Detection of swallowing sounds: Methodology revisited

Cervical auscultation is in the process of gaining clinical credibility. In order for it to be accepted by the clinical community, the procedure and equipment used must first be standardized. Takahashi et al. [Dysphagia 9:54-62, 1994] attempted to provide benchmark methodology for administering cervical auscultation. They provided information about the acoustic detector unit best suited to picking up swallowing sounds and the best cervical site to place it. The current investigation provides contrasting results to Takahashi et al. with respect to the best type of acoustic detector unit to use for detecting swallowing sounds. Our study advocates an electret microphone as opposed to an accelerometer for recording swallowing sounds. However, we agree on the optimal placement site. We conclude that cervical auscultation is within reach of the average dysphagia clinic.

Swallowing outcomes following laryngectomy and pharyngolaryngectomy

Objectives: To determine the incidence of dysphagia (defined as the inability to manage a diet of normal consistencies) at hospital discharge and beyond 1 year post-surgery and examine the impact of persistent dysphagia on levels of disability, handicap, and well-being in patients. Design: Retrospective review and patient contact. Setting: Adult acute care tertiary hospital. Patients: The study group, consecutively sampled from January 1993 to December 1997, comprised 55 patients who underwent total laryngectomy and 37 patients who underwent pharyngolaryngectomy with free jejunal reconstruction. Follow-up with 36 of 55 laryngectomy and 14 of 37 pharyngolaryngectomy patients was conducted 1 to 6 years postsurgery. Main Outcome Measures: Number of days until the resumption of oral intake; swallowing complications prior to and following discharge; types of diets managed at discharge and follow-up; and ratings of disability, handicap, and distress levels related to swallowing. Results: Fifty four (98%) of the laryngectomy and 37 (100%) of the pharyngolaryngectomy patients experienced dysphagia at discharge. By approximately 3 years postsurgery, 21 (58%) of the laryngectomy and 7 (50%) of the pharyngolaryngectomy patients managed a normal diet. Pharyngolaryngectomy patients experienced increased duration of nasogastric feeding, time to resume oral intake, and incidence of early complications affecting swallowing. Patients experiencing long-term dysphagia identified significantly increased levels of disability, handicap, and distress. Patients without dysphagia also experienced slight levels of handicap and distress resulting from taste changes and increased durations required to complete meals of normal consistency. Conclusions: The true incidence of patients experiencing a compromise in swallowing following surgery has been underestimated. The significant impact of impaired swallowing on a patient's level of perceived disability, handicap, and distress highlights the importance of providing optimal management of this negative consequence of surgery to maximize the patient's quality of life.

Acute characteristics of pediatric dysphagia subsequent to traumatic brain injury: Videofluoroscopic assessment

Objective: To document the acute characteristics of swallowing impairment in a group of children post moderate/severe traumatic brain injury (TBI) by means of videofluoroscopy. Participants: Eighteen children with moderate/severe TBI. Main Outcome Measure: Videofluoroscopy at an average of 27.7 days post-injury. Results: Subjects demonstrated a range of dysphagia severity levels: mild-moderate (n = 8), moderate (n = 6), moderate-severe (n = 3), and severe (n = 1) and had a combination of oral and pharyngeal phase characteristics. More specifically; observable features or physiological impairments that were identified included reduced lingual control, hesitancy of tongue movement, repetitive tongue pumping, the presence of aspiration (including silent aspiration), delayed swallow reflex trigger, reduced laryngeal elevation and closure, and reduced peristalsis. Conclusions: These data highlight the diversity of swallowing deficits and dysphagia severity levels in children following TBI and suggest that the former are consistent with a pattern of oropharyngeal impairments.

Dysarthria and dysphagia following treatment for a fourth ventricle choroid plexus papilloma

The present case report describes the presence of a persistent dysarthria and dysphagia as a consequence of surgical intervention for a choroid plexus papilloma (CPP). WM was a nine year ten month old male who at the time of the present study was seven years post-surgery. A comprehensive perceptual and instrumental test battery was used to document the nature of the dysarthria incorporating all components of speech production including respiration, phonation, resonance, articulation, and prosody. The nature of the dysphagia was evaluated through the use of videofluoroscopic evaluation of swallowing (VFS). Assessments confirmed the presence of a LMN dysarthria, marked by deficits in phonation, respiration, and prosody. Dysphagia assessment revealed deficits in oral preparatory, oral and pharyngeal stages of the swallow. The presence of persistent dysarthria and dysphagia in this case has a number of important implications for the management of children undergoing surgery for fourth ventricle CPPs, in particular the need for appropriate treatment, as well as counselling prior to surgery of the possible negative outcomes related to speech and swallowing. (C) 2003 Elsevier Science Ltd. All rights reserved.

Anatomy of a hemiramphid pharyngeal mill with reference to arrhamphus sclerolepis krefftii (steindachner) (teleostei: hemiramphidae)

The structure and function of the pharyngeal jaw apparatus (PJA) and postpharyngeal alimentary tract of Arrhamphus sclerolepis krefftii, an herbivorous hemiramphid, were investigated by dissection, light and scanning electron microscopy, and X-ray analysis of live specimens. A simple model of PJA operation is proposed, consisting of an adductive power stroke of the third pharyngobranchial that draws it posteriorly while the fifth ceratobranchial is adducted, and a return stroke in which the third pharyngobranchial bone is drawn anteriorly during abduction of the fifth ceratobranchial. Teeth in the posteromedial region of the PJA are eroded into an occlusion zone where the teeth of the third pharyngobranchial are spatulate incisiform and face posteriorly in opposition to the rostrally oriented spatulate incisiform teeth in the wear zone of the fifth ceratobranchial. The shape of the teeth and their pedestals (bone of attachment) is consistent with the model and with the forces likely to operate on the elements of the PJA during mastication. The role of pharyngeal tooth replacement in maintaining the occlusal surfaces in the PJA during growth is described. The postpharyngeal alimentary tract of A. sclerolepis krefftii comprises a stomachless cylinder that attenuates gradually as it passes straight to the anus, interrupted only by a rectal valve. The ratio of gut length to standard length is about 0.5. Despite superficial similarities to the cichlid PJA (Stiassny and Jensen [1987] Bull Mus Comp Zool 151: 269-319), the hemiramphid PJA differs in the fusion of the third pharyngobranchial bones, teeth in the second pharyngobranchials and the fifth ceratobranchial face anteriorly, the presence of a slide-like diarthroses between the heads of the fourth epibranchials and the third pharyngobranchial, the occlusion zone of constantly wearing teeth, and the unusual form of the muscularis craniopharyngobranchialis. The functional relationship between these structures is explained and the consequence for the fish of a complex PJA and a simple gut is discussed. (C) 2002 Wiley-Liss, Inc.

Anatomy of the pharyngeal jaw apparatus of Zenarchopterus (Gill) (Teleostei : Beloniformes)

The structure of the pharyngeal jaw apparatus (PJA) of Zenarchopterus dispar and Z. buffonis, carnivorous estuarine and freshwater West-Pacific halfbeaks, was investigated using dissection, light, and scanning electron microscopy as part of a comparison with estuarine and marine herbivorous confamilials. The Zenarchopterus PJA differs from published descriptions of hemiramphid PJAs in that the otic capsules are less pronounced; the pharyngocranial articulation facet is trough-like; the third pharyngobranchials are ankylosed; the second pharyngobranchial anterior processes are relatively hypotrophied; all pharyngeal teeth except the posterior teeth in the fifth ceratobranchial face posteriorly; the muscularis craniopharyngobranchialis 2 posterior is short; the muscularis craniopharyngobranchialis 2 anterior is lacking, as is its insertion site, the inferior parasphenoid apophysis; the protractor pectoralis is well developed; the pharyngocleithralis internus originates dorsal to the level of the fifth ceratobranchial bony process; the fifth ceratobranchial bony processes are directed ventrolaterally; the opposing upper and lower tooth fields appear not to occlude erosively; and the muscular portion of the pharyngohyoideus is well developed anteriorly. The extent of these differences and their implications for the function of the PJA support recent molecular studies that suggest that the Hemiramphidae is polyphyletic. (C) 2004 Wiley-Liss, Inc.

Relationships of sauries and needlefishes (Teleostei : Scomberesocoidea) to the internally fertilizing halfbeaks (Zenarchopteridae) based on the pharyngeal jaw apparatus

The 40 life history, myological, and osteological characters that Tibbetts (1992) used in his study of the hemiramphids are evaluated for both saury genera (Cololabis and Scomberesox) to determine if the Scomberesocidae are more closely related to the Zenarchopteridae, to the needlefishes (Belonidae), or to the halfbeaks (Hemiramphidae) and flyingfishes (Exocoetidae). Data were analyzed using PAUP*, and eight equally parsimonious trees were found (70 steps, CI 0.814, RI 0.938). This analysis indicates that sauries are most closely related to needlefishes, supporting the historical concept of the superfamily Scomberesocoidea as a monophyletic assemblage. A caudal displacement of the origin of the retractor dorsalis muscle is a tentative additional synapomorphy for all four saury species. Zenarchopteridae is strongly supported as a valid family sister to the Scomberesocoidea (decay index = 19, bootstrap = 100). Resolution of the internal structure of the Belonidae and the Hemiramphidae requires the identification of additional characters and examination of a greater number of taxa.