysphagia patients had specialist evaluation and one third of those patients were referred by their surgeon. Only six patients received diagnostic barium swallow evaluations. Conclusion Postoperative dysphagia risk increases in ACDF compared to ALDF, likely due to underlying anatomy. Postoperative dysphagia symptoms are not effectively documented by spine surgeons and as a result underevaluated by dysphagia specialists. Patients may benefit from more extensive pre- and post-operative screening, evaluation, and referral regarding dysphagia symptoms following ACDF.
Article
AIM To assess the radiation dose in standard barium swallow studies (BaSS) performed at a large tertiary referral centre, benchmarked against the national diagnostic reference level (NDRL), and to provide evidence to support reducing radiation dose through improving operator's training. MATERIALS AND METHODS In this retrospective observational study, 1,004 adult BaSS (M:F = 411:593) were assessed. The radiation dose was first compared with NDRL, and then stratified by the operator's training level and compared using analysis of variance (ANOVA). The operators were categorised as radiology residents, advanced radiography practitioners, GI radiology fellows, and GI radiology consultants. Further comparative analysis is performed by comparing the test radiation dose when stratified based on the referrer's specialty, and whether they were performed for female patients of childbearing age. RESULTS The findings show 68.2% of BaSS performed are within the NDRL and demonstrated statistically significant correlation (p<0.0001) between radiation dose and operator's training level, and for female patients of childbearing age (p<0.002) and the rest. The median dose was lower with more senior operators. There was no significant correlation between radiation dose and the referrer's specialty. CONCLUSION The study presents evidence to support revisiting consultant-supervised BaSS training, in the interests of lowering the radiation exposure to patients and improving compliance with the NDRL.
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Purpose of Review Neurogastroenterology and motility is a rapidly evolving subspecialty that encompasses over 33% of gastroenterological disorders, and up to 50% of referrals to gastroenterology practice. It includes common problems such as dysphagia, gastroesophageal reflux disease, irritable bowel syndrome, chronic constipation, gastroparesis, functional dyspepsia, gas/bloating, small intestinal bacterial overgrowth, food intolerance and fecal incontinence Standard diagnostic tests such as endoscopy or imaging are normal in these conditions. To define the underlying mechanism(s)/etiology of these disorders, diagnostic motility tests are often required. These are best performed by well-trained personnel in a dedicated motility laboratory. Our purpose is to provide an up-to-date overview on how to organize and develop a motility laboratory based on our collective experiences in setting up such facilities in academia and community practice. Recent Findings A lack of knowledge, training and facilities for providing diagnostic motility tests has led to suboptimal patient care. A motility laboratory is the hub for diagnostic and therapeutic motility procedures. Common procedures include esophageal function tests such as esophageal manometry and pH monitoring, anorectal function tests suchlike anorectal manometry, neurophysiology and balloon expulsion, dysbiosis and food intolerance tests such as hydrogen/methane breath tests, and gastrointestinal transit assessment. These tests provide an accurate diagnosis and guide clinical management including use of medications, biofeedback therapy, neuromodulation, behavioral therapies, evidence-based dietary interventions and endoscopic or surgical procedures. Further, there have been recent developments in billing and coding of motility procedures and training requirements that are not well known. Summary This review provides a stepwise approach on how to set-up a motility laboratory in the community or academic practice and includes the rationale, infrastructure, staffing needs, commonly performed motility tests and their clinical utility, billing and coding strategies, training needs and economic considerations for setting up this service.
Article
Purpose Patients receive multiple bolus trials during a videofluoroscopic swallowing study (VFSS) to assess swallow function, inclusive of narrowing within the pharyngoesophageal segment (PES). While differences in the narrowest and widest segments are visualized, the ratio of distention across boluses is not well understood. Method A retrospective review of 50 consecutive VFSSs with five boluses of varied viscosity and volume was performed. Still images at maximal PES distention were captured and scaled using a 19-mm disk. Measurements of the narrowest and widest segments were obtained, and a distention ratio was calculated. Studies were categorized by PES phenotype as normal, esophageal web, cricopharyngeal bar, or narrow PES. PES distention ratios were evaluated across bolus trials and within PES phenotypes using a mixed-methods repeated-measures analysis of variance. Results Of the 50 studies, there were 11 normal, 16 web, 10 bar, and 13 narrow PES. Quantitative differences were present for the narrowest ( p = .01) and widest ( p = .002) points across bolus volumes. No difference was present in distention ratio ( p = .2) across volumes. Evaluating the PES phenotype, web, normal, bar, and narrow PES distention ratios differed ( p = .03). Bar and PES narrow distention ratios were lower compared to that of the normal group ( p = .01 for normal vs. bar and p = .02 for normal vs. PES narrow). Conclusions PES distention ratio stability across varying bolus volumes and phenotypes suggests that a reduction in trials during a VFSS may permit an equivalent PES evaluation to traditional exams. Ultimately, this could improve our understanding and accurate diagnosis of PES dysfunction.
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Study Design Review. Objective Postoperative oropharyngeal dysphagia is one of the most common complications following anterior cervical spine surgery (ACSS). We review and summarize recent literature in order to provide a general overview of clinical signs and symptoms, assessment, incidence and natural history, pathophysiology, risk factors, treatment, prevention, and topics for future research. Methods A search of English literature regarding dysphagia following anterior cervical spine surgery was conducted using PubMed and Google Scholar. The search was focused on articles published since the last review on this topic was published in 2005. Results Patients who develop dysphagia after ACSS show significant alterations in swallowing biomechanics. Patient history, physical examination, X-ray, direct or indirect laryngoscopy, and videoradiographic swallow evaluation are considered the primary modalities for evaluating oropharyngeal dysphagia. There is no universally accepted objective instrument for assessing dysphagia after ACSS, but the most widely used instrument is the Bazaz Dysphagia Score. Because dysphagia is a subjective sensation, patient-reported instruments appear to be more clinically relevant and more effective in identifying dysfunction. The causes of oropharyngeal dysphagia after ACSS are multifactorial, involving neuronal, muscular, and mucosal structures. The condition is usually transient, most often beginning in the immediate postoperative period but sometimes beginning more than 1 month after surgery. The incidence of dysphagia within one week after ACSS varies from 1 to 79% in the literature. This wide variance can be attributed to variations in surgical techniques, extent of surgery, and size of the implant used, as well as variations in definitions and measurements of dysphagia, time intervals of postoperative evaluations, and relatively small sample sizes used in published studies. The factors most commonly associated with an increased risk of oropharyngeal dysphagia after ACSS are: more levels operated, female gender, increased operative time, and older age (usually >60 years). Dysphagic patients can learn compensatory strategies for the safe and effective passage of bolus material. Certain intraoperative and postoperative techniques may decrease the incidence and/or severity of oropharyngeal dysphagia after ACSS. Conclusions Large, prospective, randomized studies are required to confirm the incidence, prevalence, etiology, mechanisms, long-term natural history, and risk factors for the development of dysphagia after ACSS, as well as to identify prevention measures. Also needed is a universal outcome measurement that is specific, reliable and valid, would include global, functional, psychosocial, and physical domains, and would facilitate comparisons among studies. Results of these studies can lead to improvements in surgical techniques and/or perioperative management, and may reduce the incidence of dysphagia after ACSS.
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Assess patients' perspectives on the severity, time course, and relative importance of swallowing deficit before and after (chemo)radiotherapy for head and neck cancer. Before-and-after cohort study. Head and neck cancer UK multidisciplinary clinic. A total of 167 patients with a primary cancer, mostly laryngopharyngeal, completed the MD Anderson Dysphagia Index (MDADI) and the University of Washington Quality of Life Questionnaire (UWQOL) before treatment and at 3, 6, and 12 months. Pretreatment swallowing, age, gender, and tumor site and stage were assessed. Statistical methods used were Mann-Whitney, analysis of variance, and logistic regression. There was a sharp deterioration in swallowing on average by 18%, from before treatment to 3 months post treatment (mean difference in MDADI score = 14.5; P < .001). Treatment schedule, pretreatment score, and age accounted for 37% of the variance in 3-month posttreatment MDADI scores. There was then little improvement from 3 to 12 months. Patients treated with only 50-Gy radiotherapy reported significantly less dysphagia at 1 year than patients receiving higher doses or combined chemoradiation (P < .001). Swallowing was the most commonly prioritized of the 12 UWQOL domains both before and after therapy. The MDADI and UWQOL scores were strongly correlated: ρ > 0.69. Swallowing is a top priority before and after treatment for the vast majority of patients with head and neck cancer. Swallowing deteriorates significantly posttreatment (P < .001). Treatment intensity, younger age, and lower pretreatment scores predict long-term dysphagia. After chemoradiation, there is little improvement from 3 to 12 months.
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The objective of this study was to determine the disease burden of sinusitis relative to other medical conditions. The adult sample of the National Health Interview Survey for calendar years 1997 to 2006 was analyzed, extracting 1-year prevalence data for the disease conditions sinusitis, hay fever, peptic ulcer, acute asthma, and chronic bronchitis. Disease burden data for emergency room visits, general and specialist visits, health care spending, and workdays lost were also extracted. The influence of each disease condition on disease burden variables was statistically determined. Comparisons among outcomes variables were conducted across disease conditions to determine their relative economic and health care impacts. Adult patients were studied (313,982; mean age, 45.2 years). The 1-year disease prevalences were: sinusitis (15.2%), hay fever (8.9%), ulcer (2.4%), acute asthma (3.8%), and chronic bronchitis (4.8%). Patients with sinusitis were significantly more likely to: visit the emergency room (22.7% versus 17.4%, p < 0.001), spend greater than $500/year on health care (55.8% versus 45.0%, p < 0.001), and see a medical specialist (33.6% versus 22.3%, p < 0.001), than those without sinusitis. Patients with sinusitis missed an average of 5.67 workdays per 12 months versus 3.74 workdays for those without (p < 0.001). The number of workdays lost with sinusitis was similar to that of acute asthma (5.79 workdays, p > 0.05), and health care spending with sinusitis was significantly greater than that of ulcer disease, acute asthma, and hay fever (p < 0.004). Sinusitis imparts a significant disease burden both within and outside of the health care system that is comparable with or exceeds that of other conditions commonly thought to be more serious.
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1) Evaluate the prevalence and quality-of-life impact of voice and swallowing problems in the elderly; 2) determine treatment trends and barriers to treatment. Cross-sectional study of independent-living residents in two retirement communities. Prevalence of dysphonia and dysphagia, voice-related quality of life (VRQOL), 7-point Likert scale of dysphagia severity, Center for Epidemiologic Studies Depression (CES-D) scale, and barriers to treatment were collected. Spearman correlation and ANOVA statistics were performed. A total of 248 residents responded with a mean age of 82.4 years; 19.8 percent had dysphonia, 13.7 percent dysphagia, and 6 percent both. Respondents with more severe swallowing difficulty had greater impairment on the VRQOL (P = 0.04, Spearman correlation = -0.4). Respondents with both dysphonia and dysphagia had greater depression scores than those with neither symptom (mean CES-D score 15.5 vs 9.9, P = 0.009, ANOVA, P < 0.05, Bonferroni t test). Only 22.4 percent and 20.6 percent had sought treatment for dysphonia and dysphagia, respectively. Being unaware of treatment options and viewing voice and swallowing trouble as a normal part of aging were the most common reasons for not seeking treatment. Voice and swallowing problems are common in the elderly, but they are not realizing potential treatment benefits.
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Epidemiological studies of dysphagia in the elderly are rare. A non-treatment-seeking, elderly cohort was surveyed to provide preliminary evidence regarding the prevalence, risks, and socioemotional effects of swallowing disorders. Using a prospective, cross-sectional survey design, we interviewed 117 seniors living independently in Utah and Kentucky (39 men and 78 women; mean age, 76.1 years; SD, 8.5 years; range, 65 to 94 years) regarding 4 primary areas related to swallowing disorders: lifetime and current prevalence, symptoms and signs, risk and protective factors, and socioemotional consequences. The lifetime prevalence of a swallowing disorder was 38%, and 33% of the participants reported a current problem. Most seniors with dysphagia described a sudden onset with chronic problems that had persisted for at least 4 weeks. Stepwise logistic regression identified 3 primary symptoms uniquely associated with a history of swallowing disorders: taking a longer time to eat (odds ratio [OR], 9.5; 95% confidence interval [CI], 2.3 to 40.2); coughing, throat clearing, or choking before, during, or after eating (OR, 3.4; 95% CI, 1.1 to 10.2); and a sensation of food stuck in the throat (OR, 5.2; 95% CI, 1.8 to 10.0). Stroke (p = .02), esophageal reflux (p = .003), chronic obstructive pulmonary disease (p = .05), and chronic pain (p = .03) were medical conditions associated with a history of dysphagia. Furthermore, dysphagia produced numerous adverse socioemotional effects. This study provides preliminary evidence to suggest that chronic swallowing disorders are common among the elderly, and highlights the need for larger epidemiological studies of these disorders.
Article
Background The objective of this study was to determine the disease burden of sinusitis relative to other medical conditions. Methods The adult sample of the National Health Interview Survey for calendar years 1997 to 2006 was analyzed, extracting 1-year prevalence data for the disease conditions sinusitis, hay fever, peptic ulcer, acute asthma, and chronic bronchitis. Disease burden data for emergency room visits, general and specialist visits, health care spending, and workdays lost were also extracted. The influence of each disease condition on disease burden variables was statistically determined. Comparisons among outcomes variables were conducted across disease conditions to determine their relative economic and health care impacts. Results Adult patients were studied (313,982; mean age, 45.2 years). The 1-year disease prevalences were: sinusitis (15.2%), hay fever (8.9%), ulcer (2.4%), acute asthma (3.8%), and chronic bronchitis (4.8%). Patients with sinusitis were significantly more likely to: visit the emergency room (22.7% versus 17.4%, p < 0.001), spend greater than $500/year on health care (55.8% versus 45.0%, p < 0.001), and see a medical specialist (33.6% versus 22.3%, p < 0.001), than those without sinusitis. Patients with sinusitis missed an average of 5.67 workdays per 12 months versus 3.74 workdays for those without (p < 0.001). The number of workdays lost with sinusitis was similar to that of acute asthma (5.79 workdays, p > 0.05), and health care spending with sinusitis was significantly greater than that of ulcer disease, acute asthma, and hay fever (p < 0.004). Conclusions Sinusitis imparts a significant disease burden both within and outside of the health care system that is comparable with or exceeds that of other conditions commonly thought to be more serious.
Article
Objectives: This report presents health statistics from the 2006 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and ethnicity, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions. Source of data: NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2006, data were collected for 24,275 adults for the Sample Adult questionnaire. The conditional response rate was 81.4%, and the final response rate was 70.8%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for him or herself, a proxy was allowed. Highlights: In 2006, 61% of adults 18 years of age or over reported excellent or very good health. Sixty-two percent of adults never participated in any type of vigorous leisure-time physical activity, and 16% of adults did not have a usual place of health care. Eleven percent of adults had been told by a doctor or health professional that they had heart disease, and 23% had been told on two or more visits that they had hypertension. Twenty-one percent of all adults were current smokers and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 26% were obese.
Article
Objectives/HypothesisDetermine the prevalence of voice problems and types of voice disorders among adults in the United States. Study DesignCross-sectional analysis of a national health survey. Methods The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a voice problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to healthcare professionals for voice problems, diagnoses given, and severity of the voice problem were analyzed. The relationship between voice problems and lost workdays was investigated. ResultsAn estimated 17.90.5 million adults (mean age, 49.1 years; 62.9%1.2% female) reported a voice problem (7.6%+/- 0.2%). Overall, 10.0%+/- 0.1% saw a healthcare professional for their voice problem, and 40.3%+/- 1.8% were given a diagnosis. Females were more likely than males to report a voice problem (9.3%+/- 0.3% vs. 5.9%+/- 0.3%, P<.001). Overall, 22% and 11% reported their voice problem to be a moderate or a big/very big problem, respectively. Infectious laryngitis was the most common diagnosis mentioned (685,000 +/- 86,000 cases, 17.8%+/- 2.0%). Gastroesophageal reflux disease was mentioned in 308,000 +/- 54,000 cases (8.0%+/- 1.4%). The mean number of days affected with the voice problem in the past year was 56.2 +/- 2.6 days. Respondents with a voice problem reported 7.4 +/- 0.9 lost workdays in the past year versus 3.4 +/- 0.1 lost workdays for those without (contrast, +4.0 lost workdays; P<.001). Conclusions Voice problems affect one in 13 adults annually. A relative minority seek healthcare for their voice problem, even though the self-reported subjective impact of the voice problem is significant. Level of Evidence4 Laryngoscope 124:2359-2362, 2014
Article
The aims of this cross-sectional study were to explore the nationwide number and demographics of patient visits due to dysphagia and to investigate potential differences in their management between otolaryngologists and other physicians in the outpatient setting. Cross-sectional. National Ambulatory Medical Care Survey. The data sets from 2007 to 2010 were queried to extract all cases with dysphagia as a reason for visit. Data regarding demographics, imaging studies, nonmedication therapies, diagnoses, medications, and patient disposition were compared between otolaryngologists, primary care physicians, and other specialists. Annually, 1,875,187 (95% confidence interval [CI], 1,443,876-2,307,204) outpatient visits were due to dysphagia, comprising 0.19% of all visits (95% CI, 0.14%-0.23%) and 1.55% (95% CI, 1.10%-2.0%) of the visits to otolaryngologists. The visits were mostly distributed between primary care physicians and other specialists, while 16.4% (95% CI, 11.3%-21.6%) visited an otolaryngology office. Otolaryngologists, primary care physicians, and other specialists ordered imaging studies in 22.8%, 10.2%, and 24.0% (P = .02); performed aerodigestive-specific procedures in 20.8%, 4.0%, and 36.2% (P < .0001); and referred the patient to another physician in 5.8%, 14.8%, and 2.8% (P = .003) of the visits, respectively. Almost 0.2% of office visits to physicians have a complaint of dysphagia. Otolaryngologists are involved in the care of a minority of these visits. The differences in the management of dysphagic patients may be due to different etiologies of the disease.
Article
Dysphagia is a common problem that has the potential to result in severe complications such as malnutrition and aspiration pneumonia. Based on the complexity of swallowing, there may be many different causes. This article presents a systematic literature review to assess different comorbid disease associations with dysphagia based on age. The causes of dysphagia are different depending on age, affecting between 1.7% and 11.3% of the general population. Dysphagia can be a symptom representing disorders pertinent to any specialty of medicine. This review can be used to aid in the diagnosis of patients presenting with the complaint of dysphagia.
Article
Objectives/hypothesis: The goals of this study were to analyze whether cochlear implant (CI) users over 65 years of age have different surgical and audiological outcomes when compared to younger adult CI users and to identify reasons for these possible differences. Study design: Retrospective single-institution study. Methods: Records of 113 postlingually deafened adults with unilateral cochlear implants were reviewed. Preoperative and postoperative speech perception scores, and medical and epidemiological data were recorded and analyzed. Results: Speech perception ability was significantly poorer in CI users over 65 years of age compared to younger adult patients (P = .012). Patients over the age of 80 years accounted for these findings (P = .017). Older patients were less likely to have a family history of hearing deficits. A history of noise exposure and idiopathic cause of hearing loss did not correlate with audiological outcomes. A family history of hearing loss was associated with a trend toward better speech recognition (P = .062). Older patients did not experience more vestibular symptoms or other complications compared to younger patients. Conclusions: Patients over the age of 80 years had lower speech perception scores than other adult CI recipients but did not have higher rates of dizziness or vertigo after surgery. A family history of hearing loss was associated with a trend toward better speech recognition, possibly representing a new prognostic variable. These findings provide important information that will aid clinicians in counseling older CI candidates.
Article
Objectives/HypothesisCharacterize health care practice patterns for balance disorders in the elderly. Study DesignCross-sectional analysis of national health care survey. Methods Balance disorder cases in patients aged 65 years were extracted from the 2008 National Health Interview Survey. Records were analyzed for health professionals seen, diagnostic testing ordered, diagnoses given, and treatments offered. Relationships between diagnostic success, imaging studies, and specialty providers seen were compared. ResultsAmong 7.020.22 million elderly persons reporting a balance problem, 50.0% (3.440.16 million) saw a health professional, and 35.8% saw 3 providers; 59.6% of elderly patients reported a diagnosed cause for the balance problem. The most common causes were medication side effects (11.3%), inner ear infection (11.0%), heart disease (8.6%), and loose ear crystals (7.9%). Imaging studies had been obtained in 56.7% (2.00 +/- 0.11 million cases). Among 24.3% of patients receiving some form of treatment, 61.7% had been taking prescription medication, most commonly diuretic agents (36.5%), anxiolytic agents (25.1%), and meclizine (21.4%). Seeing an otolaryngologist or neurologist was associated with a higher but similar rate of diagnostic imaging studies (70.1%, P=.029 and 78.5%, P<.001). However, obtaining an imaging study was not associated with a diagnosed cause of the balance disorder (61.5% with imaging vs. 56.9% without, P=.265). Conclusions Despite a high prevalence of balance problems in the elderly, a significant proportion do not come to a clear diagnosis. There is a noteworthy rate of prescription medication utilization in this population. Given an increasingly aging population, attention needs to be given to balance problems in the elderly to optimize diagnosis and health care utilization. Level of Evidence2b Laryngoscope, 123:2539-2543, 2013
Article
Dysphagia can complicate multiple sclerosis (MS). Its real prevalence may be estimated to be around 30%–40%. Furthermore, dysphagia is life-threatening. In fact, its complications such as dehydration and aspiration pneumonia are a common cause of death and morbidity in late MS. The management of dysphagia should be focused on treatment of the specific dysphagic symptom and the underlying pathophysiology. The symptomatic management of dysphagia is based on two different types of approaches: the rehabilitative treatment and the pharmacological treatment. Botulinum toxin treatment may be a valid therapy in MS patients with oro-pharyngeal dysphagia associated with upper oesophageal sphincter hyperactivity.
Article
To quantify the prevalence and determine the impact of dizziness and balance disorders in the elderly. Cross-sectional analysis of a national database. The balance problems survey module of the 2008 National Health Interview Survey was examined, and cases of reported dizziness or balance problems in persons ≥65 years old were identified. The prevalence of balance disorders and associated symptoms and their impacts on self-reported functional limitations were determined. The related impact on daily activities for elderly persons with balance problems was quantified. Sex-based differences in balance problems were determined. Among 37.3 ± 0.9 million elderly persons (mean age, 74.4 ± 0.1 years; 56.9% ± 0.9% female), 7.0 ± 0.2 million persons (19.6% ± 0.7%) reported a problem with dizziness or balance in the preceding 12 months. Balance problems included difficulty with unsteadiness (68.0%), walking on uneven surfaces (54.8%), vertigo (30.1%), and faintness (29.6%). Prescription medication triggered the balance problem in 18.7%. Among the 50.0% of elderly persons with balance problems who sought care, 85.6%, 30.3%, 23.9%, and 16.8% saw a general practitioner, internist, neurologist, or otolaryngologist, respectively. Of this group, 27.4% reported that balance problems specifically prevented them from participating in activities including exercise (61.2%), social events (45.8%), and driving (47.1%). Females were more likely to experience balance problems than males (21.0% vs. 17.7%, P = .025). Approximately one in five elderly persons experiences annual problems with dizziness or balance. Given the significant prevalence and negative effect of balance problems on daily activities in the elderly, balance disorders merit special attention, particularly in the face of an aging population.
Article
Dysphagia is a potentially harmful feature, also in Parkinson's disease (PD). As published prevalence rates vary widely, we aimed to estimate the prevalence of oropharyngeal dysphagia in PD in a meta-analysis. We conducted a systematic literature search in February 2011 and two independent reviewers selected the papers. We computed the estimates of the pooled prevalence weighted by sample size. Twelve studies were suitable for calculating prevalence rates. Ten studies provided an estimate based on subjective outcomes, which proved statistically heterogeneous (p < 0.001), with a pooled prevalence estimate with random effect analysis of 35% (95% CI 28-41). Four studies provided an estimate based on objective measurements, which were statistically homogeneous (p = 0.23), with a pooled prevalence estimate of 82% (95% CI 77-87). In controls the pooled subjective prevalence was 9% (95% CI 2-17), while the pooled objective prevalence was 23% (95% CI 13-32). The pooled relative risk was 3.2 for both subjective outcomes (95% CI 2.32-4.41) and objective outcomes (95% CI 2.08-4.98). Clinical heterogeneity between studies was chiefly explained by differences in disease severity. Subjective dysphagia occurs in one third of community-dwelling PD patients. Objectively measured dysphagia rates were much higher, with 4 out of 5 patients being affected. This suggests that dysphagia is common in PD, but patients do not always report swallowing difficulties unless asked. This underreporting calls for a proactive clinical approach to dysphagia, particularly in light of the serious clinical consequences.
Article
Systematic review. To determine the incidence and prevalence and identify effective recommendations to minimize the incidence and prevalence of postoperative dysphagia after anterior cervical surgery. The reported incidence and prevalence of postoperative dysphagia and risk factors associated with its development varies widely in the literature. A systematic review of the English-language literature was undertaken for articles published between January 1990 and December 2008. Electronic databases and reference lists of key articles were searched to identify published studies examining the incidence and prevalence of dysphagia after anterior cervical spine surgery. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation criteria, assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus. A total of 126 articles were initially screened, and 17 ultimately met the predetermined inclusion criteria. The rates of dysphagia found in the literature varied widely. Rates declined after surgery, but plateau at 1 year at a range of 13% to 21%. Risk factors identified were multilevel surgery and female sex. Specific preventive measures were not identified. A better understanding of dysphagia will require the development of better outcome measures.
Article
Dysphagia-related sequelae are common after head and neck cancer treatment. Our aims were 1) to document overall and site-specific dysphagia, stricture, and pneumonia rates in a Medicare population, 2) to calculate treatment-specific rates and adjusted odds of developing these complications, and 3) to track changes in rates between 1992 and 1999. Head and neck cancer patients between 1992 and 1999 were identified in combined Surveillance Epidemiology and End Results (SEER) registry and Medicare databases. Multivariate analyses determined odds of dysphagia, stricture, and pneumonia based on modality. Of 8,002 patients, 40% of experienced dysphagia, 7% stricture, and 10% pneumonia within 3 years of treatment. In adjusted analyses, patients treated with chemoradiation had more than 2.5-times-greater odds of dysphagia than did those treated with surgery alone. Combined therapy was associated with increased odds of stricture (p<0.05). The odds of pneumonia were increased in patients treated with radiation with or without chemotherapy. Temporally, the dysphagia rates increased 10% during this period (p<0.05). Sequelae of head and neck cancer treatment are common and differ by treatment regimen. Those treated with chemoradiation had higher odds of experiencing dysphagia and pneumonia, whereas patients treated with any combined therapy more commonly experienced stricture. These sequelae represent major sources of morbidity and mortality in this population.
Article
To evaluate current racial/ethnic and socioeconomic disparities in the prevalence of frequent ear infections (FEI) among children in the United States. Cross-sectional study. The National Health Interview Survey (years 1997 to 2006) was utilized to evaluate children who were reported by their parent/guardian to have "3 or more ear infections during the past 12 months." Demographic variables evaluated included age, sex, race/ethnicity, income level, and insurance status. Multivariate analyses determined the influence of demographic variables on the prevalence of FEI in children. Among an annualized population of 72.6 million children (average age, 8.55 +/- 0.19 years), 4.65 +/- 0.07 million children (6.6 +/- 0.1%) reported FEI. FEI was more commonly reported in white (7.0 +/- 0.1%) and Hispanic (6.2 +/- 0.2%) than in black (5.0 +/- 0.2%) and other race/ethnic groups (4.5 +/- 0.3%, P < .001). A larger portion of children in households below the poverty level reported FEI (8.0 +/- 0.3%, P < .001). Of children with no health insurance 5.4 +/- 0.3% had FEI. On multivariate analysis, black, Hispanic and other race/ethnic group had decreased odds ratio for FEI relative to white children (odds ratios: 0.63, 0.76, and 0.60, respectively, all P < .001). Income below poverty level also predicted FEI (odds ratio, 1.322, P < .001), whereas lack of insurance coverage did not (P = .181). Despite increasing awareness, there are still notable racial/ethnic and socioeconomic disparities among children with FEI. Further efforts to eliminate these disparities and improve the care of children with FEI are needed.
Article
In 2004, more than 12% of the population in the United States was aged 65 years or older. This percentage is expected to increase to 20% of the population by 2030. The prevalence of swallowing disorders, or dysphagia, in older individuals ranges from 7% to 22% and dramatically increases to 40% to 50% in older individuals who reside in long-term care facilities. For older individuals, those with neurologic disease, or those with dementia, the consequence of dysphagia may be dehydration, malnutrition, weight loss, and aspiration pneumonia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. The high prevalence of dysphagia in individuals with dementia likely is the result of age-related changes in sensory and motor function in addition to those produced by neuropathology. The following article describes evidence based practices in caring for those individuals with dementia and dysphagia with guidelines for evaluation and management.