Medically Unexplained Oropharyngeal Dysphagia at the University Hospital ENT Outpatient Clinic for Dysphagia: A Cross-Sectional Cohort Study

Medically unexplained oropharyngeal dysphagia (MUNOD) is a rare condition. It presents without demonstrable abnormalities in the anatomy of the upper aero-digestive tract and/or swallowing physiology. This study investigates whether MUNOD is related to affective or other psychiatric conditions. The study included patients with dysphagic complaints who had no detectible structural or physiological abnormalities upon swallowing examination. Patients with any underlying disease or disorder that could explain the oropharyngeal dysphagia were excluded. All patients underwent a standardized examination protocol, with FEES examination, the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Severity Scale (DSS). Two blinded judges scored five different FEES variables. None of the 14 patients included in this study showed any structural or physiological abnormalities during FEES examination. However, the majority did show abnormal piecemeal deglutition, which could be a symptom of MUNOD. Six patients (42.8%) had clinically relevant symptoms of anxiety and/or depression. The DSS scores did not differ significantly between patients with and without affective symptoms. Affective symptoms are common in patients with MUNOD, and their psychiatric conditions could possibly be related to their swallowing problems

Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia

OBJECTIVE: The aim of the present study is to determine the presence and severity of symptoms of anxiety and depression in patients with oropharyngeal dysphagia who visit the outpatient clinic for dysphagia. METHODS: Symptoms of anxiety and depression (affective symptoms) were prospectively assessed in 96 patients using the validated Hospital Anxiety and Depression Scale. In addition, all patients underwent a standardized examination protocol used for regular healthcare in the outpatient setting for dysphagia. The protocol included the following: otorhinolaryngological examination, logopedic observation of oral intake, fiber optic endoscopic evaluation of swallowing, videofluoroscopy of swallowing, the Functional Oral Intake Scale, a dysphagia severity scale, and the M.D. Anderson Dysphagia Inventory. Depending on the presence/absence of symptoms of anxiety and depression, several groups were distinguished. Descriptive statistics and the Mann-Whitney U test were used to test for group differences. Logistic regression models were used to identify factors associated with symptoms of anxiety and/or depression (cut-off score >8). RESULTS: Clinically relevant symptoms of anxiety were observed in 37% (N=34) and clinically relevant symptoms of depression in 32.6% (N=31) of the present patient population, with 21.3% having symptoms of both anxiety and depression. In total, 47.3% (N=43) of this population showed affective symptoms. CONCLUSION: Given that psychological burden can enhance somatic complaints, the high number of patients suffering from affective symptoms is a relevant clinical outcome in dysphagic patients. The contribution of anxiety or depression to the development or worsening of oropharyngeal dysphagia and their role in interdisciplinary treatment strategy is warranting further research

Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia

OBJECTIVE: The aim of the present study is to determine the presence and severity of symptoms of anxiety and depression in patients with oropharyngeal dysphagia who visit the outpatient clinic for dysphagia. METHODS: Symptoms of anxiety and depression (affective symptoms) were prospectively assessed in 96 patients using the validated Hospital Anxiety and Depression Scale. In addition, all patients underwent a standardized examination protocol used for regular healthcare in the outpatient setting for dysphagia. The protocol included the following: otorhinolaryngological examination, logopedic observation of oral intake, fiber optic endoscopic evaluation of swallowing, videofluoroscopy of swallowing, the Functional Oral Intake Scale, a dysphagia severity scale, and the M.D. Anderson Dysphagia Inventory. Depending on the presence/absence of symptoms of anxiety and depression, several groups were distinguished. Descriptive statistics and the Mann-Whitney U test were used to test for group differences. Logistic regression models were used to identify factors associated with symptoms of anxiety and/or depression (cut-off score >8). RESULTS: Clinically relevant symptoms of anxiety were observed in 37% (N=34) and clinically relevant symptoms of depression in 32.6% (N=31) of the present patient population, with 21.3% having symptoms of both anxiety and depression. In total, 47.3% (N=43) of this population showed affective symptoms. CONCLUSION: Given that psychological burden can enhance somatic complaints, the high number of patients suffering from affective symptoms is a relevant clinical outcome in dysphagic patients. The contribution of anxiety or depression to the development or worsening of oropharyngeal dysphagia and their role in interdisciplinary treatment strategy is warranting further research

Medically Unexplained Oropharyngeal Dysphagia at the University Hospital ENT Outpatient Clinic for Dysphagia:A Cross-Sectional Cohort Study

Medically unexplained oropharyngeal dysphagia (MUNOD) is a rare condition. It presents without demonstrable abnormalities in the anatomy of the upper aero-digestive tract and/or swallowing physiology. This study investigates whether MUNOD is related to affective or other psychiatric conditions. The study included patients with dysphagic complaints who had no detectible structural or physiological abnormalities upon swallowing examination. Patients with any underlying disease or disorder that could explain the oropharyngeal dysphagia were excluded. All patients underwent a standardized examination protocol, with FEES examination, the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Severity Scale (DSS). Two blinded judges scored five different FEES variables. None of the 14 patients included in this study showed any structural or physiological abnormalities during FEES examination. However, the majority did show abnormal piecemeal deglutition, which could be a symptom of MUNOD. Six patients (42.8%) had clinically relevant symptoms of anxiety and/or depression. The DSS scores did not differ significantly between patients with and without affective symptoms. Affective symptoms are common in patients with MUNOD, and their psychiatric conditions could possibly be related to their swallowing problems.</p

The experience sampling method as an mHealth tool to support self-monitoring, self-insight, and personalized health care in clinical practice

The experience sampling method (ESM) builds an intensive time series of experiences and contexts in the flow of daily life, typically consisting of around 70 reports, collected at 8-10 random time points per day over a period of up to 10 days.status: publishe

Dyspnea in patients with atrial fibrillation:Mechanisms, assessment and an interdisciplinary and integrated care approach

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is often associated with symptoms that can significantly impact quality of life and daily functioning. Palpitations are the cardinal symptom of AF and many AF therapies are targeted towards relieving this symptom. However, up to two-third of patients also complain of dyspnea as a predominant self-reported symptom. In clinical practice it is often challenging to ascertain whether dyspnea represents an AF-related symptom or a symptom of concomitant cardiovascular and non-cardiovascular comorbidities, since common AF comorbidities such as heart failure and chronic obstructive pulmonary disease share similar symptoms. In addition, therapeutic approaches specifically targeting dyspnea have not been well validated. Thus, assessing and treating dyspnea can be difficult. This review describes the latest knowledge on the burden and pathophysiology of dyspnea in AF patients. We discuss the role of heart rhythm control interventions as well as the management of AF risk factors and comorbidities with the goal to achieve maximal relief of dyspnea. Given the different and often complex mechanistic pathways leading to dyspnea, dyspneic AF patients will likely profit from an integrated multidisciplinary approach to tackle all factors and mechanisms involved. Therefore, we propose an interdisciplinary and integrated care pathway for the work-up of dyspnea in AF patients