Arquivo da categoria: Screening and Evaluation

Importância da interdisciplinaridade na avaliação das disfagias: avaliação clínica e videofluoroscópica da deglutição

Sordi, Marina de; Mourão, Lucia Figueiredo; Silva, Ariovaldo Armando da; Flosi, Luciana Claudia Leite
Braz. j. otorhinolaryngol. (Impr.) 75(6): 776-787, GRA. 2009 Dec.

RESUMO

Opaciente disfágico apresenta prejuízos em diversos aspectos, sendo a atuação interdisciplinar fundamental para definição do diagnóstico e da conduta. A atuação em conjunto na avaliação clínica e videoendoscópica é de extrema importância.
OBJETIVO: Estudar a correlação entre a avaliação clínica (ACD) e videoendoscópica da deglutição (VED) por meio da classificação do grau de severidade e a análise qualitativo/descritiva dos procedimentos.
FORMA DE ESTUDO: Estudo transversal, descritivo, comparativo.
MATERIAL E MÉTODO: Realizado no março a dezembro de 2006 no ambulatório de Otorrinolaringologia/Disfagia de um hospital do interior de São Paulo. Foram avaliados pela ACD e VED 30 pacientes disfágicos com diferentes doenças. Os dados foram classificados por meio de escalas de severidade e análise qualitativa/descritiva.
RESULTADOS: A correlação entre as escalas de severidade de ACD e VED apontou concordância baixa (KAPA = 0,4) de modo estatisticamente significante (p=0,006). A correlação entre a análise qualitativa/descritiva apontou concordância excelente (KAPA=0.962) estatisticamente significante (p<0.001) para a amostra total.
CONCLUSÃO: A concordância baixa entre as escalas de severidade aponta a necessidade da realização de ambos os procedimentos, reforçando a VED como procedimento factível. A análise qualitativa descritiva apontou concordância excelente, dado que reforça a necessidade da compreensão da deglutição como um processo.

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Swallowing screens after acute stroke: a systematic review

Schepp SK; Tirschwell DL; Miller RM; Longstreth WT
Stroke; 43(3): 869-71, 2012 Mar.
BACKGROUND AND PURPOSE: Swallowing screens after acute stroke identify those patients who do not need a formal swallowing evaluation and who can safely take food and medications by mouth. We conducted a systematic review to identify swallowing screening protocols that met basic requirements for reliability, validity, and feasibility.
METHODS: We searched MEDLINE and supplemented results with references identified through other databases, journal tables of contents, and bibliographies. All relevant references were reviewed and evaluated with specific criteria.
RESULTS: Of 35 protocols identified, 4 met basic quality criteria. These 4 had high sensitivities of ≥87% and high negative predictive values of ≥91% when a formal swallowing evaluation was used as the gold standard. Two protocols had greater sample sizes and more extensive reliability testing than the others.
CONCLUSIONS: We identified only 4 swallowing screening protocols for patients with acute stroke that met basic criteria. Cost-effectiveness of screening, including costs associated with false-positive results and impact of screening on morbidity, mortality, and length of hospital stay, requires elucidation.

Comparação entre a avaliação clínica e objetiva de deglutição em pacientes com disfagia orofaríngea neurogênica

Autor(es): Barros, Anna Flávia Ferraz; Okubo, Paula de Carvalho Macedo Issa; Domenis, Danielle Ramos; Ricz, Hilton Marcos; Mello-Filho, Francisco Veríssimo de
Fonte: Rev. Soc. Bras. Fonoaudiol; 11(2): 90-95, 2006. tab
ABSTRACT:
Objetivo: verificar-se, em pacientes com disfagia orofaríngea neurogênica, os resultados da videofluoroscopia ou nasofibrolaringoscopia são compatíveis com os resultados da avaliação clínica da deglutição.
Métodos: foram analisados, retrospectivamente, 35 protocolos de pacientes com suspeita de disfagia orofaríngea neurogênica, avaliados no Ambulatório de Disfagia do HCFMRP-USP durante o ano de 2002, e que foram, posteriormente, submetidos à videofluoroscopia e/ou nasolaringofibroscopia da deglutição.
Resultados: para a consistência líquida, em 11 pacientes que não apresentaram risco de aspiração durante a avaliação clínica

Videofluoroscopía VFC en el estudio de los trastornos de la deglución

Paolinelli Grunert, Paola; Lukoviek B., Andrés.

Rev. chil. radiol;6(1):5-7, 2000. tab, graf.

ABSTRACT

El objetivo de este trabajo es mostrar la técnica de la videofluoroscopía de deglución y los principales trastornos de la deglución observados en nuestra experiencia. Se realizaron 41 exámenes en 39 pacientes, 20 (51 por ciento) con patología neurológica, 12 (31 por ciento) con antecedentes de cirugía y/o instrumentalización de la vía aérea y 7 por otras causas. Los procedimientos se realizaron bajo visión fluoroscópica y grabación simultánea con deglución progresiva de consistencias líquida, pasta y sólida. 27 (66 por ciento) estudios fueron patológicos, 9 presentaron alteraciones de la etapa oral, 6 en la faríngea y 12 en ambas. Las alteraciones más frecuentes de la fase oral fueron la pérdida de parte del bolo hacia la faringe y retardo en su inicio. Las alteraciones más frecuentes de la faríngea fueron la aspiración y el retardo de su inicio. 16 pacientes aspiraron y 6 de ellos no presentaron reflejo de tos, por lo tanto son aspiradores silentes. Las maniobras compensatorias realizadas con éxito fueron doblar la cabeza hacia el lado contralateral al afectado para mejorar el paso del bolo y aumentar la consistencia del alimento para evitar la aspiración. Este método de examen caracteriza adecuadamente la deglución orofaringea patológica permitiendo planificar la rehabilitación, establecer mecanismos compensatorios y detectar pacientes con aspiración silente

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Evolución de la aspiración laringo-traqueal en la disfagia orofaríngea secundaria a lesión cerebral traumática: cuantificación videofluoroscópica

Terré, R. and Mearin, F.

Rev. esp. enferm. dig. v.99 n.1 Madrid ene. 2007

RESUMEN

Introducción: la alteración de la deglución en la fase inicial de un traumatismo craneoencefálico grave (TCE) es muy frecuente.
Objetivo: definir y cuantificar las alteraciones videofluoroscópicas en pacientes después de un TCE y evaluar la evolución de los pacientes con aspiraciones laringo-traqueales.
Método: se estudiaron de forma prospectiva 10 pacientes con TCE grave con sospecha clínica de aspiración, que fue confirmada mediante exploración videofluoroscópica (VDF). La VDF se repitió al mes, 3, 6 y 12 meses de evolución.
Resultados: la exploración clínica demostró alteración en los reflejos palatal y nauseoso en el 30% de los pacientes, y tos durante la exploración en el 40%. En la primera exploración VDF se observó: aumento del tiempo de tránsito oral (TTO) en el 70% (media: 3,8 seg.; rango: 0,8-15 seg.) y alteración en el control lingual en el 60%, con disfunción en el sello glosofaríngeo en el 20%. El tiempo medio de tránsito faríngeo (TTF) fue de 0,72 seg. (rango: 0,34-1,50 seg.) y el tiempo de disparo del reflejo deglutorio (DRD) de 0,32 seg. (rango: 0,10-0,80 seg.). Al año de evolución sólo 3 pacientes aspiraban, siendo el TTO normal en 7 pacientes, el DRD en 9 y el TTF en todos. El 80% seguía dieta oral exclusiva y el 20% combinaban alimentación oral y por sonda de gastrostomía.
Conclusión: la VDF permite confirmar y cuantificar las alteraciones de la deglución en los pacientes con TCE grave. Los hallazgos más frecuentes en la fase inicial de la evolución son el aumento del TTO y la alteración en el control lingual; las aspiraciones son muy frecuentes, siendo más de la mitad aspiradores silentes. Al año la mayoría de pacientes ha evolucionado favorablemente.

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ACOUSTIC ANALYSIS OF SWALLOWING SOUNDS: A NEW TECHNIQUE FOR ASSESSING DYSPHAGIA

Andrea Santamato, Francesco Panza, Vincenzo Solfrizzi, Anna Russo, Vincenza Frisardi, Marisa Megna, Maurizio Ranieri, Pietro Fiore

J Rehabil Med 2009; 41: 639–645

Objective: To perform acoustic analysis of swallowing sounds, using a microphone and a notebook computer system, in healthy subjects and patients with dysphagia affected by neurological diseases, testing the positive/negative predictive value of a pathological pattern of swallowing sounds for penetration/aspiration.

Design: Diagnostic test study, prospective, not blinded, with the penetration/aspiration evaluated by fibreoptic endoscopy of swallowing as criterion standard.

Subjects: Data from a previously recorded database of normal swallowing sounds for 60 healthy subjects according to gender, age, and bolus consistency was compared with those of 15 patients with dysphagia from a university hospital referral centre who were affected by various neurological diseases.

Methods: Mean duration of the swallowing sounds and post-swallowing apnoea were recorded. Penetration/aspiration was verified by fibreoptic endoscopy of swallowing in all patients with dysphagia.

Results: The mean duration of swallowing sounds for a liquid bolus of 10 ml water was significantly different between patients with dysphagia and healthy patients. We also described patterns of swallowing sounds and tested the negative/positive predictive values of post-swallowing apnoea for penetration/aspiration verified by fibreoptic endoscopy of swallowing (sensitivity 0.67 (95% confidence interval 0.24–0.94); specificity 1.00 (95% confidence interval 0.56–1.00)).

Conclusion: The proposed technique for recording and measuring swallowing sounds could be incorporated into the bedside evaluation, but it should not replace the use of more diagnostic and valuable measures.

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The semisolid bolus swallow test for clinical diagnosis of oropharyngeal dysphagia: a prospective randomised study

Schultheiss C; Nusser-Müller-Busch R; Seidl RO
Eur Arch Otorhinolaryngol; 268(12): 1837-44, 2011 Dec.
ABSTRACT
Contrary to clinical experience, clinical swallow tests are predominantly performed using water (water swallow tests, WST). In this study, we examine whether swallow tests performed using a bolus of semisolid food (bolus swallow test, BST) offer benefits. In a prospective, randomised, blind study, the results of a standardised saliva swallow test (SST), WST, BST, combinations of these tests and an endoscopic swallow test (FEES) in patients with oropharyngeal swallowing disorders of neurological (NEU) and non-neurological (NNEU) origin were compared. Sensitivity, specificity, test accuracy and inter-rater reliability were analysed. 62 patients (mean age = 64.68; range = 22–84) were included in the study (NEU = 40; NNEU = 22). A sensitivity of 70.7% (NEU = 70.3%, NNEU = 71.4%) and specificity of 82.5% (NEU = 92.3%; NNEU = 100%) were determined for the WST. The BST + SST was found to have a sensitivity of 89.6% (NEU = 66.7%; NNEU = 90.9%) and a specificity of 72.7% (NEU = 87.5%; NNEU = 90.9%). Analysis of test accuracy showed a statistically significant correlation between FEES and BST + SST. Only BST + SST exhibited statistically significant inter-rater reliability. BST in combination with SST was the sensitive clinical instrument for detecting aspiration both over the patient population as a whole and over the two sub-populations. Inter-rater reliability was found to be statistically significant. The results presented here demonstrate the benefit of semisolid food in investigating clinical dysphagia.

Avaliação otorrinolaringológica e fonoaudiológica na abordagem da disfagia orofaríngea: proposta de protocolo conjunto

Santoro, Patrícia Paula; Furia, Cristina Lemos Barbosa; Forte, Ana Paola; Lemos, Elza Maria; Garcia, Roberta Ismael; Tavares, Raquel Aguiar; Imamura, Rui
Braz J Otorhinolaryngol; 77(2): 201-213, Mar.-Apr. 2011. ilus.
A disfagia é um sintoma que envolve uma gama de alterações anatômicas e funcionais, que deve ser abordado de maneira multidisciplinar para garantir melhor avaliação e tratamento, prevenindo as complicações potenciais.
OBJETIVO: utilização do protocolo de avaliação clínica e videoendoscopia da deglutição, realizado em conjunto por otorrinolaringologistas e fonoaudiólogos, no Ambulatório de Disfagia da Divisão de Clínica Otorrinolaringológica da instituição.
MATERIAL E MÉTODO: Estudo retrospectivo da utilização do protocolo de anamnese e exame físico otorrinolaringológico e fonoaudiológico, complementados pela videoendoscopia da deglutição. Foram avaliados 1332 pacientes no período de maio de 2001 a dezembro 2008, sendo 726 (54,50 por cento) indivíduos do sexo masculino e 606 (45,50 por cento) do sexo feminino. As idades variaram de 22 dias a 99 anos, com uma média de idade de 59,4 anos. RESULTADOS: Foram identificados 427 (32,08 por cento) pacientes com deglutição normal, 273 (20,48 por cento) com disfagia leve, 224 (16,81 por cento) com disfagia moderada e 373 (27,99 por cento) pacientes com disfagia grave, além de 35 (2,64 por cento) exames inconclusivos.
CONCLUSÃO: O protocolo de avaliações otorrinolaringológica e fonoaudiológica integrado permitiu uma abordagem minuciosa e complementar do paciente disfágico, em relação a classificações do distúrbio de deglutição, além de auxiliar na abordagem terapêutica.

Videofluoroscopic Swallow Studies in Unilateral Cricopharyngeal Dysfunction

Stacey L. Halum, Albert L. Merati, Judith I. Kulpa, Susan K. Danielson, Safwan S. Jaradeh and Robert J. Toohill

The Laryngoscope

Volume 113, Issue 6, June 2003, Pages: 981–984.

 

Abstract

Objectives/Hypothesis Although the cricopharyngeus muscle is a ring-like structure, unilateral cricopharyngeal dysfunction can produce significant dysphagia. This entity has not been well described in the literature. The aims of the study were to identify the characteristic findings on videofluoroscopic swallow studies in patients with dysphagia secondary to unilateral cricopharyngeal dysfunction, to note the associated vagal nerve injury, and to evaluate patient outcomes following ipsilateral cricopharyngeal myotomy.

Study Design Retrospective clinical investigation.

Methods The clinic charts, electromyographic tests, videostroboscopic examinations, and videofluoroscopic swallow studies were reviewed from a series of patients who presented to our institution from 1993 to 2001 with dysphagia and findings on videofluoroscopic swallow studies suggestive of unilateral cricopharyngeal dysfunction on posterior–anterior view. In patients treated with ipsilateral cricopharyngeal myotomy, postoperative findings on swallow studies and patient outcomes were also reviewed.

Results Eighteen patients demonstrated findings characteristic of unilateral cricopharyngeal muscle dysfunction on videofluoroscopic swallow study. The common feature was a unilateral shelf-like barrier at the cricopharyngeus on the posterior–anterior view with pooling of liquid bolus in the ipsilateral pyriform sinus and episodic shunting to the contralateral side. Eight patients did not have evidence of cricopharyngeal dysfunction (ie, cricopharyngeal bar) on lateral films. Of the 18 patients, 14 had histories consistent with vagal injury secondary to trauma (n = 2), neoplastic involvement (n = 7), iatrogenic injury (n = 2), or central nervous system disease (n = 3). Results of videostroboscopic examinations demonstrated vocal fold motion impairment in 14 patients, and electromyographic test results confirmed unilateral vagal injuries in those who underwent electromyographic testing (n = 6). In the remaining 4 of 18 patients, videostroboscopic examinations demonstrated normal vocal fold abduction but impaired lengthening with a posterior glottic gap, and electromyographic test results (n = 4) indicated unilateral superior laryngeal nerve involvement. Of the 15 patients treated with ipsilateral cricopharyngeal myotomy, 1 patient required postoperative esophageal dilations for an esophageal stricture distal to the cricopharyngeus, whereas the remaining 14 patients had functional resolution of their dysphagia.

Conclusion In patients presenting with dysphagia and evidence of unilateral vagal injury, careful assessment of posterior–anterior view on videofluoroscopic swallow study should be included to evaluate for unilateral cricopharyngeal dysfunction.

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Prospective, Randomized Outcome Study of Endoscopy Versus Modified Barium Swallow in Patients With Dysphagia

Jonathan E. Aviv

The Laryngoscope

Volume 110, Issue 4, April 2000, Pages: 563–574,  Article first published online : 13 MAY 2009.

 

Abstract

Objective Aspiration pneumonia is a significant cause of morbidity and mortality in both acute and long-term care settings. While there are many reasons for patients to develop aspiration pneumonia, there exists a strong association between difficulty swallowing, or dysphagia, and the development of aspiration pneumonia. The modified barium swallow test (MBS) and endoscopic evaluations of swallowing are considered to be the most comprehensive tests used to evaluate and manage patients with dysphagia in an effort to reduce the incidence of pneumonia. The purpose of this study was to provide an initial investigation of whether flexible endoscopic evaluation of swallowing with sensory testing (FEESST) or MBS is superior as the diagnostic test for evaluating and guiding the behavioral and dietary management of outpatients with dysphagia. FEESST combines the standard endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve.

Study Design Randomized, prospective cohort outcome study in a hospital-based outpatient setting.

Methods One hundred twenty-six outpatients with dysphagia were randomly assigned to either FEESST or MBS as the diagnostic test used to guide dietary and behavioral management (postural changes, small bites and sips, throat clearing). The outcome variables were pneumonia incidence and pneumonia-free interval. The patients were enrolled for 1 year and followed for 1 year.

Results Seventy-eight MBS examinations were performed in 76 patients with 14 patients (18.4%) developing pneumonia; 61 FEESST examinations were performed in 50 patients with 6 patients (12.0%) developing pneumonia. These differences were not statistically significant (ξ2 = 0.93, P = .33). In the MBS group the median pneumonia-free interval was 47 days; in the FEESST group the median pneumonia-free interval was 39 days. Based on Wilcoxon’s signed-rank test, this difference was not statistically significant (z = 0.04, P = .96).

Conclusion Whether dysphagic outpatients have their dietary and behavioral management guided by the results of MBS or of FEESST, their outcomes with respect to pneumonia incidence and pneumonia-free interval are essentially the same.

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