Three‐dimensional analysis of the human pharyngoesophageal sphincter

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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
https://doi.org/10.1002/lary.28450

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

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*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

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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

3º Curso “AVALIAÇÃO E INTERVENÇÃO FONOAUDIOLÓGICA EM AFASIAS E DEMÊNCIAS”d

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✔️ Local: BELO HORIZONTE/MG

✔ Palestrante: Dra. Thais Machado

✔Data e horário:

28/06 – 18 às 22h

29/06 – 08 às 18h

✔Programação:

– Bases anatômicas da linguagem

– Inter-relação funções cognitivas e linguagem

– Compreensão e produção da linguagem oral e escrita

– Semiologia e taxonomia das afasias e demências

– Avaliação e diagnóstico das afasias e demências

– Diagnóstico diferencial: Disartria e Apraxia de fala

– Neuroplasticidade

– Linhas terapêuticas

– Propostas de intervenção fonoaudiológica nas alterações de linguagem progressivas e não progressivas

– Discussão de casos clínicos

Promovido por: Nucleo Reabilite/ BH- MG

Palliation of dysphagia

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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. 

Imagem retirada da internet

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

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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;

Imagem retirada da internet

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

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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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Efficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study

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Bruno Francisco de Fraga; Sheila Tamanini de Almeida; Márcia Grassi Santana; Mauriceia Cassol

Int Arch Otorhinolaryngol 2018;22:225–230.

Fonte: Speechspark

ABSTRACT

Introduction Dysphagia causes changes in the laryngeal and stomatognathic struc- tures; however, the use of vocal exercises is poorly described.

Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients.

Methods This is a pilot study made up of two distinct groups: a control group, which performed only myofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS).

Results The FOIS levels reveal that the pre-therapy median of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments (p 1⁄4 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone (p 1⁄4 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy (p 1⁄4 0.126).

Conclusion This pilot study showed indications that using vocal exercises in swallow- ing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.

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Dysphagia in Parkinson’s Disease Improves with Vocal Augmentation

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Howell, R.J., Webster, H., Kissela, E. et al.
Dysphagia (2019)
https://doi.org/10.1007/s00455-019-09982-z

dysphagia PARK

Imagem retirada da internet

Abstract

While voice-related disorders in Parkinson’s disease (PD) are commonly discussed in the literature, dysphagia in PD is less widely published. Vocal fold augmentation, including injection laryngoplasty (IL), is a well-established treatment for glottal insufficiency (Cates et al. in Otolaryngol Head Neck Surg 155(3):454–457, 2016). This study aimed to observe the effects of IL in PD patients with vocal bowing, with or without therapy, on glottic closure and patient-reported dysphagia outcomes. The study design was based on retrospectively collected database and cohort–case series. PD patients selected for retrospective review over a 2-year period were referred and evaluated in the Voice, Swallowing, and Airway multidisciplinary clinic by speech language pathologist and laryngologist, and were undergoing IL. Charts were reviewed for age, gender, Body Mass Index (BMI), onset of PD, and Movement Disorders Society-Unified Parkinson’s Disease Rating Scale Part 3 (MDS-UPDRS) scoring. We compared pre/postoperatively (> 1 < 3 months) using validated patient-reported outcome tools: Reflux Symptom Index (RSI), Glottal Function Index (GFI), Eating Assessment Tool-10 (EAT), and stroboscopic examinations. The study included 14 patients undergoing 22 IL or 1.6 IL/patient: mean age 70 years (63–80), 100% male, and BMI 25.9 ± 4.3 (mean ± SD). MDS-UPDRS scoring 33 ± 20 (moderate severity), with time between PD diagnosis and IL 8 ± 10 years. All patients had pre- and post-stroboscopic examinations; however, only 4:14 underwent formal swallowing evaluation. Overall, 14 IL patients improved on patient-reported measures (ΔRSI = 4; ΔGFI = 3; ΔEAT = 4). Based on the findings of the study, we conclude that PD is a progressive neurodegenerative condition with dysphagia. The presented pilot data suggest that IL may be considered as a beneficial adjunct for PD patients with glottal insufficiency.

Level of Evidence: 4

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Tongue Shape Dynamics in Swallowing Using Sagittal Ultrasound

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Ohkubo, M. & Scobbie, J.M.
Dysphagia (2019) 34: 112.
https://doi.org/10.1007/s00455-018-9921-8

US Lingua                                                                                                                              Fonte: Researchgate

Abstract

Ultrasound imaging is simple, repeatable, gives real-time feedback, and its dynamic soft tissue imaging may make it superior to other modalities for swallowing research. We tested this hypothesis and measured certain spatial and dynamic aspects of the swallowing to investigate its efficacy. Eleven healthy adults wearing a headset to stabilize the probe participated in the study. Both thickened and thin liquids were used, and liquid bolus volumes of 10 and 25 ml were administered to the subjects by using a cup. The tongue’s surface was traced as a spline superimposed on a fan-shaped measurement space for every image from the time at which the tongue blade started moving up toward the palate at the start of swallowing to the time when the entire tongue was in contact with the palate. To measure depression depth, the distance (in mm) was measured along each radial fan line from the location at which the tongue’s surface spline intersected the fan line to the point where the hard palate intersected the fan line at each timepoint. There were differences between individual participants in the imageability of the swallow, and so we defined quantitatively “measureable” and “unmeasurable” types. The most common type was measureable, in which we could find a clear bolus depression in the cupped tongue’s surface. Indeed, with 10 ml of thin liquids, we were able to find and measure the depression depth for all participants. The average maximum radial distance from the palate to the tongue’s surface was 20.9 mm (median) (IQR: 4.3 mm) for swallowing 10 ml of thin liquid compared to 24.6 mm (IQR: 3.3 mm) for 25 ml of thin liquid swallow (p < 0.001). We conclude that it is possible to use ultrasound imaging of the tongue to capture spatial aspects of swallowing.

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