Background: Studies show that dysphagia is a common problem in patients with demyelinating diseases. However, there are no published studies on dysphagia in this group of patients, which would include the individual phases or the safety and effectiveness of the swallowing process. Objective: The main objective of this study was to assess the prevalence of swallowing disorders and to characterize them based on subjective assessment by the study subjects with multiple sclerosis and Devic's syndrome. Method: The study included 72 patients (47 F, 25 M). Patients at risk of dysphagia were identified using the DYMUS, EAT-10 and SDQ questionnaires. To assess the type of oral-and pharyngeal-stage dysphagia, questions in the questionnaires were classified into groups according to symptoms typical of each stage. Results: The risk of dysphagia and the need for instrumental examination were identified in 37.5% of the study subjects. Pharyngeal-stage dysphagia (repeated swallowing, increased effort of swallowing, cough, a feeling of food sticking in the throat) was reported to occur at a significantly higher frequency. However, no differences were found between difficulty in swallowing liquids and difficulty in swallowing solid food.
Conclusion:There is a need for further research, which should include a detailed dysphagia-oriented diagnosis, with a view to gaining a detailed insight into the pathophysiology of deglutition in this group of patients.
Purpose
Upper airway cough syndrome (UACS), described as chronic cough (CC) associated with allergic (AR), non-allergic rhinitis (NAR) or chronic rhinosinusitis (CRS), is one of the major causes of CC. We aimed to characterize a cohort of UACS patients with special attention to differences between patients with AR and NAR.
Methods
A prospective analysis of clinical data of patients, diagnosed with UACS between 2015 and 2018.
Results
There were 143 patients diagnosed with UACS, median age 52 years, women predominance (68.5%), The group comprised of 59 (41%) AR and 84 (59%) NAR subjects, CRS diagnosed in 17 (12%). Median cough duration: 48 months (IQR 24–120), median cough severity (VAS)—60 mm (IQR 42–78), median Leicester Cough Questionnaire (LCQ) score—11.3 (IQR 8.7–13.7), never-smokers: 70%. The most common symptoms: PND (62%), rhinorrhea (59%), nasal congestion (54%), abnormalities of sinus CT: septum deviation (62%), turbinates hypertrophy (53%), mucosal thickening (53%). UACS as the only cause of CC, was presented in 20 patients (14%). We found no differences between patients with AR and NAR in terms of age, gender, duration and severity of cough, BMI, blood eosinophil count, total IgE and FeNO. AR was associated with higher comorbidity of asthma than NAR (54% vs 35%, p = 0.019). Abnormalities in sinus CT scan were more frequently found in patients with NAR than AR (p = 0.018).
Conclusion
NAR is the most common upper airway disease associated with UACS. Clinical characteristics of UACS patients with AR and NAR are similar with only minor differences between these groups. It seems reasonable to plan further studies concerning relationship of NAR and cough sensitivity, also in terms of potential similar neurogenic mechanism.
In this article, we proposed a questionnaire for assessment of videofluorscopic examination in patients with swallowing disorders. It was developed during years 2015 - 2016 by the Department of Otolaryngology at the Medical University of Warsaw. The main body of the form consists of 3 parts assessing the oral phase, the pharyngeal phase and the esophageal phase. The main column contains a list of specific symptoms with yes/no answers. There is a four-point scale assessing the severity of the disorders from 0 to 3, where 0 corresponds to clinically insignificant findings, 1- mild impairment, 2 - moderate impairment, and 3 – severe impairment. Other elements of the form include: basic demographic and nutritional data, assessment of the consistency and texture of ingested food, food texture recommended based on the evaluation acc. to the recommendations of the International Dysphagia Diet Standardization Initiative (www.iddsi.org), and therapeutic assessment before implementation of speech therapy. The questionnaire was prepared on the basis of Trinity College survey, own experience and literature data.
According to NIH middle fossa approach is one of three possible approaches in microsurgery of cerebellopontine angle tumors. There is possible total tumor removal with hearing preservation. Monitoring of facial and cochlear nerve during operation is recommended.
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