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Print ISSN : 0447-7227
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Volume 55, Issue Suppl.2
Displaying 1-12 of 12 articles from this issue
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The 32th Society of Swallowing and Dysphagia of Japan
Symposium
Review
Educational Lecture
Review
Original Article
  • Two cases of superior laryngeal nerve internal branch paralysis after surgery using an anterior approach for the cervical spine
    Ryuichi HIROTA, Kyoko TAKANOHARA, Tomoyo YASUE, Hitoshi BAMBA, Hitoshi ...
    2009 Volume 55 Issue Suppl.2 Pages S142-S150
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S142
    JOURNAL FREE ACCESS
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    This report presents two cases of superior laryngeal nerve internal branch (SLNI) paralysis after surgery using an anterior approach for the cervical spine. Both patients complained of dysphagia, and a videoendoscopic examination detected pharyngeal edema and sensory disturbance in the epiglottis on the operated side. The symptoms improved within one month after the operation without any therapeutic intervention. SLNI paralysis after an anterior approach for a cervical spine surgery may be a common complication. It may sometimes be overlooked by the spine surgeons and otolaryngologists because of a lack of understanding of SLNI paralysis. Although the etiology of dysphagia following anterior spine surgery may vary, it is important to carefully preserve the sensory SLNI to minimize the risk of dysphagia.
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  • A case of severe dysphagia due to bulbar palsy treated by a cricopharyngeal myotomy, laryngeal suspension, and laryngeal framework surgery
    Haruko TAKAHASHI, Hideaki KANAZAWA, Atsuro SEKI, Kiyoshi MISAWA, Yuri ...
    2009 Volume 55 Issue Suppl.2 Pages S151-S157
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S151
    JOURNAL FREE ACCESS
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    A 46-year-old male presented with dysphagia caused by a subarachnoid hemorrhage. He developed nocturnal central apnea, left limb ataxia, and severe hoarseness due to left vocal fold paralysis. He also experienced severe dysphagia due to bulbar palsy. A videofluoroscopic examination (VF) of swallowing showed an impairment of the upper esophageal sphincter opening. Consequently, balloon dilatation for cricopharyngeal dysfunction was performed. The dysphagia did not improve, although the balloon dilatation was continued for 2 months. To prevent the aspiration of food and saliva, a cricopharyngeal myotomy, laryngeal suspension, laryngeal framework surgery (left arytenoid adduction and type I thyroplasty), and cricothyroid disarticulation were performed. A postoperative VF revealed that the entrance of the esophagus opened with a forward motion of the neck and the food bolus passed successfully into the esophagus by means of gravity. The aspiration of food and saliva no longer occurred and the patient was able to eat three times a day without tube feeding. In addition, his voice quality also markedly improved after the operation.
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  • Electromyographic (EMG) findings in patients with Wallenberg's syndrome with severe dysphagia
    Yoichiro AOYAGI, Yuhi KAMURA, Shinsuke SATO, Jiro HATA, Wakami YAMAGUC ...
    2009 Volume 55 Issue Suppl.2 Pages S158-S163
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S158
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    Although dysphagia due to Wallenberg's syndrome is attributed to the lesions including lower cranial nerve nucleus and the central pattern generator (CPG) in the medulla oblongata, the specific neural mechanisms are not well understood. In this study, we performed a videofluoroscopic examination of swallowing (VF) and electromyography (EMG) in patients with Wallenberg's syndrome. The subjects were 11 patients with chronic severe dysphagia due to lateral medullary infarction who had difficulty in swallowing orally even after dysphagia rehabilitation was provided for more than three months. The EMG included the masseter, suprahyoid, infrahyoid, and cricopharyngeal muscles. In all patients, the bolus was partially or fully obstructed at the cricopharyngeal part in the VF. In the EMG, coordinated and sequential muscle activities of the swallowing muscles were disturbed in 10 out of 11 patients. Cricopharyngeal muscle activities during the swallowing reflex were classified into three categories : complete rest, incomplete rest, and no rest. ‘Incomplete rest’ and ‘no rest’ were seen in more than 80% cases. In conclusion, obstruction to the passage of food in the pharyngeal stage was associated with cricopharyngeal dysfunction as well as uncoordinated muscle activities due to the lesion including the CPG in the lateral medulla oblongatas.
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  • The treatment of dysphagia at Kyorin University Hospital
    Tetsuya SATOU, Takehiro KARAHO, Takeshi NAKAYAMA, Mitsuko AKIMURA, Mik ...
    2009 Volume 55 Issue Suppl.2 Pages S164-S170
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S164
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    Kyorin University Hospital is a central medical center in the western district of Tokyo, which includes an Advanced Emergency Care Center, and has been actively working on hyperacute medicine. Early ambulation and oral feeding are encouraged in patients in the acute stage and patients with good outcomes undergo a functional assessment and rehabilitation around one week after receiving early treatment. Such in-hospital procedures were performed in 640 patients in 2007 and 436 of them were assessed for their feeding and swallowing function. The ST of the Rehabilitation Unit performed a screening test for aspiration and trained the patients regarding feeding and swallowing before oral feeding in patients in the acute stage. However, some patients should be assessed for detailed laryngeal and swallowing functions. Therefore, a clinic for swallowing and speech has recently been established in the Otolaryngology Department, to provide an “early assessment of dysphagia by ST” and an “assessment of the laryngeal and swallowing functions by an otolaryngologist”. Consequently, the clinic utilizes a team approach regarding the treatment of dysphagia. This system was introduced for the treatment of dysphagia for inpatients and has also been extended to community healthcare including cooperation between hospitals and clinics.
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  • A case of severe dysphagia after consuming a strong alkaline solution
    Takafumi YAMANO, Takeshi MURAKAMI, Hitomi HIGUCHI, Junichi FUKAURA, To ...
    2009 Volume 55 Issue Suppl.2 Pages S171-S176
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S171
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    Corrosive-esophagitis is generally caused by drinking a strong alkali or acidic solution. This is common among adults who try to commit suicide by drinking toxic substances which consist of strong alkali or acids. Accidental consumption of household cleaning solutions is the usual cause among children and infants. Specifically, alkaline solutions can cause greater damage to tissue than acidic solutions, because alkali solutions react with tissue proteins, thus resulting in coagulative necrosis. This may result in sudden death, but most patients survive for some time and continue to suffer complications such as cicatricial-stricture which affects vocalization and swallowing and generally requires long-term treatment and management. Such stricture may become progressive in cases where the damage is severe. Most studies cite effects such as esophagitis, gastritis and stricture along this path, but few reports have noted the effect on the larynx and dysphagia itself. This present case involves a patient who experienced severe dysphagia after swallowing a strong alkaline solution. In addition to stricture, esophagitis and gastritis which were diagnosed earlier, it is thought that the current swallowing dysfunction in this case was due to the effect on the pharyngeal larynx. After having undergone a surgical operation to improve the swallowing function, and postoperative psychiatric and psychosocial therapy, the patient can now enjoy eating and drinking with a significantly improved swallowing function.
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  • Paraneoplastic dysphagia associated with anti-Hu antibody and lung carcinoma
    Hideaki MIYAJI, Toshiro UMEZAKI, Kazuo ADACHI, Yasuharu YAMASHITA, Mam ...
    2009 Volume 55 Issue Suppl.2 Pages S177-S184
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S177
    JOURNAL FREE ACCESS
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    Paraneoplastic neurological syndromes (PNS) can be defined as the remote effects of cancer that are not caused by the tumor and its metastasis, or by infection, ischemia or metabolic disruptions. PNS are associated with antibodies directed against antigens expressed by both the tumor and the nervous system (onconeural antibodies). Although PNS can affect any part of the central and peripheral nervous system, the neuromuscular junctions, and muscle, so far no report has evaluated dysphagia associated with PNS by video fluorography of deglutition. A 72-year-old male presented with dysphagia and other neurological syndromes. His dysphagia was followed for over 9 months. The findings of this case suggested a broad neuropathy and an autoimmune mechanism.
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  • Investigation of the reliability and validity of the obedience score
    Takeshi TSUJINAKA, Kumiko MIYAKE, Keiko HASHIMOTO, Makoto OGAWA, Hiden ...
    2009 Volume 55 Issue Suppl.2 Pages S185-S192
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S185
    JOURNAL FREE ACCESS
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    [Objective] The goal of this study was to investigate the reliability and validity of the score used to estimate the ability to obey commands (the Obedience Score : OS). [Subjects and methods] The study subjects comprised 138 (35 male and 103 female) patients hospitalized in Sakamoto Hospital Annex. We estimated the OS by scoring the degree of the response to each command of 1) phonation, 2) throat clearing, 3) tongue movement, 4) dry swallowing, 5) eye opening and closing and 6) shaking hands. The responses were scored according to a 3-point scale and then were added together to obtain the OS. Chronbach's α co-efficient, Kappa indices among 3 estimators, and test-retest reliability were investigated as indicators of reliability. In regard to the validity, the association between OS and the subjective estimation by 3 nurses working in the wards was evaluated and the cut-off level to predict the possibility of command obedience was calculated. [Results] There was a significant association (r=0.86, p < 0.0001) between the sum of the scores for the upper aero-digestive tract motion and the sum of the scores for the other motions;furthermore, a high Cronbach's α co-efficient (0.94) was demonstrated. Kappa indices among the 3 estimators of the scores for all of the commands except dry swallowing were more than 0.8. Kappa indices between the test-retest were lower than those among the 3 estimators. An apparent difference was observed in the OS between the cases that were subjectively estimated as “possible to obey commands” and “impossible to obey commands.” Lastly, the best balance of sensitivity and specificity was demonstrated when the cut-off level was set at 1 to predict the possibility of command obedience. [Conclusion] These data demonstrate the sufficient reliability and validity of the OS. Furthermore, a single individual may estimate the OS but the test time should be selected carefully.
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  • Evaluation of the surgical closure of the larynx due to refractory aspiration pneumonia (Laryngo-tracheal separation, total laryngectomy, subglottic laryngeal closure)
    Katsuyuki KAWAMOTO, Kazunori FUJIWARA, Naritomo MIYAKE, Yuji HASEGAWA, ...
    2009 Volume 55 Issue Suppl.2 Pages S193-S201
    Published: 2009
    Released on J-STAGE: December 01, 2010
    DOIhttps://doi.org/10.11334/jibi.55.S193
    JOURNAL FREE ACCESS
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    The surgical closure of the larynx due to refractory aspiration pneumonia is a very effective method for both the prevention of aspiration pneumonia and for allowing the patient to ingest food normally. This surgical procedure includes the laryngo-tracheal separation, a total laryngectomy, and subglottic laryngeal closure. We performing this surgery on 26 cases who were refractory to aspiration pneumonia, and their ages ranged from infants to adults. In all cases, the postoperative respiratory state was excellent. One case, which happened to be a severely retarded child (GM1 gangliosidosis case), developed pulmonitis. However, the pulmonitis was able to be managed successfully. In all adult cases, the normal ingestion of food became possible, and 71% of the cases were able to consume meals normally. As for the severely retarded they children, the swallow function had either decreased or had completely disappeared due to the effects of the primary disease. In conclusion, the surgical closure of the larynx is therefore considered to be a good treatment modality because it successfully obtained a steady respiratory state, and to some degree it made the ingestion of normal foods possible in these patients.
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