Deep Laryngeal Penetration as a Predictor of Aspiration

Friedman, Barbara; Frazier, Jacqueline Bolders

doi:10.1007/s004550010018

Cited by 74 publications

(63 citation statements)

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“…Laryngeal penetration was defined by the presence of contrast medium beneath the epiglottis on a radiologic swallowing study, 10 while tracheal aspiration was ascertained by the presence of radiology contrast medium or radionuclide in the trachea or distal airways on plain radiologic and cineradiologic or radionuclide studies. A senior neuroradiologist (G.F.) with expertise in abdominal conventional imaging read and interpreted the gastrointestinal studies.…”

Section: Oral Motor Dysfunctionmentioning

confidence: 99%

Dorsal Brain Stem Syndrome: MR Imaging Location of Brain Stem Tegmental Lesions in Neonates with Oral Motor Dysfunction

Quattrocchi¹,

Longo²,

Delfino³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:The anatomic extent of brain stem damage may provide information about clinical outcome and prognosis in children with hypoxic-ischemic encephalopathy and oral motor dysfunction. The aim of this study was to retrospectively characterize the location and extent of brain stem lesions in children with oral motor dysfunction. From January 2005 to August 2009, 43 infants hospitalized at our institution were included in the study because of a history of hypoxic-ischemic events. Of this group, 14 patients showed oral motor dysfunction and brain stem tegmental lesions detected at MR imaging. MR imaging showed hypoxic-ischemic lesions in supra-and infratentorial areas. Six of 14 patients revealed only infratentorial lesions. Focal symmetric lesions of the tegmental brain stem were always present. The lesions appeared hyperintense on T2-weighted images and hypointense on IR images. We found a strong association (P Ͻ .0001) between oral motor dysfunction and infratentorial lesions on MR imaging. Oral motor dysfunction was associated with brain stem tegmental lesions in posthypoxic-ischemic infants. The MR imaging examination should be directed to the brain stem, especially when a condition of prolonged gavage feeding is necessary in infants.ABBREVIATIONS: APGAR ϭ appearance, pulse, grimace, activity, respiration; CI ϭ confidence interval; IR ϭ inversion recovery; SE ϭ spin-echo B rain MR imaging is the study of choice for assessing hypoxic-ischemic injury in neonates and infants.1,2 The pattern of brain injury suggests the pathogenetic mechanism and, together with the severity and extent of tissue damage, provides information about outcome and prognosis. Whereas conventional and advanced MR imaging protocols are appropriate for detecting supratentorial lesions, most routine MR imaging studies are not suitable for depicting brain stem hypoxic-ischemic lesions. Findings on advanced MR imaging techniques such as diffusion-weighted imaging and MR spectroscopy are difficult to interpret. In fact, to our knowledge, few reports on brain stem hypoxic-ischemic MR imaging findings in children have been reported in the literature.At the brain stem level, involvement of cranial nerve nuclei and ascending-descending tracts has important chronic and potentially life-threatening clinical consequences.Swallowing is a complex process with reflex activities that involve efferent and afferent fibers from the nuclei of cranial nerves V (cranial pons), VII, IX, X (caudal pons), and XII (medulla oblongata). The stereotypical sequence of oropharyngeal, laryngeal, and esophageal muscle contraction is elicited by stimulation of the pharynx by a food bolus and is derived from a central pattern generator. 3 The generator neurons for the sequential motor response are located in the nucleus tract solitarius and in the dorsal medullary reticular formation.The tegmentum of the brain stem corresponds to the watershed area between the paramedian and circumferential branches of the basilar artery and is known to represent a vulnerable site to ische...

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Section: Oral Motor Dysfunctionmentioning

confidence: 99%

Dorsal Brain Stem Syndrome: MR Imaging Location of Brain Stem Tegmental Lesions in Neonates with Oral Motor Dysfunction

Quattrocchi¹,

Longo²,

Delfino³

et al. 2010

AJNR Am J Neuroradiol

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“…The 3 major types of aspiration are anterograde (characterized by pre-, intra-, and postdeglutitive), retrograde (as in GER events), and silent aspiration (without any symptoms). The incidence of aspiration ranges from 25% to 73% for infants with swallowing dysfunction (5); w85% (n = 125) of children exhibiting deep laryngeal penetration eventually aspirated, and aspiration occurred 15 s after laryngeal penetration (28,29). Video-manometry results in 8 dysphagic children (age 2-28 mo) differed from adult swallowing in terms of epiglottic movement, tongue driving force, amplitude of pharyngeal contraction, and UES pressure.…”

Section: Pathophysiologic Mechanisms Of Dysphagia Symptoms and Aspiramentioning

confidence: 99%

Dysphagia in the high-risk infant: potential factors and mechanisms

Jadcherla

2016

The American Journal of Clinical Nutrition

113

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Neonatal dysphagia, or abnormalities of swallowing, represent a major global problem, and consequences of dysfunctional feeding patterns carry over into infancy and toddler age groups. Growth, development, and independent feeding skills are all delayed among high-risk infants. Such a group comprises premature birth, low-birth-weight, congenital anomalies, perinatal asphyxia, postsurgical, and sepsis categories. The conflict between pathophysiologic and pragmatic feeding strategies remains a major conundrum and is largely due to a lack of validated diagnostic approaches amid heterogeneity of the patient phenotype. Thus, well-tested feeding management strategies that can be generalizable are lacking. Furthermore, the aerodigestive symptoms and signs, potential risk factors, and contributory etiologies remain nonspecific. This article presents mechanistic evidence related to the pathophysiologic basis of neonatal dysphagia as well as potential opportunities to improve feeding abilities and long-term development.Am J Clin Nutr 2016;103(Suppl):622S-8S.

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“…From this study, it was expected that the prevalence rate would be similar to Lin et al's study 6) because subjects admitted to a hospital or a facility were enrolled. In view of the findings of a previous study 14) which stated that deep laryngeal penetration often progressed to aspiration, it is possible that patients showing supraglottic penetration without subglottic aspiration might also be at risk of aspiration. If penetration cases were included, the prevalence rate of aspiration plus penetration would increase to 50.8%.…”

Section: Discussionmentioning

confidence: 96%

Fluoroscopic Swallowing Study in Elderly Patients Admitted to a Geriatric Hospital and a Long-Term Care Facility

Han

2009

J Korean Geriatr Soc

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Background:No study has been done to detect the aspiration using the videofluoroscopic swallowing study in the elderly patients. Elderly patients admitted to hospitals or long-term care facilities may intake the food orally without any evaluation of swallowing function and may be exposed to aspiration risk, which can be eliminated by some diet modification based on the fluoroscopic findings. Methods: Sixty-three elderly patients who had an oral-feeding status were recruited in this study. They swallowed diverse food textures twice in the following order; liquid, Yoplait yogurt, pudding, soft-bland diet, and a regular diet. Swallowing parameters were checked as subglottic aspiration, supraglottic penetration, delayed pharyngeal reflex, and vallecular and pyriform sinus residues. Results: Only 2 patients showed both aspiration signs and the subglottic aspiration in the fluoroscopic study. Six patients showed the subglottic aspiration in the fluoroscopic study without any clinical sign. Seven patients who complained of aspiration signs did not show the subglottic aspiration, but all of them presented the supraglottic penetration. Multivariate logistic regression analysis showed that no covariate was correlated with the subglottic aspiration whereas delayed pharyngeal reflex during liquid (p<0.001) or Yoplait (p=0.010) swallowing were correlated with aspiration plus penetration. Conclusion: This study demonstrates that a fluoroscopic swallowing study is important for the dysphagia diagnosis in elderly patients because of no significant correlation between the aspiration signs assessed clinically and the subglottic aspiration detected by the fluoroscopic swallowing study. Diet modifications, such as, liquid thickening will be necessary when patients demonstrate the evidence of subglottic aspiration during swallowing.

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Deep Laryngeal Penetration as a Predictor of Aspiration

Cited by 74 publications

References 12 publications

Dorsal Brain Stem Syndrome: MR Imaging Location of Brain Stem Tegmental Lesions in Neonates with Oral Motor Dysfunction

Dorsal Brain Stem Syndrome: MR Imaging Location of Brain Stem Tegmental Lesions in Neonates with Oral Motor Dysfunction

Dysphagia in the high-risk infant: potential factors and mechanisms

Fluoroscopic Swallowing Study in Elderly Patients Admitted to a Geriatric Hospital and a Long-Term Care Facility

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