Causes of Dysphagia in a Tertiary-Care Swallowing Center

Hoy, Monica; Domer, Amanda S.; Plowman, Emily K.; Loch, Randall; Belafsky, Peter C.

doi:10.1177/000348941312200508

Cited by 44 publications

(33 citation statements)

References 16 publications

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“…Literature describes higher incidence of dysphagia at the elderly population, resulting from muscle atrophy, cognitive decline and increase of risk aspiration. In the studied group, the average age was 57.1, very close to the populations internationally described, which is 62 years old (24) . Dysphagia patients are known for presenting lower frequency of saliva swallowing than other non-dysphagia patients (25) .…”

Section: Discussionsupporting

confidence: 77%

Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

Alves

Andrade

2017

CoDAS

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RESUMO Objetivo O objetivo desta pesquisa foi verificar se há melhora funcional do padrão de deglutição em indivíduos identificados com risco para disfagia orofaríngea após quatro semanas da realização de exercícios orofaríngeos específicos com intensidade e duração pré-determinados. Método Esta pesquisa é de caráter longitudinal de efeito funcional, determinado por medidas comparativas inicial e final. A população-alvo foi constituída de indivíduos adultos e idosos selecionados por 24 meses. Foi incluído para esta pesquisa um total de 68 indivíduos. Foi realizada avalição clínica da deglutição e observados sinais clínicos para disfagia. Os indivíduos foram divididos em dois grupos de acordo com o nivelamento inicial na escala ASHA NOMS. No Grupo 1 (G1) – ASHA NOMS, inicial de níveis 1 e 2; Grupo 2 (G2) – ASHA NOMS, inicial de níveis 3, 4 e 5. Todos os indivíduos realizaram um protocolo de exercícios por quatro semanas. O protocolo conta com sessões presenciais e continuidade das atividades em ambiente domiciliar. Ao final, foi realizada nova mensuração do desempenho de deglutição. Resultados Para o grupo G2 houve melhora estatisticamente significante. Para o G1, a relação não foi significante, apesar de mudança intensa na escala ASHA NOMS, porém, neste grupo, temos um número reduzido de indivíduos devido à gravidade do perfil. Conclusão O programa se mostrou efetivo, pois, após as quatro sessões de exercícios, houve melhora importante no padrão de deglutição, demonstrada pela escala funcional.

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Section: Discussionsupporting

confidence: 77%

Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

Alves

Andrade

2017

CoDAS

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“…The oral phase of swallowing is swift, occurring in less than 2 seconds; once initiated, it includes highly orchestrated voluntary and reflex‐coordinated actions . The potential causes of pharyngoesophageal dysphagia are multiple and disparate, and can include such etiologies as muscular weakness, generalized deconditioning and frailty, oropharyngeal or neurologic trauma, cancer treatment, head and neck surgery, neurologic injury, and mental status changes . Patients with pharyngoesophageal dysphagia are at high risk for aspiration of secretions, liquids, or food particulates, with subsequent development of aspiration pneumonia .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the natural history of patients who aspirate

et al. 2017

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Objectives/hypothesis The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations, penetration-aspiration scale (PAS) score, and dysphagia etiology would be associated with changes in time to first pulmonary event and overall survival for patients with documented aspiration on radiologic testing. This study identified a cohort of patients with detectable unsensed penetration or aspiration on videofluoroscopic swallowing study (VFSS) and followed this cohort over time for development of pulmonary events and death. We then evaluated the association of aspiration severity and dietary modification recommendations on incidence of these endpoints. Study Type/Design Retrospective chart review. Methods A total of 2616 VFSS exam reports were reviewed from our institution performed between January 1, 2009 and December 31, 2010. Aspiration or unsensed penetration (PAS of 5 or greater) was detected in 564 (21.5%) of these patients, who were then included in the study cohort. Medical records were reviewed retrospectively for development of pulmonary events (pneumonia, pneumonitis, or other life-threatening pulmonary illness) and all-cause mortality for up to 54 months after initial VFSS. Univariate Kaplan-Meier analysis and multivariate Cox regression were performed for time to first pulmonary event and survival predicted by recommended diet, PAS score, and dysphagia etiology. Results Dysphagia etiology was highly associated with increased development of pulmonary events for some patients, especially those with generalized nonspecific dysphagia due to deconditioning or frailty (hazard ratio [HR] versus stroke 2.95, 95% CI: 1.53–5.69, p=0.001) and esophageal dysphagia (HR 2.66, 95% CI: 1.17–6.02, p=0.019). Dysphagia etiology was also associated with increased mortality for patients with generalized nonspecific dysphagia due to deconditioning or frailty (HR 3.32, 95% CI: 2.0–5.52, p<0.001), post-surgical patients (HR 1.73, 95% CI: 1.05–2.86, p=0.032) and chronic neurologic disease (HR 1.87, 95% CI: 1.12–3.13, p=0.017). Dietary modification recommendations at the time of VFSS (prohibition of oral intake or modification of food consistency) had no significant impact on time to first pulmonary event (p=0.37) or survival (p=0.17), while PAS score was associated with decreased time to first pulmonary event on univariate but not multivariate analysis (hazard ratio for 1-point increase 1.6, 95% CI: 0.99–1.36, p=0.067). Kaplan-Meier estimate of overall 3-year mortality for this patient cohort was 39%. Conclusions Etiology of dysphagia is associated with a higher mortality rate and development of pulmonary events in patients with unsensed penetration or aspiration on VFSS, especially for those patients with generalized deconditioning and frailty or esophageal dysphagia. Severity of aspiration as defined by PAS was not associated with altered overall survival. Recommendations for dietary modification to an NPO status or modifie...

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“…Etiologies for dysphagia include advanced age, neurological and neuromuscular diseases, structural and iatrogenic causes, head and neck cancers, gastroesophageal reflux, depression, and anxiety [3-5]. Dysphagia poses a risk for malnutrition, dehydration, aspiration pneumonia, and upper airway obstruction [2, 6, 7].…”

Section: Introductionmentioning

confidence: 99%

Validation of the Hebrew Version of the Eating Assessment Tool-10 (H-EAT-10)

Abu‐Ghanem

Schechter

Flesh-Eyni

et al. 2016

Folia Phoniatr Logop

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Background and Objectives: Dysphagia is a common disability with different etiologies. In order to measure dysphagia symptom severity and effects on quality of life, the Eating Assessment Tool (EAT-10) was developed and validated in the English language. We aimed to develop a Hebrew version of the EAT-10 and to evaluate its internal consistency, test-retest reliability, and validity in Hebrew-speaking adults with dysphagia. Subjects and Methods: The Hebrew EAT-10 (H-EAT-10) questionnaire was completed by 132 patients: 56 patients with dysphagia and 76 controls. Internal consistency analysis was calculated using Cronbach α, and test-retest reliability was calculated using intraclass correlation coefficient in order to assess clinical validity. Results: Internal consistency and test-retest reliability were found to be high in the H-EAT-10 (Cronbach α = 0.955 and intraclass correla tion = 0.98). In addition, H-EAT-10 scores in the dysphagia group were found to be significantly higher than those in the control group (p < 0.001). Conclusion: This study demonstrated that H-EAT-10 is a reliable and valid tool that may be implemented for clinical practice and research on dysphagia in a Hebrew-speaking population.

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Causes of Dysphagia in a Tertiary-Care Swallowing Center

Cited by 44 publications

References 16 publications

Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

Evaluation of the natural history of patients who aspirate

Validation of the Hebrew Version of the Eating Assessment Tool-10 (H-EAT-10)

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