【Introduction】
In our hospital, videoendoscopic evaluation of swallowing（VE）was done before and after videofluoroscopic examination of swallowing（VF）. We studied the benefits of performing VE before and after VF.
【Methods】
From May to July 2018, 169 VFs were examined. 160 VEs were done before VF, and 144 VEs after VF. We examined the cases retrospectively to determine what findings were recognized and addressed.
【Results】
In VE before VF, 69（43 ％）out of 160 cases abnormal findings were observed. Suction procedures were needed in 26 of these 69 cases. In VE after VF, 28（19 ％）of 144 cases were needed to performed suction procedures to remove the remaining food in the pharyngeal cavity.
【Considerations】
VE before and after VF allows safe and accurate assessment of swallowing function and gives us many valuable information about direct therapy.

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Postoperative complications following inappropriate tracheotomy can lead to significant laryngeal and tracheal stenosis, as well as swallowing disorders. In those cases, recovery of the airway, voice, and swallowing functions is likely to be complicated. We reported a case of a male patient in his 40s who underwent a tracheotomy during treatment for a left thalamic hemorrhage. Due to the cannula placement through the cricothyroid membrane, the anterior vocal fold commissure and anterior part of the bilateral vocal fold were defective, and laryngeal stenosis due to the granulation tissue at the glottis was also observed. He underwent surgery for the removal of granulation and scar tissue around the tracheostoma（in fact, cricothyroid stoma） with a silicone stent placement to minimize the risk of postoperative laryngeal restenosis. Following the stent removal, laryngeal stenosis was improved; however, the voice and swallowing disorders remained. We additionally performed laryngeal framework surgery and surgical intervention for dysphagia in accordance with the closure of the laryngocutaneous fistula. Postoperatively, the laryngeal restenosis was not observed, and vocal and swallowing functions were improved. We then successfully performed decannulation. This case highlights the importance of staged approach to appropriate surgical interventions for complex and severe airway, vocal, and swallowing disorders.

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Laryngeal elevation dysfunction is a relatively common swallowing disorder symptoms and can be a risk factor for aspiration. Shaker exercise is one of the training exercises for the patients with poor laryngeal elevation. Although this is an evidence-based training exercise, it is physically demanding and many patients are unable to complete the session. In recent years, there has been an increase in the use of devices that use electrical stimulation therapy to stimulate muscle contraction of the suprahyoid muscles in swallowing rehabilitation.
In this study, we performed short-term intensive swallowing rehabilitation using high-voltage pulse stimulation in three patients with swallowing disorders who had shown little improvement in swallowing function with conventional swallowing rehabilitation.
As a result, the elevation and anterior displacement of the thyroid cartilage and hyoid bone during swallowing increased in all cases, and improvements in PAS and FILS were also observed.
Short-term intensive swallowing rehabilitation combined with high-voltage pulse stimulation therapy has been shown to have some effect on improving swallowing function.

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We report a case of pseudobulbar dysphagia in an 80-year-old woman with mild impaired consciousness caused by subarachnoid hemorrhage. The combination of “ee” maneuver and a palatal augmentation prosthesis（PAP）improved bolus transport from the oral cavity to the pharynx. The patient condition of “reclining posture of 45 degrees, modified dysphagia diet level 3, Food Intake LEVEL Scale 5（1 meal-assisted intake, and tube feeding）”. Due to impaired consciousness and severe tongue dysfunction，bolus transport from oral cavity to the pharynx took considerable time. On day 49, a video-fluoroscopic examination of swallowing（VF）was performed. During the oral phase, contact between the posterior tongue and soft palate prevented bolus transport to the pharynx. Pharyngeal function was preserved. In the VF conducted on day 118, the “ee” maneuver was partially effective. However, the bolus remained in the oral cavity due to impaired tongue movement. PAP was made to compensate for this impairment. The combined use of the “ee” maneuver and PAP reduced the oral transit time. The “ee” maneuver might be effective in cases with bolus transport difficulties due to posterior tongue and soft palate contact, while PAP was beneficial for patients with anterior tongue movement disorder.

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A man in his 70s was hospitalized for a head injury and subsequently developed a chronic subdural hematoma. After undergoing subdural hematoma evacuation, his inflammatory markers increased. He was initially treated with antibiotics for suspected urinary tract infection, but his C-reactive protein （CRP） levels remained elevated. Although dysphagia was not suspected at first, vomiting and a high fever were observed, and aspiration pneumonia was diagnosed on chest CT.
A videoendoscopic evaluation of swallowing （VE） revealed that pharyngeal passage was relatively preserved, but fluid that had passed the esophageal orifice was seen reaccumulating in the pyriform sinuses, indicating esophagopharyngeal reflux. Aspiration of this refluxed fluid through the interarytenoid notch was also observed. We initiated bridge dry swallowing exercise, which aims to strengthen esophageal peristalsis. Following this intervention, his CRP levels normalized without further antibiotic administration, and VE findings also improved. On the third VE, esophagopharyngeal reflux and aspiration were no longer observed. Along with improvements in swallowing, the patient’s appetite and overall condition improved, allowing him to resume oral intake and ultimately be discharged home.

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