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Swallowing Dysfunction (swallowing + dysfunction)
Selected AbstractsCapsaicin Troche for Swallowing Dysfunction in Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Takae Ebihara MD Objectives: To determine whether oral capsaicin troche supplementation with every meal upregulates the impairment of upper respiratory protective reflexes such as the swallowing reflex and the cough reflex. Design: Randomized, controlled study with recruitment through nursing homes. Setting: Sendai, Japan, from September 2002 through December 2003. Participants: Sixty-four participants in nursing homes with a mean age±standard deviation of 81.9±1.0 with stable physical status. Intervention: Participants were randomly assigned to the program for the supplementation of capsaicin trochisci or placebo trochisci before every meal for 4 weeks. Measurements: Assessment of individual latency time of the swallowing reflex (LTSR) and cough reflex sensitivity. Results: Before the commencement of this study, there were no significant baseline differences in multiple parameters between the intervention group and control group. LTSR in participants in the intervention group was significantly shorter than in the control group (P<.05). The odds ratio (OR) of the shortening of the LTSR of more than 1 minute in the intervention group was 3.4 (95% confidence interval (CI)=1.1,10.4), compared with the control group (P=.03). In particular, daily capsaicin supplementation significantly increased the ratio of LTSR reduction at 4 weeks after the study to baseline LTSR in the high-risk group (baseline LTSR >6.0 seconds) compared with the low-risk group (baseline LTSR <3.0 seconds) and the intermediate group (3.0 seconds Complete hypopharyngeal obstruction by mucosal adhesions: A complication of intensive chemoradiation for advanced head and neck cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2006Elizabeth J. Franzmann MD Abstract Background. Severe swallowing dysfunction is the dominant long-term complication observed in patients treated for head and neck squamous cell carcinoma (HNSCC) with treatment protocols using intensive concurrent chemotherapy with radiation therapy (chemo/XRT). We identified a subset of these patients, who were seen with complete obstruction of the hypopharynx distal to the site of the primary cancer, and in whom we postulate that the obstruction was caused by separable mucosal adhesions rather than obliteration by a mature fibrous stricture. Methods. Seven patients were referred to the senior author with a diagnosis of complete hypopharyngeal obstruction between 1992 and 2001. The diagnosis was confirmed by barium swallow imaging and/or endoscopy before referral in all patients. Patients underwent recanalization by passing a Jesberg esophagoscope under general anesthesia, followed by serial dilations and intensive swallowing therapy. Patient charts were reviewed retrospectively after institutional review board approval. Results. All seven patients were successfully recanalized. No patient had a perforation or other significant complication related to the recanalization procedure or subsequent dilations. Five of the seven patients showed improvement in swallowing at some point after the initial procedure, but just two patients recovered sufficiently to have their gastrostomy tube removed permanently. Conclusions. We conclude that complete hypopharyngeal obstruction secondary to mucosal adhesions is one cause of gastrostomy tube dependence in patients who have been treated with chemo/XRT for HNSCC. It is a difficult problem to treat, but most patients can recover useful swallowing function without undergoing laryngectomy or major surgical reconstruction. The postulated pathophysiology has implications for prevention as well as treatment. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Definitive radiotherapy with interstitial implant boost for squamous cell carcinoma of the tongue baseHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2005Omur Karakoyun-Celik MD Abstract Background. The purpose of this study was to examine the long-term outcome of a cohort of patients with unresected base of tongue carcinoma who received interstitial brachytherapy after comprehensive external beam radiation therapy. Methods. Between 1983 and 2000, 122 patients with primary or recurrent squamous cell carcinoma of the oropharynx or oral cavity received interstitial brachytherapy as part of their overall management. Forty patients had primary, unresected carcinoma of the base of tongue and are the subjects of this analysis. The median age was 54 years. Fifty-four percent had T3 or T4 disease, and 70% had clinical or radiographic lymphadenopathy. Twenty-four (60%) received two to three cycles of neoadjuvant chemotherapy. The oropharynx, bilateral neck, and supraclavicular fossae were comprehensively irradiated, and the tongue base received a median external beam dose of 61.2 Gy (50,72 Gy). The primary site was then boosted with an interstitial 192Iridium implant by use of a gold-button single-strand technique and three-dimensional treatment planning. The dose rate was prescribed at 0.4 to 0.5 Gy/hr. The median implant dose was 17.4 Gy (9.6,24 Gy) and adjusted to reach a total dose to the primary tumor of 80 Gy. N2 to 3 disease was managed by a planned neck dissection performed at the time of the implant. Results. The median follow-up for all patients was 56 months, and the overall survival rates were 62% at 5 years and 27% at 10 years. The actuarial primary site control was 78% at 5 years and 70% at 10 years. The overall survival and primary site control were independent of T classification, N status, or overall stage. Systemic therapy was associated with an improvement in overall survival (p = .04) and a trend toward increased primary site control with greater clinical response. There were seven documented late effects, the most frequent being grade 3 osteonecrosis (n = 2), grade 2 swallowing dysfunction (n = 2), trismus (n = 2), and chronic throat pain (n = 1). Conclusions. In an era of greatly improved dose distributions made possible by three-dimensional treatment planning and intensity-modulated radiation therapy, brachytherapy allows a highly conformal dose to be delivered in sites such as the oropharynx. If done properly, the procedure is safe and delivers a dose that is higher than what can be achieved by external beam radiation alone with the expected biologic advantages. The long-term data presented here support an approach of treating advanced tongue base lesions that includes interstitial brachytherapy as part of the overall management plan. This approach has led to a 78% rate of organ preservation at 5 years, with a 5% incidence of significant late morbidity (osteonecrosis) that has required medical management. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Prevalence of laryngomalacia in children presenting with sleep-disordered breathing,,§¶THE LARYNGOSCOPE, Issue 8 2010Mahilravi Thevasagayam FRCS(Ed) FRCS (ORL-HNS) Abstract Objective: To determine the prevalence of laryngomalacia among children presenting with symptoms of sleep-disordered breathing (SDB). Method: A retrospective observational study was conducted at a tertiary care paediatric hospital. All children presenting with SDB during a 55-month period were investigated using sleep nasopharyngoscopy (SNP). Patients who had laryngomalacia were identified. Patients who did not present primarily with SDB, or were not examined with SNP were excluded. Data for analysis was collected from a prospectively kept surgical database and medical records. This included patients' demographics, symptoms (including symptoms in infancy), diagnoses, SNP findings, overnight pulse oximetry findings, and treatment. Results: We identified 358 patients with documented primary diagnosis of SDB and who had undergone SNP. Fourteen of these also had a documented diagnosis of laryngomalacia, giving a prevalence rate of 3.9%. Three children were syndromic, and one had cerebral palsy in addition to SDB and laryngomalacia. Three children were obese, and three children had gastroesophageal reflux disease. Seven cases (50%) had symptoms of snoring and/or swallowing dysfunction and/or stridor in infancy. Twelve patients had adenotonsillar surgery. In eight cases symptoms resolved completely with adenotonsillar surgery only. In total, six patients had a supraglottoplasty. There were three failures to supraglottoplasty. Conclusion: The prevalence of laryngomalacia within children presenting with SDB is 3.9%. Our findings support full evaluation of the airway to identify the site of pathology mediating SDB symptoms. Laryngoscope, 2010 [source] Outcomes Studies of Epiglottic and Base of Tongue Prolapse in Children,THE LARYNGOSCOPE, Issue 3 2008FACS, Robert F. Yellon MD Abstract Objectives: The purpose of this study was to compare previously reported flexible fiberoptic laryngoscopy (FFL) findings of a grading system for children with epiglottic and base of tongue (EBT) prolapse with findings at follow-up FFL. Surgical outcomes and tracheotomy decannulation are also reported. Study Design: Retrospective medical record review. Methods: Fourteen children with EBT prolapse had transnasal FFL in the supine position on at least two occasions. Findings were graded for initial versus most recent FFL. The previously published EBT prolapse grading system was reapplied. Mean age was 8.7 years at the last evaluation. Mean interval between initial and most recent FFL was 1.9 years. Results: At follow-up FFL, six (43%) children had the same grade of EBT prolapse, five (36%) had a milder grade, and three (21%) had a more severe grade. Five (36%) children were decannulated, and nine (64%) children remain tracheotomy dependant. Of nine children who had surgery, four (44%) were decannulated. Eight (89%) of nine children who were not decannulated have a history of developmental delay (P < .03). Twelve (86%) children had gastroesophageal reflux disease, and six (43%) had abnormal swallowing function. Conclusions: The grading system was successfully reapplied to compare initial with follow-up findings in a cohort of children with EBT prolapse. Gastroesophageal reflux disease and swallowing dysfunction are common in this population. Judicious surgery may have some efficacy for EBT prolapse in selected patients. Many children with EBT prolapse still require tracheotomy, especially those with developmental delay. [source] Early Laryngeal Inhalation Injury and its Correlation with Late SequelaeTHE LARYNGOSCOPE, Issue 2 2006Tulio A. Valdez MD Abstract Objective: Inhalation injury can permanently alter normal laryngeal function. The aim of this study was to examine the early changes in voice, swallowing, and breathing in laryngeal inhalation injuries. Study Design: This was a prospective analysis of nine patients with inhalation injuries at a tertiary care institution. Methods: Laryngeal function of patients admitted for inhalation injury requiring intubation was documented using videostroboscopy and swallowing evaluation by the speech pathology service. Bronchoscopy was used to classify the degree of inhalation injury. Association among total body surface area, facial burns, severity of laryngotracheal injuries, and loss of function was attempted. Results: All three patients with severe tracheal inhalation injury presented persistent hoarseness at 1-year follow up with abnormal videostroboscopy findings. No association was found between inhalation injury and total body surface area burned. None of the patients in this series presented permanent swallowing dysfunction. Conclusion: The otolaryngologist plays an important role in the initial and long-term management of inhalation injuries. Inhalation injuries should be managed in a multidisciplinary fashion. There may be a correlation between the degree of tracheal injury and laryngeal injury and hoarseness. [source]
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