Arquivo da categoria: Dysphagia

Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: a review and summary of an international expert meeting

Rainer Wirth, Rainer Dziewas, Anne Marie Beck, Pere Clavé, Shaheen Hamdy, Hans Juergen Heppner, Susan Langmore,9 Andreas Herbert Leischker, Rosemary Martino, Petra Pluschinski, Alexander Rösler, Reza Shaker, Tobias Warnecke, Cornel Christian Sieber and Dorothee Volkert

Clin Interv Aging. 2016; 11: 189–208. 
Published online 2016 Feb 23. doi: 10.2147/CIA.S97481
PMCID: PMC4770066
PMID: 26966356

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Abstract

Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.

Keywords: aspiration, dehydration, dysphagia, geriatric, malnutrition, older

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Three‐dimensional analysis of the human pharyngoesophageal sphincter

Derrick R. Randall, MD, MSc ; Daniel J. Cates, MD ; E. Brandon Strong; Peter C. Belafsky, MD, PhD, MPH

Laryngoscope

© 2019 The American Laryngological, Rhinological and Otological Society

First published: 14 December 2019

Abstract

Objectives: Dysfunction of the pharyngoesophageal segment (PES) is a common cause of oropharyngeal dysphagia. Surgi- cal dilation of the PES uses cylindrical dilators that expand radially in a circular shape. Animal studies, however, suggest that the PES is kidney-shaped. The purpose of this investigation was to evaluate the 3D shape of the human PES with a novel cast- ing method.

Methods: A platinum-cured liquid silicone polymer was infused under pressure into the upper aerodigestive tract of nine fresh human cadavers to construct 3D casts of the maximally distended PES. Cross-sectional and volumetric analysis were per- formed using computed tomography and serial sectioning of the models. Canonical variate analysis was used to identify the shape features that best distinguishes the PES from the cervical esophagus.

Results: The mean age of the cadavers was 77.9 (SD 10.6) years, with 67% women. Analysis of the casts confirms that the human PES possesses a kidney-shaped structure at maximal distention, which is discretely different from the adjacent esophagus (P < 0.001). The posterior body of the cricoid cartilage formed the anterior wall of the PES, which provided a rigid structure responsible for preservation of the kidney shape during distention. The diameter of the maximally distended PES at the cricopharyngeus was highly variable (range = 0.86–4.68 cm2; SD = 1.33 cm2).

Conclusion: The data suggest that the human PES is not round and that targeted expansion at the level of the cricopharyngeus with an eccentrically shaped dilator may provide improved distention.

Key Words: Dysphagia, laryngology, pharynx.

Level of Evidence: 4

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Aula Solidária: Disfagia Neonatal e Pediátrica

*5ª Aula Solidária Núcleo Reabilite/BH*.

Venha aprender e fazer o Natal de uma criança mais feliz 🎄 🎅🏻 🎁❤️

💫Tema: Disfagia Neonatal e Pediátrica

💫Palestrante:

Fga. Mariah Batalha Ribeiro

💫Data: 18/12

💫Horário: 18:30/21:30

💫Local: Associação Médica de Minas Gerais (Avenida João Pinheiro, 161 – Centro). Belo Horizonte/MG

🎁 O Valor de R$20,00 deve ser pago no dia, em dinheiro e o brinquedo para doação deverá ser novo.

Fotobiomodulação Aplicada à Fonoaudiologia

Cidade: Belo Horizonte/ MG

 O curso visa desenvolver o raciocínio clínico para adequação da dosimetria laser baseada em evidências; detalhar os diferentes tipos de laser e as estruturas que os absorvem; apresentar e discutir os efeitos fisiológicos e terapêuticos da laserterapia baseados evidências nas diversas áreas da Fonoaudiologia.

Professores:

Ftp. Alexandre Cavallieri Gomes/Portugal

Fgª Vanessa Mouffron/MG

Fgª Tatiana Chaves/MG

Programação:

Curso teórico e prático!

1. Laserterapia como facilitadora do exercício e redutor da fadiga muscular;

2. Interação da FBM com os tecidos;

3. lesões nervosas periféricas (paralisias faciais e parestesias);

5. tratamento de fraturas;

6. prevenção e tratamento de mucosites (oncologia);

7. cicatrização de feridas e incisões;

8. como agente analgésico e modulador da inflamação;

9. Laserterapia na amamentação;

10. Disfunções neurológicas;

11. Voz;

12. Estética Facial;

13. Disfagias;

14. Fonoaudiologia Hospitalar;

15. Fotobiomodulação e o cérebro: perspectivas futuras e evidências científicas (AVC, TCE, Alzheimer, Parkinson, demências).

Local:

Associação Médica de Minas Gerais: Avenida João Pinheiro, 161 – Centro

Informações:

(31)992783239 – Tatiana Chaves

(31)986927256 – Graziela Bougo

Palliation of dysphagia

van der Bogt, R D; Vermeulen, B D; Reijm, A N; Siersema, P D; Spaander, M C W.

Best Pract Res Clin Gastroenterol; 36-37: 97-103, 2018 Oct – Dec. 

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RESUMO

Palliation of dysphagia is the cornerstone of palliative treatment in patients with incurable oesophageal cancer. Available palliative options for dysphagia are oesophageal stent placement and radiotherapy. In general, oesophageal stent placement is the preferred therapeutic option in patients with a relatively poor prognosis because of its rapid relief of dysphagia. Regardless of ongoing technical developments, recurrence of dysphagia and stent-related complications are still occurring. For patients with a relatively good prognosis, intra-luminal brachytherapy is advised because of its sustained palliation of dysphagia. Due to limited availability of intra-luminal brachytherapy in clinical practice, fractionated external beam radiation therapy is commonly applied as an alternative. Selection of the optimal palliative approach for patients remains however challenging as conclusive high-quality evidence is limited. Moreover, with the introduction of new palliative treatment options (e.g. palliative chemotherapeutic and radiotherapeutic options) and the concurrent change of patient characteristics, supporting evidence from large randomised studies is warranted.

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Sinais, sintomas e função vocal em indivíduos com disfagia tratados de câncer de cabeça e pescoço

Felipe Moreti;

Bruna Morasco-Geraldini;

Simone Aparecida Claudino-Lopes;

Elisabete Carrara-de

Audiol., Commun. Res. vol.23  São Paulo  2018  Epub 18-Out-2018

http://dx.doi.org/10.1590/2317-6431-2017-1873&nbsp;

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RESUMO

Objetivos

Avaliar a presença de sinais e sintomas vocais e função vocal em indivíduos com disfagia, tratados de câncer de cabeça e pescoço – CCP e identificar os valores de corte dos respectivos instrumentos. 

Métodos

Estudo prospectivo com 96 indivíduos (68 homens e 28 mulheres), divididos em grupo experimental – GE (pacientes tratados de CCP com disfagia, independente de queixa vocal) e grupo controle – GC (sem queixas autorrelatadas de voz e deglutição, pareados em média de idade e sexo com GE), que responderam a um questionário com dados de identificação e caracterização da amostra, Lista de Sinais e Sintomas Vocais – LSS, e dois protocolos de avaliação vocal (Índice de Função Glótica – IFG e Escala de Sintomas Vocais – ESV). Por fim, as notas de corte dos protocolos foram identificadas por meio da curva ROC (Receiver Operating Characteristic). 

Resultados

Indivíduos do GE apresentaram mais sinais e sintomas vocais e maiores escores no IFG e ESV que os indivíduos do GC, além de pior autoavaliação vocal. Os três instrumentos apresentaram máxima área sob a curva ROC, com valores de corte ESV=17, IFG=4 e LSS=6 pontos. 

Conclusão

Indivíduos tratados de CCP com disfagia apresentam mais sinais e sintomas vocais, pior autopercepção da disfunção vocal e maior prejuízo nos aspectos de limitação, emocional e físico da voz, que indivíduos vocalmente saudáveis. Os três instrumentos evidenciaram sensibilidade e especificidade máximas, podendo ser utilizados como ferramentas de triagem. 

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Augmentation of Deglutitive Thyrohyoid Muscle Shortening by the Shaker Exercise

Rachel Mepani, Stephen Antonik, Benson Massey, Mark Kern, Jerilyn Logemann, Barbara Pauloski, Alfred Rademaker, Caryn Easterling, Reza Shaker

Dysphagia. Author manuscript; available in PMC 2010 Jun 28.

Published in final edited form as: Dysphagia. 2009 Mar; 24(1): 26–31. Published online 2008 Aug 7.

doi: 10.1007/s00455-008-9167-y

Abstract

Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown. Therefore the aim of this study was to determine the effect of the exercise on thyrohyoid muscle shortening. We studied 11 dysphagic patients with UES dysfunction. Six were randomized to traditional swallowing therapy and five to the Shaker Exercise. Videofluoroscopy was used to measure deglutitive thyrohyoid shortening before and after completion of assigned therapy regimen. Maximum thyrohyoid muscle shortening occurred at close temporal proximity to the time of maximal thyroid cartilage excursion. The percent change in thyrohyoid distance from initiation of deglutition to maximal anterior/superior hyoid excursion showed no statistically significant difference between the two groups prior to either therapy (p = 0.54). In contrast, after completion of therapy, the percent change in thyrohyoid distance in the Shaker Exercise group was significantly greater compared to the traditional therapy (p = 0.034). The Shaker Exercise augments the thyrohyoid muscle shortening in addition to strengthening the suprahyoid muscles. The combination of increased thyrohyoid shortening and suprahyoid strengthening contributes to the Shaker Exercise outcome of deglutitive UES opening augmentation.

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