Dysphagia
-
The aim of this study was to obtain a quantitative anatomical description of the hyoid bone using modern 3D reconstruction tools and to discuss potential applications of the knowledge in clinical practice. The study was conducted on 88 intact hyoid bones taken from cadavers during forensic autopsies (group 1) and on 92 bones from CT scan images of living adult subjects (group 2). Three-dimensional reconstructions were created from CT scan images using Amira 5.3.3® software. ⋯ Significant metric differences were shown between group 1 and group 2. This very reproducible methodology is important because it may lead to clinical studies in, e.g., head and neck cancer or sleep apnea. Such studies are ongoing in our research program.
-
Comparative Study
Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad Dysphagia patients.
Automated impedance manometry (AIM) analysis measures swallow variables defining bolus timing, pressure, contractile vigour, and bolus presence, which are combined to derive a swallow risk index (SRI) correlating with aspiration. In a heterogeneous cohort of dysphagia patients, we assessed the impact of bolus volume and viscosity on AIM variables. We studied 40 patients (average age = 46 years). ⋯ SRI was lower with increased viscosity. In patients with dysphagia, the SRI is elevated in relation to aspiration, reduced by bolus viscosity, and not affected by bolus volume. These data provide evidence that pharyngeal AIM analysis may have clinical utility for assessing deglutitive aspiration risk to liquid boluses.
-
Comparative Study
The role of C2-C7 and O-C2 angle in the development of dysphagia after cervical spine surgery.
Dysphagia is a known complication of cervical surgery and may be prolonged or occasionally serious. A previous study showed that dysphagia after occipitocervical fusion was caused by oropharyngeal stenosis resulting from O-C2 (upper cervical lordosis) fixation in a flexed position. However, there have been few reports analyzing the association between the C2-C7 angle (middle-lower cervical lordosis) and postoperative dysphagia. ⋯ We conclude that postoperative dysphagia is common after cervical surgery. The dC2-C7 angle may play an important role in the development of dysphagia in both anterior and posterior cervical spine surgery. Intraoperative measurement of the dC2-C7 angle is practical and essential in avoiding inadvertent postoperative dysphagia.
-
Comparative Study
Use of glucagon in relieving esophageal food bolus impaction in the era of eosinophilic esophageal infiltration.
Esophageal food bolus impaction may require an urgent endoscopy. Glucagon is often administered to promote spontaneous passage of the food bolus. Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia, and food impaction is often the presenting symptom. ⋯ None of the 17 episodes with EEI as compared to 8 of the 28 without EEI responded to glucagon (0 % vs. 28.5 %, p = 0.017). Glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Patients with EEI appear less likely to respond to glucagon.