Purpose: We evaluated the adjustment of breathing and deglutition in patients with chronic respiratory disease. We studied the relationship between incidence of deglutition in the inspiratory phase as a factor of aspiration and respiratory function, and weight loss as a prognostic factor of respiratory disease.
Method: We evaluated saliva (30 s), water (10 ml×5), and jelly (5 g×5) in a deglutition test in 20 patients with chronic respiratory disease including COPD, interstitial pneumonia and bronchodilatation. We used an air flow pressure sensor and a thoracic abdominal inductive sensor to detect breathing phase. We used a throat microphone for detecting the sound of deglutition, which was confirmed by the sound of deglutition occurring within the deglutition apnea period. We defined deglutition during the expiratory phase to be a normal pattern, and deglutition during the inspiratory phase as an abnormality. We analyzed the relationships of low weight and number of times of deglutition in the inspiratory phase, and investigated the correlation between deglutition in the inspiratory phase and respiratory function.
Result: In the saliva and water deglutition test, deglutition in the inspiratory phase was associated with low weight (saliva: p＜0.05, water: p＜0.01). In the water deglutition test, TV was significantly associated with deglutition in the inspiratory phase (p＜0.05). Quantity of muscle mass (AMC: p＜0.01) and respiratory function (IC: p＜0.01) were significantly lower in the group with lower body weight, and muscular strength (grip) and exercise tolerance (6MWD) showed lower levels in the group with lower body weight similarly.
Discussion: Deglutition which occurred prior to inspiration or occurred subsequently was found at high frequency in the patients with chronic respiratory disease. Deglutition in the inspiratory phase was found at a significantly high frequency in the group with low weight. It is suggested that weight loss suggesting sarcopenia may be a factor of abnormal adjustment of respiration and deglutition.
Dysphagia is a common symptom associated with a number of childhood acute cerebral diseases. The purpose of this study was to investigate the factors affecting dysphagia recovery in patients with childhood cerebral disease.
Forty-two patients with childhood cerebral disease and disease-related dysphagia who were admitted to an emergency hospital between April 2009 and March 2014 were recruited. Multivariate analyses were performed to identify variables with a significant association with dysphagia recovery.
The mean age of the patients was 4.1 years (SD 4.3 years). At the time of discharge from the hospital, dysphagia had resolved in 16 patients (38.1%). Logistic regression analysis identified four factors that significantly predicted dysphagia recovery: Glasgow Coma Scale score, complication of respiratory diseases, presence or absence of developmental delay, and presence or absence of cough.
In patients with childhood cerebral disease-related dysphagia, these findings may have predictive value for feeding tube removal and successful oral intake before discharge from an emergency hospital.
Objective: Aging affects the sense of taste, and consequently food preferences change in the elderly. However, preferences might be influenced not only by oral sensory function but also by chewing and swallowing function. This study aimed to clarify the relationship between oral function and food preferences among elderly Japanese.
Materials and Methods: Forty patients (mean age, 74.2 years) of the dental hygiene clinic in Tokushima University Hospital were enrolled in the elderly group. Twenty-five university students (mean age, 21.4 years) were enrolled in the young group.
Food preferences were assessed using a questionnaire on favorite foods among 35 items, based on mastication score (MS). Chewing function was assessed using a xylitol gum-chewing test (Lotte Co., Ltd.) and MS. Swallowing function was assessed using number of saliva swallows in 30 seconds, water swallow test, maximum voluntary tongue pressure (MVTP) and subjective swallowing evaluation (SSE).
The Mann-Whitney U test, χ2 test, Spearman’s rank correlation coefficient, and stepwise regression analysis were performed for statistical analyses using SPSS ver.21.
This study was conducted with the approval of the Ethics Committee of Tokushima University Hospital (Approval number: 1378).
Results and Discussion: The scores of the gum-chewing test, MS, number of saliva swallows in 30 seconds, MVTP and SSE of the elderly group were significantly lower than those of the young group. There was a significant correlation between RSST and food preference scores in the elderly group, but not in the young group. Moreover, there were significant correlations between SSE and food preference score, and also between the number of saliva swallows in 30 s and food preference scores in the elderly group with stepwise regression analysis in order to exclude confounding factors between age and oral function.
It is considered that the changes of swallowing function with aging affect food preferences among elderly Japanese.
Conclusion: Our results indicate that swallowing function influences food preferences among elderly Japanese.
When patients aspirate on thin liquids, thickening liquids may help to prevent aspiration. We compiled a new brochure about adding thickness to liquids in 2014, and used it in giving thickener guidance to patients.
In this study, we surveyed 97 patients who received the guidance provided by medical staff, in order to assess how our guidance with the brochure affects patients, to evaluate the introduction of the brochure. In addition, we investigated on what patients place more importance regarding thickeners.
The results revealed that the guidance using the brochure was effective to improve the patients’ knowledge and motivation to use thickeners. We also found that the patients valued “easy to dissolve”, “recommendation from medical staff”, and “less change in taste” when choosing a thickener to purchase. Based on solid knowledge, medical staff should help patients learn how to thicken liquids in the proper manner.
The male patient was 71 years old at first examination. Resection of tongue base, horizontal laryngectomy, bilateral neck dissection, and tracheostomy were performed for oropharyngeal cancer at 62 years old, with additional chemoradiotherapy. No postoperative recurrence of the tumor was found, but the patient suffered repeated bouts of pneumonia, malnutrition, and dehydration. Feeding and swallowing rehabilitation intervention commenced during the summer at 71 years old, when the patient was hospitalized for aspiration pneumonia.
Progress after hospital admission: Endoscopic examination of swallowing was carried out on hospital day 3, and videofluoroscopic examinations of swallowing on day 5. Incomplete laryngeal closure and incomplete pharyngeal constriction were observed, confirming silent aspiration. Feeding commenced using a paste given with the patient reclining or in a side-lying position, and guidance for supraglottic swallow was given. As the patient learned to carry out supraglottic swallow, feeding moved to a seated position. Videofluoroscopic examination of swallowing carried out on day 19 of hospitalization showed that compensatory prevention of aspiration had been achieved by the supraglottic swallow. For the type of food, watery cooked rice, finely chopped food, and thickening of fluids were no longer considered necessary, and the patient was discharged to his home on the 21st day. No incidences of pneumonia were seen in the year following discharge. Aspiration due to incomplete laryngeal closure is a problem with horizontal laryngectomy for oropharyngeal cancer. In the present case, favorable progress was obtained using supraglottic swallow to prevent aspiration. Learning the supraglottic swallow prior to surgery is likely to prove useful for patients who scheduled to undergo horizontal laryngectomy.
Although several studies have suggested that dysphagia results from deep neck infections, the efficacy of swallowing rehabilitation in these cases is not fully understood. Here we report a case of dysphagia due to deep neck infection and the effect of neck stretching and passive exercise of the hyoid and larynx on dysphagia.
The patient was a 63-year-old male who had a sore throat and swollen neck. Left abscess tonsillectomy with cervical drainage was performed. Neck computed tomography revealed a deep neck infection in the left amygdala and parapharyngeal, masticator, and parotid spaces. The posterior belly of digastricus and stylohyoid was reconstructed during debridement. On postoperative day 18, cervical drainage was performed due to infection progression in the retropharyngeal space and superior mediastinum determined by neck computed tomography. On postoperative day 51, indirect therapy was conducted.
The patient had tongue muscle weakness, left facial nerve paralysis, and restricted jaw opening and laryngeal elevation. The patient presented with severe dysphagia, which restricted laryngeal elevation and upper esophageal sphincter opening by videofluoroscopic (VF) examination of swallowing on postoperative day 85. Neck stretching of suprahyoid and infrahyoid muscles with passive exercise of the hyoid and larynx was performed.
The patient showed improvements in laryngeal elevation and upper esophageal sphincter opening by VF on postoperative day 114. The extent of upward and forward movement of the hyoid bone was assessed by VF on postoperative days 85 and 114. Forward movement of the hyoid bone increased from 2.0 mm to 8.6 mm, whereas its upward movement increased from 3.9 mm to 13.7 mm. The patient could eat soft foods for dysphagia on postoperative day 149.
The cause of dysphagia in this patient may have been the neck contracted scar caused by inflammation and debridement. He showed improvements in laryngeal elevation and upper esophageal sphincter opening as the extent of upward and forward movement of the hyoid bone improved. These results suggested that neck stretching and passive exercise of the hyoid and larynx are effective for dysphagia due to deep neck infection.