Impaired Opening of the Upper Esophageal Sphincter in Patients with Medullary Infarctions

Bian, Ren-Xiu; Choi, In-Sung; Kim, Jae-Hyung; Han, Jae‐Young; Lee, Sam-Gyu

doi:10.1007/s00455-008-9179-7

Cited by 28 publications

(20 citation statements)

References 32 publications

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“…Manometric parameters describing the muscular activity in this region are strong predictors of pharyngeal function, as an inability to pass the bolus through the UES due to poorly controlled muscular activity can result in penetration and aspiration of materials retained in the pharynx. 26,27 Our efforts to improve performance by modifying the architecture of the ANN, such as increasing the number of hidden nodes, had a minimal effect on classification accuracy (Table IV). This is likely a consequence of implementing measures to prevent overfitting in large networks.…”

Section: Discussionmentioning

confidence: 99%

Artificial neural network classification of pharyngeal high‐resolution manometry with impedance data

et al. 2012

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Purpose To use classification algorithms to classify swallows as safe, penetration, or aspiration based on measurements obtained from pharyngeal high-resolution manometry (HRM) with impedance. Study design Case series evaluating new method of data analysis. Method Multilayer perceptron (MLP), an artificial neural network (ANN), was evaluated for its ability to classify swallows as safe, penetration, or aspiration. Data were collected from 25 disordered subjects swallowing 5 or 10 ml boluses. Following extraction of relevant parameters, a subset of the data was used to train the models and the remaining swallows were then independently classified by the ANN. Results A classification accuracy of 89.4±2.4% was achieved when including all parameters. Including only manometry-related parameters yielded a classification accuracy of 85.0±6.0% while including only impedance-related parameters yielded a classification accuracy of 76.0±4.9%. Receiver operating characteristic (ROC) analysis yielded areas under the curve (AUC) of 0.8912 for safe, 0.8187 for aspiration, and 0.8014 for penetration. Conclusions Classification models show high accuracy in classifying swallows from dysphagic patients as safe or unsafe. HRM-impedance with ANN represents one method which could be used clinically to screen for patients at risk for penetration or aspiration.

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Section: Discussionmentioning

confidence: 99%

Artificial neural network classification of pharyngeal high‐resolution manometry with impedance data

et al. 2012

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“…While the incidence, clinical features, severity and lesions responsible for dysphagia have been investigated, few studies have examined the relationship between swallowing dynamics and the site of the lesion (4)(5)(6)(7)(8). Some studies have focused on upper esophageal sphincter (UES) opening (6,9). It is known that the UES ipsilateral to the unaffected side of the medulla is disturbed in patients with LMI (9).…”

Section: Introductionmentioning

confidence: 99%

Prediction of Dysphagia Severity: An Investigation of the Dysphagia Patterns in Patients with Lateral Medullary Infarction

et al. 2013

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Objective In order to identify the factors that influence the swallowing function in patients who develop Wallenberg syndrome (WS) following lateral medullary infarction (LMI), we examined various patient characteristics, including the passage pattern abnormality (PPA) of a bolus through the upper esophageal sphincter (UES). Methods Fifty-four pure LMI patients with dysphagia participated in this study. PPA, defined as the failure of bolus passage through the UES corresponding to the intact side of the medulla, was identified during videofluorographic swallowing evaluations of each patient. On brain magnetic resonance imaging, the subjects' lesions were classified vertically into three levels and horizontally into seven levels in relation to the involvement of the ambiguous and/or solitary nuclei. Logistic regression analyses were performed for age, sex, PPA and the vertical and horizontal sites of the lesions. Results In terms of severity, 15 subjects were categorized as having mild dysphagia, 26 subjects were categorized as having moderate dysphagia and 13 were categorized as having severe dysphagia. Subjects with cephalic lesions, greater vertical spread of the lesion and PPA were more likely to have severe dysphagia. PPA and a greater vertical spread of the lesion were related to the severity of the functional outcome (p<0.01). The horizontal extent of the lesion was not strongly related to the prognosis. Conclusion The presence of PPA in LMI patients is suggestive of abnormalities in the swallowing pattern and, in turn, damage to the medullary central pattern generator. The presence of PPA and a greater vertical spread of the lesion can be useful predictors of severe dysphagia.

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“…These conditions can be seen in strokes of various locations, including subcortical and supratentorial, lateral medullary and cerebellum [4][5][6]. PSR was also found in head and neck cancer patients [7], most commonly caused by reduced tongue mass and limited tongue mobility that was associated with total or partial glossectomy with or without reconstruction [8,9], and radiation-induced esophageal strictures as well [10].…”

Section: Introductionmentioning

confidence: 99%

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

Ding¹

2017

OHNS

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ObjectiveTo evaluate the effect of balloon dilatation in treating pyriform sinus residue caused by various swallow physiology changes from different medical diagnoses. Study designMedical records of 12 in-patients with moderate to severe pyriform sinus residue were retrospectively reviewed. MethodsAll patients were examined with fiberoptic endoscopic evaluation of swallowing and video fluoroscopic swallowing assessment. The diagnoses of the 12 patients included infarction, nasopharyngeal carcinoma post-radiation, oral cancer post partial glossectomy, and motor neuron disease. All 12 patients underwent balloon dilatation.Each session lasted 30 minutes, with eight dilatations per session, three sessions per week for two weeks. ResultsThere was significant reduction in pharyngeal residue pre-versus post-balloon dilatation (p=0.002). There were also significant improvements in cricopharyngeal muscle achalasia (p=0.004) and weak pharyngeal contraction (p=0.008) pre-versus post-treatment. Eight out of the 12 patients made significant progress toward oral feeding (66.67%). ConclusionOur study found cricopharyngeal muscle achalasia and weak pharyngeal contraction were closely related to pyriform sinus residue in pharyngeal dysphagia. Balloon dilatation eliminated cricopharyngeal muscle achalasia and weak pharyngeal contraction and significantly reduced pyriform sinus residue in 8 of the 12 patients. Balloon dilatation seems to have no effect on the reduction of pyriform sinus residue when the cause was either from discoordination of swallowing subsystems in the case of infarction of the left pontocerebellar trigone or loss of large bulk of tongue tissue in the case of cancer treatment.

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Impaired Opening of the Upper Esophageal Sphincter in Patients with Medullary Infarctions

Cited by 28 publications

References 32 publications

Artificial neural network classification of pharyngeal high‐resolution manometry with impedance data

Artificial neural network classification of pharyngeal high‐resolution manometry with impedance data

Prediction of Dysphagia Severity: An Investigation of the Dysphagia Patterns in Patients with Lateral Medullary Infarction

The Swallow Physiology Change of Balloon Dilatation on Pharyngeal Dysphagia

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