Petra Pluschinski

Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting.

Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.

A Documentation System to Save Time and Ensure Proper Application of the Fiberoptic Endoscopic Evaluation of Swallowing (FEES

A properly performed fiberoptic endoscopic evaluation of swallowing (FEES®) is comprehensive and time-consuming. Editing times of FEES protocols and attempts for efficiency maximization are unknown. Here, the protocol editing times of completed FEES examinations were determined. The present study reports the time savings and quality gains of a newly developed documentation system tailored to the FEES standard of Langmore. Four independent examiners analyzed twelve videos of FEES procedures, six without and six with the documentation system. Effectiveness of the documentation system was evaluated according to the times for total evaluation, interpretation, documentation, report writing, and for report completeness. The documentation system reduced editing times and increased report completeness with large effect sizes. Averaged total evaluation time decreased from 42 to 27 min, report completeness increased from 55 to 80%. The use of the documentation system facilitates and improves the assessment of the swallowing process.

Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century.

The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. The central coordination of this complex sensorimotor task uses a widespread network of cortical, subcortical, and brainstem structures. Many diseases and disorders affecting the central swallowing network or downstream peripheral nerves, muscles, and structures may result in an impaired oropharyngeal swallow. In addition, aging is also associated with multifactorial changes of swallowing physiology for which the term presbyphagia has been coined. Oropharyngeal dysphagia broadly affects respiratory safety due to the increased risk of aspiration, and swallowing efficacy leading to the impeding danger of insufficient nutrition and hydration.

Validierung der deutschen Kurzversion der Sekretbeurteilungsskala nach Murray

OBJECTIVE Accumulation of secretions in hypopharynx, aditus vestibule, and trachea is often found in cases of severe dysphagia and is considered a cardinal trait of high clinical and therapeutic importance. For the graduation of the severity level of accumulated secretions, a short version of the 4-point Murray secretion scale is available, which is also integrated into the protocol of the fiberoptic endoscopic evaluation of swallowing (FEES) according to the Langmore standard. This study aimed at the validation of the German translation of this short version in order to facilitate a uniform, standardized evaluation of the accumulation of secretions in dysphagic patients in the German language area. MATERIAL AND METHODS For the examination of reliability and validity, a reference standard was defined by 2 dysphagia experts on the basis of 40 video files of the FEES examination, 10 videos for each of the severity grades. Afterwards, these videos were rated independently by 4 raters and re-rated in a new randomized order 2 weeks later. RESULTS Both the intra-rater reliability (τ>0,830***) and the inter-rater reliability (Kendalls W>0,890***) were highly significant and can be considered good. The same is valid for the correlation of ratings with the reference standard (τ=0,969***). CONCLUSIONS The German translation of the short version of the 4-point Murray secretion scale is recommendable as a reliable and valid instrument for the graduation of the cardinal trait of oropharyngeal dysphagia and also as an evidence-based instrument for standardized use in the German language area.

Validierung der deutschen Version des Eating Assessment Tool bei Kopf-Hals-Tumor-Patienten

OBJECTIVE The assessment of subjective swallowing complaints constitutes an important element in a multidimensional, modern management of head and neck cancer patients suffering from dysphagia. For this purpose, an internationally recognized and validated 10-item questionnaire EAT-10 is used that was developed and validated by Belafski et al. in 2008. The purpose of the present study is the translation of EAT-10 into the German language and its validation for head and neck cancer patients. MATERIAL AND METHODS After the translation of EAT-10 into German according to the guidelines for the translation of foreign measuring instruments, a validation of gEAT-10 was carried out on the basis of the sample of 210 head and neck cancer patients. The reliability was determined by means of the internal consistency (Cronbachs Alpha) and item-total correlations (Spearman). The construct validity was verified by the uni- and multivariate analyses of the distribution of gEAT-10 total scores depending on gender, age, BMI, tumor stage and localization as well as type of the oncological therapy. RESULTS The internal consistency amounted to α = .94, the item-total correlations varied between ρ = .59 and ρ = .85. No significant associations between gEAT-10 total scores and gender as well as age were identified in univariate calculations. Such associations were found for BMI, tumor stage and localization as well as type of the oncological therapy. However, only the tumor stage yielded a significant result in a regression. CONCLUSIONS The gEAT-10 was shown to be a reliable and construct valid questionnaire for the assessment of subjective swallowing complaints in patients with head and neck cancer.