RESUMO

OBJECTIVE: To identify internal structure validity evidence of a dysphagia screening questionnaire for caregivers of older adults with Alzheimer's disease dementia and/or vascular dementia. METHODS: The 24-question Dysphagia Screening in Older Adults with Dementia - Caregiver Questionnaire (RaDID-QC) was administered by interviewing 170 caregivers of older people with dementia, selected by convenience at the Outpatient Reference Center for Older People. Exploratory Factor Analysis (EFA) was used to assess the internal structure validity of the questionnaire, and Cronbach's alpha was used to analyze reliability. Questions with factor loadings lower than 0.45 in magnitude were removed from the final questionnaire. Multivariate multiple linear regression was used to assess the percentage of variance explained by the remaining questions. RESULTS: Kayser-Meyer-Olkin (KMO) and Bartlett's tests suggested that the questionnaire was adequate for EFA. Principal Component Analysis (PCA) suggested that 12 components captured at least 75 % of the total variance. The corresponding 12-factor EFA model showed a statistically significant fit, and 15 out of the 24 questions had factor loadings greater than 0.45. Cronbach's alpha was 0.74 for the 15 questions, which explained 71 % of the total variance in the complete dataset. The questionnaire has adequate internal structure validity and good reliability. Based on EFA, RaDID-QC decreased from 24 to 15 questions. Other internal validity and reliability parameters will be obtained by administering the questionnaire to larger target populations. CONCLUSION: The RaDID-QC applied to caregivers of older adults with dementia due to Alzheimer's disease and/or vascular dementia produced valid and reliable responses to screen dysphagia signs and symptoms.

Assuntos

Cuidadores , Transtornos de Deglutição , Demência , Humanos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Inquéritos e Questionários/normas , Feminino , Masculino , Idoso , Reprodutibilidade dos Testes , Cuidadores/psicologia , Pessoa de Meia-Idade , Demência/complicações , Demência/diagnóstico , Idoso de 80 Anos ou mais , Análise Fatorial , Adulto , Programas de Rastreamento/métodos , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Demência Vascular/diagnóstico

RESUMO

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

RESUMO

BACKGROUND: Swallowing is a complex process that requires the coordination of muscles in the mouth, pharynx, larynx, and esophagus. Dysphagia occurs when a person has difficulty swallowing. In the case of subjects with respiratory diseases, the presence of oropharyngeal dysphagia potentially increases lung disease exacerbations, which can lead to a rapid decline in lung function. This study aimed to analyze the swallowing of patients with idiopathic pulmonary fibrosis (IPF). METHODS: Patients with IPF were evaluated using the Eating Assessment Tool (EAT-10), tongue pressure, the Timed Water Swallow Test (TWST), and the Test of Mastication and Swallowing Solids (TOMASS). The findings were related to dyspnea severity assessed by the modified Medical Research Counsil (mMRC) score; the nutritional status screened with Mini Nutritional Assessment (MNA) tool; and pulmonary function tests, specifically spirometry and measurement of the diffusing capacity for carbon monoxide (DLCO), the maximal inspiratory pressure (PImax), and the maximal expiratory pressure (PEmax). RESULTS: The sample consisted of 34 individuals with IPF. Those who exhibited swallowing modifications scored lower on the MNA than those who did not (9.6 ± 0.76 vs. 11.64 ± 0.41 points; mean difference 1.98 ± 0.81 points; p = 0.02). They also showed poorer lung function when considering the predicted force vital capacity (FVC; 81.5% ± 4.61% vs. 61.87% ± 8.48%; mean difference 19.63% ± 9.02%; p = 0.03). The speed of liquid swallowing was altered in 31of 34 of the evaluated subjects (91.1%). The number of liquid swallows correlated significantly with the forced expiratory volume in 1 s (FEV1)/FVC ratio (r = 0.3; p = 0.02). Solid eating and swallowing assessed with the TOMASS score correlated with lung function. The number of chewing cycles correlated negatively with PImax% predicted (r = -0.4; p = 0.0008) and PEmax% predicted (r = -0.3; p = 0.02). FVC% predicted correlated with increased solid swallowing time (r = -0.3; p = 0.02; power = 0.6). Swallowing solids was also impacted by dyspnea. CONCLUSION: Patients with mild-to-moderate IPF can present feeding adaptations, which can be related to the nutritional status, lung function, and the severity of dyspnea.

Assuntos

Transtornos de Deglutição , Deglutição , Fibrose Pulmonar Idiopática , Língua , Humanos , Masculino , Feminino , Idoso , Fibrose Pulmonar Idiopática/fisiopatologia , Fibrose Pulmonar Idiopática/complicações , Deglutição/fisiologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/etiologia , Pessoa de Meia-Idade , Língua/fisiopatologia , Testes de Função Respiratória , Pressão , Estado Nutricional , Pulmão/fisiopatologia , Dispneia/fisiopatologia , Dispneia/etiologia , Avaliação Nutricional , Idoso de 80 Anos ou mais

RESUMO

This study aims to develop and validate the content and response processes of a questionnaire intended for caregivers to screen for dysphagia in Brazilian older adults with dementia due to Alzheimer's disease and/or vascular dementia. The instrument items were developed in Brazilian Portuguese language based on the theoretical framework. A committee of speech-language-hearing therapists analyzed the relevance, objectivity, clarity, and understandability of the items with the Delphi method. The content validity index cutoff agreement score for experts' answers to validate each item in the questionnaire was 0.78; in the intraclass correlation coefficient, it was 0.75 for all items. For response process validity evidence, the questionnaire was applied to 30 caregivers of older adults with dementia, who judged the clarity and understandability of the items. Each item was validated when understood by at least 95% of participants. The first version of the instrument had 29 items. After two expert assessments, the last version had 24 items. The intraclass correlation coefficient was 0.85. Only one item needed semantic adjustments in the pre-test. The dysphagia screening instrument applied to caregivers of older adults with dementia was developed with adequate content and response process validity evidence, enabling adjustments in its construct. Future studies will analyze the remaining evidence of validity and reliability.

RESUMO

OBJECTIVE: To examine the biomarkers of pharyngoesophageal swallowing during oral feeding sessions in infants undergoing pH-impedance testing and determine whether swallow frequencies are distinct between oral-fed and partially oral-fed infants. STUDY DESIGN: One oral feeding session was performed in 40 infants during pH-impedance studies and measurements included swallowing frequency, multiple swallow rate, air and liquid swallow rates, esophageal swallow clearance time, and gastroesophageal reflux (GER) characteristics. Linear and mixed statistical models were applied to examine the swallowing markers and outcomes. RESULTS: Infants (30.2 ± 4.4 weeks' birth gestation) were evaluated at 41.2 ± 0.4 weeks' postmenstrual age. Overall, 10 675 swallows were analyzed during the oral feeding sessions (19.3 ± 5.4 minutes per infant) and GER events were noted (2.5 ± 0.3 per study). Twenty-four-hour acid reflux index (ARI) was 9.5 ± 2.0%. Differences were noted in oral-fed and partially oral-fed infants for volume consumption (P < .01), consumption rate (P < .01), and length of hospital stay in days (P < .01). Infants with ARI >7% had greater frequency of swallows (P = .01). The oral-fed group had greater ARI (12.7 ± 3.3%, P = .05). CONCLUSIONS: Oropharyngeal swallowing regulatory characteristics decrease over the feeding duration and were different between ARI >7% vs ≤7%. Although GER is less in infants who are partially oral-fed, the neonates with increased acid exposure achieved greater oral intakes and shorter hospitalizations, despite the presence of comorbidities. Pharyngoesophageal stimulation as during consistent feeding or GER events can activate peristaltic responses and rhythms, which may be contributory to the findings.

RESUMO

INTRODUCTION/AIMS: Objective and practical biomarkers to determine the need for gastrostomy in patients with amyotrophic lateral sclerosis (ALS) are lacking. Tongue pressure (TP) is a promising biomarker because it is associated with bulbar dysfunction. The aims of this study were to evaluate the association of TP with the need for gastrostomy, and to determine its optimal cut-off value. METHODS: This prospective observational study included participants with ALS taking nutrition orally. TP was evaluated using the Iowa Oral Performance Instrument. Need for gastrostomy as determined by a multidisciplinary team during a 12-month follow up period was recorded. Associations between TP and need for gastrostomy placement were performed. ROC curve analysis determined the optimal cut-off value of TP to predict gastrostomy. RESULTS: Of 208 screened participants, 119 were included. Gastrostomy was indicated in 45% (53), in a 12-month follow up period. TP of ≤20 kPA was a strong predictor of gastrostomy indication (OR 11.8, CI 95% [4.61, 34.7], p < .001). The association persisted even after adjustment for weight loss, pneumonia, prolonged feeding duration, Revised ALS Functional Rating Scale score, and American Speech-Language-Hearing Association scale score (OR 4.51, CI 95% [1.50, 14.9], p = .009). By receiver operating characteristic curve analysis, 20 kPA represented the optimal cut-off value (sensitivity 0.75, specificity 0.89). DISCUSSION: TP is a strong independent predictor of gastrostomy indication in the subsequent 12 months in patients with ALS, with good sensitivity and specificity at a cutoff value of ≤20 kPA, suggesting that it may be a promising biomarker in clinical practice.

Assuntos

Esclerose Lateral Amiotrófica , Gastrostomia , Língua , Humanos , Esclerose Lateral Amiotrófica/fisiopatologia , Esclerose Lateral Amiotrófica/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Língua/fisiopatologia , Pressão , Curva ROC , Seguimentos

RESUMO

PURPOSE: The aim of this systematic review was to assess the role of hyperbaric oxygen therapy  (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. METHOD: A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. RESULTS: We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. CONCLUSION: Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted.

Assuntos

Transtornos de Deglutição , Neoplasias de Cabeça e Pescoço , Oxigenoterapia Hiperbárica , Lesões por Radiação , Humanos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Neoplasias de Cabeça e Pescoço/radioterapia , Oxigenoterapia Hiperbárica/métodos , Lesões por Radiação/terapia , Lesões por Radiação/etiologia

RESUMO

Abstract Objective: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. Method: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. Results: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). Conclusion: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

RESUMO

Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.

RESUMO

OBJECTIVE: The purpose of this study is to examine vocal fatigue and impairment, gastroesophageal symptoms, dysphagia risk, and sleep-related quality of life in individuals with obstructive sleep apnea (OSA) who have been treated with continuous positive airway pressure (CPAP) compared to those who have not received treatment. METHODS: Fifty-four participants diagnosed with OSA completed an online research form. Of these, 29 were receiving CPAP treatment, while 25 were not undergoing treatment. The following instruments were used: Vocal Fatigue Index, Voice Handicap Index, Gastroesophageal symptoms, Eating Assessment Tool, and Quebec Sleep Questionnaire. RESULTS: The group that received CPAP treatment had significantly lower scores in the functional domain and total Voice Handicap Index. They also experienced fewer symptoms of regurgitation, reduced daytime sleepiness, fewer nocturnal symptoms, and better emotional and social interactions in their quality of life compared to the untreated group. There were no significant differences in voice fatigue and dysphagia risk between the groups. CONCLUSION: Individuals treated with CPAP experience reduced vocal impairment, fewer regurgitation symptoms, and improvement in the emotional and social interactions domains of their quality of life compared to individuals without treatment.

RESUMO

Swallowing is an essential process to maintain homeostasis in the human body. With aging, changes occur in both central and peripheral structures, giving rise to presbyphagia, involving morphological and functional alterations in swallowing. However, there is a lack of consensus on the definition of presbyphagia and its relationship with dysphagia. The primary objective of this research is to analyze the proposed definitions for the term "presbyphagia" in specialized literature and, secondarily, to assess how these definitions can influence the diagnosis of oropharyngeal dysphagia (OD). A systematic review was conducted to analyze the proposed definitions of presbyphagia and their impact on dysphagia diagnosis. Three main approaches to the definitions of presbyphagia were identified: (1) presbyphagia as an alteration in the swallowing process in healthy older adults, (2) presbyphagia as a swallowing disorder compensated by the physiological potential of healthy older adults, and (3) presbyphagia as a synonym for dysphagia. This study addresses the need for a clear definition of presbyphagia in older adults. It is concluded that presbyphagia should be understood as the etiology of OD rather than a compensated disorder or a synonym. This has significant implications for the diagnosis and treatment of swallowing disorders in the aging population. Given the ongoing nature of scientific discussion in this field, further research is required.

Assuntos

Transtornos de Deglutição , Deglutição , Humanos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/etiologia , Deglutição/fisiologia , Idoso , Terminologia como Assunto , Envelhecimento/fisiologia , Masculino , Feminino

RESUMO

OBJECTIVE: To determine the influence of the radius of Monson's sphere, the number of posterior laterotrusive, mediotrusive, and protrusive contacts, and the chewing rate on food comminution. DESIGN: Sixty healthy dentate subjects, aged 21.22 ± 2.30 years, were selected. The three-dimensional coordinates of the cusp tips of the lower canine, premolar, and molar teeth were identified from the subjects' digital models. Monson's sphere was designed using the simplex method for function minimisation by adjusting the coordinates on its surface. The contacts were verified using 12 µm metal strips in jaw excursions at 0.5, 1.0, 2.0, and 3.0 mm. The masticatory performance and efficiency, swallowing threshold, and chewing rate were assessed through particle size fractionation. Data were analysed with multiple linear regression (α = 0.05). RESULTS: The sphere's radius, laterotrusive and protrusive contacts at 0.5 mm, and chewing rate were found to be negative predictor variables for masticatory performance until 20 chewing cycles (R2 = 0.429). For 40 cycles, the radius and total contacts (0.5 mm) were also explanatory factors (R2 = 0.223). Only the radius (R2 = 0.176) and the chewing rate (R2 = 0.082) were found to be significant for 60 cycles and swallowing threshold, respectively. Masticatory efficiency was influenced by masticatory performance until 40 and 60 cycles, as well as the radius and total contacts at 2.0 and 3.0 mm (R2 = 0.958). CONCLUSION: A larger radius of Monson's sphere and a greater number of posterior excursive contacts were found to be related to better masticatory function.

Assuntos

Dente Molar , Rádio (Anatomia) , Humanos , Alimentos , Mastigação , Dente Pré-Molar

RESUMO

OBJECTIVE: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. METHOD: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. RESULTS: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). CONCLUSION: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

Assuntos

Transtornos de Deglutição , Refluxo Gastroesofágico , Laringomalácia , Lactente , Recém-Nascido , Humanos , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Recém-Nascido Prematuro , Laringomalácia/complicações , Estudos Transversais , Unidades de Terapia Intensiva Neonatal , Comportamento de Sucção , Fatores de Risco , Ataxia/complicações

RESUMO

To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%-70%; I2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%-36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample.

Assuntos

Transtornos de Deglutição , Adulto , Humanos , Transtornos de Deglutição/epidemiologia , Prevalência

RESUMO

Analyzing fiberoptic endoscopic evaluation of swallowing (FEES) is challenging and requires training to ensure the proficiency of health professionals and improve reliability. This scoping review aims to identify and map the available evidence on training health professionals to analyze FEES functional parameters. The method proposed by the Joanna Briggs Institute and the PRISMA-ScR guidelines were followed. The search was performed in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL databases, and in the gray literature. Two blinded independent reviewers screened articles by title and abstract. Then, they read the full text of the included reports, considering the eligibility criteria. Data were extracted using a standardized form. Six studies met the established eligibility criteria, published between 2009 and 2022, with few participants. All these studies addressed training as part of the process to validate a rating scale. No standardized criteria were observed regarding the selection of experts and participants, training structure, and outcome measures to assess participants' competence. The reviewed literature indicates that training must be developed to equip students and health professionals who treat dysphagia, enabling them to analyze the functional parameters of the FEES, considering variables that may influence the participants' performance.

Assuntos

Transtornos de Deglutição , Deglutição , Humanos , Reprodutibilidade dos Testes , Endoscopia/métodos , Transtornos de Deglutição/diagnóstico , Pessoal de Saúde

RESUMO

ABSTRACT Background: People recurrently have difficulties swallowing solid medications, which can be associated with the size of the medication and the age and gender of individuals. Objective: To evaluate the impact of capsule size and adults' age and gender on oral and pharyngeal capsule transit during capsule swallows. Methods: Videofluoroscopy was used to measure capsule oral and pharyngeal transit during swallows in 49 healthy individuals (17 men and 32 women), with a mean age of 46 years (ranging from 23 to 88 years). Smaller capsules were filled with 0.50 mL of barium sulfate, and larger capsules were filled with 0.95 mL of barium sulfate; the volume of liquid ingested with the capsules was also quantified in each ingestion. The measurements included the oral preparation time, oral transit time, swallowing reaction time, time to laryngeal vestibule closure, laryngeal vestibule closure duration, pharyngeal transit time, and upper esophageal sphincter opening duration. Results: The capsule size did not influence either the oral or pharyngeal transit time. Increased liquid volume was ingested with larger capsules and by people older than 40 years. The oral transit time was shorter in older adults (60-88 years), and the time to laryngeal vestibule closure was longer in women. Conclusion: The size of large capsules did not make a difference in oral or pharyngeal transit when compared with smaller capsules. The capsule size and the participant's age influenced the volume of liquid ingested - larger capsules and older individuals required a larger volume. The capsule oral transit was faster in individuals older than 60 years.

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RESUMO Contexto: Algumas pessoas apresentam recorrentemente dificuldades para engolir medicamentos sólidos, o que pode estar associado ao tamanho do medicamento, à idade e ao gênero dos indivíduos. Objetivo: Avaliar, em adultos, o impacto do tamanho da cápsula, da idade e do gênero no trânsito oral e faríngeo de cápsulas. Métodos: Videofluoroscopia foi utilizada para medir o trânsito oral e faríngeo de cápsulas em 49 indivíduos saudáveis (17 homens e 32 mulheres), com idade média de 46 anos (limites de 23 e 88 anos). Cápsulas menores foram preenchidas com 0,50 mL e cápsulas maiores foram preenchidas com 0,95 mL de sulfato de bário; o volume de líquido ingerido com as cápsulas foi quantificado em cada ingestão. Foram medidos o tempo de preparo oral, tempo de trânsito oral, tempo de reação da deglutição, tempo para fechamento do vestíbulo laríngeo, tempo de fechamento do vestíbulo laríngeo, tempo de trânsito faríngeo e tempo de abertura do esfíncter superior do esôfago. Resultados: O tamanho da cápsula não influenciou o tempo de trânsito oral ou faríngeo. Mais líquido foi ingerido com cápsulas maiores e por pessoas com mais de 40 anos. O tempo de trânsito oral foi menor em idosos (60-88 anos) e o tempo de fechamento do vestíbulo laríngeo foi maior em mulheres. Conclusão: O tamanho da cápsula não influenciou o trânsito oral e faríngeo, porém houve maior volume de líquido ingerido com a cápsula maior e nos mais idosos. O trânsito oral da cápsula foi mais rápido em indivíduos com mais de 60 anos.

RESUMO

Abstract Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.

RESUMO

Resumen La videodeglución es un estudio fisiológico y en tiempo real que, al momento, no tiene reemplazo por otra modalidad. Ofrece información relevante sobre el sistema estomatognático del paciente, así como sobre la estructura y la funcionalidad orofaríngea y esofágica. Este estudio cuenta con distintas fases (oral, faríngea y esofágica) en las que se analizan diversas estructuras, así como la funcionalidad de estas a través de degluciones inducidas de diferentes consistencias (semisólido, líquido, sólido). Las patologías que pueden encontrarse son múltiples, siendo algunas de las más frecuentes la disfunción del músculo cricofaríngeo, la penetración/aspiración en la vía aérea, los divertículos y la acalasia. Resulta fundamental su ejecución con una técnica correcta, conociendo previamente la sintomatología, el motivo por el cual fue indicada, la anatomía de las estructuras/cavidades y la fisiología de la deglución. Por lo tanto, una adecuada técnica en la ejecución de la videodeglución y el conocimiento preliminar de la anatomía y la fisiología, así como de los hallazgos y patologías más frecuentes, son fundamentales para una adecuada evaluación del paciente y una correcta interpretación de las imágenes.

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Abstract Video swallowing is a physiological and real-time study that, at the moment, cannot be replaced by another modality. It offers relevant information about the patient's stomatognathic system, as well as the oropharyngeal and esophageal structure and function. This study has different phases (oral, pharyngeal and esophageal) where various structures are analyzed, as well as their functionality through induced objects of different consistencies (semi-solid, liquid and solid). The pathologies that can be found are multiple, some of the most frequent being dysfunction of the cricopharyngeal muscle, penetration/aspiration into the airway, diverticula and achalasia. Its execution with a correct technique is fundamental, knowing previously the symptomatology, reason for which it was indicated, the anatomy of the structures/cavities and the physiology of swallowing. Therefore, an adequate technique in the execution of video swallowing and preliminary knowledge of anatomy and physiology, as well as the most frequent findings and pathologies, are fundamental for a correct evaluation of the patient and interpretation of the images.

RESUMO

ABSTRACT BACKGROUND: The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE: Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING: A retrospective study. METHODS: The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS: In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87-−0.96; OR: 0.24; 95% CI: 0.80-−0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70-3.17, P < 0.001; β: −1.24, 95% CI: −1.55-−0.92; P < 0.001). CONCLUSION: Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.

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La traqueostomía es un procedimiento quirúrgico enfocado en brindar una vía de respiración alterna, en el que sus mayores consecuencias son las afectaciones comunicativas y deglutorias. La evaluación e intervención fonoaudiológica es indispensable dentro del proceso de rehabilitación de pacientes traqueostomizados, teniendo en cuenta las secuelas comunicativas, deglutorias y de fonación asociadas a este procedimiento. El presente artículo tiene como objetivo destacar el rol y actuar fonoaudiológico dentro de la restauración de las funciones alteradas en el caso de una paciente femenina con traqueostomía, quien acude al servicio de urgencias de un hospital público de Bogotá, Colombia. Se aplicaron pruebas estandarizadas y subjetivas para la valoración fonoaudiológica, estableciendo así el plan de manejo enfocado en la restauración de la deglución y la fonación, así como la intervención para el mantenimiento del estado orofacial, sensibilidad y movilidad de las estructuras. Se evidenciaron mejoras en la efectividad y seguridad deglutoria, una exitosa adaptación de válvula fonatoria y mantenimiento de habilidades de lenguaje y cognición, preservando el estado comunicativo. En conclusión, este estudio de caso brinda un aporte significativo con respecto a la importancia del actuar fonoaudiológico, la aplicación de conocimientos y estrategias basadas en la literatura y el análisis, evaluación e intervención.

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Tracheostomy is a surgical procedure focused on providing an alternate breathing path, in which its greatest consequences are communication and swallowing impairments.Speech therapy evaluation and intervention is essential within the rehabilitation process of tracheostomized patients, taking into account the swallowing and phonatory consequences associated. The aim of this article is to highlight the role and actions of the speech language therapist in the restoration of altered functions in the case of a female patient with atracheostomy, who went to the emergency department of a public hospital in Bogotá,Colombia, due to swallowing disorders. Standardized and subjective tests were applied for speech therapy assessment. The management plan was developed focused on the restoration of swallowing and phonatory function as well as the intervention to maintain the orofacial state, sensitivity and mobility of the structures. Improvements were evident in swallowing effectiveness and safety, a successful adaptation of the speaking valve and maintenance of language and cognition skills, preserving the communicative state. In conclusion, this case study provides a significant contribution regarding regarding the importance of the speech therapist role, the application of knowledge and strategies based on literature and analysis, evaluation and intervention.