Dysphagia Resource Center News December 2006
Posted 2006-12-01 11:22:11
It's rather striking how quickly and how much food professional eaters can swallow. At Artie's Deli in Chicago, 21-year-old culinary student won the annual turkey-eating contest eating 4.8 pounds of the holiday bird in 12 minutes. His winning strategy included starting his attack on the turkey breast. "It's white meat and harder to eat. You want to get it out of the way first. My jaws are pretty tired," he said after winning the contest.
In between contests, I understand that professional eaters often chew large amounts of gum to maintain and improve their muscle strength and endurance.
Posted 2006-12-04 09:13:45
Speechy Keen posted insightful considerations about the use and necessity of videofluoroscopic swallowing studies and other instrumental assessments. An excerpt from the post:
What are the reasons behind the heavy reliance on VFSS or other instrumental assessments? They are numerous and interrelated. The ones I’ve come up with so far:
- Lack of training or experience in thorough clinical assessment;
- Characterization of clinical dysphagia assessment as “subjective” -- and therefore falliable and unreliable -- while instrumental assessment is “objective”;
- Viewing clinical dysphagia assessment as merely a “screening” procedure;
- Fear of litigation;
- Overemphasis on prevention of prandial aspiration (aspiration occurring during meals);
- Belief that “silent aspiration” is common and frequently harmful;
- Belief that VFSS reflects what happens during a meal; and
- Belief that only instrumental assessment can yield information about the physiology of the pharyngeal swallow.
I would like to talk about each of these in more detail, but for now let’s focus on the last one -- the belief that instrumental assessment is required to gain any reliable information about the physiology of a patient’s swallow...
Posted 2006-12-16 15:37:35
Botulinum Toxin Treatment for Oropharyngeal Dysphagia Associated With Diabetic Neuropathy
Domenico A. Restivo, MD, PHD1, Rosario Marchese-Ragona, MD2, Giuseppe Lauria, MD3, Sebastiano Squatrito, MD4, Damiano Gullo, MD4 and Riccardo Vigneri, MD4
OBJECTIVE — No specific treatment for oropharyngeal dysphagia related to diabetic neuropathy has been described to date. Chemical myotomy of the cricopharyngeus (CP) muscle by botulinum neurotoxin type A (BoNT/A) has been effective in reducing or abolishing dysphagia associated with upper esophageal sphincter (UES) hyperactivity of different etiologies. In the present study, we evaluated the efficacy of BoNT/A injections into the CP muscle in diabetic patients with severe oropharyngeal dysphagia associated with diabetic autonomic and/or somatic peripheral neuropathy.
RESEARCH DESIGN AND METHODS — Twelve type 2 diabetic patients with severe dysphagia for both solid and liquid foods associated with autonomic and/or peripheral somatic neuropathy were investigated. Swallowing function was evaluated by clinical examination, videofluoroscopy, and simultaneous needle electromyography (EMG) of the CP and pharyngeal inferior constrictor (IC) muscles. Clinical evaluation using a four-level dysphagia severity score was performed every other day for the 1st week and thereafter every other week until week 24. Videofluoroscopy and EMG follow-up were carried out at week 1, 4, 12, 16, 18, and 24 after BoNT/A injection. BoNT/A was injected percutaneously into the CP muscle under EMG control.
RESULTS — BoNT/A induced the complete recovery of dysphagia in 10 patients and had a significant (P = 0.0001, ANOVA) improvement in 2 patients within 4 ± 1.1 days (range 3–7). Clinical improvement was confirmed by videofluoroscopy and EMG.
CONCLUSIONS — Our findings suggest a potential benefit from BoNT/A treatment in dysphagia associated with diabetic neuropathy. Randomized controlled trials are needed to confirm this observation.
Abbreviations: BoNT/A, botulinum neurotoxin type A • CP, cricopharyngeus • EMG, electromyography • IC, inferior constrictor • UES, upper esophageal sphincter
Posted 2006-12-18 20:43:13
The coexistence of a swallowing impairment, or dysphagia, can severely impact upon the medical condition and recovery of a child with traumatic brain injury (TBI; Logemann, Pepe, & Mackay, 1994). Despite this fact, there is limited data that provide evidence of the progression or outcome of dysphagia in the pediatric population post-TBI (Rowe, 1999). The present study aimed to (1) provide a prospective radiologically based profile of swallowing outcome and (2) determine the clinical significance of any persistent physiological swallowing deficits by investigating the presence/absence of any coexistent respiratory complications. Seven children with moderate/severe TBI were evaluated via an initial videofluoroscopic swallowing assessment (VFSS) at an average of 24.1 days postinjury, during the acute phase of management.
Posted 2006-12-18 20:46:00
A 45-year-old man presented with diplopia, dysarthria and difficulty with swallowing. Over the next few days he developed weakness of the upper and lower limbs. On day 4 he was unable to walk unaided. He denied any sensory symptoms or bladder disturbances. His previous medical history is unremarkable. He is a non-smoker,
does not drink alcohol excessively. He does not take any drugs On examination he was apyrexial. His general medical examination was normal. His higher mental function was unremarkable. There were no signs of meningism. Cranial nerve examination showed bilateral dilated and fixed pupils. He had binocular diplopia but no obvious ophthalmoplegia. He was dysarthric with weak cough. His vital capacity was 3.15 standing and 2.00 lying flat. He had lower motor neuron tetraparesis of power 3/5. He was hyporeflexic with normal sensation. He was unable to walk unaided. Blood tests including FBC, U+Es, LFTs, TFTs, Ca, Autoantibody screen, ESR, CRP were normal. ECG and CXR were unremarkable. CT brain was normal. Nerve conduction studies and EMG were normal. What is the most likely diagnosis?
1) Guillain Barre Syndrome
2) Lyme disease
3) Myasthenia gravis
Posted 2006-12-18 20:49:30
Reversible atrial fibrillation secondary to a mega-oesophagus
Tahwinder Upile , Waseem Jerjes , Mohammed El Maaytah , Sandeep Singh, Colin Hopper and Jaspal Mahil
Published 13 December 2006
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it increases in prevalence with advancing age to about 5% in people older than 65 years. We present a rare case of atrial fibrillation secondary to a mega-oesophagus occurring in an 84-years-old Caucasian woman. The patient had a history of progressive dysphagia and the accumulation of food debris lead to mega-oesophagus. The diagnosis was made by barium swallow and electrocardiogram; evacuations of 300ml of the food debris lead to complete resolution of the arrhythmia. The possible aetiology leading to this AF is discussed.