Le manovre e gli esercizi

Gli esercizi e le manovre per la disfagia vengono presentate insieme alle pi\uf9 recenti evidenze nell'ambito

Valutazione clinica e strumentale

La presentazione ricopre il tema della valutazione clinica e strumentale della disfagia

Factors related to swallowing oral phase

Introduction: Efficacy of swallowing oral phase is often impaired in dysphagic patients and may impact on pharyngeal stage, meal consumption, nutritional status and quality of life. However, factors related to oral phase of swallowing have been little studied. Matherial & Methods: Thirty-nine adult patients with dysphagia of different etiology were enrolled. FEES and the Test of Mastication and Swallowing Solids (TOMASS) were performed. The Penetration-Aspiration scale, the Yale Pharyngeal Residue Severity Rating Scale and the Dysphagia Outcome and Severity Scale (DOSS) were used to assess the FEES. Tongue strength was assessed using the Iowa Oral Performance Instrument. Patients completed the Eating Assessment Tool-10. The time the patients needed to consume a meal, the Functional Oral Intake Scale score and the body mass index (BMI) were recorded. Correlations between the TOMASS and other variables were studied using Spearman\u2019s correlation coefficient. TOMASS scores were compared between patients with complete denture and those with partial edentulism through Mann-Whitney test. Results: The number of discrete bites correlated only with the BMI (r=-0.38; p=0.01). Statistically significant correlations were found between the number of masticatory cycles and tongue strength (r=-0.47; p<0.01), pharyngeal residue (r=0.42; p<0.01), DOSS (r=-0.38; p=0.01). The total time of the TOMASS correlated with tongue strength (r=-0.45; p<0.01), pharyngeal residue (r=0.48; p<0.01), time needed to consume a meal (r=0.41; p=0.01) and DOSS (r=-0.36; p=0.02). A significant difference was found between patients with complete denture and patients with partial edentulism for the number of masticatory cycles (p=0.02) and total time (p=0.03). Conclusions: Swallowing oral phase seems to correlate with tongue strength, denture, pharyngeal residue, overall dysphagia severity, duration of meals and BMI. Further studies involving a larger sample size are necessary to confirm present data

Characterization of pharyngeal hypocontractility patterns during deglutition: High Resolution Impedance Manometry findings

Introduction High resolution impedance manometry (HRIM) provides an objective measure of pharyngeal pressurization and bolus flow and can be analysed using pressure flow analysis (PFA). The aim of the study is to investigate different types of pharyngeal hypocontractility and their distribution in patients with pharyngeal dysphagia. Material and Methods A cohort study was conducted on patients with dysphagia referred for HRIM. Inclusion criteria were abnormal (<5th percentile) pharyngeal contractile integral (PhCI) or abnormal regional contractile integrals (velo- or meso- or hypo-pharyngeal integrals). PFA was performed on 10ml liquid swallows using the Swallow GatewayTM open access analysis portal. Patients were classified based on a proposed HRIM scheme. The distribution of PFA metrics was compared between patients with normal and abnormal PhCI using the chi-squared test. Results In total 38 patients were studied and 137 swallows were analysed. Absent pharyngeal contractility was found in 5.3% (2/38) of the patients, ineffective pharyngeal contractility in 68.4% (26/38), and fragmented pharyngeal contractility in 26.3% (10/38). Regional weakness was mainly observed in the mesopharynx (94.7% of the patients), followed by the hypopharynx (50%) and the velopharynx (15.8%). A combined disorder of pharyngeal propulsion and UES restriction was seen in 44.7% (17/38) of the patients. Patients with a normal PhCI (fragmented pharyngeal contractility) were more likely to present an abnormal integrated relaxation pressure at the level of the upper esophageal sphincter (\u3c72=14.56, p=0.001) Conclusion Based on the pharyngeal contractile integrals, two main types of pharyngeal hypocontractility are present in the clinical population of patients: ineffective and fragmented pharyngeal contractility. Totally absent peristalsis in uncommon. In almost half of the patients, pharyngeal propulsion disorders are combined to disorders of UES restriction

The Vocal Score Profile in Verdi's Characters

OBJECTIVES: Selecting the appropriate repertoire for an opera singer may be crucial for both the prevention of voice disorders and the career progression. Here, we reviewed the score of 14 Verdi's operas to gain the data for the creation of the vocal score profile of each role. MATERIALS AND METHODS: Seven musicians were involved in the analysis process. Notes were counted and reported as absolute and relative frequency. Pitch measurements included pitch range, percentage of high-pitched notes, percentage of medium-pitched notes, percentage of low-pitched notes, high-pitched and low-pitched notes rate, percentage of the notes in the passaggio, identification of the prevalent octave, percentage of notes in the prevalent octave, and percentage of notes in a moderate range tessitura. The total phonation time was calculated for each character. RESULTS: A heterogeneity among pitch and duration measurement was found among roles within the same voice type, leading to highly different vocal efforts required by the performer. CONCLUSIONS: Data on 67 Verdi characters were gained, and the vocal demand of each role was discussed. Potentially, these results may support singers, singing teachers, and vocal coaches in the selection of the repertoire. The data may also assist clinicians in the conduction of counseling and during eventual voice therapy. Future studies must investigate the predictive value of the vocal score profile in appraising the risk of vocal injury

Analysis of videofluoroscopic variables affecting swallowing safety and efficiency in ophl patients

Open partial horizontal laryngectomy (OPHL) could represent a valuable alternative to total laryngectomy for selected laryngeal carcinoma. In long-term, occasional aspiration ranges from 12.9 to 67% after OPHL [1]. Rate of aspiration pneumonia can reach the 21.7% [2]. Main causes of swallowing impairment vary from a defective glottic closure to a reduced upper esophageal sphincter (UES) opening. At the present time, only one study analysed spatial and temporal videofluoroscopic variables to evaluate factors affecting postoperative aspiration. No studies before have compared videofluoroscopic variables between OPHL patients with and without dysphagia

Association between maximum tongue pressure and swallowing safety and efficacy in amyotrophic lateral sclerosis

Background Oropharyngeal dysphagia (OD) is common in amyotrophic lateral sclerosis (ALS), leading to a reduction of swallowing safety and efficacy. The tongue has an important role in swallowing function for oral processing and bolus propulsion through the pharynx. The study aims to analyze the association between instrumental findings of OD and tongue pressure. Methods Patients with ALS referred for fiberoptic endoscopic evaluation of swallowing (FEES) were recruited. FEES was conducted to test swallowing function with liquid (5, 10, and 20 ml), semisolid (5, 10, and 20 ml), and solid. FEES recordings were assessed for swallowing safety, using the penetration-aspiration scale (PAS), and for swallowing efficacy, using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). PAS scores >2 were suggestive of penetration, PAS scores >5 of aspiration, and YPRSRS scores >2 of residue. Maximum tongue pressure (MTP) and tongue endurance were measured using the Iowa Oral Performance Instrument. Tongue pressure measurements were compared between patients with and without penetration, aspiration, or residue. Key results Fifty-five patients with ALS were included. Mean MTP was 29.7 kPa, and median tongue endurance was 10 seconds. Patients with residue in the pyriform sinus had a significantly lower MTP than patients without residue in the pyriform sinus with semisolids 10 ml (P = .011) and 20 ml (P = .032). Patients with a tongue endurance <10 seconds exhibited higher frequency of penetration with liquids 5 ml (P = .046), liquids 10 ml (P = .015), and solids (P = .22). Conclusion and inferences In patients with ALS, MTP is significantly associated with an impairment of swallowing efficacy and tongue endurance was significantly associated with an impairment of swallowing safety

Plantar pain is not always fasciitis

The case is described of a patient with chronic plantar pain, diagnosed as fasciitis, which was not improved by conventional treatment. Magnetic resonance imaging revealed flexor hallucis longus tenosynovitis, which improved after local glucocorticoid injection

Adaptation of the Penetration-Aspiration Scale to Open Partial Horizontal Laryngectomy: reliability analysis

The study aimed at adapting the Penetration-Aspiration scale to OPHL and analysing its reliability