Tongue thickness evaluation using ultrasonography can predict swallowing function in amyotrophic lateral sclerosis patients

Nakamori, Masahiro; Hosomi, Naohisa; Takaki, Sachiko; Oda, Masaya; Hiraoka, Aya; Yoshikawa, Mineka; Matsushima, Hayato; Ochi, Kazuhide; Tsuga, Kazuhiro; Makino, Hírofumi; Izumi, Yuishin; Matsumoto, Masayasu

doi:10.1016/j.clinph.2015.07.032

Cited by 60 publications

(46 citation statements)

References 25 publications

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“…Additionally, it is not possible to perform videofluoroscopic examinations for all acute stroke patients. Therefore, it is important that the risk of swallowing dysfunction be accurately evaluated using a combination of simple modalities such as ultrasonography for bedside assessment [25]. …”

Section: Discussionmentioning

confidence: 99%

Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements

Nakamori

Hosomi

Ishikawa³

et al. 2016

PLoS ONE

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Swallowing dysfunction caused by stroke is a risk factor for aspiration pneumonia. Tongue pressure measurement is a simple and noninvasive method for evaluating swallowing dysfunction. We have hypothesized that low tongue pressure may be able to predict pneumonia occurrence in acute stroke patients. Tongue pressure was measured using balloon-type equipment in 220 acute stroke patients. The modified Mann Assessment of Swallowing Ability (MASA) score was evaluated independently on the same day. Tongue pressure was measured every week thereafter. An improvement in tongue pressure was observed within the first 2 weeks. Receiver operating curve analysis was performed to determine the ability of tongue pressure to predict modified MASA score <95, which suggests swallowing dysfunction. The optimal cutoff for tongue pressure was 21.6 kPa (χ2 = 45.82, p<0.001, sensitivity 95.9%, specificity 91.8%, area under the curve = 0.97). The tongue pressure was significantly lower in patients with pneumonia than in those without pneumonia. Using a Cox proportional hazard model for pneumonia onset with a cutoff tongue pressure value of 21.6 kPa and adjustment for age, sex, and National Institutes of Health Stroke Scale score at admission, the tongue pressure had additional predictive power for pneumonia onset (hazard ratio, 7.95; 95% confidence interval, 2.09 to 52.11; p = 0.0013). In the group with low tongue pressure, 27 of 95 patients showed improvement of tongue pressure within 2 weeks. Pneumonia occurred frequently in patients without improvement of tongue pressure, but not in patients with improvement (31/68 and 2/27, p<0.001). Tongue pressure is a sensitive indicator for predicting pneumonia occurrence in acute stroke patients.

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Section: Discussionmentioning

confidence: 99%

Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements

Nakamori

Hosomi

Ishikawa³

et al. 2016

PLoS ONE

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“…Further, the clinical presentation and progression of swallowing impairment and dysphagia in MND is heterogeneous – even between subtypes classic ALS, grouped by onset-type (i.e., bulbar- vs. spinal-onset). Several factors reported to influence or predict the severity and rate of progression of dysphagia in MND (particularly ALS), include: age at disease onset (i.e., older individuals often progress faster, require non-oral feeding sooner) [27–29], sex (i.e., females often present with bulbar symptoms earlier, and possibly greater severity) [27,30,31], and symptom onset (i.e., bulbar-onset ALS and PBP show faster rate of decline, different clinical presentation) [13,15,30,32,29]. Disease duration and the length of time since onset of bulbar symptoms have also been reported as prognostic indicators of function and severity [29,33].…”

Section: Discussionmentioning

confidence: 99%

“…Recordings taken from EMG have identified longer swallow durations [67,68,72], variability in cricopharyngeal pause duration [68,72], and discoordination between the timing of laryngeal excursion and cricopharyngeal relaxation [72]. Additional tools used as part of a swallowing assessment, including spirometry/airflow measures, tongue pressure measurement, and sonography, have identified (respectively): irregularities in voluntary cough airflow and respiratory-swallow coordination [67,73–75], reduced swallow pressures and maximum isometric tongue strength [52,76–78], and reduced tongue thickness and reduced/disorganized tongue movement during swallowing [29,78,79]. Taken together, research to-date has generated a great deal of information regarding the physiological and functional differences of swallowing that may be observed in individuals with MND.…”

Section: Discussionmentioning

confidence: 99%

“…With respect to direct swallowing strategies, a number of techniques have been suggested, including (but not limited to): compensatory maneuvers (e.g., supra-glottic swallow, Mendelsohn maneuver, chin tuck, head turn, head flexion) [11,12,14,39,45,49,61,66,79,95–105]; behavioural strategies (e.g., reduced bolus size, taking multiple swallows, avoiding distractions during meals) [12,14,42,57,61,97,100–102,104–106]; sensory tricks (e.g., vibration, thermal stimulation, increase sensory aspects of bolus) [14,57,97,100,102,105,107]; and dietary modifications (e.g., mechanically altered food, thickened liquids, soft diet, liquidize food) [11–14,29,39,42,49,54,57,61,66,79,95–116]. Still, almost half (48%) of these recommendations were provided as secondary source review (e.g., [12,14,100,102,104,105]), which may include general techniques that have not been specifically evaluated for individuals with MND.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review

et al. 2017

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Dysphagia in motor neuron diseases (MNDs) is highly complex, affecting all stages of swallowing and leading to impaired swallowing safety and efficiency. In order to explore the degree to which research is capturing the symptom of dysphagia in MND, we conducted a scoping review of the existing literature. The primary aims of this review were to identify common themes within the literature on dysphagia in MND, explore patterns and trends in research focus, and identify if any imbalances exist between the research themes related to dysphagia description and management. Methods A comprehensive search strategy yielded 1690 unique articles for review. Following relevance screening, a total of 157 articles were included in the synthesis. Relevant data and keywords were extracted from each article and grouped into themes. Frequency estimates were calculated for each theme to identify trends across research literature. Results Swallowing impairment in MNDs is described in a variety of ways across current research. The most commonly reported theme was Aspiration/Penetration, mentioned in 73.2% of all included articles; a significant imbalance was identified between reports of swallowing safety and efficiency (p=0.008). The most frequently reported theme related to dysphagia management was Enteral Nutrition, and very few studies have reported on the efficacy of Rehabilitation/Compensatory recommendations. Conclusions It is suggested that researchers and clinicians remain mindful of imbalances and gaps in research, and aim to characterize dysphagia in MNDs in a comprehensive manner. Further research investigating discrete, measureable changes in swallowing pathophysiology would be beneficial to delineate the key factors contributing to impaired swallowing safety and efficiency.

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“…Other tests that are considered complementary for studying dysphagia are oro-pharyngo-oesophageal scintigraphy [17,18,19], ultrasound [20,21,22,23], pH manometry [24,25,26,27] and, most recently, high-resolution manometry [27,28,29,30]. All the instrumental tests used for assessing dysphagia have advantages, disadvantages and side effects.…”

Section: Introductionmentioning

confidence: 99%

Complications with Fiberoptic Endoscopic Evaluation of Swallowing in 2,820 Examinations

Nacci

Matteucci²,

Romeo³

et al. 2016

Folia Phoniatr Logop

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Objective: To perform a retrospective evaluation of the incidence of complications and adverse events during fiberoptic endoscopic evaluation of swallowing (FEES) in 2,820 examinations. Patients and Methods: Subjects included in- and outpatients at Pisa University Hospital referred for FEES by other physicians due to dysphagia symptoms. Neurologic diseases were the most commonly diagnosed conditions in the patients tested (48.3%). Informed consent was obtained from all subjects. Results: Our study showed minor side effects (discomfort, occasional gagging and vomiting) and a few complications [three cases of anterior epistaxis (0.1%), one case of posterior epistaxis (0.04%), three cases of vasovagal syncope (0.1%) and two cases of laryngospasm (0.07%)]. These cases of laryngospasm occurred in patients with amyotrophic lateral sclerosis (ALS) and spontaneously resolved after some difficulty. Conclusions: Our study confirms the published data regarding the safety of FEES and the incidence of complications with this procedure, but also highlights that in neurologic patients with neurodegenerative diseases such as ALS, laryngospasm is more likely to occur as a severe complication. The overall risk of FEES is minimal, but it is recommended that clinicians be well trained in recognising the signs and symptoms of adverse reactions and be ready to take appropriate action if these occur.

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Tongue thickness evaluation using ultrasonography can predict swallowing function in amyotrophic lateral sclerosis patients

Cited by 60 publications

References 25 publications

Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements

Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements

Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review

Complications with Fiberoptic Endoscopic Evaluation of Swallowing in 2,820 Examinations

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