Journal Detail Information

1

Cite

Share

Swallowing Difficulty due to Hypothyroid Myopathy: A Case Report.

Donggyun SOHN ; Geun Young PARK ; Hyunjung KOO ; YongJun JANG ; Sun IM

Journal of the Korean Dysphagia Society.2018;8(2):126-131.

Musculoskeletal symptoms, such as muscle weakness, stiffness and pain, are observed frequently in patients with hypothyroidism. In theory, hypothyroidism can cause weakness of the swallowing muscles, but dysphagia associated with hypothyroidism-associated myopathy has not been reported. The present case involved a 51-year-old man who experienced acute onset of severe dysphagia with aspiration pneumonia. A video fluoroscopic swallowing study and fiberoscopic endoscopic evaluation of swallowing revealed pharyngo-laryngeal function impairment. With a prior history of subclinical hypothyroidism and clinical symptoms such as proximal limb weakness, further evaluation involving a hormonal study, electrodiagnostic study, and histopathology assessment revealed myopathy. Hormone replacement therapy was started and the patient recovered within three weeks of treatment and was taking a regular diet. In conclusion, this study suggests that it is necessary to consider further evaluations to determine if hypothyroid myopathy is involved in the case of unknown origin dysphagia accompanied by hypothyroid myopathy.
Deglutition Disorders ; Deglutition* ; Diet ; Extremities ; Hormone Replacement Therapy ; Humans ; Hypothyroidism ; Middle Aged ; Muscle Weakness ; Muscles ; Muscular Diseases* ; Pneumonia, Aspiration

2

Cite

Share

Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases.

Sang Hoon JUNG ; Dong Hwan OH ; Doo Ho LEE ; Na Kyoung HWANG ; Hee Su PARK ; Hee Jung KIM ; Yong Hwa KWON ; Yunho KIM ; Nami HAN

Journal of the Korean Dysphagia Society.2018;8(2):121-125.

This study recruited two men with dysphagia after stroke, aged 57 and 62 years. They had difficulty using both hands properly due to paralysis of the left upper extremity and rheumatoid arthritis of the right hand in patient 1 and paralysis of both upper extremities in patient 2. This study examined the effects of 4 weeks of hand-free chin-tuck-resistance exercise on the hyoid movement and aspiration. The exercises involved isotonic and isometric parts. In isometric CTAR, the patients were asked to chin tuck against the device 3 times for 60 s each with no repetition. In isotonic CTAR, the patient performed 30 consecutive repetitions by strongly pressing against the resistance device and then releasing it. Based on a video fluoroscopic swallowing study, the degree of aspiration was measured using the Penetration-Aspiration Scale (PAS) and two-dimensional motion analysis of the hyoid bone. Post-intervention, the hyoid movements in both patients improved by 0.16 and 0.22 cm (anterior movement), and 0.26 and 0.28 cm (superior movement), and the PAS scores decreased by 2 and 2 points, respectively. This study confirms that hands-free chin-tuck resistance exercise is applicable and helpful for improving the hyoid movement and reducing aspiration in patients with dysphagia after stroke. Therefore, this exercise can be introduced as an intervention for improving the swallowing function in patients with dysphagia who have difficulty using both hands.
Arthritis, Rheumatoid ; Chin ; Deglutition ; Deglutition Disorders* ; Exercise ; Hand ; Humans ; Hyoid Bone* ; Male ; Paralysis ; Stroke* ; Upper Extremity

3

Cite

Share

Dysphagia Following Anterior Approach Cervical Spinal Surgery in a Patient with Ankylosing Spondylitis.

Wang Hyeon YUN ; Jinyoung PARK ; Joon Sang PARK ; Doyoung KIM ; Jung Hyun PARK

Journal of the Korean Dysphagia Society.2018;8(2):117-120.

The known causes of dysphagia following cervical spine surgery include pre-vertebral soft tissue swelling, decreased posterior pharyngeal movement, and impaired upper esophageal sphincter opening. Some studies have suggested that dysphagia is associated with movement of the cervical vertebrae during swallowing. In the present case, a 59-year-old man with a limited cervical range of motion due to ankylosing spondylitis slipped and fell, resulting in a C7 vertebral body fracture. He underwent anterior cervical discectomy as well as C5-T1 anterior fusion and C5-T2 level postero-lateral fusion. After surgery, he showed signs and symptoms of aspiration. A video-fluoroscopic swallowing study (VFSS) revealed incomplete laryngeal elevation, cricopharyngeal dysfunction, and vallecular remnant. Aspiration was observed in the semisolid-swallowing test. The patient's dysphagia could be attributed to two main causes. First, the esophagus might have been compressed by thickened pre-vertebral soft tissue after surgery. Second, the cervical range of motion, which was already limited by ankylosing spondylitis, might have been limited further by the anterior fusion of the cervical spine. In conclusion, a preoperative evaluation, including VFSS, should be considered before cervical spinal surgery, particularly in patients with ankylosing spondylitis presenting with a limited cervical range of motion.
Cervical Vertebrae ; Deglutition ; Deglutition Disorders* ; Diskectomy ; Esophageal Sphincter, Upper ; Esophagus ; Female ; Humans ; Middle Aged ; Range of Motion, Articular ; Spine ; Spondylitis, Ankylosing*

4

Cite

Share

Effects of Neuromuscular Electrical Stimulation on the Swallowing Function in a Child - A Case Report.

In Jin YOON ; Jee Hee SHIN ; Eun Sun PARK

Journal of the Korean Dysphagia Society.2018;8(2):110-116.

This paper reports the effects of neuromuscular electrical stimulation (NMES) when applied to the facial muscles and submental region on a child with dysphagia. The subject was a 5 month girl who had hypoxic brain damage. Two electrodes were applied to the submental region horizontally (6.0 mA) and two electrodes were applied to each side of the mouth (5.0 mA). The child's jaw movement, swallowing food/liquid without excess loss, and swallowing without cough were improved. In addition, she could intake nutrition through the mouth. The result of the level on the Penetration Aspiration Scale (PAS) decreased from 4 to 1, the score on the Behavioral Assessment Scale of Oral Function in Feeding (BASOFF) increased from 13 to 17, and the level on the American Speech Language and Hearing Association: National outcomes measurements system (ASHA NOMS) increased from 1 to 3. When applying NMES to a child with dysphagia, the practitioner should consider various attachment places for improvements in the children's swallowing function.
Anoxia ; Child* ; Cough ; Deglutition Disorders ; Deglutition* ; Electric Stimulation* ; Electrodes ; Facial Muscles ; Female ; Hearing ; Humans ; Hypoxia, Brain ; Jaw ; Mouth

5

Cite

Share

Effects of Neuromuscular Electrical Stimulation in Combination with Saliva or Dry Swallowing in Stroke Patients with Dysphagia.

Sang Hoon JUNG ; Young A KIM ; Na Kyoung HWANG ; Ji Su PARK ; YunHo KIM

Journal of the Korean Dysphagia Society.2018;8(2):103-109.

OBJECTIVE: Dysphagia after stroke can cause a range of complications, especially aspiration pneumonia, which can be life-threatening. Therefore, rehabilitation methods to reduce aspiration in patients with dysphagia are important. This study examined the effects of neuromuscular electrical stimulation combined with saliva or dry swallowing on the swallowing function of stroke patients with dysphagia. METHODS: The participants were assigned to either the experimental group (n=9) or control group (n=8). The experimental group received neuromuscular electrical stimulation combined with saliva or dry swallowing, whereas the control group received only voluntary swallowing. Both groups received training 5 days per week for 4 weeks. The oropharyngeal swallowing function was assessed using the video fluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a video fluoroscopic swallowing study. RESULTS: After the intervention, the experimental group showed greater improvement in the pharyngeal phase of the VDS and PAS scores than the control group (P=0.038, 0.027, respectively). CONCLUSION: Neuromuscular electrical stimulation combined with saliva or dry swallowing improves the pharyngeal swallowing function of stroke patients with dysphagia better than saliva or dry swallowing alone.
Deglutition Disorders* ; Deglutition* ; Electric Stimulation* ; Humans ; Pneumonia, Aspiration ; Rehabilitation ; Saliva* ; Stroke*

6

Cite

Share

Normative Temporal Data of Hyolaryngeal Movements during Swallowing.

Min Yong SEONG ; Han Gil SEO ; Byung Mo OH ; Hui Jae DO ; Ji Woon YEOM ; Tai Ryoon HAN

Journal of the Korean Dysphagia Society.2018;8(2):95-102.

OBJECTIVE: This study evaluated the temporal variables of hyolaryngeal movements during normal swallowing using kinematic analysis of the video fluoroscopic swallowing study (VFSS) to present the normal cut-off values of those variables. METHODS: Seventy-five healthy volunteers (17 men, 58 women) without swallowing dysfunctions were recruited to examine the swallowing of 2-ml diluted barium by a VFSS. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the vocal cords, hyoid bone, and epiglottis during normal swallowing. The time points and duration of hyolaryngeal movements were measured. The time points were the start point, maximal point, and the end point of the LE (Laryngeal Elevation), HE (Hyoid Excursion), and EF (Epiglottic Folding). The durations of LE, HE, and EF were obtained by subtracting the time of the start point from the time of the maximal point. The onset time of LE was defined as the reference time point (0 sec). The upper and lower limits of the 95% confidence interval were adopted as the normal cut-off values for the temporal variables of hyolaryngeal movements after transformation to a normal distribution. If a transformation formula to a normal distribution was not found in a variable, the values of the 2.5–97.5 percentile were adopted. RESULTS: The cut-off values of the maximal and end points of the LE were 0.281 to 0.916 sec, and 0.830 to 2.205 sec, respectively. The cut-off values of the start, maximal and end points of the HE were −0.233 to 0.400 sec, 0.320 to 0.874 sec, and 0.889 to 2.055 sec, respectively. The cut-off values of the start, maximal, and end points of the EF were 0.017 to 0.483 sec, 0.364 to 1.055 sec, and 0.774 to 1.773 sec, respectively. The cut-off values of the duration of LE, HE, and EF were 0.281 to 0.916 sec, 0.258 to 0.767 sec, and 0.255 to 0.787 sec, respectively. CONCLUSION: This study presented the normal cut-off values of temporal variables of hyolaryngeal movements during normal swallowing. This study can serve as a basis for classifying and analyzing the patterns of patients with dysphagia.
Barium ; Deglutition Disorders ; Deglutition* ; Epiglottis ; Healthy Volunteers ; Humans ; Hyoid Bone ; Male ; Vocal Cords

7

Cite

Share

Nutritional Support for Patients with Radiation-induced Dysphagia.

Ji Yeon MIN

Journal of the Korean Dysphagia Society.2018;8(2):87-94.

Radiation therapy is a common and effective treatment for various types of head and neck cancers. On the other hand, it usually leads to radiation therapy-induced dysphagia, which manifests as symptoms of obstruction or difficulty in swallowing. Dysphagia may cause several clinical problems, including depression and anxiety disorder, which can degrade a patient's quality of life (QOL). Furthermore, dysphagia may result in malnutrition, dehydration and weight loss, and eventually accelerate the disease. Therefore, it is important to identify the options for measurement and monitoring the nutritional status of dysphagia patients and determine clinically feasible interventions for nutritional supplement. A careful review of the literature provided several important implications. A nasogastric (NG) tube and percutaneous endoscopic gastrostomy (PEG) are useful options for providing nutritional supplement. In addition, continuous monitoring should be given to patients undergoing enteral nutritional support to check the degree to which nutrition supply, aspiration pneumonia or intrinsic enteral nutrition is supplemented. Several special forms of dysphagia diets may also serve as well-balanced nutrition care. Dysphagia patients may be provided with oral nutrition supplement (ONS), including intensified nutritional element, coupled with their preference for tastes and types of viscosity texture.
Anxiety Disorders ; Deglutition ; Deglutition Disorders* ; Dehydration ; Depression ; Diet ; Enteral Nutrition ; Gastrostomy ; Hand ; Head ; Humans ; Malnutrition ; Neck ; Nutritional Status ; Nutritional Support* ; Pneumonia, Aspiration ; Quality of Life ; Viscosity ; Weight Loss

8

Cite

Share

Medical Management for Radiation-induced Dysphagia.

Han Gil SEO

Journal of the Korean Dysphagia Society.2018;8(2):82-86.

Dysphagia after radiotherapy for head and neck cancer is a common problem that affects the nutritional status and quality of life of patients. In particular, although radiation-induced dysphagia associated with late fibroatrophy is often progressive and intractable, there have been only few studies on the therapeutic options, and preventive efforts are not performed well in clinics. This review summarizes the management of radiation-induced dysphagia and suggests possible medical treatments based on the current evidence and reported pathophysiologic mechanisms.
Deglutition Disorders* ; Disease Management ; Fibrosis ; Head and Neck Neoplasms ; Humans ; Nutritional Status ; Quality of Life ; Radiotherapy

9

Cite

Share

Dental Problems Associated with Radiation Therapy.

Yong Jae JOUNG ; Jun Hee HONG ; Kang Min AHN

Journal of the Korean Dysphagia Society.2018;8(2):76-81.

Dental problems associated with radiation therapy are difficult to treat because of the irreversible nature of radiation therapy and permanent tissue damage. Common oral complications include oral mucosa ulceration, xerostomia, and radiation caries. Other oral complications found infrequently are mouth opening limitation and osteonecrosis of the jaw bone. The acute complication of oral ulceration is associated with dysphagia. In addition, delayed complications, such as xerostomia and dental caries, could lower the quality of life, particularly in terms of chewing and swallowing. The treatment of each complication is dependent on the condition and severity. Symptomatic treatment to relieve pain and discomfort is typical for oral complications. Surgical and radical resection is required for the advanced stage of osteoradionecrosis. In this review, oral complications and their treatments are suggested for clinical guidance.
Aphasia ; Deglutition ; Deglutition Disorders ; Dental Caries ; Jaw ; Mastication ; Mouth ; Mouth Mucosa ; Oral Ulcer ; Osteonecrosis ; Osteoradionecrosis ; Quality of Life ; Ulcer ; Xerostomia

10

Cite

Share

Video Fluoroscopic Swallowing Study of Radiation Induced Dysphagia in Head and Neck Cancer.

Sung Hwa KO

Journal of the Korean Dysphagia Society.2018;8(2):67-75.

Dysphagia is a symptom of head and neck cancer itself and a significant complication of its treatments. Radiation therapy also causes dysphagia due to radiation toxicity. Therefore, it is necessary to evaluate patients who complain of dysphagia after radiation therapy. A video fluoroscopic swallowing study (VFSS) is an imaging tool that can diagnose dysphagia objectively from the oral to the esophagus phase. This tool is also used to evaluate to radiation-induced dysphagia. The abnormal findings in each swallowing phase are diverse. Interpreting each abnormal finding in relation to periodic complications caused by radiation toxicity is very important. A delayed pharyngeal transit time is the most characteristic abnormal finding of VFSS due to fibrosis, which is a chronic complication. To accurately assess the radiation-induced dysphagia, an evaluation of dysphagia prior to radiation therapy in head and neck cancer patients should be preceded. A multidisciplinary approach for evaluating dysphagia is needed throughout the entire period of head and neck cancer treatment.
Deglutition Disorders* ; Deglutition* ; Esophagus ; Fibrosis ; Head and Neck Neoplasms* ; Head* ; Humans

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share