Aim: Studies have reported that both survival rate and patients' Quality of Life (QOL) post-treatment need to be considered when determining treatments for head and neck cancer. This study aimed to evaluate the actual QOL of post-discharge patients who underwent laryngectomy and identify factors affecting the global health status of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (hereafter QL2).
Subjects: We selected post-discharge patients who underwent laryngectomy at a regional medical care support hospital and who could answer the questionnaire themselves. Subjects who provided informed consent were included in the study. The EORTC QLQ-C30 and EORTC QLQ-H＆N35 questionnaires were used to determine the patients' actual QOL.
Methods: The EORTC QLQ-C30 and EORTC QLQ-H＆N35 questionnaires were administered to each patient. Patients were categorized into the QL2 high and low score groups based on the median QL2 scores that were statistically analyzed using Mann-Whitney's U test and χ2 test between the two groups. Pearson's correlation coefficient was assessed among multiple-item scales, single-item scales, and each scale in EORTC QLQ-H＆N35. Barthel Index, occupation, years after surgery, and age parameters were included in a binary logistic regression analysis to identify factors affecting QL2.
Results: Subjects were categorized in the QL2 high score group (n＝35) and QL2 low score group (n＝27), respectively. Barthel Index (p＝0.002) and occupation (p＝.011) were significant between the two groups. We found strong correlations between trouble with social eating and trouble with social contact and between trouble with social eating and swallowing in the EORTC QLQ-H＆N35 questionnaire. We also found strong correlations between swallowing and senses problems and between swallowing and trouble with social eating. Occupation was an independent factor affecting QL2 (OR:4.46, 95%CI: 1.03–19.32, p＝0.046).
Conclusion: Swallowing was correlated with senses problems and trouble with social eating as swallowing for QOL of post-discharge patients who underwent laryngectomy. Occupation was a factor affecting QL2.
The present study assessed the difference in physical properties between α-amylase-added bread, which is bread prepared with the addition of α-amylase (a starch-degrading enzyme used for promoting the gelatinization of wheat starch and inhibiting the ageing of the gelatinized starch), and additive-free bread to which α-amylase has not been added. The study also examined the difference in masticability of the two bread samples by means of electromyography of masseter muscles during mastication and by observing the changes in properties of the bread sample boluses during mastication. The results indicated that the addition of α-amylase to bread promotes the gelatinization of wheat starch and enables the preparation of bread that is soft. Furthermore, electromyography of masseter muscles during mastication showed that, compared with the bread to which α-amylase had not been added, the more softly prepared α-amylase-added bread was easier to masticate. As to the relation between the number of times of mastication and the properties of the bread sample boluses, the hardness of the α-amylase-added bread sample at five times of mastication was found to be softer than that of the bread sample prepared without the addition of α-amylase. However, no significant difference between the two bread samples was found at mastication of ten times or more. The moisture content ratio of the bread boluses increased with the number of times of mastication. This trend is presumably due to the effects of saliva secreted during mastication. These results suggest that, by adding α-amylase to bread, it is possible to prepare bread that is easy for elderly people to masticate.
Purpose: The purpose of this study was to clarify by questionnaire the actual oral function of healthy elderly people and the relationship between the swallowing function, the symptoms of the oral/pharyngeal phase during eating and devising food modifications.
Methods: The subjects were 104 home-based elderly people aged 65 and over, except those requiring care, who could answer questions.
Firstly, we measured the oral function [oral moisture degree, oral diadochokinesis (hereinafter, this is called "ODK"), tongue pressure, chewing ability] and investigated the relationships between the oral function and survey items. Survey items are the swallowing function by the Seirei Swallowing Questionnaire, symptoms of oral/pharyngeal phase during eating (Questions 3 to 11 of the Seirei Questionnaire), food forms that are difficult to eat, devising food modifications.
Results: ODK / pa // ta //ka /・Tongue pressure and chewing function were correlated with age, ODK / pa// ta // ka / were correlated with each other, tongue pressure was correlated with ODK/ ta // ka/.
As for the group with dysphagia, ODK / ta / showed a significantly lower value than the group with suspected dysphagia or the normal group.
As for the symptoms of oral / pharyngeal phase, ODK / ta / were associated with the group that became slow to eat, tongue pressure was associated with the group that has coughing fits during meals, and chewing ability was associated with the group that had difficulty eating hard foods.
As for foods which became hard to eat and devising food modifications, ODK / pa // ka / were associated with the group that had difficulty eating hard food, ODK / ka / were associated with foods which easily stuck to throats, ODK / pa // ka / were associated with the group that devised soft foods.
Conclusion: In healthy elderly people over 65 years of age, ODK / pa // ta // ka /・tongue pressure and chewing function were correlated with age. The oral function had a lower value the older the people got. In addition, the group with symptoms in the oral/pharyngeal phase and the group devising food modification were significantly lower values than the group that did not.
Introduction: We present a case in which movements of the epiglottis caused by cervical osteophyte were improved by postural adjustments made under video fluorography.
Case: The patient, a 76-year-old man, had suffered a pontine infarction 7 years before the current presentation. During his hospitalization for treatment of chronic prurigo, the patient developed aspiration pneumonia and acute empyema.
Course: As silent aspiration was suspected, we performed video fluorography but found no evidence of aspiration. However, the epiglottis was in contact with a beak-shaped osteophyte arising from the anterior cervical spine (at C4-C5), which interfered with epiglottic movements, hindering the passage of bolus. Additionally, the epiglottis did not invert at times, and pharyngeal residues and dysphagia were noted. Under video fluorography, we adjusted the patient’s weight bearing on the seat surface, as well as the head and neck position, which led to improved movements of the epiglottis and pharyngeal clearance. At meal times, the patient was encouraged to move both hands and gained the ability to consistently hold dishes as he ate, which allowed him to maintain the posture adjusted under video fluorography. Aspiration pneumonia did not recur throughout the remainder of his hospital stay.
Discussion: It was estimated to be in addition to the beak-shaped cervical plexus, another factor underlying the epiglottis movement disorder is the insufficiency of the tongue base retraction caused by the bridge infarct and the poor forward movement of the hyoid bone. Video fluorography is useful for postural adjustment, in which the patient switches his weight bearing on the seat surface from sacral support to ischial support and changes the position of the head and neck so that the chin is down. Maintaining this position probably aided the retraction of the tongue base during swallowing and helped to expand the pharyngeal cavity and promote epiglottis inversion.