We examine the mean of method of laryngeal elevation. We examine the laryngeal elavation and forward movement of hyoid bone of normal swallowing and examine our operated case. We think that it is less meaning of the operation for the laryngeal pulling ahead, but is more meaning of the operation for laryngeal elevation.

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We perform crico-pharyngeal myotomy and laryngeal suspension as surgical operation for dysphagia. Between four years from January 2001 to December 2004, this operation was performed in 16 patients with severe dysphagia in our hospital, Seirei Mikatahara General Hospital. The patients ranged in age from 56 to 73 years (mean 64.2 years). 13 cases were dysphagic patients with cerebrovascular disease. Rehabilitation was performed after this operation, and the degree of dysphagia was improved in all cases. A crico-pharyngeal myotomy and a laryngeal suspension can contribute to the improvement of severe dysphagia, if appropriate rehabilitation was done after this operation.

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Dysphagia is common in acute stroke. In addition to causing increased risks of chest infection, malnutrition and resulting in longer hospital stay, dysphagia is also associated with increased mortality. The clinical outcomes can be improved using appropriate and valid treatment. We examined the nutrition of 96 acute stroke patients with dysphagia (44 males, 52 females, mean age 75.7 years). Results:(1) In this study, 91 patients (94.8%) were able to achieve adequate oral intake finally.(2) The mean duration required to consume 1,000 kcal/day was 11.2 days.(3) Malnutrition(TP<6.0g/dl, Alb<3.5g/dl) was found in 56 patients (58.9%).(4) The incidence of complication with infection was higher in the malnutrition group than it in non-malnutrition group(58.9 and 10.0%, respectively) Conclusion: Using appropriate treatment, dysphagia in acute stroke was much improved by around 10 days. Infusion of peripheral parental nutrition (PPN) can indirectly contribute to decrease the incidence of infection by keeping the patient in adequate nutrition state.

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Sixty eight elderly inpatients with dysphagia more than 64 years old were investigated. The causes of dysphagia were cerebrovascular disorder (40%), unknown affected by aging and dementia (46%) and so on. 65% of the cases had slightly severe or severe dementia. 7% of the cases were treated with food swallowing training and 15% with basal training without food. 29% with eating observation by speech therapist and 49% with evaluation alone had no training due to dementia. 25% of the cases were suspected to show malnutrition and intervened by the nutrition support team (NST). The results were as follows. Food shapes were changed to more ordinary and degrees of dysphagia severity were improved significantly. The improvement rate of dysphagia severity was as low as 10% in the evaluation alone group, while 33-70% in the other therapy groups. The improvement rate was low in the slightly severe or severe dementia group. In the NST intervention group, it was supposed that the complication, e. g., aspiration pneumonia, was suppressed by nutritional improvement, although the improvement rate of dysphagia severity was not so high.

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We evaluated the dysphagial patient who suffered pseudo bulbar palsy and hemiplegia by the radiological swallowing test or endoscopic examination. In case of the in-the-home patient, endoscopic study is preferable, because of the disturbance of hospital visit and without exposure to radiation. We devised the endoscopic examination with test food seeing by the video system for the dysphagial patient. This time, we saw the patient in his home with a dentist, a dental hyginiest, a expert in nutrition as a group. We prescribed oral hygiene and oral rehabilitation. Resultingly, he recovered swallowing function. We emphasize the group of experts therapy for the in-the-home patient.

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Aim: On the dysphagic patients, we investigated the threshold volume of the pharyngeal swallowing elicited by water infusion into oropharynx, and also discussed the potentiality of swallowing training with infusion of chilled carbonated water. Subjects and Methods: Subjects were 5 dysphagic patients due to CVA. All were within 4 weeks after onset. We confirmed their decreased initiation of swallowing reflex without aspiration for small volume of liquid swallowing by preceding Videofluorography. For oropharyngeal infusion, we inserted a polyethylene infusion catheter orally and fixed it on the base of tongue. The site of fixation was monitored by laryngoscope nasally inserted. The types of liquid were:(1) room temperature water (21-23°);(2) chilled water (12-14°);(3) chilled carbonated water (12-14°). We examined infusion volume of 3 swallowing actions. Results: The mean threshold volume of chilled water was less than that of room temperature water and significantly lesser in chilled carbonated water. We considered chilled stimulation and physical stimulation of effervescence might have affected this result. Then we suppose infusion of chilled carbonated water can be applied to swallowing training for patients who decreased elicitation of swallowing reflex because relatively small volume of water infusion (<1ml) can elicit reflex.

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The purpose of this study was to investigate the timing of glottic closure during normal swallowing. Concurrent videoendoscopic and videofluorograpic examinations were performed in 3 patients, who had performed tracheotomy. A flexible endoscope inserted through the tracheal stoma, and the tip was positioned in the subglottic region. The subjects performed each of 5m9 normal liquid swallows. In normal swallows, the glottis was partially open in the onset of laryngeal elevation, and the timing of full glottic closure coincided that of maximal laryngeal elevation, UES opening and laryngeal closure. The duration of glottic closure was significantly shorter than that of laryngeal closure. We conclude that glottic closure during normal swallowing typically occurs in the process of laryngeal elevation, and the glottis dose not completely close until the peak of laryngeal elevation.

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We had a patient with dysphasia due to ALS. His tongue could not reach palate because of severe atrophy and oral propulsion was impossible. Then, we tried PAP that was dental prosthesis to improve oral stage of swallowing, and it brought him shortening of meal time about one half. We examined the effect of PAP with Video-manometry. The results were (1) He could not swallow jelly and puree without PAP. However, he could make bolus, send it into the pharynx, and swallow them with PAP.(2) The swallowing pressure of UES was lower with PAP than without PAP.(3) The excursion of hyoid bone when swallowing was shorter with PAP than without PAP. PAP might be effective not only for oral stage dysfunction but also for pharyngeal stage dysfunction. Moreover, PAP is useful for the dysphagic patients who has progressive disease and whose swallowing is hard to improve by training or therapeutic approach.

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This report examines oropharyngeal swallowing disorders by measuring laryngeal and pharyngeal movement during swallowing. Videofluorographic studies of oropharyngeal swallowing in four patients who had undergone supraglottic or supracricoid laryngectomy were conducted. In the early postoperative stage, all patients had reduced laryngeal elevation, and aspiration was observed in the ascending stage of the larynx. The main therapy regimen consisted of breath-holding maneuvers. From 16 days to 46 days postoperatively, after breath-holding therapy, all patients had reduced residue in the pharynx and no aspiration was observed. The use of breath-holding maneuvers produced some degree of change in hyoid bone position in all patients before swallowing; prolonged duration of laryngeal elevation was observed in all patients during swallowing. These results indicate that swallowing therapy after supraglottic or supracricoid laryngectomy should focus on techniques such as breath-holding maneuvers that induce improvements in vertical laryngeal position before and during swallowing to close the airway entrance and improve bolus propulsion.

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The effectiveness of mandibular control was investigated in 6 developmentally disabled children who had eating or swallowing disorders, through examination the results of ingestion practice and videofluoroscopic studies. In 1 subject no movement of the mandible or tongue was seen and food could not be transported through the oral cavity. However, rhythmical up and down movement of the mandible led to the appearance of smooth, coordinated movement of the mandible and tongue, making it possible to transport food. In 3 patients whose tongue thrusted at the time of ingestion, placement of food on the molars and encouragement of chewing movements like biting made it possible for food to be transported and swallowed smoothly without tongue thrust. However, there were also subjects in whom high muscle tonus made it difficult to induce rhythmical chewing movement, or in whom chewing movements could not be induced at all.

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This report deals with the causes and the prognosis of the dysphagia patients with cervical spinal cord injury (abbreviation: CSCI). The subjects were eight men with CSCI, the age ranged from nineteen to seventy-three. They were divided into two categories. the five of them had dysphagia less than a year after the onset CSCI. The other three had dysphagia more than a year after the onset CSCI. All of the former had undergone anterior cervical fusion in acute period. One of the two who required tube feeding had recurrent atelectasis of the lung. Any causes were not found in other one who required tube feeding. All subjects in the later category aged over fifty-seven. Those who were in thirties and forties were not found in this category. All of them required tube feeding. One of them had recurrent atelectasis of the lung. The other one aged seventy-three had atelectasis of the lung only for one time, however he did not come to swallow. The subject with history of lung tuberculosis required tube feeding and died of pneumonia. In conclusion, younger subjects with dysphagia due to CSCI came to swallow, if they did not have recurrent atelectasis. Recurrent ateletasis resulted in poor prognosis of dysphagia. Those who were over fifty age required tube feeding. The poor prognosis resulted from aging.

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A 60-year-old woman was admitted to our hospital with hoarseness and dysphagia after right earache. She showed right glossopharyngeal nerve and vagus nerve palsies causing sever bulbar type dysphagia, but other neurological disorders did not exist. There was no skin rash within the regions of her ear, oral cavity, pharynx and larynx. The cell count and the protein were elevated in the cerebrospinal fluid. MR imaging of brain was normal. We diagnosed her as zoster sine herpete (ZSH) and treated with acyclovir. The patient almost completely recovered after therapy of acyclovir and swallowing rehabilitation. Examinations of antibodies and DNA of varicella zoster virus (VZV) revealed only the pattern of previous zoster infection, but no evidence of reactivation of VZV. Immunological examinations are useful for diagnosis of ZSH, but negative results do not exclude a reac- tivation of VZV. Antiviral therapy should be discussed in a case of cranial nerve palsy of unknown etiology, especially with pain.

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