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Basic Science
AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome
Authors:
Konradi, Jürgen, Dr.
Zajber, Milla
Betz, Ulrich, Dr.
Drees, Philipp, Dr.
Gerken, Annika, Dr.
Meine, Hans, Dr.
Full Citation:
Konradi J, Zajber M, Betz U, Drees P, Gerken A, Meine H. AI-Based Detection of Aspiration for Video-Endoscopy with Visual Aids in Meaningful Frames to Interpret the Model Outcome. Sensors (Basel). 2022 Dec 4;22(23):9468. doi: 10.3390/s22239468. PMID: 36502169; PMCID: PMC9736280.
Abstract:
Disorders of swallowing often lead to pneumonia when material enters the airways (aspiration). Flexible Endoscopic Evaluation of Swallowing (FEES) plays a key role in the diagnostics of aspiration but is prone to human errors. An AI-based tool could facilitate this process. Recent non-endoscopic/non-radiologic attempts to detect aspiration using machine-learning approaches have led to unsatisfying accuracy and show black-box characteristics. Hence, for clinical users it is difficult to trust in these model decisions. Our aim is to introduce an explainable artificial intelligence (XAI) approach to detect aspiration in FEES. Our approach is to teach the AI about the relevant anatomical structures, such as the vocal cords and the glottis, based on 92 annotated FEES videos. Simultaneously, it is trained to detect boluses that pass the glottis and become aspirated. During testing, the AI successfully recognized the glottis and the vocal cords but could not yet achieve satisfying aspiration detection quality. While detection performance must be optimized, our architecture results in a final model that explains its assessment by locating meaningful frames with relevant aspiration events and by highlighting suspected boluses. In contrast to comparable AI tools, our framework is verifiable and interpretable and, therefore, accountable for clinical users.
Why you should read this article:
This study is the first approach to automatically recognize glottis and vocal chords as well as to automatically detect aspirations in FEES videos by an AI. Although there is room for improvement regarding aspiration detection, the promising results show that an explainable AI could support dysphagia diagnostics.
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Difference in Drinking Times as a Function of Liquid Consistency in Adults With Oculopharyngeal Muscular Dystrophy: A Comparative Study Using Bostwick Consistometer and IDDSI Flow Test Methods
Authors:
Villeneuve-Rhéaume, Annie, RD, PhD
Gagnon, Cynthia, OT, PhD
Germain, Isabelle, RD, PhD
Côté, Claudia, RD, PhD
Full Citation:
Villeneuve-Rhéaume A, Gagnon C, Germain I, Côté C. Difference in Drinking Times as a Function of Liquid Consistency in Adults With Oculopharyngeal Muscular Dystrophy: A Comparative Study Using Bostwick Consistometer and IDDSI Flow Test Methods. J Texture Stud. 2024 Dec;55(6):e12872. doi: 10.1111/jtxs.12872. PMID: 39511704.
Abstract:
The main objective was to document the differences between drinking times and oral perception between liquids in individuals with dysphagia. A second objective was to assess variations in consistency categorization across instruments. A third objective was to explore the relationship between drinking time and dysphagia severity.
A sample of individuals with OPMD (n = 30; 40-75 years) was recruited. Participants drank 80 mL of water, followed by three blinded commercially pre-thickened cranberry cocktails (CranA, CranB, CranC). Flow rates were measured with Bostwick consistometer, IDDSI Flow Test, and Discovery HR 20 rheometer. Patient-reported outcome measures were used to assess dysphagia. Mean drinking times for participants with OPMD were as follows: 7.9 ± 4.4 s for water, 10.7 ± 4.8 s for CranA, 12.3 ± 5.7 s for CranB, and 15.2 ± 7.2 s for CranC. All four times were statistically different from each other.
Participants reported noticeable differences in oral perception. The Bostwick flow rates were different for all three cocktails. Based on IDDSI Flow Test, CranA was categorized as IDDSI level-2, while both CranB and CranC were categorized as IDDSI level-3. Correlations ranging from 0.39 to 0.55 were found between drinking times and dysphagia severity. In conclusion, liquids within the same IDDSI category can have different Bostwick flow rates and oral perception.
The hypothesis that participants with OPMD may find certain liquids more challenging to swallow, despite being in the same IDDSI category, deserves further exploration in future studies.
Why you should read this article:
This article compare methods to assess liquids consistency, including the IDDSI Flow Test and the Bostwick consistometer. The results show the importance to personalize treatments.
How to access this article:
This article is not open access. To request the original article, please contact claudia.cote4@usherbrooke.ca
The role of laryngeal hypersensitivity in dysphagia: A scoping review with embedded stakeholder involvement
Authors:
Chalmers, Sophie; Gillies, Fiona; Wallace, Sarah.
Full Citation:
Chalmers, S., Gillies, F. and Wallace, S., 2024. The role of laryngeal hypersensitivity in dysphagia: A scoping review with embedded stakeholder involvement. International Journal of Language & Communication Disorders, 59(6), pp.2333-2351.
Abstract:
Speech and language therapists observe cases of dysphagia with suspected laryngeal hypersensitivity. These presentations have been coined as ‘muscle tension dysphagia’ with concurrent laryngeal sensitivity symptoms. However, the role of laryngeal hypersensitivity in dysphagia is not fully understood. Knowledge user engagement highlights a lack of clarity around diagnosis and investigative approaches, limited clinical guidance and inconsistent practice, which leads to inequity in service delivery and care.
Why you should read this article:
This scoping review contributes to our expanding knowledge of the role of laryngeal hypersensitivity in dysphagia by providing an overview of the current evidence related to the terminology and assessment tools reported in the literature. Embedded patient and stakeholder involvement further deepens real-world insights into the increased referrals for these individuals with increasing uncertainty in how to best assess, manage and support patients. Patients equally have reported that reduced professional awareness and inequalities in service delivery pathways result in poor patient experience and quality of life, and healthcare economic burden. The study raises awareness of this population and the impact for services, speech and language therapists and clinicians; and highlights evidence–practice gaps and inconsistency in the terminology and assessment approaches.
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Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature
Authors:
Allen, J; Clunie, G; Slinger, C; Haines, J; Mossey-Gaston, C; Zaga, C; Scott, B; Wallace, S; Goviner, R.
Full Citation:
Allen, Jodi E; Clunie, Gemma M; Slinger, Claire; Haines, Jemma; Mossey-Gaston, Corinne; Zaga, Chariss J; Scott, Becky; Wallace, Sarah; Govender, Roganie; v(2021) Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature. International Journal of Language & Communication Disorders , 56 (1) pp. 174-204. 10.1111/1460-6984.12584.
Abstract:
Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID-19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non-invasive, non-aerosol-generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature.
Why you should read this article:
This paper identifies that the current evidence base for US as a swallowing or laryngeal assessment tool is heterogenous and of variable quality. No study combined the assessment of swallowing and laryngeal function, and only two studies assessed more than one parameter of swallowing, limiting the clinical application of the results. US is a non-invasive accessible tool that can offer a detailed focal assessment of swallowing and laryngeal function, such as hyoid displacement and vocal fold mobility. With the development of protocols, training packages and competency standards, US has the potential to be used as an adjunct to SLT assessment of swallowing and laryngeal function. There is not currently enough evidence to support the use of US as a stand-alone tool for SLT assessment of swallowing or laryngeal function.
How to access this article:
Jodi.allen@nhs.net
Esophageal Dysphagia
Nature, severity, and impact of chronic oropharyngeal dysphagia following curative resection for esophageal cancer: a cross-sectional study
Authors:
A Gillman, C Kenny, M Hayes, M Walshe, JV Reynolds, J Regan
Full Citation:
Gillman, A., Kenny, C., Hayes, M., Walshe, M., Reynolds, J. V., & Regan, J. (2024). Nature, severity, and impact of chronic oropharyngeal dysphagia following curative resection for esophageal cancer: a cross-sectional study. Diseases of the Esophagus, doae003.
Abstract:
Chronic oropharyngeal dysphagia (COD) and aspiration after esophageal cancer surgery may have clinical significance; however, it is a rarely studied topic. In a prospective cross-sectional observational study we comprehensively evaluated the nature, severity, and impact of COD, its predictors, and the impact of the surgical approach and site of anastomosis. Forty participants were recruited via purposive sampling from the (Irish) National Center between November 2021 and August 2022. Swallow evaluations included videofluoroscopy [Dynamic Imaging Grade of Swallowing Toxicity v2 (DIGESTv2), MBS Impairment Profile, Penetration-Aspiration Scale)]. Functional Oral Intake Scale (FOIS) identified oral intake status. The patient reported outcome measures of swallowing, and Quality of Life (QL) included EAT-10 and MD Anderson Dysphagia Inventory (MDADI). Fourteen (35%) participants presented with COD on DIGESTv2 and 10% had uncleared penetration/aspiration. Avoidance or modification of diet on FOIS was observed in 17 (42.5%). FOIS was associated with pharyngeal dysphagia (OR = 4.05, P = 0.046). Median (range) EAT-10 and MDADI Composite results were 3(0–30) and 77.9(60–92.6), respectively. Aspiration rates significantly differed across surgical groups (P = 0.029); only patients undergoing transhiatal surgery aspirated. Survivors of esophageal cancer surgery may have COD that is undiagnosed, potentially impacting swallow-related QL. Given the small number of aspirators, further research is required to determine whether aspiration risk is associated with surgical approach. A FOIS score below 7 may be a clinically useful prompt for the MDT to refer for evaluation of COD following curative intent surgery. These data present findings that may guide preventive and rehabilitative strategies toward optimizing survivorship.
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Oesophageal fluoroscopy in adults—when and why?
Authors:
Scharitzer, Martina, MD, Pokieser, Peter, MD, Ekberg, Olle, MD
Full Citation:
Oesophageal fluoroscopy in adults-when and why? Scharitzer M, Pokieser P, Ekberg O. Br J Radiol. 2024 Jun 18;97(1159):1222-1233. doi: 10.1093/bjr/tqae062. PMID: 38547408
Abstract:
Oesophageal fluoroscopy is a radiological procedure that uses dynamic recording of the swallowing process to evaluate morphology and function simultaneously, a characteristic not found in other clinical tests. It enables a comprehensive evaluation of the entire upper gastrointestinal tract, from the oropharynx to oesophagogastric bolus transport. The number of fluoroscopies of the oesophagus and the oropharynx has increased in recent decades, while the overall use of gastrointestinal fluoroscopic examinations has declined. Radiologists performing fluoroscopies need a good understanding of the appropriate clinical questions and the methodological advantages and limitations to adjust the examination to the patient’s symptoms and clinical situation. This review provides an overview of the indications for oesophageal fluoroscopy and the various pathologies it can identify, ranging from motility disorders to structural abnormalities and assessment in the pre- and postoperative care. The strengths and weaknesses of this modality and its future role within different clinical scenarios in the adult population are discussed. We conclude that oesophageal fluoroscopy remains a valuable tool in diagnostic radiology for the evaluation of oesophageal disorders.
Why you should read this article:
As a widely available imaging technique, oesophageal fluoroscopy remains one of the primary examination methods for various oesophageal pathologies. Simultaneous assessment of morphology and function enables real-time evaluation of bolus flow, requiring trained operators with experience in dysphagia care. The spectrum of pathological findings and referral indications has changed over time. This review article discusses current indications and specific clinical situations, highlights examination components for assessing the oesophagus, and describes typical radiological findings.
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The prevalence, nature and severity of oropharyngeal dysphagia following esophagectomy
Authors:
PhD Candidate Michelle Hayes, Dr. Anna Gillman, Ms Jessie A. Elliott, Ms Claire L. Donohoe, Prof John V. Reynolds, Prof Julie Regan
Full Citation:
Hayes M, Gillman A, Elliott JA, Donohoe CL, Reynolds, JV, Regan, J. The prevalence, nature and severity of oropharyngeal dysphagia in the acute post-operative phase following curative resection for esophageal cancer. Diseasews if the Esophagus. 2025 August, 38 (4), 1-10.
Dis Esophagus . 2025 Jul 3;38(4):doaf054. doi: 10.1093/dote/doaf054.
Abstract:
Background: Oropharyngeal dysphagia and aspiration in the early post-esophagectomy period is rarely studied. This study investigated its prevalence, nature and severity, differences across surgical subgroups, and predictors of risk.
Methods: A prospective cohort study was conducted (January 2022-January 2024) at the National Esophageal Cancer Centre. Data was collected on post-operative day (POD) 4 or 5. Swallowing evaluations included videofluoroscopy [Dynamic Imaging Grade of Swallowing Toxicity v2(DIGESTv2), Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale (PAS)]. Functional Oral Intake Scale (FOIS) was used to identify oral intake status.
Results: N = 30 (25 males) were recruited, mean age (range) of 65 (46-80y), n = 13 2-stage, n = 8 3-stage, and n = 9 transhiatal resections. At POD 4/5, 60% (18/30) showed signs of aspiration, with no differences across surgical groups (P = 0.114). Dysphagia per the DIGESTv2 was present in 83% (25/30) of patients, with severe dysphagia in 23% (7/30). MBSImP assessment revealed reduced tongue base retraction (82%), pharyngeal residue (100%) and impaired neo-esophageal clearance (100%). Predictors of aspiration were: pre-operative abnormal FOIS (score < 7) (OR = 7.00, 95%CI 1.2-38.4; P = 0.024), and > 65 years (OR = 7.80, 95%CI 1.47-41.6; P = 0.016). Predictors for oropharyngeal dysphagia were: abnormal pre-operative FOIS (score < 7) (OR = 7.42, 95%CI 1.22-45.45; P = 0.029); age > 65 years (OR = 11.00, 95%CI 1.99-58.8; P = 0.006) and neoadjuvant treatment (OR = 7.20, 95%CI 1.08-47.96, P = 0.041).
Conclusion: Oropharyngeal dysphagia and aspiration are prevalent in the early period after esophageal cancer surgery. These data should inform an increased input from speech and language specialists in the assessment and management of post-operative patients, and overall caution in the implementation and progression of early per orum intake.
Why you should read this article:
There are no current protocols or guidelines for Speech and Language Therapists to assess patients following curative oesophagectomy. There is limited data, of which is low volume, poor methodology examining oropharyngeal dysphagia and aspiration following oesophageal resection to date. Our research findings is new data which highlights the prevalence, nature and severity across different surgical approaches. Our findings will add to the oesophageal cancer research and establishes a role for the Speech and Language Therapist in regards assessment and management of care within the acute post-operative setting.
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Geriatrics
A systematic review on dysphagia treatments for persons living with dementia
Authors:
Chan, Charis Tsz Wun Chan, Ms
Wu, Tsz Yin, Mr
Cheng, Ivy, Dr
Abstract:
Purpose
Dysphagia in persons living with dementia (PLWD) is raising concern due to the absence of swallowing treatments specific to this population. Dysphagia can result in detrimental effects, such as malnutrition, dehydration, and aspiration pneumonia. This systematic review aimed to evaluate the existing literature on dysphagia management of PLWD and reveal their limitations to facilitate clinical practitioners in decision-making.
Methods
Five electronic databases were searched systematically from the date of inception to January 2024 by two independent reviewers. Eligible studies investigated any treatments with outcome measurements evaluating swallowing function. Qualitative analyses were performed.
Results
A total of 10 studies, involving 1360 participants, were included in the systematic review. They were analyzed qualitatively and evaluated for quality. Studies included were observational (n = 5) with prospective or retrospective designs, and randomized controlled trials (n = 5). Compensatory, rehabilitative, stimulation, and pharmacological treatments were addressed.
Conclusion
There is currently limited evidence available revealing the efficacy of dysphagia treatments for PLWD. Based on the current evidence, no definitive conclusions can be drawn on which treatments are more effective for this population. In the future, more randomized controlled trials with large sample sizes investigating the long-term effects of treatments are warranted.
Why you should read this article:
1. This is one of the few systematic review in the literature with a focus on efficacy of dysphagia treatments for persons living with dementia (PLWD)
2. The evidence on the efficacy of dysphagia treatments for PLWD remains limited, predominantly consisting of studies with high heterogeneity in methodology and sample populations.
3. There is an urgent need for systematic investigations through randomized controlled trials on the clinical efficacy of dysphagia treatments for PLWD.
4. Future research should focus on the roles of caregivers and interdisicplinary mangement team in supporting swallowing in PLWD.
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Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults
Authors:
Bendix Labeit, Paul Muhle, Jonas von Itter, Janna Slavik, Andreas Wollbrink, Peter Sporns, Thilo Rusche, Tobias Ruck, Anna Hüsing-Kabar, Reinhold Gellner, Joachim Gross, Rainer Wirth, Inga Claus, Tobias Warnecke, Rainer Dziewas, Sonja Suntrup-Krueger
Abstract:
Background: "Presbyphagia" refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity.
Materials and methods: 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule.
Results: 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model.
Conclusions: Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
Why you should read this article:
In this article, we provide a analysis of age-related swallowing abnormalities (presbyphagia). We thoroughly examine various clinical and biological determinants. Additionally, we investigate the neuronal compensation mechanisms within the swallowing network as a consequence of presbyphagia. Moreover, we engage in a discussion regarding the presbyphagia model as a whole.
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Cognitive decline limits compensatory resource allocation within the aged swallowing network
Authors:
Suntrup-Krueger, Sonja, Prof. Dr.
Muhle, Paul, PD Dr.
Slavik, Janna
von Itter, Jonas
Wollbrink, Andreas
Wirth, Rainer, Prof. Dr.
Warnecke, Tobias, Prof. Dr.
Dziewas, Rainer, Prof. Dr.
Gross, Joachim, Prof. Dr.
Meuth, Sven G., Prof. Dr.
Labeit, Bendix, PD Dr.
Full Citation:
Suntrup-Krueger S, Muhle P, Slavik J, von Itter J, Wollbrink A, Wirth R, Warnecke T, Dziewas R, Gross J, Meuth SG, Labeit B. Cognitive decline limits compensatory resource allocation within the aged swallowing network. Geroscience . 2025 Apr 9. doi: 10.1007/s11357-025-01649-y.
Abstract:
Cognitive decline has been postulated to predispose to presbyphagia but the neurophysiological basis of this interaction is unclear.
To investigate the role of cognition for compensatory resource allocation within the swallowing network and behavioral swallowing performance in dual-task cognitive and motor interference in ageing, volunteers ≥ 70 years of age without preexisting diseases causing dysphagia were investigated using Flexible Endoscopic Evaluation of Swallowing (FEES) including a cognitive and motor dual-task paradigm and a Montreal Cognitive Assessment. The neural correlates of swallowing during dual-task were characterized using magnetoencephalography. Results were related to cognitive function. Sixty-three participants (77.7 ± 6.1 years) underwent FEES, of which 40 additionally underwent MEG.
Both cognitive and motor dual-tasks interfered with swallowing function resulting in an increase in pharyngeal residue and premature bolus spillage. The extent of swallowing deterioration ("dual-task cost") was associated with cognitive decline (cognitive dual-task: Spearman's rho = - 0.39, p = 0.002; motor dual-task: Spearman's rho = - 0.25, p = 0.046).
When challenged with dual-tasking participants with regular cognition showed compensatory stronger and broader brain activation in cortical pre- and supplementary motor planning areas as well as in frontal executive regions within the cortical swallowing network (p = 0.004) compared to participants with cognitive deficits. They also performed better in the competing cognitive and motor dual-task and showed fewer incorrect responses (p = 0.028).
Oropharyngeal swallowing involves cognitive cortical processing. Cognitive decline seems to limit the capacity for compensatory resource allocation within the swallowing network. This may lead to deterioration in both swallowing function and concurrent cognitive-motor performance in challenging dual-task situations.
Why you should read this article:
This article provides compelling evidence that oropharyngeal swallowing is not merely a reflexive motor act but is significantly influenced by cognitive function, especially in older adults. Through a combination of flexible endoscopic swallowing assessment and magnetoencephalography, the study demonstrates how cognitive decline limits the brain’s ability to compensate during multitasking, leading to impaired swallowing performance. These findings have important clinical implications for the management of presbyphagia, particularly in the context of dementia, Parkinson’s disease, and other age-related cognitive disorders. If you are a clinician, researcher, or healthcare professional interested in neurogeriatric care, dysphagia, or the intersection of cognition and motor function, this article offers novel insights into the aging brain’s capacity for functional compensation.
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Comparison of Simultaneous Swallowing Endoscopy and Videofluoroscopy in Neurogenic Dysphagia
Authors:
Bendix Labeit, Sigrid Ahring, Maik Boehmer, Peter Sporns, Sonja Sauer, Inga Claus, Malte Roderigo, Sonja Suntrup-Krueger, Rainer Dziewas, Tobias Warnecke, Paul Muhle
Abstract:
Objective: In the evaluation of oropharyngeal dysphagia, instrumental procedures, for example, flexible endoscopic evaluation of swallowing or videofluoroscopic swallowing study, are essential to improve diagnostic accuracy for salient findings such as penetration, aspiration, or pharyngeal residue. To date, it is unclear which of the 2 methods represents the diagnostic gold standard. The aim of this study, therefore, was to compare videofluoroscopy and swallowing endoscopy during a simultaneous swallowing examination in a large cohort of patients with oropharyngeal dysphagia.
Designs: Prospective observational study.
Setting and participants: In this study, 49 patients with oropharyngeal dysphagia (mean age 70.0 ± 10.8 years) were evaluated using simultaneous swallowing endoscopy and videofluoroscopy. Furthermore, the effect of narrow-band imaging in swallowing endoscopy on the assessment of penetration and aspiration was investigated in a subgroup of 19 patients.
Measures: The Penetration-Aspiration Scale and the Yale Pharyngeal Residue Severity Rating Scale were rated independently based on both modalities.
Results: Both modalities showed a high correlation between penetration, aspiration, and pharyngeal residue. Causes for a higher score on the Penetration-Aspiration Scale in videofluoroscopy were intradeglutitive events that were not visible in swallowing endoscopy or false-positive events because of the loss of the lateral dimension in videofluoroscopy. A typical reason for a higher score on this scale in swallowing endoscopy was the better visualization of the anatomical structures. Narrow-band imaging in swallowing endoscopy resulted in a higher score on the Penetration-Aspiration Scale for liquids and semisolids in individual cases, although overall there was no statistically significant difference between scores using white light or narrow-band imaging.
Conclusions and implications: Videofluoroscopy and swallowing endoscopy may equally be considered as a diagnostic gold standard for oropharyngeal dysphagia regarding penetration, aspiration, and pharyngeal residue. Narrow-band imaging may increase the sensitivity for penetration and aspiration in individual cases.
Why you should read this article:
This study conducted a simultaneous investigation comparing FEES and VFSS, providing valuable insights on diagnostic parameters for significant dysphagia pathologies. Furthermore, it sheds light on the underlying reasons for disparities in diagnostics. For anyone with an interest in instrumental swallowing diagnostics, this article holds particular relevance.
How to access this article:
https://www.sciencedirect.com/science/article/pii/S1525861021008628?via%3Dihub
Glucose interaction with thickeners used in dysphagy oropharyngeal control
Authors:
Universitat Politècnica de Catalunya (UPC). Departamento de Ingeniería agroalimentaria y Biotecnología (DEAB). Programa de Doctorado en Tecnología
Agroalimentaria y Biotecnología. + 3 Articulos . Barcelona juliol 2017. Spain
María Luisa García González. 1a , Josep García Raurich 2a ,Mercè Raventós Santamaría. , Mercè Alba Mora 4a
Abstract:
Abstract
Dysphagia is defined as a swallowing disorder characterized by a difficulty in
the alimentary bolus preparation or in food displacement from the mouth to
the stomach. It is the fourth cause of death in adults and it is identified as a
malnutrition agent. Food destined to individuals with dysphagia is prepared
with products which modify their viscosity to make them safer to swallow. The
Bromatología
Interacción de la glucosa con espesantes
utilizados en el control de la disfagia
orofaríngea
Glucose interaction with thickeners used in dysphagy
oropharyngeal control
Interação da glicose com espessantes utilizados no
controle da disfagia orofaríngea
` María Luisa García González1a, Josep García Raurich2a;
Mercè Raventós Santamaría3b, Silvia Marceló Moros4a
1 Doctor Universitat Politècnica de Catalunya.
2 Doctor en Ciencias Químicas.
3 Doctora Ingeniera Agrónoma.
4 Graduada en Ingeniería Química.
Centre de Recerca en Seguretat i Control Alimentari de la UPC (CRESCA - C/Colom 1, 08222 Terrassa. Barcelona, España.
Departamento de Ingeniería Agroalimentaria y Biotecnología (Universidad Politécnica de Cataluña) C/ Esteve Terrades 8, 08860 Castelldefels. Barcelona, España.
Dysphagia is defined as a swallowing disorder characterized by a difficulty in
the alimentary bolus preparation or in food displacement from the mouth to
the stomach. It is the fourth cause of death in adults and it is identified as a
malnutrition agent. Food destined to individuals with dysphagia is prepared
with products which modify their viscosity to make them safer to swallow. Thepresent job tries to establish an interaction between glucose and three commercial thickeners of vegetal origin (two from starch and a third one made from a mix of maltodextrin, xanthan gum and guar gum in order to identify the most suitable one to be used in diets of patients with oropharyngeal dysphagia on the tested conditions. The stability degree in concordance with the time relation (0-24 hours) and its performance on the gap temperature between 25 and 50 oC is determined. Tests have been done with thickener concentrations up to a maximum of 6% in combination with 5 glucose concentration up to a maximum of 27%. The common interaction of xanthan gum, guar gum and maltodextrin with glucose is found. Those thickeners potentially suitable to regulate the consistency degree of food products destined to the nour-
ishment of patients with oropharyngeal dysphagia show a slow hydration process which is also aggravated by the glucose interaction.
Keywords: dysphagia * thickener * viscosity * starch * gum * glucose
Why you should read this article:
This doctoral thesis is based on professional experience with patients with oropharyngeal dysphagia. This clinical syndrome, which is highly prevalent in the health and social environment, with very diverse etiologies is systematically underdiagnosed and poorly treated. This leads to unacceptable morbidity rates. The experience acquired with treated patients, conclude in an epidemiological study that allows conclusions to be drawn.
The need for a protocol aimed at the evaluation of risk swallowing, oropharyngeal dysphagia, was detected.
Taking into account the food thickeners and gelatins commonly used to mix with water and food, it was proposed to initiate a laboratory investigation to determine if what was widely done in hospitals, nursing homes, schools and homes was correct or not. This study was carried out at the Universitat Politècnica de Catalunya (UPC), using the usual thickeners and a type of gelatine commonly used. This study aimed to check whether certain products recommended for use in diets for people affected by dysphagia adequately fulfill
the functions for which they have been designed and manufactured, whether they are pharmaceuticals or simply food additives.
The results obtained confirm that the so-called second-range thickeners, mainly
composed of gums (xanthan, guar ...), are safer from the point of view of health than the first range, consisting mainly of starch, modified or not. Significant differences were observed in relation to the resting time of the sample and the percentage of thickener applied to obtain sanitary consistencies: fine liquid, nectar, honey and pudding.
Specifically, a 6% thickener of the 1st range is required to achieve the highest consistency, while this value is only 2% in the 2nd range thickener.
Key words: deglutition, thickener, viscosity, starch, gum, glucose.
How to access this article:
https://7b2ee5dc-0810-4214-a0b6-c79b7147be89.filesusr.com/ugd/4feb34_2e4a2619261943b2a0a2548d828d8139.pdf
Oropharyngeal dysphagia: a narrative review towards an integrated neurogeriatric perspective
Authors:
Labeit B, Lapa S, Lueg G, Joebges R, Hofacker J, Muhle P, Suntrup-Krueger S, Werner CJ, Schreiber S, Wirth R, Warnecke T, Dziewas R, Meuth SG.
Full Citation:
Oropharyngeal dysphagia: a narrative review towards an integrated neurogeriatric perspective. Labeit B, Lapa S, Lueg G, Joebges R, Hofacker J, Muhle P, Suntrup-Krueger S, Werner CJ, Schreiber S, Wirth R, Warnecke T, Dziewas R, Meuth SG. Lancet Healthy Longev. 2025 Dec 2:100794. doi: 10.1016/j.lanhl.2025.100794.
Abstract:
Oropharyngeal dysphagia, prevalent in neurogeriatric populations, increases the risks of malnutrition, pneumonia, and mortality. Oropharyngeal dysphagia manifests as a multi-aetiological syndrome with diverse phenotypes. We advocate for a neurogeriatric perspective that integrates specific neurological insights with geriatric care principles to improve dysphagia management. This approach highlights the diagnostic value of disease-specific neurological dysphagia manifestations and recognises the condition as a potential target for neurological therapies, as shown by the benefits that acetylcholinesterase inhibitors in myasthenia gravis and dopaminergic agents in Parkinson's disease have against the syndrome.
Age-related factors such as presbyphagia, which includes reduced pharyngeal sensation, sarcopenia, and decreased neuroplasticity, further contribute to the pathophysiology of oropharyngeal dysphagia. Cross-disease treatment strategies encompass oral hygiene, nutritional support, dietary modifications, individualised interventions to improve swallowing physiology, and emerging neurostimulation techniques that are currently under investigation.
Current research aims to refine assessment protocols tailored to these interventions, identify outcome predictors to contextualise dysphagia findings, and evaluate the potential of neurostimulation or pharmacological agents, with the aim to improve quality of life and reduce mortality.
Why you should read this article:
This article is worth reading because it reframes oropharyngeal dysphagia as a neurogeriatric syndrome, showing how swallowing disorders in older adults are not just complications, but key diagnostic and therapeutic targets in neurological disease. It integrates cutting-edge neurological insights with geriatric care, explains why dysphagia phenotypes matter for accurate diagnosis and personalised treatment, and highlights emerging therapies—from disease-specific medications to neurostimulation—that can improve outcomes.
By connecting dysphagia to malnutrition, pneumonia, frailty, and mortality, the review offers clinicians and researchers a practical, interdisciplinary framework to improve quality of life and survival in neurogeriatric patients.
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Viscosidad en la dieta de pacientes diagnosticados de disfagia orofaríngea.
Authors:
Universitat Politècnica de Catalunya (UPC). Departamento de Ingeniería agroalimentaria y Biotecnología (DEAB). Programa de Doctorado en Tecnología
Agroalimentaria y Biotecnología. + 3 Articulos . Barcelona juliol 2017. Spain
María Luisa García González. 1a , Josep García Raurich 2a ,Mercè Raventós Santamaría. , Mercè Alba Mora 4a
Abstract:
Summary Acta Bioquím Clín Latinoam 2016
Oropharyngeal dysphagia is present in a large part of the population and
described as a symptom that may affect the formation and handling of the
patient’s own bolus food when transferred into the stomach. Although it is a
very prevalent symptom that can occur at any time of life, it is at senior age
when this symptom is more common. In order to prevent the consequences
that can result in this physiological alteration, food for people who suffer from
this disorder is prepared with products that modify their viscosity, so that it
follows the normal course of swallowing and later digestion. This study aims at
verifying whether certain products recommended for use with
people affected by dysphagia diets properly meet the functions for which they have been designed and pro-duced, regardless of
whether they are pharmaceutical products or, simply, food additives. The results indicate that corn starch presents a different
behaviour from potato, the type of water used being very important. Signif-icant differences related to the dwell time of rest from
the sample and the percentage of thickener applied to achieve the valued health consistencies of thin liquid, nectar, honey and
pudding were detected.
Key words: starch * thickener * viscosity * water * dysphagia
Why you should read this article:
This doctoral thesis is based on professional experience with patients with oropharyngeal dysphagia. This clinical syndrome, which is highly prevalent in the health and social environment, with very diverse etiologies is systematically underdiagnosed and poorly treated. This leads to unacceptable morbidity rates. The experience acquired with treated patients, conclude in an epidemiological study that allows conclusions to be drawn.
The need for a protocol aimed at the evaluation of risk swallowing, oropharyngeal dysphagia, was detected.
Taking into account the food thickeners and gelatins commonly used to mix with water and food, it was proposed to initiate a laboratory investigation to determine if what was widely done in hospitals, nursing homes, schools and homes was correct or not. This study was carried out at the Universitat Politècnica de Catalunya (UPC), using the usual thickeners and a type of gelatine commonly used. This study aimed to check whether certain products recommended for use in diets for people affected by dysphagia adequately fulfill
the functions for which they have been designed and manufactured, whether they are pharmaceuticals or simply food additives.
The results obtained confirm that the so-called second-range thickeners, mainly
composed of gums (xanthan, guar ...), are safer from the point of view of health than the first range, consisting mainly of starch, modified or not. Significant differences were observed in relation to the resting time of the sample and the percentage of thickener applied to obtain sanitary consistencies: fine liquid, nectar, honey and pudding.
Specifically, a 6% thickener of the 1st range is required to achieve the highest consistency, while this value is only 2% in the 2nd range thickener.
Key words: deglutition, thickener, viscosity, starch, gum, glucose.
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Head-and-Neck Cancer
A new computed tomography-based approach to quantify swallowing muscle volume by measuring tongue muscle area in a single slice
Authors:
Javier Hurtado-Oliva, Aniek T Zwart, Jeroen Vister, Anouk van der Hoorn, Roel J H M Steenbakkers, Inge Wegner, Gyorgy B Halmos
Full Citation:
Hurtado-Oliva, J., Zwart, A. T., Vister, J., van der Hoorn, A., Steenbakkers, R. J. H. M., Wegner, I., & Halmos, G. B. (2024). A new computed tomography-based approach to quantify swallowing muscle volume by measuring tongue muscle area in a single slice. Journal of cachexia, sarcopenia and muscle, 15(5), 1858–1868.
Abstract:
Background: Measuring the swallowing muscle mass with volume measurements is complex and time intensive; therefore, it is not used in clinical practice. However, it can be clinically relevant, for instance, in the case of sarcopenic dysphagia. The aim of the study was to develop a feasible and clinically applicable method to measure swallowing muscle mass.
Methods: Data from 10 head and neck cancer patients were collected from the Oncological Life Study data-biobank of the University Medical Center Groningen. The pharyngeal constrictor, genioglossus, mylohyoid and geniohyoid complex muscles, as well as the tongue complex muscles, were delineated manually on routinely performed head and neck computed tomography scans. Axial and sagittal planes were used for volume and area measurements, respectively. Muscle density measurements were performed with and without Hounsfield unit thresholding. Correlations were assessed by Pearson correlation coefficients, and interobserver reliability was measured using intra-class correlation coefficients (ICCs).
Results: Significant differences were observed between sagittal area measurements with and without Hounsfield unit thresholds for pharyngeal constrictor, tongue complex and the sum of the swallowing muscles (t > 6; P-value < 0.001). Stronger correlations emerged without Hounsfield unit thresholding. Strong positive and significant correlations were found between the total swallowing muscle mass volume and the sagittal area of the tongue complex muscles (r = 0.87, P-value < 0.05) and the sum of the sagittal areas of the pharyngeal constrictor and tongue complex muscles (r = 0.85, P-value < 0.05). The use of the Hounsfield unit threshold weakened correlations. Interobserver reliability was assessed and found to be fair to good for the pharyngeal constrictor muscle (ICC = 0.68, P-value < 0.05), excellent for the tongue complex muscles (ICC = 0.98, P-value < 0.05) and excellent for the total swallowing muscle area (ICC = 0.96, P-value < 0.05).
Conclusions: Single-slice delineation of the sagittal area of tongue complex muscle and pharyngeal constrictor muscle is a promising, fast, simple and clinically applicable method for measuring the total volume of the swallowing muscle mass in head and neck cancer patients without Hounsfield unit thresholding. These advancements and findings would help in the early and accurate diagnosis of definitive sarcopenic dysphagia.
Why you should read this article:
This study offers a practical and innovative method to measure swallowing muscle mass using a single CT slice. It simplifies a process that is usually complex and time-consuming, making it more suitable for clinical use. The method shows strong correlations with full muscle volume and excellent reliability between observers. It opens new possibilities for identifying sarcopenic dysphagia early in head and neck cancer patients. While further validation is needed, this approach is a promising step toward more accessible and clinically relevant assessment of swallowing muscles.
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Home-based intensive treatment of chronic radiation-associated dysphagia in head and neck cancer survivors (HIT-CRAD trial)
Authors:
Hanne Massonet
Ann Goeleven
Leen Van den Steen
Alice Vergauwen
Margot Baudelet
Gilles Van Haesendonck
Olivier Vanderveken
Heleen Bollen
Lisette van der Molen
Fréderic Duprez
Peter Tomassen
Sandra Nuyts
Gwen Van Nuffelen
Abstract:
Background: Chronic radiation-associated dysphagia (C-RAD) is considered to be one of the most severe functional impairments in head and neck cancer survivors treated with radiation (RT) or chemoradiation (CRT). Given the major impact of these late toxicities on patients’ health and quality of life, there is a strong need for evidence-based dysphagia management. Although studies report the benefit of strengthening exercises, transference of changes in muscle strength to changes in swallowing function often remains limited. Therefore, combining isolated strengthening exercises with functional training in patients with C-RAD may lead to greater functional gains.
- Methods: This 3-arm multicenter randomized trial aims to compare the efficacy and possible detraining effects of mere strengthening exercises (group 1) with a combination of strengthening exercises and functional swallowing therapy (group 2) and non-invasive brain stimulation added to that combination (group 3) in 105 patients with C-RAD. Patients will be evaluated before and during therapy and 4 weeks after the last therapy session by means of swallowing-related and strength measures and quality of life questionnaires.
- Discussion: Overall, this innovative RCT is expected to provide new insights into the rehabilitation of C-RAD to optimize post-treatment swallowing function.
How to access this article:
Impact of Frailty on Post-Treatment Dysphagia in Patients with Head and Neck Cancer
Authors:
Javier Hurtado-Oliva, Hans Paul van der Laan, Julius de Vries, Roel J H M Steenbakkers, Gyorgy B Halmos, Inge Wegner
Full Citation:
Hurtado-Oliva, J., van der Laan, H. P., de Vries, J., Steenbakkers, R. J. H. M., Halmos, G. B., & Wegner, I. (2025). Impact of Frailty on Post-Treatment Dysphagia in Patients with Head and Neck Cancer. Dysphagia, 40(3), 563–575.
Abstract:
In the rising and frail head and neck cancer (HNC) population, geriatric assessments are crucial. Frail HNC patients often experience dysphagia. The coexistence of dysphagia and frailty presents complex health challenges, however, there is limited evidence on the prognostic value of frailty on post-treatment dysphagia. This study explores the relationship between pre-treatment frailty status and post-treatment dysphagia in HNC patients.
A retrospective data analysis from the OncoLifeS data-biobank at the University Medical Center Groningen of 242 patients diagnosed with HNC between 2014 and 2016. The study involved several physical, functional and psychological pre-treatment geriatric assessments, and frailty screening using the Groningen Frailty Indicator (GFI) and the Geriatric-8 screening tool (G8). Outcome measures were swallowing-related quality of life (HNSW-QoL) and toxicity-related dysphagia evaluations (CTCAE-D) at 3, 6, 12 and 24 months. Linear mixed-effects models assessed factors associated with HNSW-QoL and CTCAE-D. Frail patients consistently reported worse HNSW-QoL and CTCAE-D than non-frail patients over time, with symptoms increasing at 3 months, but gradually decreasing by 24 months.
Frailty status (G8 or GFI) was a significant predictor for lower HNSW-QoL (β = 11.770 and 10.936, both p < 0.001), and lower CTCAE-D (β = 0.245, p = 0.058; β = 0.331, p = 0.019), respectively. In this study, frailty was found to be associated with a worse of swallowing-related quality of life, and with increased toxicity-related dysphagia.
These findings provide insights for the identification of HNC patients at higher risk of post-treatment swallowing-related issues, and offer opportunities for optimizing their post-treatment swallowing outcomes.
Why you should read this article:
This study highlights frailty as a key predictor of post-treatment dysphagia in head and neck cancer patients, emphasizing its relevance across the continuum of care. By linking pre-treatment frailty with long-term swallowing outcomes, it offers valuable insights for early risk identification and tailored intervention. The findings are relevant not only for oncologists and speech-language pathologists, but also for geriatricians and other healthcare professionals involved in multidisciplinary cancer care. Understanding the impact of frailty can help improve patient-centered strategies and long-term functional outcomes.
How to access this article:
https://link.springer.com/article/10.1007/s00455-024-10754-7
Intensive swallowing rehabilitation for Head and Neck Cancer survivors with chronic dysphagia: outcomes from a prospective multicentre cohort study with 6-month follow-up
Authors:
Oldenbeuving, JI, MA
van der Molen, L, PhD
Groothuis, JT, MD PhD
Kalf, JG, PhD
Full Citation:
Oldenbeuving, J. I., van der Molen, L., Groothuis, J. T., & Kalf, J. G. (2026). Intensive Swallowing Rehabilitation for Head and Neck Cancer Survivors With Chronic Dysphagia: Outcomes From a Prospective Multicentre Cohort Study With 6-Month Follow-Up. Head Neck. https://doi.org/10.1002/hed.70271
Abstract:
Background:
Chronic dysphagia persists in some head and neck cancer (HNC) survivors despite preventive exercises, negatively impacting quality of life. Evidence for effective rehabilitation strategies remains limited.
Methods:
This prospective cohort study included 34 HNC survivors (≥1 year post-treatment) who completed a three-week intensive swallowing rehabilitation (ISR) program (15 sessions, 60 min/day). Outcomes were measured at baseline (T0), post-treatment (T1), and six-month follow-up (T2) using patient-rated (VAS, MDADI, PSS-HN), clinician-rated (food level, AUS-TOM), and objective swallowing outcomes (MSS, MSV, TOMASS).
Results:
ISR was feasible and safe (92% completion, no adverse events). Patient-rated and most clinician-rated outcomes improved significantly post-ISR and remained stable at six months (VAS: p<0.001; PSS-HN: p<0.001; food level: p=0.002). MDADI and AUS-TOM for solids further improved at follow-up. Objective swallowing tests showed no clinically relevant change.
Conclusions:
ISR effectively improves normalcy of diet and quality of life in HNC survivors with chronic dysphagia, with benefits sustained at six months.
Why you should read this article:
Chronic dysphagia remains a significant challenge for a subgroup of head and neck cancer (HNC) survivors, often persisting years after treatment and profoundly affecting eating, social participation and quality of life. While several rehabilitation approaches exist, evidence for effective treatment in the chronic phase is limited, particularly regarding improvements in normalcy of diet, the aspect of dysphagia that patients themselves report as most problematic. In this prospective multicentre study, we evaluated a 3-week intensive swallowing rehabilitation (ISR) program tailored to HNC survivors with chronic dysphagia. ISR resulted in significant improvements in swallowing-related quality of life and normalcy of diet, with benefits that maintained or further enhanced at six-month follow-up. Importantly, participants were a median of four years post-treatment, suggesting that it is never too late to initiate such an intervention. By focusing on outcomes that matter most to patients and demonstrating benefit in a population that is traditionally considered difficult to rehabilitate, this work has the potential to influence clinical practice and reshape expectations for long-term dysphagia recovery.
How to access this article:
https://link.springer.com/article/10.1007/s00455-024-10754-7
Self-perception of oropharyngeal cancer patients regarding the impacts of chemoradiotherapy treatments on swallowing and voice functions
Authors:
Daniela Vieira, PhD
Sérgio Barreira, PhD
Mário Dinis-Ribeiro, PhD
Eurico Monteiro, PhD
Full Citation:
Vieira, D., Barreira, S., Dinis-Ribeiro, M., Monteiro, E. (2025). Self-perception of oropharyngeal cancer patients regarding the impacts of chemoradiotherapy treatments on swallowing and voice functions, Revista de Logopedia, Foniatría y Audiología. Volume 45, Issue 2, doi.org/10.1016/j.rlfa.2025.100518.
Abstract:
Objective
Understanding the effects of chemoradiotherapy (CRT) on the swallowing and voice functions of oropharyngeal cancer patients based on their reported perceptions, and how these are related to clinical and sociodemographic variables.
Methods
Thirty-eight oropharyngeal cancer patients treated exclusively with CRT were included. Patients’ perceptions were assessed using the EORTC QLQ-C30, H&N43, VHI-9i, and SWAL-QOL questionnaires. Descriptive, correlational, and inferential analyses were performed.
Results
The results from the QLQ-H&N43, SWAL-QOL, and VHI-9i revealed the existence of functional changes after CRT treatments that agreed with the results of clinical evaluations. Patients’ perceptions were associated with clinical variables such as FOIS, feeding route, solid-food consistency, and liquid consistency. Having undergone tracheostomy or having dysphagia or dysphonia was associated with poorer QLQ-C30, QLQ-H&N43, SWAL-QOL, and VHI-9i scores. In contrast, having undergone speech therapy was associated with having a better QoL as assessed by the QLQ-C30, QLQ-H&N43, and SWAL-QOL. Statistical analysis revealed correlations between scores from the QLQ-H&N43, SWAL-QOL, and VHI-9i, and scores from the QLQ-C30 with QLQ-H&N43 and SWAL-QOL. Statistically significant associations were found between the questionnaires scores and some sociodemographic variables (age, sex, and educational level).
Conclusion
Scores from generic QoL and specific symptom questionnaires were correlated with swallowing and voice function in oropharyngeal cancer patients. In cases with unfavourable scores, patients could benefit from early referral for the assessment of swallowing and voice functions to improve their QoL. The results of this study further indicate that there are certain clinical characteristics that, when present, should initiate this same course of action.
Why you should read this article:
This article provides a patient-centred perspective on the functional consequences of chemoradiotherapy in individuals with oropharyngeal cancer, focusing on swallowing and voice outcomes. By integrating patient-reported outcome measures with clinical and sociodemographic variables, it offers robust evidence that patients’ self-perceptions closely reflect clinically relevant impairments. The study highlights the significant impact of dysphagia and dysphonia on quality of life and demonstrates the positive association between speech therapy and better patient-reported outcomes. Its findings reinforce the clinical value of routinely incorporating patient-reported measures into oncological follow-up and support early referral to speech and language therapy as a key component of multidisciplinary cancer care. This work is particularly relevant for clinicians, researchers, and decision-makers seeking to improve functional outcomes and quality of life in head and neck cancer survivors.
How to access this article:
Request by email to: dvieira@ufp.edu.pt
The impact of dysphagia prehabilitation on swallowing outcomes post-chemoradiation therapy in head and neck cancer: A systematic review
Authors:
Rhona Brady, Laura McSharry, Susan Lawson, Julie Regan
Full Citation:
Brady, R., McSharry, L., Lawson, S., & Regan, J. (2022). The impact of dysphagia prehabilitation on swallowing outcomes post‐chemoradiation therapy in head and neck cancer: a systematic review. European Journal of Cancer Care, 31(3), e13549
Abstract:
Introducation: This study aimed to summarise research findings on dysphagia prehabilitation initiated before chemoradiation therapy (C)RT in head and neck cancer (HNC) including its impact on three swallowrelated outcomes at distinct time points.
Methods: A comprehensive search was completed in PubMed, Embase, Web of Science and CINAHL. Inclusion criteria were studies of adults with HNC with an exercise-based prehabilitation programme beginning before (C)RT. Methodological quality was rated using the Downs and Black checklist. The Template for Intervention Descriptions and Replication (TIDieR) checklist was used to evaluate how well studies were reported.
Results: Eight studies (three randomised control trials) involving 295 adults with HNC were included. The largest participant group (63%) were Stage III/IV head and neck squamous cell carcinoma (HNSCC). Prehabilitation was completed independently at home (100%) and typically began 2 weeks before CRT (75%). Studies evaluated the impact of dysphagia prehabilitation across functional (n = 6), quality of life (n = 5) and physiological (n = 4) domains. Prehabilitation significantly altered physiological (25%), functional (66%) and quality of life (50%) outcomes. Fifty per cent of studies included long-term (>1 year) outcomes. 1Quality of included studies ranged from poor (25%) to good (38%). Six (75%) studies reported sufficient details of exercise programmes.
Conclusion: Limited evidence supports exercise-based dysphagia prehabilitation before (C)RT to improve swallowrelated outcomes, and long-term benefits remain unclear. Further high-quality research using core outcome sets is required.
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Unveiling the relation between swallowing muscle mass and skeletal muscle mass in head and neck cancer patients
Authors:
Javier Hurtado-Oliva, Lucy Núñez-Miranda, Aniek T Zwart, Jeroen Vister, Boudewijn E C Plaat, Roel J H M Steenbakkers, Anouk van der Hoorn, Inge Wegner, Gyorgy B Halmos
Full Citation:
Hurtado-Oliva, J., Núñez-Miranda, L., Zwart, A. T., Vister, J., Plaat, B. E. C., Steenbakkers, R. J. H. M., van der Hoorn, A., Wegner, I., & Halmos, G. B. (2025). Unveiling the relation between swallowing muscle mass and skeletal muscle mass in head and neck cancer patients. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 282(6), 3173–3182.
Abstract:
Purpose: Sarcopenia, characterized by loss of skeletal muscle mass (SMM) and strength, often leads to dysphagia in the elderly. This condition can also worsen treatment outcomes in head and neck cancer (HNC) patients, who are susceptible to swallowing difficulties. This study aimed to establish the correlation between swallowing muscle mass (SwMM) and SMM in HNC patients.
Methods: Data from 157 HNC patients in the OncoLifeS biobank of the University Medical Center Groningen were analyzed using pre-treatment neck CT scans. The SwMM was assessed by the cross-sectional area (CSA) of the tongue complex muscles (TCM), and SMM was indicated by the skeletal muscle index (SMI), calculated from corrected CSA at the third lumbar vertebra (L3). Correlations between SwMM and SMM were analyzed using Pearson or Spearman tests, and multivariable linear regression with SMI as dependent variable was performed.
Results: SwMM was moderately correlated with SMI (r = 0.600, p < 0.001), CSA at C3 (r = 0.538, p < 0.001), and CSA at L3 (r = 0.651, p < 0.001). The CSA at C3 strongly correlated with SMI (r = 0.871, p < 0.001). In multivariable regression analysis, age, sex, and weight were strong predictors of SMI, while the TCM area was a less robust predictor (p = 0.059). Models with CSA at C3 and L3 showed all variables as significant predictors (p < 0.001).
Conclusions: Although SwMM was significantly correlated with SMI and holds clinical utility, it is not strong enough to be considered interchangeably with C3 for predicting SMI, suggesting that swallowing muscles represent a different entity than skeletal muscles and not reflect accurately the general muscle mass.
Why you should read this article:
This study highlights frailty as a key predictor of post-treatment dysphagia in head and neck cancer patients, emphasizing its relevance across the continuum of care. By linking pre-treatment frailty with long-term swallowing outcomes, it offers valuable insights for early risk identification and tailored intervention. The findings are relevant not only for oncologists and speech-language pathologists, but also for geriatricians and other healthcare professionals involved in multidisciplinary cancer care. Understanding the impact of frailty can help improve patient-centered strategies and long-term functional outcomes.
How to access this article:
https://link.springer.com/article/10.1007/s00405-025-09207-0
Intensive Care
Geographical inequities in access to speech and language therapy critical care services in UK
Authors:
Kelly, Eileen; Wallace, Sarah; Puthucheary, Zudin.
Full Citation:
Kelly, E; Wallace, S; Puthucheary, Z. Geographical inequities in access to speech and language therapy critical care services in UK. The Lancet Respiratory Medicine, Volume 11, Issue 10, e85 - e86
Abstract:
41–80% of patients experience dysphagia or dysphonia in critical care. When left undiagnosed, this can lead to symptomatic aspiration, reintubation, increased morbidity, and increased length of hospital stay. SLT-led treatments enable early return of voice and oral intake, supporting humanisation of care, improved mood, nutrition, and quality of life. Workforce challenges are not unique to SLTs; however, they are perhaps among the starkest. Using data obtained from the Intensive Care National Audit and Research Centre, we estimated that 4,717 ICU beds are available across the UK. National intensive care standards require a SLT to patient ratio of one SLT to ten patients, the current provision is estimated at one SLT to 157 patients. We examined UK staffing data acquired by Freedom of Information Requests to National Health Service (NHS) England, Scotland, Wales, and Northern Ireland and the Health and Care Professionals Council. Geographical inequality in SLT service provision is evident across the UK. We compared these inequalities with the index of multiple deprivation, and found that in the top ten most deprived areas, the SLT to population ratio averaged one SLT to 7841 individuals; 30% of these areas have a ratio of one SLT to 10,000 individuals. Patients who are critically ill face the simultaneous barriers of an SLT workforce that is not growing rapidly enough to meet the escalating need, nor distributed in a manner that addresses health inequality. In the absence of targeted financial intervention for recruitment, training or ring-fencing of services, innovative approaches are required
Why you should read this article:
This article explains the current workforce challenges for SLTs working in critical care, the impact of ineqaulities in service provision and highlights the absence of targeted financial intervention for recruitment, training or ring-fencing of services. There is a need for innovative approaches and rethinking of models of patient care, workforce structures, and data collection for those who commission and govern services.
How to access this article:
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00334-X/fulltext
Interprofessional Quality Improvement Project to Reduce the Length of Stay of Tracheostomized Patients in a Multi-Etiological Intensive Care Unit-The Contribution of Speech and Language Therapy to the Overall Result (IQ-ICU-SLT)
Authors:
Jürgen Konradi, Isabella Neef, Lukas Müller, Robert Kuchen, Heike Maagh, Ulrich Betz, Marc Bodenstein
Full Citation:
Konradi J, Neef I, Müller L, Kuchen R, Maagh H, Betz U, Bodenstein M. Interprofessional Quality Improvement Project to Reduce the Length of Stay of Tracheostomized Patients in a Multi-Etiological Intensive Care Unit-The Contribution of Speech and Language Therapy to the Overall Result (IQ-ICU-SLT). J Clin Med. 2025 Dec 31;15(1):303. doi: 10.3390/jcm15010303. PMID: 41517553; PMCID: PMC12787043.
Abstract:
Background/Objectives: Reasons for long-term stays in intensive care units (ICUs) include various critical conditions, prolonged weaning with post-extubation dysphagia (PED), as well as the mere presence of a tracheal cannula. In an interprofessional QM project, medicine, nursing, physiotherapy, speech and language therapy (SLT), and occupational therapy work together to reduce the length of stay (LOS) in ICUs. SLT focuses on tracheal cannula management (TCM) and PED.
The primary aim of SLT is fast and safe decannulation and thereby the reduction in LOS. Methods: Two SOPs for dealing with PED patients and for structured TCM were developed for this purpose and were both implemented in a postoperative ICU, together with a SLT staff increase. To compare the effects on the intervention group (IG, n = 54), a historical control (HC, n = 58) group was created through a retrospective data analysis.
We screened all patients from ICU (n = 5605), including those with tracheostomy, and analyzed them during their ICU stay. Results: Clinically relevant results were observed for the mean time in days of tracheostomy in those who could be decannulated (HC = 43.43, IG = 23.8; d = 0.99) and, even more importantly, for LOS in days (HC = 33.41, IG = 23.8; d = 0.48). Conclusions: The integration of SLT in ICU care is feasible and helps to reduce the time to decannulation and LOS.
Why you should read this article:
This project demonstrated that interprofessional teamwork between medicine, nursing, physiotherapy, SLT, and occupational therapy in a general ICU is feasible and can improve the quality of treatment and reduce morbidity, as well as LOS in the ICU. Integrating SLT and its expertise into intensive care will likely lead to benefits such as shorter times to decannulation and safer decannulation processes, since necessary diagnostics like FEES can be performed more often and by specially trained staff. This also enhances patients’ quality of life.
How to access this article:
Laryngeal complications after tracheal intubation and tracheostomy
Authors:
Wallace, Sarah; McGrath, Brendan.
Full Citation:
Laryngeal complications after tracheal intubation and tracheostomy Wallace, S. et al. BJA Education, Volume 21, Issue 7, 250 - 257
Abstract:
Pharyngolaryngeal injury or dysfunction has significant consequences for patients recovering from critical illness, including failed extubation and decannulation. Early detection of post-extubation dysphagia is important for prevention of avoidable complications. A variety of interventions can promote early vocalisation and positively impact swallow recovery. Management requires a multidisciplinary approach with a fully integrated speech and language therapist.
Why you should read this article:
This article explains the aetiology, prevalence and risk factors for dysphagia and dysphonia after prolonged translaryngeal intubation and tracheostomy. The reader will learn the physiological and psychological impact of laryngeal dysfunction in the critically ill, relevant investigations, therapeutic strategies and specialist interventions to promote recovery and the multidisciplinary management of laryngeal functions.
How to access this article:
https://www.bjaed.org/article/S2058-5349(21)00028-7/fulltexthttps://doi.org/10.1111/coa.13832
Management of swallowing disorders in ICU patients - A multinational expert opinion
Authors:
Likar, Rudolf
Aroyo, Ilia
Bangert, Katrin
Degen, Björn
Dziewas, Rainer
Galvan, Oliver
Trapl Grundschober, Michaela
Köstenberger, Markus
Muhle, Paul
Schefold, Joerg C.
Zuercher, Patrick
Abstract:
Background: Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization.
Purpose: To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights.
Methods: A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed.
Results: The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU.
Conclusions: Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in
ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
Why you should read this article:
Swallowing disorders often occur in the course of acute illnesses and dysphagia is often difficult to recognize during intensive care treatment.
The consequences of dysphagia can be serious, from pneumonia to the need for intubation, prolonged hospital stays, and the need for prolonged rehabilitative care.
In this work, as part of an expert opinion, a concept is presented for the structured management of dysphagia in the intensive care unit, from evidence-based recommendations to practical applications.
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Post-extubation dysphagia and dysphonia amongst adults with COVID-19 in the Republic of Ireland: A prospective multisite observational cohort study
Authors:
Julie Regan, Margaret Walshe, Sarah Lavan, Eanna Horan, Patricia Gillivan Murphy, Anne Healy, Caoimhe Langan, Karen Malherbe, Breda Flynn Murphy, Maria Cremin, Denise Hilton, Jenni Cavaliere, Alice Whyte
Full Citation:
Regan, J., Walshe, M., Lavan, S., Horan, E., Gillivan Murphy, P., Healy, A., ... & Whyte, A. (2021). Post‐extubation dysphagia and dysphonia amongst adults with COVID‐19 in the Republic of Ireland: a prospective multi‐site observational cohort study. Clinical Otolaryngology, 46(6), 1290-1299.
Abstract:
Objectives: This study aims to (i) investigate post-extubation dysphagia and dysphonia amongst adults intubated with SARS-COV-2 (COVID-19) and referred to speech and language therapy (SLT) in acute hospitals across the Republic of Ireland (ROI) between March and June 2020; (ii) identify variables predictive of post-extubation oral intake status and dysphonia and (iii) establish SLT rehabilitation needs and services provided to this cohort.
Design: A multi-site prospective observational cohort study.
Participants: One hundred adults with confirmed COVID-19 who were intubated across eleven acute hospital sites in ROI and who were referred to SLT services between March and June 2020 inclusive.
Main Outcome Measures: 1 Oral intake status, level of diet modification and perceptual voice quality.
Results: Based on initial SLT assessment, 90% required altered oral intake and 59% required tube feeding with 36% not allowed oral intake. Age (OR 1.064; 95% CI 1.018–1.112), proning (OR 3.671; 95% CI 1.128–11.943) and pre-existing respiratory disease (OR 5.863; 95% CI 1.521–11.599) were predictors of oral intake status post-extubation. Two-thirds (66%) presented with dysphonia post-extubation. Intubation injury (OR 10.471; 95% CI 1.060–103.466) and pre-existing respiratory disease (OR 24.196; 95% CI 1.609–363.78) were predictors of post-extubation voice quality. Thirty-seven per cent required dysphagia intervention postextubation, whereas 20% needed intervention for voice. Dysphagia and dysphonia persisted in 27% and 37% cases, respectively, at hospital discharge.
Discussion: Post-extubation dysphagia and dysphonia were prevalent amongst adults with COVID-19 across the ROI. Predictors included iatrogenic factors and underlying respiratory disease. Prompt evaluation and intervention is needed to minimise complications and inform rehabilitation planning.
Why you should read this article:
Post-extubation dysphagia and dysphonia are multifactorial and can lead to prolonged ICU stay, prolonged tube feeding, aspiration pneumonia and increased morbidity and mortality. In this multi-site prospective cohort study across eleven acute hospitals, 90% of adults required an altered oral diet post-extubation and 36% were not allowed oral intake based on SLT evaluation. Sixty-six per cent presented with post-extubation dysphonia. Age, proning and pre-existing respiratory disease were predictors of post-extubation oral intake status, whereas intubation injury and pre-existing respiratory disease were predictors of post-extubation dysphonia. Over a third (37%) required dysphagia intervention post-extubation, whereas 20% needed intervention for voice. Dysphagia and dysphonia persisted in 27% and 37% cases, respectively, at hospital discharge, indicating that speech and language therapists should be included in outpatient multidisciplinary COVID clinics in the community.
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Safety and feasibility of above cuff vocalisation for ventilator-dependant patients with tracheostomies
Authors:
McGrath, Brendan; Wallace, Sarah; Wilson, Mark; Nicholson, Leanne; Felton, Tim; Bowyer, Christine; Bentley, Andrew.
Full Citation:
McGrath BA, Wallace S, Wilson M, et al. Safety and feasibility of above cuff vocalisation for ventilator-dependant patients with tracheostomies. Journal of the Intensive Care Society. 2019;20(1):59-65. doi:10.1177/1751143718767055
Abstract:
Temporary tracheostomy is commonly used in patients admitted to intensive care units. Cuffed tubes prevent laryngeal airflow, preventing vocalisation. Sub-glottic suction tubes such as the ‘Blue Line Ultra Suctionaid are used primarily to remove sub-glottic secretions, but retrograde gas flows via the suction port can facilitate above cuff vocalisation. The aims were to assess whether patients could achieve an audible voice using above cuff vocalisation, to demonstrate the safe use of the Blue Line Ultra Suctionaid™ tracheostomy tube for above cuff vocalisation, and to assess potential benefits of above cuff vocalisation for communication, secretion management and swallowing. FEES was used to capture swallow metrics.
Why you should read this article:
This study demonstrates the safety and benefits of using Above Cuff Vocalisation (ACV) to achieve effective, safe, vocalisation in ventilator-dependant intensive care unit patients and reports for the first time the potential therapeutic benefits for improving laryngeal function and swallowing.
How to access this article:
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00334-X/fulltext
Neurology
A Retrospective Review of Clinical Characteristics and Risk Factors of Dysphagia in Patients with Dermatomyositis
Authors:
Cheng, Ivy, Dr
Wong, Christina Sze Man, Dr
Chan, Henry Hin Lee, Prof
Full Citation:
Cheng, I., Wong, C.S.M. & Chan, H.H.L. A Retrospective Review of Clinical Characteristics and Risk Factors of Dysphagia in Patients with Dermatomyositis. Dysphagia (2024). https://doi.org/10.1007/s00455-024-10763-6
Abstract:
Background: Dermatomyositis is a rare autoimmune-mediated disease characterised by distinctive rash and progressive muscle weakness. Patients with dermatomyositis may develop swallowing disorders (dysphagia) due to the inflammation of muscles involved in swallowing which may lead to serious health consequences. However, to date, the clinical characteristics of and risk factors for dysphagia in dermatomyositis remain poorly understood. This retrospective study aimed to identify the characteristics and risk factors for dysphagia in dermatomyositis. Methods: All patients with clinical diagnosis of dermatomyositis (ICD-9-CM 701.3) were identified and retrieved retrospectively via hospital electronic record over a 10-year period for review. Results: A total of 231 patients were identified with 149 fulfilled the inclusion criteria (median age [range] = 54.5 [3–92] years; 51 males) were recruited. The incidence of dysphagia was 18.8%, with predominantly pharyngeal phase impairments. Six patients had silent aspiration. Dysphagia was positively correlated with the age of diagnosis (r[148] = 0.187, p = 0.023), mortality (r[149] = 0.186, p = 0.023), presence of underlying malignancy (r[149] = 0.222, p = 0.007), methylprednisolone use (r[149] = 0.166, p = 0.042) and intravenous immunoglobulin (IVIg; r[149] = 0.217, p = 0.008), and negatively correlated with disease duration (r[147]=-0.273, p < 0.001). Moreover, it was more likely to have symptomatic dysphagia in patients prescribing systemic corticosteroid (OR[95%CI] = 4.43[1.02, 19.27], p = 0.047) and IVIg (OR[95%CI] = 6.39[1.14, 35.68], p = 0.035). Discussion: Dysphagia was associated with advanced age, increased mortality and malignancy in patients with dermatomyositis. Routine screening of dysphagia is recommended at initial diagnosis and severe disease activity requiring high dose systemic steroid and IVIg use.
Why you should read this article:
Dermatomyosytis is a rare autoimmune disease. Dysphagia may develop in patients with this condition, yet it is often underestimated. This retrospective review highlighted the prevalence and characteristics of dysphagia in patients with dermatomyositis. Our findings call for routine dysphagia screening as part of the assessment battery for dermatomyositis in clinical practice.
How to access this article:
https://doi.org/10.1007/s00455-024-10763-6
Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults
Authors:
Bendix Labeit, Paul Muhle, Jonas von Itter, Janna Slavik, Andreas Wollbrink, Peter Sporns, Thilo Rusche, Tobias Ruck, Anna Hüsing-Kabar, Reinhold Gellner, Joachim Gross, Rainer Wirth, Inga Claus, Tobias Warnecke, Rainer Dziewas, Sonja Suntrup-Krueger
Abstract:
Background: "Presbyphagia" refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity.
Materials and methods: 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule.
Results: 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model.
Conclusions: Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
Why you should read this article:
In this article, we provide a analysis of age-related swallowing abnormalities (presbyphagia). We thoroughly examine various clinical and biological determinants. Additionally, we investigate the neuronal compensation mechanisms within the swallowing network as a consequence of presbyphagia. Moreover, we engage in a discussion regarding the presbyphagia model as a whole.
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Cognitive decline limits compensatory resource allocation within the aged swallowing network
Authors:
Suntrup-Krueger S, Muhle P, Slavik J, von Itter J, Wollbrink A, Wirth R, Warnecke T, Dziewas R, Gross J, Meuth SG, Labeit B.
Full Citation:
Geroscience . 2025 Apr 9. doi: 10.1007/s11357-025-01649-y.
Abstract:
Cognitive decline has been postulated to predispose to presbyphagia but the neurophysiological basis of this interaction is unclear. To investigate the role of cognition for compensatory resource allocation within the swallowing network and behavioral swallowing performance in dual-task cognitive and motor interference in ageing, volunteers ≥ 70 years of age without preexisting diseases causing dysphagia were investigated using Flexible Endoscopic Evaluation of Swallowing (FEES) including a cognitive and motor dual-task paradigm and a Montreal Cognitive Assessment.
The neural correlates of swallowing during dual-task were characterized using magnetoencephalography. Results were related to cognitive function. Sixty-three participants (77.7 ± 6.1 years) underwent FEES, of which 40 additionally underwent MEG. Both cognitive and motor dual-tasks interfered with swallowing function resulting in an increase in pharyngeal residue and premature bolus spillage. The extent of swallowing deterioration ("dual-task cost") was associated with cognitive decline (cognitive dual-task: Spearman's rho = - 0.39, p = 0.002; motor dual-task: Spearman's rho = - 0.25, p = 0.046). When challenged with dual-tasking participants with regular cognition showed compensatory stronger and broader brain activation in cortical pre- and supplementary motor planning areas as well as in frontal executive regions within the cortical swallowing network (p = 0.004) compared to participants with cognitive deficits. They also performed better in the competing cognitive and motor dual-task and showed fewer incorrect responses (p = 0.028).
Oropharyngeal swallowing involves cognitive cortical processing. Cognitive decline seems to limit the capacity for compensatory resource allocation within the swallowing network. This may lead to deterioration in both swallowing function and concurrent cognitive-motor performance in challenging dual-task situations.
How to access this article:
https://link.springer.com/article/10.1007/s11357-025-01649-y
Costs of post-stroke dysphagia during acute hospitalization from a health-insurance perspective
Authors:
Bendix Labeit, Almut Kremer, Paul Muhle, Inga Claus, Tobias Warnecke, Rainer Dziewas, Sonja Suntrup-Krueger
Abstract:
Purpose: Oropharyngeal dysphagia is a common and complication-prone symptom after stroke and is assumed to increase medical expenses. The purpose of this study was therefore to examine acute hospitalization costs associated with post-stroke dysphagia.
Method: This retrospective study included patients with acute stroke who had been examined by Flexible Endoscopic Evaluation of Swallowing (FEES). Health insurance expenditures were determined for the patient cases according to the 2021 revenue criteria. Multiple linear regression was used to examine predictors of health insurance spending including age, sex, stroke severity, stroke characteristics, comorbidity, therapeutic interventions, duration of artificial ventilation, length of hospital stay, and severity of dysphagia, as assessed by the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), ranging from 1 (best) to 6 (worst).
Findings: Six hundred seventy four patients (men/women: 367/307; mean age: 71.1 ± 12.8 years; mean National Institute of Health Stroke Scale: 11.2 ± 6.2; FEDSS 1/2/3/4/5/6: 113/73/144/119/124/101; mean health-insurance costs 11,521.5 ± 12,950.5€) were included in the analysis. Advanced age (p = 0.007; B = 57.6), catheter interventions (p < 0.001; B = 4105.6), tracheotomy (p = 0.006; B = 5195.2), duration of artificial ventilation (p < 0.001; B = 388.6), length of hospital stay (p < 0.001; B = 441.9), and severe dysphagia with an FEDSS of 6 (p = 0.004, B = 2554.3) were independent predictors of increased health insurance expenditures (p < 0.001, R-squared = adjusted-R-squared = 0.83).
Discussion and conclusion: The results of this study show an association between severe dysphagia and health care costs for acute hospitalization from a health-insurance perspective. Therefore, therapies that target severe dysphagia with impaired secretion management may have the potential to reduce costs.
Why you should read this article:
This article offers a comprehensive analysis of the cost structures associated with post-stroke dysphagia for health insurance providers. It highlights specific dysphagia-related findings that are linked to additional costs, allowing for insights into potential cost-saving measures.
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Detecting myositis as a cause of unexplained dysphagia: Proposal for a diagnostic algorithm
Authors:
Bendix Labeit, Thalia Grond, Achim G Beule, Maik Boehmer, Christian Thomas, Paul Muhle, Inga Claus, Malte Roderigo, Claudia Rudack, Heinz Wiendl, Rainer Dziewas, Tobias Warnecke, Sonja Suntrup-Krueger
Abstract:
Background and purpose: Idiopathic inflammatory myopathy (IIM) can present with dysphagia as a leading or only symptom. In such cases, diagnostic evaluation may be difficult, especially if serological and electromyographical findings are unsuspicious. In this observational study we propose and evaluate a diagnostic algorithm to identify IIM as a cause of unexplained dysphagia.
Methods: Over a period of 4 years, patients with unexplained dysphagia were offered diagnostic evaluation according to a specific algorithm: The pattern of dysphagia was characterized by instrumental assessment (swallowing endoscopy, videofluoroscopy, high-resolution manometry). Patients with an IIM-compatible dysphagia pattern were subjected to further IIM-focused diagnostic procedures, including whole-body muscle magnetic resonance imaging, electromyography, creatine kinase blood level, IIM antibody panel and, as a final diagnostic step, muscle biopsy. Muscle biopsies were taken from affected muscles. In cases where no other muscles showed abnormalities, the cricopharyngeal muscle was targeted.
Results: Seventy-two patients presented with IIM-compatible dysphagia as a leading or only symptom. As a result of the specific diagnostic approach, 19 of these patients were diagnosed with IIM according to the European League Against Rheumatism (EULAR) criteria. Eighteen patients received immunomodulatory therapy as a result of the diagnosis. Of 10 patients with follow-up swallowing examination, dysphagia improved in three patients after therapy, while it remained at least stable in six patients.
Conclusions: Idiopathic inflammatory myopathy constitutes a potentially treatable etiology in patients with unexplained dysphagia. The diagnostic algorithm presented in this study helps to identify patients with an IIM-compatible dysphagia pattern and to assign those patients for further IIM-focused diagnostic and therapeutic procedures.
Why you should read this article:
Are you struggeling with the challenges involved in diagnostic work-up in patients with unclear dysphagia? This article introduces a diagnostic algorithm that can assist in identifying myositis as an underlying condition. Utilizing this algorithm may help you pinpoint this potentially treatable ailment in your patients.
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Developing a core outcome set for dysphagia interventions in Parkinson’s disease: an international Delphi consensus study
Authors:
Hirschwald, Julia, PhD; Conroy, Paul, PhD; Boyle, Gary; Warnecke, Tobias, MD; Walshe, Margaret, PhD
Abstract:
Objectives
To develop a core outcome set (COS) for oropharyngeal dysphagia (swallowing disorder) interventions in Parkinson’s disease by agreeing core outcomes and definitions, outcome measurement instruments (OMIs) and time points of measurement for these core outcomes.
Design
International online Delphi survey and consensus meetings.
Participants
Individuals living with oropharyngeal dysphagia and Parkinson’s disease, family members and caregivers, healthcare professionals and researchers in the field of oropharyngeal dysphagia and Parkinson’s disease.
Methods
A long list of outcomes was generated previously through scoping reviews, online surveys and focus groups with key stakeholders. Building on this, an international three-round online Delphi survey was conducted where participants rated the importance of outcomes. In subsequent online consensus meetings, core outcomes, their definitions, OMIs and time points of measurement were agreed on.
Results
90 participants from 21 countries completed all three rounds of the Delphi survey. Of these, 35 participated in a consensus meeting. Six outcomes were agreed as the core outcomes: ‘penetration/aspiration’, ‘aspiration pneumonia’, ‘choking’, ‘oropharyngeal dysphagia severity’, ‘swallowing related quality of life’ and ‘post swallow pharyngeal residue’.
Conclusions
The use of a COS in future oropharyngeal dysphagia intervention studies in Parkinson’s disease will facilitate comparative effectiveness research and ensure that outcomes are relevant to all key stakeholders. This should help improve the evidence base for oropharyngeal dysphagia interventions in Parkinson’s disease.
Registration
The study was registered prospectively with the Core Outcome Measures in Effectiveness Trials Database on 24 September 2021 (www.comet-initiative.org, registration number: 1942).
Why you should read this article:
Oropharyngeal dysphagia affects up to 80% of individuals with Parkinson’s disease, yet evidence for effective interventions is limited. A key barrier is difficulty in comparing results of oropharyngeal dysphagia intervention studies due to the use of a diverse range of outcomes, outcome measurement instruments (OMIs) and time points of measurement. One proven solution to this challenge is the development and use of core outcome sets (COS).
This COS provides a minimum of clearly defined outcomes with recommendations for OMIs and time points of measurement for all clinical trials on oropharyngeal dysphagia interventions in Parkinson’s disease. It also considers some of the challenges associated with COS research.
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Dysphagia after stroke: research advances in treatment interventions
Authors:
Labeit, Bendix, MD Michou, Emilia, PhD Trapl-Grundschober, Emilia, PhD Suntrup-Krueger, Sonja, MD Muhle, Paul, MD Bath, Philip, MD Dziewas, Rainer MD
Full Citation:
Lancet Neurol 2024; 23: 418–28
Abstract:
After a stroke, most patients have dysphagia, which can lead to aspiration pneumonia, malnutrition, and adverse functional outcomes. Protective interventions aimed at reducing these complications remain the cornerstone of treatment. Dietary adjustments and oral hygiene help mitigate the risk of aspiration pneumonia, and nutritional supplementation, including tube feeding, might be needed to prevent malnutrition. Rehabilitative interventions aim to enhance swallowing function, with different behavioural strategies showing promise in small studies. Investigations have explored the use of pharmaceutical agents such as capsaicin and other TransientReceptor-Potential-Vanilloid-1 (TRPV-1) sensory receptor agonists, which alter sensory perception in the pharynx. Neurostimulation techniques, such as transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and pharyngeal electrical stimulation, might promote neuroplasticity within the sensorimotor swallowing network. Further advancements in the understanding of central and peripheral sensorimotor mechanisms in patients with dysphagia after a stroke, and during their recovery, will contribute to optimising treatment protocols.
Why you should read this article:
This manuscript provides an up-to-date summary of the different treatment modalities of post-stroke dysphagia. Protective and restorative treatment options are differentiated, and their indications are discussed with regards to the different time windows after stroke.
How to access this article:
This article is not open access.
Please email benlabeit@gmail.com to request the original article.
Dysphagia for medication in Parkinson's disease
Authors:
Bendix Labeit, Elijahu Berkovich, Inga Claus, Malte Roderigo, Anna-Lena Schwake, Dvora Izgelov, Dorit Mimrod, Sigrid Ahring, Stephan Oelenberg, Paul Muhle, Verena Zentsch, Fiona Wenninger, Sonja Suntrup-Krueger, Rainer Dziewas, Tobias Warnecke
Abstract:
Dysphagia is common in Parkinson's disease (PD) and is assumed to complicate medication intake. This study comprehensively investigates dysphagia for medication and its association with motor complications in PD. Based on a retrospective analysis, a two-dimensional and graduated classification of dysphagia for medication was introduced differentiating swallowing efficiency and swallowing safety. In a subsequent prospective study, sixty-six PD patients underwent flexible endoscopic evaluation of swallowing, which included the swallowing of 2 tablets and capsules of different sizes. Dysphagia for medication was present in nearly 70% of PD patients and predicted motor complications according to the MDS-UPDRS-part-IV in a linear regression model. Capsules tended to be swallowed more efficiently compared to tablets, irrespective of size. A score of ≥1 on the swallow-related-MDS-UPDRS-items can be considered an optimal cut-off to predict dysphagia for medication. Swallowing impairment for oral medication may predispose to motor complications.
This article delves into the phenomenon of medication dysphagia. It introduces a two-dimensional classification of medication dysphagia and investigates the connection between medication dysphagia and motor complications in patients with Parkinson's disease.
Why you should read this article:
This article delves into the phenomenon of medication dysphagia. It introduces a two-dimensional classification of medication dysphagia and investigates the connection between medication dysphagia and motor complications in patients with Parkinson's disease.
How to access this article:
Dysphagia in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody disease as a surrogate of brain involvement?
Authors:
Marc Pawlitzki, Sigrid Ahring, Leoni Rolfes, Rainer Dziewas, Tobias Warnecke, Sonja Suntrup-Krueger, Heinz Wiendl, Luisa Klotz, Sven G Meuth, Bendix Labeit
Abstract:
Background and purpose: Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are demyelinating disorders that typically affect the optic nerves and the spinal cord. However, recent studies have demonstrated various forms of brain involvement indicating encephalitic syndromes, which consequently are included in the diagnostic criteria for both. Swallowing is processed in a distributed brain network and is therefore disturbed in many neurological diseases. The aim of this study was to investigate the occurrence of oropharyngeal dysphagia in NMOSD and MOGAD using flexible endoscopic evaluation of swallowing (FEES) as a surrogate parameter of brain involvement.
Methods: Thirteen patients with NMOSD and MOGAD (mean age 54.2 ± 18.6 years, six men) who received FEES during clinical routine were retrospectively reviewed. Their extent of oropharyngeal dysphagia was rated using an ordinal dysphagia severity scale. FEES results were compared to a control group of healthy individuals. Dysphagia severity was correlated with the presence of clinical and radiological signs of brain involvement, the Expanded Disability Status Scale (EDSS) and the occurrence of pneumonia.
Results: Oropharyngeal dysphagia was present in 8/13 patients, including six patients without other clinical indication of brain involvement. Clinical or subclinical swallowing impairment was significantly more severe in patients with NMOSD and MOGAD compared to the healthy individuals (p = 0.009) and correlated with clinical signs of brain involvement (p = 0.038), higher EDSS (p = 0.006) and pneumonia (p = 0.038).
Conclusion: Oropharyngeal dysphagia can occur in NMOSD and MOGAD and might be associated with pneumonia and disability. FEES may help to detect subclinical brain involvement.
Why you should read this article:
Delve into the intriguing realm of dysphagia in demyelinating disorders, such as Neuromyelitis Optica Spectrum Disorder (NMOSD) and Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD), with this study. While traditionally affecting optic nerves and spinal cords, emerging research reveals brain involvement in these conditions, adding a new dimension to their diagnostic criteria. This investigation employs FEES to explore oropharyngeal dysphagia as a potential marker of brain engagement.
How to access this article:
Effect of cognitive and motor dual-task on oropharyngeal swallowing in Parkinson's disease
Authors:
Bendix Labeit, Inga Claus, Paul Muhle, Liesa Regner, Sonja Suntrup-Krueger, Rainer Dziewas, Tobias Warnecke
Abstract:
Background: Dysphagia frequently occurs in patients with Parkinson's disease (PD) and is associated with severe complications. However, the underlying pathology is poorly understood at present. This study investigated the effect of cognitive and motor dual-task interference on oropharyngeal swallowing in PD.
Methods: Thirty PD patients (23 men, mean age 65.90 ± 9.32 years, mean Hoehn and Yahr stage 2.62 ± 0.81, mean UPDRS 18.00 ± 7.18) were examined using flexible endoscopic evaluation of swallowing (FEES). FEES was performed during three paradigms: at baseline without interference, during a cognitive dual-task, and during a motor dual-task. Oropharyngeal swallowing function was rated using a score which was validated to detect changes in PD related dysphagia. The three paradigms were compared using a two-way-repetitive-measures-ANOVA and a post-hoc-analysis.
Results: Mean swallowing score in baseline FEES was 10.67 ± 5.89. It significantly increased (worsened) to 15.97 ± 7.62 (p < 0.001) in the motor dual-task and to 14.55 ± 7.49 (p < 0.001) in the cognitive dual-task. Premature bolus spillage and pharyngeal residue both significantly increased during both of the dual-task conditions whereas penetration/aspiration events did not change.
Conclusion: Oropharyngeal swallowing in patients with PD is not purely reflexive but requires mental capacity. Additional allocation of attentional resources in the central control of swallowing seems to be an effective compensatory mechanism in PD-related dysphagia: The proposed dual-task protocol may be useful to challenge swallowing functional reserve. Conversely, as a therapeutic strategy, it could be beneficial to focus attention on swallowing and to avoid dual-task situations.
Why you should read this article:
Dive into the intricate relationship between cognitive and motor functions in Parkinson's disease-related dysphagia with this pioneering study. Swallowing, a seemingly automatic process, is revealed to be influenced by cognitive demands in Parkinson's disease patients. The study, conducted using FEES, uncovers the impact of cognitive and motor dual-task interference on oropharyngeal swallowing.
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Effect of Intestinal Levodopa-Carbidopa Infusion on Pharyngeal Dysphagia: Results from a Retrospective Pilot Study in Patients with Parkinson's Disease
Authors:
Bendix Labeit, Inga Claus, Paul Muhle, Sonja Suntrup-Krueger, Rainer Dziewas, Tobias Warnecke
Abstract:
Background. Pharyngeal dysphagia is a common symptom of Parkinson’s disease (PD) leading to severe complications. PD-related pharyngeal dysphagia (PDrPD) may significantly improve in up to half of patients following acute oral levodopa challenge. Objective. The aim of this study was to investigate the effects of levodopa-carbidopa intestinal gel (LCIG) on PDrPD. Methods. Forty-five PD patients under LCIG treatment were available for retrospective analysis. In all patients with PDrPD who underwent flexible endoscopic evaluation of swallowing (FEES) in the clinical “on-state” both before and after implementation of LCIG treatment, FEES videos were systematically reassessed. PDrPD was characterized using a PD-specific FEES score evaluating premature bolus spillage, penetration/aspiration, and pharyngeal residue. Further, the duration of white-out was assessed, as a parameter for pharyngeal bradykinesia. Results. Eleven patients with PDrPD (mean age 74.6 ± 4.4 years; mean Hoehn and Yahr stage 3.8 ± 0.6) received FEES both before and after the onset of LCIG treatment. The mean swallowing score improved from 14.9 ± 7.3 to 13.0 ± 6.9 after implementation of LCIG; however, this difference was not significant (). Premature bolus spillage decreased significantly () from 5.4 ± 1.1 to 3.6 ± 1.0, and white-out duration decreased significantly () from 984 ± 228 ms to 699 ± 131 ms after implementation of LCIG. Conclusions. LCIG may affect PDrPD and reduce premature bolus spillage and pharyngeal bradykinesia. Future studies with larger sample sizes are required to follow-up on these pilot results and identify which factors predict a good response of PDrPD to LCIG treatment.
Why you should read this article:
Delve into the realm of Parkinson's disease-related pharyngeal dysphagia and its potential improvement with levodopa-carbidopa intestinal gel treatment in this enlightening study.
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FEES-based assessment of pharyngeal hypesthesia-Proposal and validation of a new test procedure
Authors:
Bendix Labeit, Paul Muhle, Mao Ogawa, Inga Claus, Thomas Marian, Sonja Suntrup-Krueger, Tobias Warnecke, Jens Burchard Schroeder, Rainer Dziewas
Abstract:
Background: Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia.
Methods: A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tube was positioned transnasally in the upper third of the oropharynx with contact to the lateral pharyngeal wall. Increasing volumes of blue-dyed water were injected through the tube, and the latency of swallowing response (LSR) was determined by two independent raters from the endoscopic video recording. Three trials were performed for each administered volume starting with 0.1 mL and increased by 0.1 mL up to 0.5 mL.
Key results: The average LSR without anesthesia was 2.24 ± 0.80 s at 0.1 mL, 1.79 ± 0.84 s at 0.2 mL, 1.29 ± 0.62 s at 0.3 mL, 1.17 ± 0.41 s at 0.4 mL, and 1.19 ± 0.52 s at 0.5 mL. With anesthesia applied, the average LSR was 2.65 ± 0.62 s at 0.1 mL, 2.64 ± 0.49 s at 0.2 mL, 2.44 ± 0.65 s at 0.3 mL, 2.10 ± 0.80 s at 0.4 mL, and 2.18 ± 0.85 s at 0.5 mL. LSR was significantly longer following anesthesia at 0.2 mL (t = -3.82; P = .001), 0.3 mL (t = -4.65; P < .000), 0.4 mL (t = -5.77; P < .000), and 0.5 mL (t = -3.49; P = .005).
Conclusion and inferences: Pharyngeal hypesthesia can be quantified with sensory testing using LSR. Suitable volumes to distinguish between normal and impaired pharyngeal sensation are 0.2 mL, 0.3 mL, 0.4 mL and 0.5 mL. Experimentally induced pharyngeal anesthesia represents a valid model of sensory dysphagia.
Why you should read this article:
Discover a novel method for quantifying pharyngeal hypesthesia and its implications in dysphagia diagnosis. This prospective study, involving 20 healthy volunteers, introduces and validates a diagnostic test to assess pharyngeal sensation.
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Measurement Properties of the Dysphagiameter for the Assessment of Dysphagia in Oculopharyngeal Muscular Dystrophy
Authors:
Côté, Claudia, RD, PhD
Brais, Bernard, MD, PhD
Sèbiyo Batcho, Charles, PhD
Brisson, Jean-Denis, MD, MS
Youssof, Sarah, MD, MS
Sègnon Sogbossi, Emmanuel, PhD
Gagnon, Cynthia, OT, PhD
Full Citation:
Côté C, Brais B, Batcho CS, Brisson JD, Youssof S, Sogbossi ES, Gagnon C. Measurement Properties of the Dysphagiameter for the Assessment of Dysphagia in Oculopharyngeal Muscular Dystrophy. Dysphagia. 2024 Dec 21. doi: 10.1007/s00455-024-10791-2. Epub ahead of print. PMID: 39708080.
Abstract:
Oculopharyngeal muscular dystrophy (OPMD) is a rare late-onset muscle disease with progressive dysphagia as a major symptom. The Dysphagiameter is a newly developed patient-reported outcome measure (PROM) to assess the severity of dysphagia and its impact in patients with OPMD. This article reports on item reduction and a first assessment of the Dysphagiameter's psychometrics properties, in a French and English-speaking population of individuals with OPMD.
Classical test theory and Rasch model were used for item reduction and scoring (n = 162). Construct validity was assessed using the time to drink 80 ml of cold water and the Sydney Swallow Questionnaire (SSQ) (n = 40).
Part A of the final PROM resulted in a 21-item scale assessing the capacity to swallow foods of various textures and a 3-item scale assessing the capacity to swallow liquids (Cronbach Alpha = 0.90); the hierarchical structure of the 21-item scale was confirmed with a Rasch analysis (Person separation index = 0.95).
Part B resulted in a 6 item-scale assessing the impact on mealtime and a 2-item scale assessing discomfort related to thick saliva (Alpha Cronbach = 0.91 and 0.79). Convergent validity was demonstrated by significant correlations with the SSQ. Known-group validity was supported by the ability of the Dysphagiameter to detect significant differences according to the severity of dysphagia.
In summary, the Dysphagiameter-OPMD, a newly developed PROM, exhibits strong psychometric properties and holds promise as a valuable tool for assessing the severity of dysphagia and its impact on individuals with OPMD.
Why you should read this article:
This article introduce a novel patient-reported outcome measure to assess dysphagia in individuals with oculopharyngeal muscular dystrophy. The tool could have potential for other neuromuscular diseases.
How to access this article:
This article is not open access. To request the original article, please contact: claudia.cote4@usherbrooke.ca
Neurogenic Dysphagia: Systematic Review and Proposal of a Classification System
Authors:
Tobias Warnecke*, Bendix Labeit*, Jens Schroeder, Alexander Reckels, Sigrid Ahring, Sriramya Lapa, Inga Claus, Paul Muhle, Sonja Suntrup-Krueger, Rainer Dziewas
Abstract:
Objective: Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).
Methods: A systematic literature review was conducted, searching MEDLINE from inception to May 2020 for FEES findings in neurologic diseases of interest. Based on a retrospective analysis of FEES videos in neurologic diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1,012 randomly selected FEES videos of patients with various neurologic disorders. Chi-square tests were used to compare the distribution of dysphagia phenotypes between the underlying neurologic disorders.
Results: A total of 159 articles were identified, of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) "premature bolus spillage" and (2) "delayed swallowing reflex" occurred mainly in stroke, (3) "predominance of residue in the valleculae" was most common in Parkinson disease, (4) "predominance of residue in the piriform sinus" occurred only in myositis, motoneuron disease, and brainstem stroke, (5) "pharyngolaryngeal movement disorder" was found in atypical Parkinsonian syndromes and stroke, (6) "fatigable swallowing weakness" was common in myasthenia gravis, and (7) "complex disorder" with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic lateral sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84).
Conclusion: Neurogenic dysphagia is not a symptom, but a multietiologic syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.
Why you should read this article:
Discover a novel approach to understanding neurogenic dysphagia with this study: By introducing and validating a phenotypic classification of neurogenic dysphagia based on FEES, this research paves the way for a more refined diagnosis and tailored treatment.
How to access this article:
Oropharyngeal freezing and its relation to dysphagia - An analogy to freezing of gait
Authors:
Bendix Labeit, Inga Claus, Paul Muhle, Sriramya Lapa, Sonja Suntrup-Krueger, Rainer Dziewas, Nani Osada, Tobias Warnecke
Abstract:
Introduction: The pathophysiology of dysphagia in Parkinson's disease (PD) is heterogeneous and poorly understood at present. This study investigated the phenotypes, prevalence and pathophysiology of oropharyngeal freezing (OPF) in PD and its relation to dysphagia.
Methods: In a prospective study, 50 PD patients were systematically screened for OPF using flexible endoscopic evaluation of swallowing (FEES). In addition, FEES-videos of 50 patients with post-stroke dysphagia and 50 healthy subjects were retrospectively evaluated as control groups. In PD patients freezing was assessed with the "freezing of gait (FoG) questionnaire" and the relationship between OPF and FoG was analyzed.
Results: In analogy to FoG, signs for OPF presented as either temporarily missing or delayed swallowing reflex in combination with freezing associated movement abnormalities e.g. festination, trembling, or akinesia. Seventeen PD patients (34%) showed considerable signs for OPF (15 cases of festination, 3 cases of trembling, 3 cases of akinesia). In the patients with post-stroke dysphagia, OPF was detected in 2 patients (4%). The healthy subjects showed no signs for OPF. The distribution of OPF differed significantly between the investigated groups (p < 0.01). PD patients with signs for OPF scored significantly higher in the FoG-questionnaire (12.69 ± 6.37) compared to patients without OPF (7.29 ± 5.17; p < 0.01).
Conclusion: Swallowing in PD patients can be impaired by OPF. We suggest that OPF and FoG share common pathophysiologic mechanisms based on their association and similar semiologies.
Why you should read this article:
Dive into the intricate relationship between cognitive and motor functions in Parkinson's disease-related dysphagia with this pioneering study. Swallowing, a seemingly automatic process, is revealed to be influenced by cognitive demands in Parkinson's disease patients. The study, conducted using FEES, uncovers the impact of cognitive and motor dual-task interference on oropharyngeal swallowing.
How to access this article:
This article is not open access. Please email benlabeit@gmail.com to request the original article.
Pharyngeal Electrical Stimulation favorably modifies healthy human pharyngo-esophageal function - a randomized trial using High Resolution Manometry Impedance
Authors:
Everaert, Marthe, Drs.
Hamdy, Shaheen, Prof. Dr.
Goeleven, Ann, Prof. Dr.
Tack, Jan, Prof. Dr.
Vanuytsel, Tim, Prof. Dr.
Rommel, Nathalie, Prof. Dr.
Full Citation:
Everaert M, Hamdy S, Goeleven A, Tack J, Vanuytsel T, Rommel N. Pharyngeal Electrical Stimulation favorably modifies healthy human pharyngo-esophageal function - a randomized trial using High Resolution Manometry Impedance. J Appl Physiol (1985). 2025 Feb 19. doi: 10.1152/japplphysiol.00516.2024. Epub ahead of print. PMID: 39970337.
Abstract:
Background: Despite positive clinical evidence for the effects of Pharyngeal Electrical Stimulation (PES) on swallowing performance in disease, it remains unknown which specific swallow characteristics improve. Using High Resolution Manometry Impedance (HRMI) with Pressure Flow Analysis (PFA), we aimed to assess the effects of PES on normal swallow function and to evaluate the impact of pharyngeal length variability on electrode placement.
Methods: As part of a prospective RCT, 20 asymptomatic volunteers were randomly assigned to three days of PES or SHAM treatment. HRMI assessments were conducted at baseline (during which pharyngeal length measurements were acquired) and repeated at 1-2 hours, and at 24-72 hours following PES or SHAM treatment.
Key results: Twenty healthy adults (10 male, median age: 28.0 (IQR 23.8-45.0) years, age range: 20-65 years) participated in this RCT. We developed an objective, standardized method of catheter placement based on pharyngeal length measurements. Over 3 days, the median stimulation intensity of PES was 11 mA. When compared to the SHAM group, the PES group scored better on multiple pharyngeal and esophageal metrics resulting in improved global swallow function values 1-2 hours after treatment (p=0.029). One day later, most of these beneficial effects were no longer present.
Conclusions: This study suggests that PES can temporarily alter swallow function in healthy individuals. Functional reserve in healthy individuals may be further enhanced by PES. In the majority of volunteers, electrode position needed to be adjusted 1-3 cm to account for variations in pharyngeal length.
Keywords: Gastrointestinal Motility; High Resolution Manometry; Neuromodulation; Pharyngeal Electrical Stimulation; Swallowing.
Why you should read this article:
Pharyngeal Electrical Stimulation (PES) is a new treatment option for patients with neurogenic dysphagia. It is known that PES positively influences clinical swallow-outcomes in patients with dysphagia. However, its effect on the underlying swallowing physiology remains unknown. Our study evaluated the effect of PES in healthy individuals using High-Resolution Manometry Impedance. PES showed short-term improved pharyngeal contractility, upper esophageal sphincter relaxation, proximal esophageal contractility and bolus flow. This study suggests that PES can temporarily alter swallowing function, even in healthy individuals.
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Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy
Authors:
Bendix Labeit, Ksenia Perlova, Marc Pawlitzki, Tobias Ruck, Paul Muhle, Inga Claus, Sonja Suntrup-Krueger, Heinz Wiendl, Rainer Dziewas, Tobias Warnecke
Abstract:
Introduction: Oropharyngeal dysphagia is a clinical hallmark of idiopathic inflammatory myopathy (IIM). This study investigated predictors, outcome, and characteristics of oropharyngeal dysphagia in patients with different types of IIM.
Methods: Flexible endoscopic evaluation of swallowing (FEES) videos of 71 IIM patients were retrospectively analyzed for bolus spillage, penetration, aspiration, and pharyngeal residue. Based on these findings, dysphagia severity was rated. Regression analyses were performed to investigate demographic and disease-specific predictors of dysphagia severity and pneumonia as outcome-relevant complications of dysphagia. A score was developed to rate the quality of the endoscopic white-out as a surrogate marker for pharyngeal muscle weakness with consecutive residue.
Results: Our analysis revealed no independent predictors of dysphagia severity. Dysphagia severity, however, was an independent predictor for pneumonia, which occurred in 24% of patients. Pharyngeal residue with risk of postdeglutitive aspiration was the most common dysphagia pattern. Attenuation of the endoscopic white-out was related to residue severity.
Discussion: Dysphagia in IIM assessed with FEES is associated with relevant complications, such as aspiration pneumonia, and must be considered independently of peripheral muscle weakness and disease duration. Swallowing impairment mainly presents with pharyngeal residue. The quality of the white-out may serve as a semi-quantitative surrogate marker for pharyngeal contractility.
Why you should read this article:
Discover the essential insights into oropharyngeal dysphagia in idiopathic inflammatory myopathy (IIM) with this study. By analyzing FEES videos from 71 IIM patients, the authors uncover predictors, outcomes, and characteristics of dysphagia in various IIM types. This research underscores the significant impact of dysphagia severity on complications like pneumonia, highlighting the importance of early intervention. With pharyngeal residue as a primary dysphagia pattern and the innovative use of endoscopic white-out quality as a surrogate marker for pharyngeal muscle weakness, this article provides valuable insights for clinicians and researchers in the field of dysphagia and IIM.
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Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential
Authors:
Bendix Labeit, Hannah Mueller, Paul Muhle, Inga Claus, Tobias Warnecke, Rainer Dziewas, Sonja Suntrup-Krueger
Abstract:
Background: For the early detection of post-stroke dysphagia (PSD), valid screening parameters are crucial as part of a step-wise diagnostic procedure. This study examines the role of the National Institute of Health Stroke Scale (NIH-SS) as a potential low-threshold screening parameter.
Methods: During a ten-year period, 687 newly admitted patients at University Hospital Muenster were included in a retrospective analysis, if they had ischemic or haemorrhagic stroke confirmed by neuroimaging and had received NIH-SS scoring and endoscopic swallowing evaluation upon admission. The NIH-SS score was correlated with dysphagia severity as measured by the validated 6-point fiberoptic endoscopic dysphagia severity score (FEDSS), and the ideal cut-off score to predict PSD, defined as FEDSS > 1, was calculated. Supra- and infratentorial strokes were analysed separately due to their differing role in the pathophysiology of neurogenic dysphagia.
Results: NIH-SS and dysphagia severity show a significant positive correlation in the whole study population (R2 = 0.745) as well as in both analysed subgroups (R2 = 0.494 for supra- and R2 = 0.646 for infratentorial strokes, p < 0.0005, respectively). For supratentorial strokes, the ideal NIH-SS cut-off is > 9 (sensitivity 68.3%, specificity 61.5%, positive predictive value 89.7%, negative predictive value 28.4%). For infratentorial strokes, a lower ideal cut-off > 5 was calculated (sensitivity 67.4%, specificity 85.0%, positive predictive value 95.1%, negative predictive value 37.8%).
Conclusions: NIH-SS may be used as an adjunct to predict dysphagia in acute stroke patients with moderate sensitivity and specificity. Differentiation between supra- and infratentorial regions is essential not to miss dysphagia in infratentorial stroke.
Why you should read this article:
Explore the potential of the National Institute of Health Stroke Scale as a valuable screening parameter for the early detection of post-stroke dysphagia in a comprehensive ten-year retrospective analysis with 687 patients.
How to access this article:
This article is not open access. Please email benlabeit@gmail.com to request the original article.
Relationship between post-stroke dysphagia and pharyngeal sensory impairment
Authors:
Bendix Labeit, Anne Jung, Sigrid Ahring, Stephan Oelenberg, Paul Muhle, Malte Roderigo, Fiona Wenninger, Jonas von Itter, Inga Claus, Tobias Warnecke, Rainer Dziewas, Sonja Suntrup-Krueger
Abstract:
Background: Post-stroke dysphagia (PSD) is common and can lead to serious complications. Pharyngeal sensory impairment is assumed to contribute to PSD. The aim of this study was to investigate the relationship between PSD and pharyngeal hypesthesia and to compare different assessment methods for pharyngeal sensation.
Methods: In this prospective observational study, fifty-seven stroke patients were examined in the acute stage of the disease using Flexible Endoscopic Evaluation of Swallowing (FEES). The Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and impaired secretion management according to the Murray-Secretion Scale were determined, as well as premature bolus spillage, pharyngeal residue and delayed or absent swallowing reflex. A multimodal sensory assessment was performed, including touch-technique and a previously established FEES-based swallowing provocation test with different volumes of liquid to determine the latency of swallowing response (FEES-LSR-Test). Predictors of FEDSS, Murray-Secretion Scale, premature bolus spillage, pharyngeal residue, and delayed or absent swallowing reflex were examined with ordinal logistic regression analyses.
Results: Sensory impairment using the touch-technique and the FEES-LSR-Test were independent predictors of higher FEDSS, Murray-Secretion Scale, and delayed or absent swallowing reflex. Decreased sensitivity according to the touch-technique correlated with the FEES-LSR-Test at 0.3 ml and 0.4 ml, but not at 0.2 ml and 0.5 ml trigger volumes.
Conclusions: Pharyngeal hypesthesia is a crucial factor in the development of PSD, leading to impaired secretion management and delayed or absent swallowing reflex. It can be investigated using both the touch-technique and the FEES-LSR-Test. In the latter procedure, trigger volumes of 0.4 ml are particularly suitable.
Why you should read this article:
This article explores the connection between pharyngeal sensory impairment and post-stroke dysphagia, as well as various dysphagia findings.
How to access this article:
Systematic approach to contextualize findings of flexible endoscopic evaluation of swallowing in neurogenic dysphagia– towards an integrated FEES report
Authors:
Dziewas, Rainer Warnecke, Tobias Labeit, Bendix Claus, Inga Muhle, Paul Oelenberg, Stephan Ahring, Sigrid Wüller, Christina Jung, Anne von Itter, Jonas Suntrup-Krueger, Sonja
Full Citation:
Neurol Res Pract 2024 May 9;6(1):26. doi: 10.1186/s42466024-00321-8
Abstract:
Flexible endoscopic evaluation of swallowing (FEES) is one of the most important methods for instrumental swallowing evaluation. The most challenging part of the examination consists in the interpretation of the various observations encountered during endoscopy and in the deduction of clinical consequences. This review proposes the framework for an integrated FEES-report that systematically moves from salient findings of FEES to more advanced domains such as dysphagia severity, phenotypes of swallowing impairment and pathomechanisms. Validated scales and scores are used to enhance the diagnostic yield. In the concluding part of the report, FEES-findings are put into the perspective of the clinical context. The potential etiology of dysphagia and conceivable differential diagnoses are considered, further diagnostic steps are proposed, treatment options are evaluated, and a timeframe for reassessment is suggested. This framework is designed to be adaptable and open to continuous evolution. Additional items, such as novel FEES protocols, pathophysiological observations, advancements in disease-related knowledge, and new treatment options, can be easily incorporated. Moreover, there is potential for customizing this approach to report on FEES in structural dysphagia.
Why you should read this article:
This article provides a twelve-step structure to prepare a comprehensive FEES-report, which closely refers to the clinical context and includes precise recommendations for further diagnostic and therapeutic interventions.
How to access this article:
This article is open access and may be found here: DOI: 10.1186/s42466-024-00321-8
The assessment of dysphagia after stroke: state of the art and future directions
Authors:
Bendix Labeit, Emilia Michou, Shaheen Hamdy, Michaela Trapl-Grundschober, Sonja Suntrup-Krueger, Paul Muhle, Philip M Bath, Rainer Dziewas
Abstract:
Dysphagia is a major complication following an acute stroke that affects the majority of patients. Clinically, dysphagia after stroke is associated with increased risk of aspiration pneumonia, malnutrition, mortality, and other adverse functional outcomes. Pathophysiologically, dysphagia after stroke is caused by disruption of an extensive cortical and subcortical swallowing network. The screening of patients for dysphagia after stroke should be provided as soon as possible, starting with simple water-swallowing tests at the bedside or more elaborate multi-consistency protocols. Subsequently, a more detailed examination, ideally with instrumental diagnostics such as flexible endoscopic evaluation of swallowing or video fluoroscopy is indicated in some patients. Emerging diagnostic procedures, technical innovations in assessment tools, and digitalisation will improve diagnostic accuracy in the future. Advances in the diagnosis of dysphagia after stroke will enable management based on individual patterns of dysfunction and predisposing risk factors for complications. Progess in dysphagia rehabilitation are essential to reduce mortality and improve patients' quality of life after a stroke.
Why you should read this article:
This review paper comprehensively discusses the pathophysiology and diagnostic aspects of post-stroke dysphagia. In addition to providing insights into the current state of knowledge, the paper offers specific recommendations for clinical practice and outlines future directions in the field.
How to access this article:
This article is not open access.
Please email benlabeit@gmail.com to request the original article.
The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis
Authors:
Bendix Labeit, Marc Pawlitzki, Tobias Ruck, Paul Muhle, Inga Claus, Sonja Suntrup-Krueger, Tobias Warnecke, Sven G Meuth, Heinz Wiendl, Rainer Dziewas
Abstract:
1) Background: Dysphagia is a clinical hallmark and part of the current American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) diagnostic criteria for idiopathic inflammatory myopathy (IIM). However, the data on dysphagia in IIM are heterogenous and partly conflicting. The aim of this study was to conduct a systematic review on epidemiology, pathophysiology, outcome and therapy and a meta-analysis on the prevalence of dysphagia in IIM. (2) Methods: Medline was systematically searched for all relevant articles. A random effect model was chosen to estimate the pooled prevalence of dysphagia in the overall cohort of patients with IIM and in different subgroups. (3) Results: 234 studies were included in the review and 116 (10,382 subjects) in the meta-analysis. Dysphagia can occur as initial or sole symptom. The overall pooled prevalence estimate in IIM was 36% and with 56% particularly high in inclusion body myositis. The prevalence estimate was significantly higher in patients with cancer-associated myositis and with NXP2 autoantibodies. Dysphagia is caused by inflammatory involvement of the swallowing muscles, which can lead to reduced pharyngeal contractility, cricopharyngeal dysfunction, reduced laryngeal elevation and hypomotility of the esophagus. Swallowing disorders not only impair the quality of life but can lead to serious complications such as aspiration pneumonia, thus increasing mortality. Beneficial treatment approaches reported include immunomodulatory therapy, the treatment of associated malignant diseases or interventional procedures targeting the cricopharyngeal muscle such as myotomy, dilatation or botulinum toxin injections. (4) Conclusion: Dysphagia should be included as a therapeutic target, especially in the outlined high-risk groups.
Why you should read this article:
Discover the comprehensive insights provided by this systematic review and meta-analysis, delving into the intricate relationship between dysphagia and idiopathic inflammatory myopathy (IIM). Dysphagia, now a part of the diagnostic criteria for IIM, is investigated in terms of epidemiology, pathophysiology, outcome, and therapy.
This study synthesizes data from 234 articles and 116 meta-analyzed studies, encompassing a vast cohort of IIM patients. Therapeutically, it emphasizes the importance of considering dysphagia as a therapeutic target, especially for high-risk groups. Don't miss this opportunity to gain a deeper understanding of the complex interplay between IIM and dysphagia.
How to access this article:
https://www.mdpi.com/2077-0383/9/7/2150
Treatment of Post-stroke Dysphagia With Interferential Current: Three Case Reports and a Review of the Literature
Authors:
Bülent Alyanak, Fatih Bağcıer, Serkan Kablanoğlu
Full Citation:
Alyanak B, Bağcıer F, Kablanoğlu S. Treatment of Post-stroke Dysphagia With Interferential Current: Three Case Reports and a Review of the Literature. Cureus. 2024;16(2):e54806. Published 2024 Feb 24. doi:10.7759/cureus.54806
Abstract:
Stroke is damage to the central nervous system due to vascular pathology. Stroke causes many complications. One of the most important of these complications is dysphagia. Dysphagia is a major cause of morbidity and mortality. In recent years, the benefits of using interferential current (IFC) stimulation in the treatment of dysphagia due to various etiologies have been demonstrated. However, there are significant gaps in the literature regarding patient populations, treatment procedures, and evaluation of treatment response. Here, we report the treatment of three cases of dysphagia after ischemic stroke with IFC stimulation and review the current literature. The patients had no previous treatment for dysphagia and were using only compensatory methods. This case report highlights the benefit of IFC stimulation in the treatment of post-stroke dysphagia both clinically and videofluoroscopically. It should be kept in mind that IFC stimulation may be an important alternative in the treatment of post-stroke dysphagia.
Why you should read this article:
Interferential current has emerged as a new treatment modality for dysphagia. Although various benefits have been described, the number of methodologically sound studies is small and has not been applied to all patient populations. This article demonstrates the benefits of interferential flow in the most common post-stroke dysphagia using videofluoroscopy. There are no studies evaluating the effects of videofluoroscopic interferential flow in patients with post-stroke dysphagia. Therefore, we hope that this article can give clinicians an idea and pave the way for new studies.
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Treating postextubation dysphagia after stroke with pharyngeal electrical stimulation -insights from a randomized controlled pilot trial
Authors:
Suntrup-Krueger S, Labeit B, von Itter J, Jung A, Claus I, Ahring S, Warnecke T, Dziewas R, Muhle P.
Full Citation:
Neurotherapeutics . 2025 May 17:e00613. doi: 10.1016/j.neurot.2025.e00613.
Abstract:
Postextubation dysphagia is a major risk factor for extubation failure in acute stroke. Pharyngeal electrical stimulation (PES) is a novel neurostimulation technique for neurogenic dysphagia rehabilitation. We conducted a randomized controlled pilot trial evaluating PES early after extubation in acute stroke (N = 60) focusing on dysphagia recovery trajectories and related outcomes until discharge. Patients with severe postextubation dysphagia, defined as Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) score >4, received daily PES (real or sham, 10 min/day) for 3 consecutive days. By day 3, significantly fewer patients in the PES group exhibited persistent absence of spontaneous swallows (8 vs. 41 %) or pharyngeal sensory loss (4 vs. 55 %) compared to the sham group, indicating enhanced airway safety. Functional Oral Intake Scale (FOIS) score at day 3 was significantly higher in the PES group (4.1 vs 2.1 pts). FEDSS at days 5-7 and 8-10 showed a sustained treatment effect over time (2.4 vs. 3.7 pts. and 2.2 vs. 3.4 pts), resulting in better FOIS at discharge (4.7 vs. 3.5 pts.). PES shortened LOS in the intensive care unit (ICU) (3.1 vs. 8.5 days, p = 0.008) and total hospital stay (13.8 vs. 21.9 days, p = 0.004) from study inclusion. Tracheotomy rates were 13 vs. 33 % (p < 0.067). The proportion of patients still cannulated at discharge (7 vs. 10 %) and the modified Rankin Scale at discharge (3.9 vs. 4.0) were comparable. PES enhanced recovery of postextubation dysphagia, improved airway safety and shortened length of ICU and hospital stay in acute stroke.
How to access this article:
https://www.sciencedirect.com/science/article/pii/S1878747925000911?via%3Dihub
Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson's Disease
Authors:
Bendix Labeit, Sriramya Lapa, Paul Muhle, Sonja Suntrup-Krueger, Inga Claus, Florin Gandor, Sigrid Ahring, Stephan Oelenberg, Rainer Dziewas, Tobias Warnecke
Abstract:
Flexible Endoscopic Evaluation of Swallowing (FEES) is one of two diagnostic gold standards for pharyngeal dysphagia in Parkinson's disease (PD), however, validated global outcome measures at the patient level are widely lacking. The Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) represents such an outcome measure but has been validated primarily for head and neck cancer collectives. The objective of this study was, therefore, to investigate the validity of the DIGEST-FEES in patients with PD. Content validity was evaluated with a modified Delphi expert survey. Subsequently, 66 FEES videos in PD patients were scored with the DIGEST-FEES. Criterion validity was determined using Spearman's correlation coefficient between the DIGEST-FEES and the Penetration-Aspiration Scale (PAS), the Yale-Residue-Rating-Scale, the Functional-Oral-Intake-Scale (FOIS), and the swallowing-related Unified-Parkinson-Disease-Rating-Scale (UPDRS) items. Inter-rater reliability was determined using 10 randomly selected FEES-videos examined by a second rater. As a result, the overall DIGEST-FEES-rating exhibited significant correlations with the Yale-Valleculae-Residue-Scale (r = 0.84; p < 0.001), the Yale-Pyriform-Sinus-Residue-Scale (r = 0.70; p < 0.001), the FOIS (r = - 0.55, p < 0.001), and the UPDRS-Swallowing-Item-Score (r = 0.42, p < 0.001). Further, the DIGEST-FEES-safety subscore correlated with the PAS (r = 0.63, p < 0.001). Inter-rater reliability was high for the overall DIGEST-FEES rating (quadratic weighted kappa of 0.82). Therefore, DIGEST-FEES is a valid and reliable score to evaluate overall pharyngeal dysphagia severity in PD. Nevertheless, the modified Delphi survey identified domains where DIGEST-FEES may need to be specifically adapted to PD or neurological collectives in the future.
Why you should read this article:
This is the first validation study for the DIGEST-FEES, a patient based dysphagia severity classification, for Parkinson's disease
How to access this article:
https://link.springer.com/article/10.1007/s00455-023-10650-6
What is measured in dysphagia interventions in Parkinson’s disease: An international online survey of dysphagia clinicians
Authors:
Hirschwald, Julia, PhD; Mooney, Lauren, B.Sc.; Battel, Irene, PhD; Riera, Stephanie, M.Sc., Walshe, Margaret, PhD
Full Citation:
Hirschwald, J., Mooney, L., Battel, I., Riera, S., & Walshe, M. (2025). What is measured in dysphagia interventions in Parkinson’s disease: An international online survey of dysphagia clinicians. International Journal of Speech-Language Pathology, 1–10. https://doi.org/10.1080/17549507.2025.2555252
Abstract:
Purpose
What we measure as success in dysphagia intervention programmes and how we measure this attainment is important in clinical practice. This study aimed to provide insight into international perspectives of dysphagia clinicians in relation to important outcomes, applied outcome measurement instruments, and evaluation timepoints in oropharyngeal dysphagia interventions in Parkinson’s disease.
Method
An international, cross-sectional, anonymous, online survey was conducted with dysphagia clinicians. The survey was translated from English into German, Italian, Mandarin Chinese (Simplified), and Spanish. Survey results were analysed using descriptive statistics.
Result
The survey included 214 participants from 28 countries and found that 46 outcome measurement instruments are currently used, with the Penetration-Aspiration Scale being most common (n = 132, 27.7%). All 34 surveyed outcomes were considered important by ≥ 60% of participants, with penetration/aspiration rated most frequently (n = 209, 97.7%) important. Participants valued measuring outcomes before treatment and up to 24 months after completion of treatment.
Conclusion
This study highlights diverse approaches and preferences among dysphagia clinicians worldwide regarding outcome priorities, outcome measurement instruments, and timepoints of measurement in oropharyngeal dysphagia interventions in Parkinson’s disease.
Why you should read this article:
How do clinicians measure swallowing outcomes in Parkinson’s disease?
Despite dysphagia being common in Parkinson’s disease, there is limited clarity on what outcomes clinicians focus on and how these are measured in everyday practice.
As part of this study, we asked dysphagia clinicians worldwide about their current clinical approaches - what they measure, how, and when - to better understand real-world practice and highlight gaps for future research and standardization.
How to access this article:
Please email: hirschwj@tcd.ie
‘Without the Data You’re Not Going to Know If It’s Important or Not’: A Mixed Methods Study on What Dysphagia Intervention Outcomes are Important to People with Parkinson’s Disease and Family Members.
Authors:
Hirschwald, Julia, M.Sc.
Mooney, Lauren, B.Sc.
Wolf, Moritz, M.A.
Boyle, Gary
Warnecke, Tobias, Prof.
Walshe, Margaret, Prof.
Full Citation:
Hirschwald, J., Mooney, L., Wolf, M., Boyle, G., Warnecke, T., & Walshe, M. (2024). ‘Without the Data You’re Not Going to Know If It’s Important or Not’: A Mixed Methods Study on What Dysphagia Intervention Outcomes are Important to People with Parkinson’s Disease and Family Members. Dysphagia. https://doi.org/10.1007/s00455-024-10788-x
Abstract:
The lack of patient and public involvement in oropharyngeal dysphagia (OD) intervention studies in Parkinson’s disease (PD) can bias the choice of outcomes to be measured in these studies. This study aimed to obtain perspectives of individuals living with OD in PD and family members/caregivers on OD intervention outcomes that are important to them. This is part of a larger Core Outcome Set project. A mixed methods study with an international online cross-sectional survey and subsequent focus groups involving people with OD in PD and family members/caregivers was conducted. Survey results were analyzed using descriptive and inferential statistics. Intervention outcomes rated most important, significantly different, inconclusive, or identified as missing in the survey were clarified in follow-up focus groups with seven previous survey participants. Focus group data were audio recorded, transcribed verbatim and analyzed following inductive and deductive content analysis using NVivo. Twelve outcomes were rated as important by ≥ 80% of the 62 survey participants. The most important outcomes were penetration/aspiration and laryngeal sensation. Fear of choking was added as an important but missing intervention outcome. In the focus groups, findings from the survey were validated. Four content categories with eleven sub-categories were identified. OD intervention outcome priorities by people with OD in PD and family members/caregivers show only partial agreement with outcomes measured in published intervention studies on OD in PD. This highlights the importance of stakeholder involvement in the design and implementation of these studies to make findings relevant to all.
Why you should read this article:
Although we measure some of the outcomes that are important to both researchers and people with Parkinson's disease, we may be overlooking outcomes in current research studies that are important to people with Parkinson's disease, such as fear of choking.
How to access this article:
hirschwj@tcd.ie
Rehabilitation
Decannulation ahead: a comprehensive diagnostic and therapeutic framework for tracheotomized neurological patients
Authors:
Rainer Dziewas, Tobias Warnecke, Bendix Labeit, Volker Schulte, Inga Claus, Paul Muhle, Anna Brake, Lena Hollah, Anne Jung, Jonas von Itter, Sonja Suntrup-Krüger
Full Citation:
Neurol Res Pract . 2025 Mar 17;7(1):18. doi: 10.1186/s42466-025-00376-1
Abstract:
Background:
Decannulation in tracheotomized neurological patients is often complicated by severe dysphagia, which compromises airway safety and delays weaning. Additional challenges, including reduced cough strength, excessive bronchial secretions, and altered airway anatomy exacerbate weaning issues, thereby increasing morbidity and mortality. This review summarizes diagnostic procedures and therapeutic options crucial for the rehabilitation of tracheotomized patients.
Main body:
Key diagnostic strategies for assessing decannulation readiness focus on airway protection, airway patency, bronchial secretion management, and cough function. These are collectively introduced as the A2BC criteria in this review. Advanced tools such as flexible endoscopic evaluation of swallowing, endoscopic assessment of airway anatomy, measurement of cough strength, and intrathoracic pressure are essential components of a systematic evaluation. Therapeutic interventions encompass restoring physiological airflow, behavioral swallowing treatment, secretion management, and pharyngeal electrical stimulation. The proposed decannulation algorithm integrates two pathways: the “fast-track” pathway, which facilitates rapid decannulation based on relevant predictors of decannulation-success, and the “standard-track” pathway, which progressively increases cuff deflation intervals to build tolerance over time.
Conclusion:
Successful decannulation in neurological patients demands a multidisciplinary, patient-centered approach that combines advanced diagnostics, targeted therapies, and structured management pathways. The proposed algorithm integrates fast-track and standard-track pathways, balancing rapid diagnostics with gradual weaning strategies. This framework promotes flexibility, enabling clinicians to tailor interventions to individual patient needs while maintaining safety and optimizing outcomes.
Why you should read this article:
Decannulation is a critical step in the care of tracheotomized neurological patients — but practices vary widely. This open-access article presents expert-based, evidence-informed recommendations to support clinical decision-making and improve patient outcomes. Download now to explore practical algorithms, key considerations, and a consensus framework developed by an interdisciplinary team of authors.
How to access this article:
Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: a pharyngeal highresolution manometry study
Authors:
N Heslin, J Regan
Full Citation:
Heslin, N., & Regan, J. (2022). Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: a pharyngeal high-resolution manometry study. International Journal of Speech-Language Pathology, 24(2), 190-199.
Abstract:
Purpose: Evidence base to support the use of the effortful swallow in clinical populations with dysphagia is currently lacking. This study aims to quantify the effects of effortful swallowing on pharyngeal swallowing biomechanics in adults with dysphagia using pharyngeal high-resolution manometry (PHRM).
Method: ManoScan HRM equipment with a 4.2 mm pressure catheter was used. Participants completed duplicate 10ml baseline and 10ml effortful liquid (IDDSI Level 0) swallows in randomised order. PHRM data were analysed using a semi-automated online platform (www.swallowgateway.com).
Result: Fifteen adults (8 males; range 45-86 years) with mixed aetiology dysphagia (Functional Oral Intake Scale Level 2–5) were included. Median pharyngeal contractile (156.81 mmHg cm s; IQR 80.62) increased significantly (213.50 mmHg cm s; IQR 117.2) during effortful swallowing. Significant increases were also observed in velopharyngeal pressure, mesopharyngeal pressure, hypopharyngeal pressure and upper oesophageal sphincter (UOS) relaxation duration. UOS integrated relaxation pressure (IRP) was not significantly altered with effortful swallowing.
Conclusion: Effortful swallowing induced significant biomechanical changes to swallow in adults with dysphagia. Increases in global pharyngeal rigour, tongue base pressure and UOS opening duration were captured by PHRM during effortful swallowing. Further investigation in larger homogeneous clinical populations is needed to verify the physiological effects of this frequently employed intervention.
How to access this article:
Effect of Thickened Fluids on Swallowing Function in Oropharyngeal Dysphagia: Impact of Shear Rheology and Disorder Subtype
Authors:
Omari Taher, Ross Alex, Schar Mistyka, Campbell Jonathan, Thompson Alison, Besanko Laura, Lewis David, Robinson Ian, Farahani Mahshid, Cock Charles, Mossel Brenda.
Full Citation:
Omari, T., Ross, A., Schar, M., Campbell, J., Thompson, A., Besanko, L., Lewis, D.A., Robinson, I., Farahani, M., Cock, C. and Mossel, B. (2025), Effect of Thickened Fluids on Swallowing Function in Oropharyngeal Dysphagia: Impact of Shear Rheology and Disorder Subtype. Neurogastroenterology & Motility e15003.
Abstract:
Introduction: Fluid thickeners used in the management of oropharyngeal dysphagia exhibit non-Newtonian shear-thinning rheology, impacting their viscosity during deglutition. This study investigated how the rheological properties of thickened fluids affect pharyngeal swallowing parameters in patients with oropharyngeal motor disorders diagnosed by pharyngeal high-resolution manometry impedance (P-HRM-I).
Methods: Seventy-two patients (18–89 years) referred for P-HRM-I were diagnostically assessed with a 10 mL thin bolus. In 57 of the patients, 10 mL swallows of two moderately thick formulations—xanthan gum (XG) and sodium carboxymethylcellulose gum (CMC)—were also tested. The XG and CMC fluids had equivalent empirical thickness but different viscosity at pharyngeal phase shear rates: XG 87 mPa.s (83–91) versus CMC mean 157 mPa.s (148–164) at 300 s−1. Standard metrics of pharyngeal and upper esophageal sphincter (UES) function were derived from P-HRM-I recordings and analyzed to characterize patients into one of four disorder subtypes: (i) No Disorder, (ii) UES Disorder, (iii) Pharyngeal Disorder, and (iv) Combination UES/Pharyngeal Disorder. Impedance recordings also assessed pharyngeal bolus transit.
Results: Patients with a Combination UES/Pharyngeal Disorder were most likely to have abnormal bolus transit (82%, p < 0.001). Increasing bolus viscosity significantly influenced UES residual pressure, UES opening area, and post-swallow residue. Patients with UES Disorder exhibited pronounced increases in UES residual pressure with CMC compared to XG. Pharyngeal contractility was unaffected by viscosity changes. Post-swallow residue increased with CMC, particularly in patients with a Combination Disorder. Case-by-case analysis revealed individual variability in response to the different viscosities.
Conclusion: The rheological properties of thickened fluids significantly affect swallowing function, with these effects dependent upon the disorder subtype.
Why you should read this article:
The paper uses Pharyngeal-HRM-Impedance (P-HRM-I) to assess swallowing function in patients and demonstrates that two fluids with similar IDDSI thickness can produce markedly different results, dependent on their shear rheology and the type of swallowing dysfunction. The study opens the door to undertake further investigations to establish whether P-HRM-I assessment may have a complementary role for optimizing fluid thickener interventions.
How to access this article:
https://doi.org/10.1111/nmo.15003
Effects of the eccentric chin closure exercise on submental muscle activation, muscle strength, dysphagia limit, perceived exertion and pain in healthy volunteers: A prospective, randomized parallel group study
Authors:
Cengiz, Emre, PT, PhD, Res. Assist. Dr.
Arslan Serel, Selen, PT, SLP, Prof. Dr.
Yaşaroğlu, Ömer Faruk, PT, PhD, Assist. Prof.
Alıcı, Rabia, PT, Mac, Res. Assist.
Topçuoğlu, Mehmet Akif, MD, Prof. Dr.
Mutlu, Akmer, PT, PhD, Prof. Dr.
Full Citation:
Cengiz, E., Serel Arslan, S., Yaşaroğlu, Ö. F., Alıcı, R., Demir, N., Topçuoğlu, M. A., & Mutlu, A. (2024). Effects of the eccentric chin closure exercise on submental muscle activation, muscle strength, dysphagia limit, perceived exertion and pain in healthy volunteers: A prospective, randomized parallel group study. PloS one, 19(11), e0313995.
Abstract:
Objective(s)
Eccentric Chin Closure (ECC) exercise is a model designed to strengthen the suprahyoid muscles, aligned with the principles of eccentric exercise and the characteristics of these muscles. This study aimed to investigate the effects of the ECC exercise on submental muscle activation, muscle strength, dysphagia limit, perceived exertion, and pain, in comparison to the Shaker and Chin-Tuck Against Resistance (CTAR) exercises.
Methods
In this parallel randomized controlled trial, for the initial assessment fifty-four healthy volunteers aged between 19–28 years with submental activations were recorded during the isotonic components of the Shaker, CTAR, and ECC exercises using surface electromyography. After the initial assessment, the volunteers were randomized to the Shaker, CTAR, and ECC exercise groups with 18 volunteers each group, and followed an 8-week exercise program. Maximum voluntary isometric contractions (MVC), muscle strength, dysphagia limit, perceived exertion, and pain were recorded at baseline in 4th week and 8th week.
Results
At the initial assessment, lower submental muscle activation was observed during the Shaker exercise (p<0.05). Follow-up measurements demonstrated that the eight weeks of exercise was effective in increasing MVC activations and muscle strength across all groups. Considering the group*time effect, CTAR (0.36 ± 0.10) and ECC (0.40 ± 0.14) exercises were found to be more effective in increasing MVC than the Shaker (0.29 ± 0.19) exercise (F = 7.203, p<0.001), and the ECC (32.87 ± 6.55) exercise was more effective in improving muscle strength than both the Shaker (26.03 ± 5.86) and CTAR (27.95 ± 6.33) exercises (F = 6.786, p<0.001). Perceived exertion (F = 1.044, p = 0.388) and pain scores (F = 0.346, p = 0.846) showed statistically similar changes across the Shaker, CTAR, and ECC exercise groups.
Conclusion
The ECC exercise demonstrated similar effects on MVC to CTAR, but resulted in greater MVC than the Shaker exercise among healthy volunteers at 8 weeks. ECC was also more effective compared to Shaker and CTAR in terms of strength gain, with all exercises showing comparable levels of perceived exertion and pain.
Why you should read this article:
In this study, the effects of eccentric chin closure (ECC) exercise developed with eccentric contraction prescriptions on muscle strength, submental muscle activation, perceived exertion level and pain were examined. At the end of 8 weeks of exercise, ECC exercise showed similar effects to Chin-Tuck Against Resistance (CTAR) in terms of maximum voluntary contraction (MVC), but exhibited higher MVC than Shaker exercises among healthy volunteers at week 8. It was also observed that ECC exercise was more effective than Shaker and CTAR in terms of muscle strength gains after 8 weeks of exercise. Furthermore, these exercises showed similar levels of perceived exertion and pain. From a clinical perspective, ECC is a well-tolerated, full ROM eccentric exercise model that shows promise as a rehabilitation tool to increase suprahyoid muscle activation and muscle strength. The fact that it can be adjusted according to the individual's abilities, combined with manageable levels of perceived exertion and pain, demonstrates its potential utility in clinical practice.
How to access this article:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0313995#:~:text=The%20ECC%20exercise%20demonstrated%20similar,of%20perceived%20exertion%20and%20pain.
Impact of Sensory Stimulation on Pharyngo-esophageal Swallowing Biomechanics in Adults with Dysphagia: A HighResolution Manometry Study
Authors:
Julie Regan
Full Citation:
Regan, J. (2020). Impact of sensory stimulation on pharyngoesophageal swallowing biomechanics in adults with dysphagia: a high-resolution manometry study. Dysphagia, 35(5), 825-833.
Abstract:
Evidence supporting sensory stimulation of swallowing is based mostly on videofluoroscopy and provides little insight into changes to swallowing physiology. In this study, the impact of sensory stimulation on pharyngo-esophageal swallowing biomechanics was investigated in adults with dysphagia using pharyngeal high-resolution manometry. Fifteen adults (8 males; 45–86 years) with mixed etiology dysphagia were consecutively recruited over a three-month period. PHRM equipment with a 4.2 mm pressure catheter was used. The protocol included duplicate 10 ml neutral, sour, cold, and carbonated liquid swallows in randomized order. Semi-automated analysis was completed using an online portal (www.swallowgateway.com). Data from 98/120 swallows were analyzed. During the pharyngeal phase, mean pharyngeal contractile integral (PhCI) increased significantly with cold (p = 0.03), sour (p = 0.00), and carbonation (p = 0.02). Mean velopharyngeal contractile integral (VCI) (p = 0.01) and mesopharyngeal contractile integral (MCI) (p = 0.04) both increased significantly with carbonation. Mean hypopharyngeal contractile integral (HPCI) was not significantly altered by sensory stimulation. Regarding UES opening, UES relaxation time (UESRT) increased significantly with cold (p = 0.032), carbonation (p = 0.032), and sour (p = 0.027). Extent of UES opening as measured by IRP reduced significantly with cold stimulation (9.34 to 5.17 mmHg) (p = 0.032). No significant changes were observed to UES basal pressure or UES peak pressure with sensory stimulation. Sensory stimulation induced biomechanical changes to pharyngeal contraction vigor, UES relaxation time and extent of UES opening during swallowing in adults with dysphagia. This study contributes evidence to support sensory stimulation as a dysphagia intervention. Further combined pressure impedance studies in homogeneous clinical populations are ongoing.
How to access this article:
https://link.springer.com/article/10.1007/s00455-019-10088-9
New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP®
Authors:
J Regan, M Walshe, Nathalie Rommel, Jan Tack, BP McMahon
Full Citation:
Regan, J., Walshe, M., Rommel, N., Tack, J., & McMahon, B. P. (2013). New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP®. Neurogastroenterology & Motility, 25(1), e25-e34.
Abstract:
Background: This paper aims to measure upper esophageal sphincter (UES) distensibility and extent and duration of UES opening during swallowing in healthy subjects using EndoFLIP®.
Methods: Fourteen healthy subjects (20–50 years) were recruited. An EndoFLIP® probe was passed trans-orally and the probe balloon was positioned across the UES. Two 20-mL ramp distensions were completed and UES cross-sectional area (CSA) and intra-balloon pressure (IBP) were evaluated. At 12-mL balloon volume, subjects completed dry, 5- and 10-mL liquid swallows and extent (mm) and duration (s) of UES opening and minimum IBP (mmHg) were analyzed across swallows.
Key Results: Thirteen subjects completed the study protocol. A significant change in UES CSA (P < .001) and IBP (P < .000) was observed during 20-mL distension. UES CSA increased up to 10-mL distension (P < .001), from which point IBP raised significantly (P = 0.004). There were significant changes in UES diameter (mm) (P < .000) and minimum IBP (mmHg) (P < .000) during swallowing events. Resting UES diameter (4.9 mm; IQR 0.02) and minimum IBP (18.8 mmHg; IQR 2.64) changed significantly during dry (9.6 mm; IQR 1.3: P < .001) (3.6 mmHg; IQR 4.1: P = 0.002); 5 mL (8.61 mm; IQR 2.7: P < .001) (4.8 mmHg; IQR 5.7: P < .001) and 10-mL swallows (8.3 mm; IQR 1.6: P < 0.001) (3 mmHg; 4.6: P < .001). Median duration of UES opening was 0.5 s across dry and liquid swallows (P = 0.91). Color contour plots of EndoFLIP® data capture novel information regarding pharyngo-esophageal events during swallowing. 1
Conclusions & Inferences: Authors obtained three different types of quantitative data (CSA, IBP, and timing) regarding UES distensibility and UES opening patterns during swallowing in healthy adults using only one device (EndoFLIP®). This new measure of swallowing offers fresh information regarding UES dynamics which may ultimately improve patient care.
How to access this article:
This article is not open access.
Please contact juregan@tcd.ie for how to access.
Predictors of pharyngeal electrical stimulation treatment success in tracheotomised stroke patients with dysphagia: Secondary analysis from PHADER cohort study
Authors:
Cheng, Ivy, Dr
Bath, Philip M, Prof
Hamdy, Shaheen, Prof
Muhle, Paul, Dr
Mistry, Satish, Dr
Dziewas, Rainer, Prof. Dr.
Suntrup-Krueger, Sonja, Prof. Dr.
Abstract:
Pharyngeal electrical stimulation (PES) has emerged as a promising intervention for neurogenic dysphagia, with potential benefits in reducing dysphagia severity in stroke patients. PES may facilitate decannulation in tracheotomised stroke patients with dysphagia, yet the predictive factors for treatment success have not been investigated in detail. This study used data from the PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) study to identify predictive factors for PES treatment success among patients with post stroke dysphagia who required mechanical ventilation and tracheotomy. Multiple linear regression was performed to predict treatment success, as measured in improvement in dysphagia severity rating scale (DSRS), accounting for age, sex, stroke type, lesion location, baseline National Institutes of Health Stroke Scale (NIHSS) score, feeding status, time from stroke onset to PES, PES perceptual threshold and PES stimulation intensity at the first session. Cox regression was conducted to identify the predictors for decannulation for all participants. Ninety-eight participants (mean [SD] age = 66.6 [13.0]; male 73.5%) were included in the analyses. Regression analyses showed that early intervention (p = 0.004) and younger age (p = 0.049) were significant predictors for treatment success. For participants who received PES during tracheotomy (n = 60; mean [SD] age = 66.6 [11.2]; male 73.3%), supratentorial stroke (p = 0.033) and feeding status at baseline (p = 0.025) were predictors of treatment success. Among all participants, early intervention was associated with higher likelihood of decannulation (p = 0.026). These results highlight the importance of timely intervention, age and stroke location in PES treatment success for stroke patients with mechanical ventilation and tracheotomy.
Why you should read this article:
This study analysed the predictive factors for pharyngeal electrical stimulation (PES) treatment success in tracheotomised stroke patients with dysphagia. The findings furthered our understanding on how we can optimise the treatment benefits. These implications have a direct impact on the clinical practice of using PES for dysphagia rehabilitation.
How to access this article:
Respiration
The Eating Assessment Tool-10 Predicts Aspiration in Adults with Stable Chronic Obstructive Pulmonary Disease
Authors:
Julie Regan, Susan Lawson & Vânia De Aguiar
Full Citation:
Regan, J., Lawson, S., & De Aguiar, V. (2017). The Eating Assessment Tool-10 predicts aspiration in adults with stable chronic obstructive pulmonary disease. Dysphagia, 32, 714720.
Abstract:
Adults with COPD frequently present with dysphagia, which often leads to clinical complications and hospital admissions. This study investigates the ability of the Eating Assessment Tool (EAT-10) to predict aspiration during objective dysphagia evaluation in adults with stable COPD. Thirty adults (20 male, 10 female; mean age = 69.07 ± 16.82) with stable COPD attended an outpatient dysphagia clinic for a fiberoptic endoscopic evaluation of swallowing (FEES) in an acute teaching hospital (January 2015November 2016). During evaluations, individuals completed an EAT-10 rating scale followed immediately by a standardised FEES exam. Aspiration status during FEES was rated using the penetration–aspiration scale by clinicians blinded to EAT-10 scores. Data were retrospectively analysed. Significant differences in mean EAT-10 scores were found between aspirators (16.3; SEM = 2.165) and non-aspirators (7.3; SEM = 1.009) (p = 0.000). The EAT-10 predicted aspiration with a high level of accuracy (AUC = 0.88). An EAT-10 cut-off value of >9 presented a sensitivity of 91.67, specificity of 77.78 with positive and negative likelihood ratios of 4.12 and 0.11, respectively. Positive and negative predictive values were 73.30 and 93.30, respectively. Diagnostic odds ratio was 38.50 (p < 0.01, CI 3.75–395.42). EAT-10 is a quick, easy to administer tool, which can accurately predict the presence of aspiration in adults with COPD. The scale can also very accurately exclude the absence of aspiration, helping clinicians to determine the need for onward referral for a comprehensive dysphagia evaluation. This may ultimately reduce clinical complications and hospital admissions resulting from dysphagia in this clinical population.
How to access this article:
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