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| 2. |
- Nilsson, Håkan, et al.
(författare)
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Dysphagia in stroke: a prospective study of quantitative aspects of swallowing in dysphagic patients
- 1998
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Ingår i: Dysphagia. - 1432-0460. ; 13:1, s. 32-38
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Tidskriftsartikel (refereegranskat)abstract
- This is a prospective study of 100 consecutive stroke patients. Within 24 h after stroke onset they were asked specifically about swallowing complaints and subjected to a clinical examination including neurologic examination, Mini-Mental test, and Barthel score. Dysphagic patients were examined with the repetitive oral suction swallow test (the ROSS test) for quantitative evaluation of oral and pharyngeal function at 24 h, after 1 week, and after 1 month. At 6 months, the patients were interviewed about persistent dysphagia. Seventy-two patients could respond reliably at 24 h after the stroke onset and 14 of these complained of dysphagia. Non-evaluable patients were either unconscious, aphasic, or demented. The presence of dysphagia was not influenced by age or other risk factors for stroke. Facial paresis, but no other clinical findings, were associated with dysphagia. Dysphagia 24 h after stroke increased the risk of pneumonia but did not influence the length of hospital stay, the manner of discharge from hospital, or the mortality. The initial ROSS test, during which the seated patient ingests water through a straw, was abnormal in all dysphagic stroke patients. One-third of the patients were unable to perform the test completely. Above all, dysfunction was disclosed during forced, repetitive swallow. All phases of the ingestion cycle were prolonged whereas the suction pressures, bolus volumes, and swallowing capacities were low. Abnormalities of quantitative swallowing variables decreased with time whereas the prevalences of swallowing incoordination and abnormal feeding-respiratory pattern became more frequent. After 6 months, 7 patients had persistent dysphagia. Five of these were initially non-evaluable because of unconsciousness, aphasia, or dementia.
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| 3. |
- Olsson, Rolf, et al.
(författare)
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Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers
- 1995
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Ingår i: Dysphagia. - 1432-0460. ; 10:1, s. 36-41
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Tidskriftsartikel (refereegranskat)abstract
- Recent technological advances in manometry, including solid state transducers and computerized analysis, allows for reliable interpretation of intraluminal pharyngeal pressures. Simultaneous videoradiography (barium swallow) provides fluoroscopic control of the manometric sensors (videomanometry), thereby eliminating the uncertainty of sensor dislocation during laryngeal elevation. This is the first study describing normal manometric parameters in videomanometry during barium swallow. Seven manometric parameters and six videoradiographic parameters were analyzed. We included 25 nondysphagic volunteers with normal videoradiographic parameters in the study. The examination was performed in an upright physiologic position during 10-ml barium and dry swallows. Mean resting pressure in the upper esophageal sphincter was 89.6 +/- 32.6 (+/- 2 SD) mmHg. Mean residual pressure during relaxation of the upper esophageal sphincter was 7.2 +/- 8.0 (+/- 2 SD) mmHg during barium swallow and 3.8 +/- 6.2 (+/- 2 SD) mmHg during dry swallow. The mean duration of upper esophageal sphincter relaxation was 601 +/- 248 (+/- 2 SD) msec. The mean peristaltic contraction of the upper esophageal sphincter was 253.8 +/- 142.8 (+/- 2 SD) mmHg. Fourteen (56%) of the 25 had a measurable intrabolus pressure (mean 33.2 +/- 17.3 mmHg) at the level of the inferior pharyngeal constrictor. A specific finding was discovered when the epiglottis tilts down hitting the manometric sensor. This epiglottic tilt was identified in 7 subjects (28%) and caused pressures of around 600 mmHg. A standardized manometric technique is important in videomanometry, and normal values as described in this study are essential in clinical use.
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| 4. |
- Ekberg, Olle, et al.
(författare)
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Autonomic nerve dysfunction in patients with bolus-specific esophageal dysmotility
- 1995
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Ingår i: Dysphagia. - 1432-0460. ; 10:1, s. 44-48
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Tidskriftsartikel (refereegranskat)abstract
- The pathogenetic mechanisms causing esophageal dysmotility is not well understood. We examined 13 patients with solid bolus dysphagia in a radiologic barium study including the swallowing of a 14-mm tablet. In all 13 patients the tablet was caught in the proximal or midesophagus. In 8 patients, the entrapment was associated with symptoms (Group 1) whereas in 5 patients (Group 2), no symptoms were reported. All 13 patients together with a control group of 56 healthy, nondysphagic subjects were tested for autonomic nerve function. Autonomic nerve function tests included registration of electrocardiographic R-R interval variation during deep breathing test (E/I ratio), a test of parasympathetic, vagal, nerve function. The results showed that the E/I ratio was significantly lower in patients with symptoms of bolus-specific esophageal dysmotility (-2,19 [1.76]) (median [interquartile range]) compared with patients without symptoms (0.05 [2, 87], p = 0.0192) and controls (-0.25 [1.26], p = 0.0009). In conclusion, symptomatic bolus-specific esophageal dysmotility is associated with vagal nerve dysfunction.
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| 5. |
- Bülow, Margareta, et al.
(författare)
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Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in healthy volunteers
- 1999
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Ingår i: Dysphagia. - 1432-0460. ; 14:2, s. 67-72
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Tidskriftsartikel (refereegranskat)abstract
- Simultaneous videoradiography and solid-state manometry (videomanometry) was applied in eight healthy volunteers (four women, four men; age range 25-64 years, mean age 41 years) without swallowing problems. Three different swallowing techniques were tested; supraglottic swallow, effortful swallow, and chin tuck. Seven videoradiographic variables and six manometric variables were analyzed. The supraglottic swallowing technique did not differ significantly from that of the control swallows. The effortful swallow had a significantly (p = 0.0001) reduced hyoid-mandibular distance preswallow due to an elevation of the hyoid and the larynx, which caused a significantly (p = 0.007) reduced maximal hyoid movement and a significantly (p = 0.009) reduced laryngeal elevation during swallow. The chin tuck swallow had a significantly (p = 0. 001) reduced laryngohyoid distance and also a significantly (p = 0. 004) reduced hyoid-mandibular distance. The chin tuck swallow also displayed significantly (p = 0.003) weaker pharyngeal contractions. Videomanometry allows for analysis of bolus transport, movement of anatomical structures, and measurement of intraluminal pressures. These variables are important when evaluating swallowing techniques. In the present study, we made a few observations that never have been reported before. When healthy volunteers performed supraglottic swallow, they performed the technique somewhat differently. Therefore, we assume dysphagic patients would need a substantial period of training to perform a technique efficiently. Chin tuck could impair protection of the airways in dysphagic patients with weak pharyngeal constrictor muscles.
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| 6. |
- Ekberg, Olle, et al.
(författare)
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Das pharyngoosophageale Segment
- 1995
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Ingår i: Radiologe. - 0033-832X. ; 35:10, s. 689-692
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Tidskriftsartikel (refereegranskat)abstract
- The pharyngoesophageal segment (PES) is a striated muscular structure separating the relatively wide pharynx from the narrow cervical esophagus. There is a substantial axial and longitudinal asymmetry within the PES, as well as basal resting pressure that is substantially influenced by a variety of stimuli as well as deglutition.
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| 7. |
- Ekberg, Olle, et al.
(författare)
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Dynamic radiology of swallowing disorders
- 1997
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Ingår i: Endoscopy. - 1438-8812. ; 29:6, s. 439-446
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Tidskriftsartikel (refereegranskat)abstract
- Dysphagia is a common symptom from the oral cavity, pharynx and esophagus, and its causes may be morphological or functional. A biphasic barium swallow is the best way of evaluating these patients. Using a careful clinical history, and by tailoring the examination to the individual case, the radiologist is usually able to pinpoint the cause of the patient's complaints and suggest further diagnostic procedures and treatment.
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| 8. |
- Ekberg, Olle, et al.
(författare)
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Radiologic evaluation of dysphagia
- 1999
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Ingår i: Abdominal Imaging. - : Springer Science and Business Media LLC. - 0942-8925 .- 1432-0509. ; 24:5, s. 444-444
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Tidskriftsartikel (refereegranskat)
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| 9. |
- Lundquist, Ann, et al.
(författare)
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Clinical and radiologic evaluation reveals high prevalence of abnormalities in young adults with dysphagia
- 1998
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Ingår i: Dysphagia. - 1432-0460. ; 13:4, s. 202-207
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to retrospectively evaluate the radiologic findings in young adults with dysphagia undergoing barium swallow and to compare these with the final clinical diagnosis. Clinical history, barium swallow, endoscopy (21 patients), manometry (18 patients), 24 h pH monitoring (4 patients), and outcome of treatments were studied and compared in 43 patients aged 14-30 years (mean 24 years). There were 26 men and 17 women. Duration of symptoms varied between 2 weeks and 22 years and included globus (n = 22), obstruction (n = 31), water brash (n = 6), classic reflux symptoms (n = 10), atypical reflux symptoms (n = 9), slow eating (n = 6), and vomiting (n = 11). The final diagnosis was achalasia (n = 2), arteria lusoria (n = 1), esophagitis (n = 1), esophageal dysfunction (n = 11), esophageal stricture (n = 5), gastroesophageal reflux disease (n = 8), and pharyngeal dysfunction (n = 2). Thirteen patients were assessed to be normal. The result of the barium swallow was in agreement with the final diagnosis in all but 3 patients who were assessed as normal, and the final diagnosis was esophagitis (n = 1), dysmotility (n = 1), and reflux disease (n = 1). Anatomic and functional abnormalities are common in young adults with dysphagia. Barium swallow reveals the explanation of the symptoms in 70% of such patients. Radiology therefore should be the method of choice for the investigation of dysphagic young adults.
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| 10. |
- Nilsson, Håkan, et al.
(författare)
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Quantitative aspects of swallowing in an elderly nondysphagic population
- 1996
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Ingår i: Dysphagia. - 1432-0460. ; 11:3, s. 180-184
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of swallowing impairment increases with age and is a major health care problem in the elderly. It has been assumed that age-related changes in nerves and muscles hamper muscle strength and coordination of swallowing. However, it is unclear what impairment is related to primary aging and what is the consequence of diseases prevalent in the elderly (secondary aging). In order to quantify swallowing in nondysphagic elderly we used the noninvasive ROSS (Repetitive Oral Suction Swallow) test. A total of 53 individuals aged 76 +/- 5 years (mean +/- SD) were examined. We found that the nondysphagic elderly demonstrated significant differences compared with young individuals in 10 of 17 measured variables, i.e., decreased peak suction pressure, increased frequency of multiple swallows after one ingestion, increased frequency of polyphasic laryngeal movements, increased frequency of inspiration after swallowing, and increased frequency of coughing during or after swallowing. Therefore, primary aging mainly seems to influence coordination of swallowing, but oral and pharyngeal swallow per se seem to be unaffected.
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