Dysphagia
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The rigid spine syndrome (RSS) is not a recognized cause of dysphagia. The "vacuolar variant" of RSS causes mild, generalized, and slowly progressive weakness. Respiratory evaluation detected severe restrictive chest wall defect and significant respiratory muscle weakness. ⋯ The myopathy that underlies this syndrome likely caused dysfunction of the striated muscle of the pharyngeal constrictors and upper esophageal sphincter. The documented abnormalities of esophageal smooth muscle motility were nonspecific and tenuously associated with the muscle disorder. The incongruity between complaints of intermittent dysphagia and study results was perhaps due to transient pharyngoesophageal dysmotility, altered swallowing mechanics of limited cervical spine mobility, altered swallowing perception after previous intubation/tracheostomy, or a "functional" upper intestinal complaint.
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Comparative Study
Cervical auscultation synchronized with images from endoscopy swallow evaluations.
Cervical auscultation is the use of a listening device, typically a stethoscope in clinical practice, to assess swallow sounds and by some definitions airway sounds. Judgments are then made on the normality or degree of impairment of the sounds. Listeners interpret the sounds and suggest what might be happening with the swallow or causing impairment. ⋯ At present there is no robust evidence that cervical auscultation of swallow sounds should be adopted in routine clinical practice. There are no data to support the inclusion of the technique into clinical guidelines or management protocols. More evaluation using imaging methods such as videofluoroscopy is required before this subjective technique is validated for clinical use by those assessing swallowing outside of a research context.
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The purpose of this study was to investigate clinical assessment practices and instrumental examination decision-making by speech and language therapists (SLTs) in Ireland. A 21-question survey (including patient scenarios) was sent to 480 SLTs in Ireland. A total of 261 completed surveys were returned (54%), providing demographic information on SLTs currently working in Ireland and their services. ⋯ The results also showed clinician variability regarding which components are included in a bedside clinical examination of swallowing, with a high degree of consistency for only 11 of the 20 components. Clinicians agreed in their instrumental vs. noninstrumental evaluation recommendations for two of the six patient scenarios, with wide variability in clinical decision-making. Possible influences on clinical decision-making are discussed in relation to the findings of similar previous studies, as well as the current status and future needs of dysphagia training and services in Ireland.
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The aim of this study was to evaluate leakage of liquids, i.e., water and saliva, past low-pressure cuffs of tracheostomy tubes. Three different types of tracheostomy tubes, TRACOE vario (TRACOE Medical GmbH, Germany), Rüsch Ultra-Tracheoflex (Rüsch GmbH, Germany), and Portex Blue Line Ultra (Smiths Medical, UK) were tested in isolated pig tracheas. Sixty samples (10 tubes each of 7- and 8-mm inner diameter of each type) were used. ⋯ Leakage after treatment with water or artificial saliva is higher without artificial ventilation than with ventilation. The amount of leakage among the tubes with respect to manufacturer showed statistically significant results. However, there were no differences among tracheostomy tubes with respect to internal diameter.
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Patients with unexplained chest pain or dysphagia are often referred for esophageal manometric studies to further investigate their symptoms. Four main manometric abnormalities have been described: achalasia, diffuse esophageal spasm, "nutcracker" (hypercontracting) esophagus, and hypocontracting esophagus. With the exception of achalasia, treatments are of limited benefit and the natural history of these conditions is largely unknown. ⋯ The significance of diffuse esophageal spasm, "nutcracker" esophagus, and hypocontracting esophagus found at esophageal manometry remains uncertain. Although treatment is often ineffective, these conditions typically run a benign course. Patients can be reassured that their symptoms are likely to improve with time.