Spasmodic dysphonia is defined as a focal laryngeal disorder characterized by dystonic spasms of the vocal cord during speech. We described a case of a 22-year-old male patient who presented complaining of idiopathic difficulty swallowing that suddenly developed 6 months ago. The patient also reported pharyngolaryngeal pain, throat discomfort, dyspnea, and voice change. Because laryngoscopy found no specific problems, an electrodiagnostic study and videofluoroscopic swallowing study (VFSS) were performed to find the cause of dysphagia. The VFSS revealed continuous twitch-like involuntary movement of the laryngeal muscle around the vocal folds. Then, he was diagnosed with spasmodic dysphonia by VFSS, auditory-perceptual voice analysis, and physical examination. So, we report the first case of spasmodic dysphonia accompanied with difficulty swallowing that was confirmed by VFSS.
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To determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC).
Risk factors associated with aspiration were investigated retrospectively in 241 patients with HNC using medical records and pre-recorded VFSS. Age, gender, lesion location and stage, treatment factors, and swallowing stage abnormalities were included.
Aspiration occurred in 50.2% of patients. A univariate analysis revealed that advanced age, increased duration from disease onset to VFSS, higher tumor stage, increased lymph node stage, increased American Joint Committee on Cancer (AJCC) stage, operation history, chemotherapy history, and radiotherapy history were significantly associated with aspiration (p<0.05). Among them, advanced age, increase AJCC stage, operation history, and chemotherapy history were significantly associated with aspiration in the multivariate analysis (p<0.05). Delayed swallowing reflex and reduced elevation of the larynx were significantly associated with aspiration in the multivariate analysis (p<0.05).
The major risk factors associated with aspiration in patients with HNC were advanced age, higher AJCC stage, operation history, and chemotherapy history. A VFSS to evaluate aspiration is needed in patients with NHC who have these risk factors. Delayed swallowing reflex and reduced elevation of the larynx were major abnormal findings associated with aspiration. Dysphagia rehabilitation should focus on these results.
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To investigate the clinical usefulness of the Schedule for Oral-Motor Assessment (SOMA) in children with dysphagia by comparing findings of SOMA with those of the videofluoroscopic swallowing study (VFSS).
Both SOMA and VFSS were performed in 33 children with dysphagia (21 boys and 12 girls; mean age 17.3±12.1 months) who were referred for oropharyngeal evaluation. Ratings of oral-motor functions indicated by SOMA were based upon the cutting score of each specific texture of food (puree, semi-solids, solids, cracker, liquid-bottle, and liquid-cup). Abnormalities of either the oral phase, or the pharyngeal phase as indicated by VFSS were assessed by a physician and a speech-language pathologist.
There was significant consistency between the findings of SOMA and the oral phase evaluation by VFSS (Kappa=0.419, p=0.023). SOMA reached 87.5% sensitivity, 66.6% specificity, and 95.4% positive predictive value when compared with the oral phase of the VFSS. We were able to evaluate oral-motor function by using SOMA in 6 children who were unable to complete the oral phase evaluation by VFSS, due to fear and crying during the study. The findings of SOMA failed to show any consistency with the pharyngeal phase evaluation by VFSS (Kappa=-0.105, p=0.509).
These results suggest that SOMA is a reliable method for evaluation of oral-motor function in children with dysphagia. In particular, SOMA is recommended for children that were unable to complete the oral phase evaluation by VFSS due to poor cooperation.
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Objective: Post-stroke dysphagia occurs in the form of lingual discoordination, pharyngeal dysmotility, and delayed swallowing reflex. The purpose of this study is to define the pattern of post-stroke swallowing disorder according to the location of brain lesion.
Method: Thirty-nine post-stroke patients and ten normal persons participated to perform the videofluoroscopic swallowing study (VFSS) with fluid and semisolid gastrograffin. Brain lesions were classified by cortical, subcortical, or brainstem groups and by the involved hemisphere.
Results: There was no difference of swallowing pattern between the cortical and subcortical lesions. However patients with brainstem lesion more frequently showed incomplete laryngeal elevation, prolonged pharyngeal transit time, failure of cricopharyngeal muscle relaxation, and aspiration than with cortical and subcortical lesions (p＜0.01). In the patients with cortical and subcortical lesions, aspiration occurred before the laryngeal elevation due to discoordination of laryngopharynx. Whereas in the brainstem lesion, aspiration occurred after the laryngeal elevation due to incomplete laryngeal closure. Premature posterior spillage (p＜0.05), poor laryngeal elevation(p＜0.05), and tracheal aspiration (p＜0.01) were more frequently seen in the patients with right hemispheric dysfunction than the left.
Conclusion: Discoordination of the tongue, oropharynx, and laryngopharynx is predominant in the cortical and subcortical lesion, whereas incomplete laryngeal closure and failure of cricopharyngeal muscle relaxation are predominant in the brianstem lesion.
Objective: This study was designed to examine swallowing function of 16 head and neck surgical patients who had postoperative swallowing difficulties and to identify the relationship between the physiologic causes of aspiration and the surgical procedure in each patient.
Method: Group A was five patients who had partial pharyngolaryngectomy due to hypopharyngeal cancer, Group B was nine patients who had wide excision due to oral cavity cancer, and Group C was two patients who had supraglottic horizontal laryngectomy due to supraglottic laryngeal cancer. Their swallowing function was evaluated with videofluoroscopic swallowing study (VFSS).
Results: Aspiration occurred in 40% of patients with partial pharyngolaryngectomy, 44% of patients with wide excision, and 100% of patients with supraglottic horizontal laryngectomy. Group A showed swallowing difficulty because of reduced laryngeal closure and reduced pharyngeal peristalsis. Group B showed swallowing difficulty because of reduced pharyngeal peristalsis, reduced laryngeal function, and impaired tongue control. Group C showed swallowing difficulty for impaired tongue control, reduced laryngeal function, reduced pharyngeal peristalsis, and late swallowing reflex. Most of the patients who had had head and neck cancer surgery can regain normal swallowing function after adequate swallowing rehabilitation.
Conclusion: Each group of head and neck surgical patients had different cause of swallowing difficulty. The knowledge of the determinant component of swallowing pathophysiology is important for successful swallowing rehabilitation.
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