Videofluoroscopic evaluation of patients with Guillain-Barr� syndrome

Abstract

We reviewed 14 patients with clinically confirmed Guillain-Barré syndrome for swallowing dysfunction. All had swallowing dysfunction varying from mild to severe. Six patients (43%) had equivalent impairment during oral and pharyngeal phases. Seven patients (50%) had more severe functional abnormalities during the pharyngeal phase than during the oral phase. One patient (7%) had moderate disorder during the oral phase and mild disorder during the pharyngeal phase. Thirty-six percent of the patients had moderate-to-severe dysfunction during the oral phase, and 71% had moderate-to-severe dysfunction during the pharyngeal phase. In 5 patients who had multiple sequential examinations, moderate or severe swallowing disorders improved to mild-to-moderate disorders within 4-8 weeks after the onset of the symptoms. Residual swallowing disorders may be seen in those who had severe swallowing dysfunction during the later phases of their disease. Further investigations are needed to determine if swallowing abnormalities persist after complete recovery from Guillain-Barré syndrome.

Tongue weakness is associated with respiratory failure in patients with severe Guillain-Barré syndrome

“…In one study evaluating swallowing dysfunction in 14 GBS patients, 36% had moderate-to-severe dysfunction during the first oral phase of swallowing and 71% had moderate-to-severe dysfunction during the pharyngeal phase. In five patients who underwent multiple sequential examinations, moderate or severe swallowing disorders improved to mild or moderate disorders within 4-8 weeks after symptom onset (23). Although the significance of tongue weakness in patients with GBS is unknown, those patients in our study who had impaired swallowing also exhibited greater tongue weakness.…”

“…By example, in a recent study using the same device and comparing eight patients with sleep apnea syndrome (SAS) and eight normal subjects, we found that maximal tongue force varied from 275 g to 1066 g (mean: 486 g) (15). In five patients who underwent multiple sequential examinations, moderate or severe swallowing disorders improved to mild or moderate disorders within 4-8 weeks after symptom onset (23). This is also the first study showing that an indicator of bulbar strength is associated to the indicator of respiratory function in GBS.…”

“…The bolus is transferred on the tongue blade towards the pharynx, and the pharyngeal phase then begins (21,22). More objective methods such as videofluroscopy are not routinely available in the ICU (23). In one study evaluating swallowing dysfunction in 14 GBS patients, 36% had moderate-to-severe dysfunction during the first oral phase of swallowing and 71% had moderate-to-severe dysfunction during the pharyngeal phase.…”

“…Misdiagnosing dysphagia expose to the risk of silent aspiration especially during sleep. More objective methods such as videofluroscopy are not routinely available in the ICU (23). Nevertheless, despite important limitation, tongue strength measurement is non-invasive and may help in objectively achieving early detection of bulbar dysfunction.…”

Swallowing and swallowing‐breathing interaction as predictors of intubation in Guillain‐Barré syndrome

“…It is thus essential to evaluate bulbar muscle impairment, however, it is not simple. Other than the basic clinical evaluation, there are no simple tools to evaluate the severity of bulbar disorders at the bedside and videofluroscopic swallowing evaluation is difficult to perform in ICU patients (Chen, Donofrio, Frederick, Ott, & Pikna, ). The bedside clinical swallowing evaluation has been criticized for its low accuracy and it has been reported that even the most experienced clinicians fail to identify about 40–50% of aspirating patients during a bedside examination (Ertekin et al., ).…”