Comparison of timing abnormalities leading to penetration versus aspiration during the oropharyngeal swallow

Nativ‐Zeltzer, Nogah; Logemann, Jeri A.; Kahrilas, Peter J.

doi:10.1002/lary.24408

Cited by 9 publications

(10 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The characteristics of articles that met inclusion criteria are displayed in Table 2. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The prevalence of symptomatic dysphagia among patients with UVFI, as identified by self-reporting or clinical evaluation, was 55.6% to 69.0%. In studies that identified swallowing dysfunction mechanistically through videofluoroscopic swallowing study (VFSS) or functional endoscopic evaluation of swallowing (FEES), the aspiration rate ranged from 20.0% to 50.0%.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies went beyond merely identifying dysphagia among patients with UVFI and investigated the mechanism and kinetics of the disordered swallow by measuring pathophysiologic and temporal endpoints (Table 4). 8,9,[11][12][13][14][15][16][17][19][20][21][22][23] Aspiration was reported in 10 studies, followed by pharyngeal bolus residue in 7 studies, laryngeal penetration in 6 studies, and reduced UES opening or contractility in 4 studies. Prolonged TPT time, epiglottis immobility, paresis of pharyngeal constrictor muscles, and reduced laryngeal elevation were separate outcomes in 3 studies, while 2 studies examined delayed initiation in pharyngeal swallowing.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Identifying the Prevalence of Dysphagia among Patients Diagnosed with Unilateral Vocal Fold Immobility

Zhou

Jafri

Husain

2018

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective To identify dysphagia prevalence and characteristics among patients with unilateral vocal fold immobility (UVFI) through a systematic review of current literature. Data Sources Embase, PubMed, ScienceDirect, Wiley Online Library. Review Methods Four electronic databases were reviewed according to the PRISMA criteria. Original English-language studies examining dysphagia among adult patients with UVFI met eligibility. Two researchers independently analyzed qualified articles. Results Of 227 studies discovered through the literature search, 17 satisfied eligibility criteria. The prevalence of symptomatic dysphagia ranged from 55.6% to 69.0%, and the aspiration rate was 20.0% to 50.0%. Self-reporting and clinical evaluation were used to identify symptomatic dysphagia, while videofluoroscopic swallowing study and functional endoscopic evaluation of swallowing evaluated aspiration. Left-sided UVFI predominated. The most common causes of UVFI were iatrogenic and idiopathic. Central lesions and acute-onset UVFI were each associated with more severe dysphagia. Patients were more likely to aspirate on liquids versus purées and pastes. Benefits of medialization thyroplasty and vocal cord injection were equivocal. Conclusion A significant portion of patients with UVFI present with dysphagia due to anatomic and physiologic disruptions during the swallow. Study population heterogeneity and small sample sizes in the reviewed studies may have compromised reliability, calling for large-scale studies with rigorous methodology. Future studies should not only strive to identify the mechanics of the disordered swallow but also explore patients’ quality of life and the effectiveness of current treatments for dysphagia with underlying UVFI.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Identifying the Prevalence of Dysphagia among Patients Diagnosed with Unilateral Vocal Fold Immobility

Zhou

Jafri

Husain

2018

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…The integrity and timing of LVC are critical for preventing penetration–aspiration ( Rofes et al, 2010 ; Steele et al, 2015 ), while short duration of LVC (LVCDur) may be related to aspiration risk. The data regarding LVC after Radiation Therapy (RT) are unclear regarding whether deficits exist in the integrity, timing, or duration of closure ( Kotz et al, 2004 ; Nativ-Zeltzer et al, 2014 ).…”

Section: Factors Related To Swallowing Safetymentioning

confidence: 99%

Mechanisms of Impaired Swallowing on Thin Liquids Following Radiation Treatment for Oropharyngeal Cancer

Barbon

Chepeha

Hope

et al. 2020

J Speech Lang Hear Res

View full text Add to dashboard Cite

Purpose Dysphagia is one of the most debilitating chronic symptoms experienced by patients who undergo radiation treatment for head and neck cancer. Despite the high prevalence of dysphagia in patients with head and neck cancer, we lack understanding of the specific changes in swallowing physiology that arise in the short-term following radiation therapy and how these changes impact the key functions of swallowing safety and efficiency. This study sought to identify pathophysiological mechanisms underlying impairments in swallowing safety and efficiency on thin liquids following (chemo)radiation for oropharyngeal cancer. Method Videofluoroscopic swallowing studies were completed in 12 male patients within 6 months following completion of (chemo)radiation and in 12 healthy male controls. To compare swallowing function and physiology between groups, we analyzed three discrete sips of 20% w/v thin liquid barium per participant. The videofluoroscopic swallowing study recordings were rated for swallowing safety, efficiency, timing parameters, and pixel-based measures of structural area or movement. Results The oropharyngeal cancer cohort displayed significantly higher frequencies of penetration–aspiration, incomplete laryngeal vestibule closure, prolonged time-to-laryngeal vestibule closure, and poor pharyngeal constriction. Incomplete or delayed laryngeal vestibule closure was associated with airway invasion, while poor pharyngeal constriction was associated with pharyngeal residue. Conclusions This study highlights the primary mechanisms behind impaired safety and efficiency of the swallow in patients following (chemo)radiation for oropharyngeal cancer.

show abstract

“…Previous studies suggest that the risk of penetration and aspiration is much higher in situations of incomplete LVC ( Steele et al, 2015 ; Vose & Humbert, 2018 ). Prolonged time-to-LVC, previously called “LVC reaction time” ( Humbert et al, 2018 ; Steele et al, 2019 ), is also thought to be a characteristic that increases the risk of penetration and aspiration ( Nativ-Zeltzer et al, 2014 ; Steele et al, 2015 ). Longer time-to-LVC has been found to differentiate between PAS scores of 1 and 2 in a sample of healthy older adults recently reported by Herzberg et al (2019) .…”

Section: Discussionmentioning

confidence: 99%

Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Chronic Obstructive Pulmonary Disease

Mancopes

Péladeau-Pigeon

Barrett

et al. 2020

J Speech Lang Hear Res

View full text Add to dashboard Cite

Purpose Dysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD. Method Participants were 28 adults aged 41–79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD / > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters). Results Participants with COPD did not display greater frequencies of penetration–aspiration, but they were significantly more likely ( p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue. Conclusion This analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.

show abstract

Comparison of timing abnormalities leading to penetration versus aspiration during the oropharyngeal swallow

Cited by 9 publications

References 35 publications

Identifying the Prevalence of Dysphagia among Patients Diagnosed with Unilateral Vocal Fold Immobility

Identifying the Prevalence of Dysphagia among Patients Diagnosed with Unilateral Vocal Fold Immobility

Mechanisms of Impaired Swallowing on Thin Liquids Following Radiation Treatment for Oropharyngeal Cancer

Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Chronic Obstructive Pulmonary Disease

Contact Info

Product

Resources

About