Objective:To explore the correlation between bolus of different viscosity and swallowing physiological components,as well as penetration and aspiration,in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma.Method:Total 67 patients with dysphagia after NPCR were evaluated by videofluoroscop.They were required to swallow 5 ml bolus per mouth,in the order of medium-low-zero-high consistency.Modified barium swal-low impairment profile(MBSImP)and penetration-aspiration scale(PAS)were used for semi-quantitative analysis.Result:Wide probability ranges(＞0.2)can be observed between different swallowing tasks for 7 physiologi-cal components:oral residue,initiation of pharyngeal swallow,laryngeal elevation,laryngeal vestibular clo-sure,pharyngeal contraction,tongue base retraction,and pharyngeal residue.The risk of penetration and aspira-tion increased with lower viscosity.There was a significant positive correlation between the penetration aspira-tion scale and epiglottic movement,laryngeal vestibular closure,bolus transpor,initiation of pharyngeal swal-low and tongue base retraction.Conclusion:The performance of swallowing physiological components in patients with dysphagia after NPCR are closely related to the viscosity of the bolus being swallowed.

Objective:To explore the correlation between bolus of different viscosity and swallowing physiological components,as well as penetration and aspiration,in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma.Method:Total 67 patients with dysphagia after NPCR were evaluated by videofluoroscop.They were required to swallow 5 ml bolus per mouth,in the order of medium-low-zero-high consistency.Modified barium swal-low impairment profile(MBSImP)and penetration-aspiration scale(PAS)were used for semi-quantitative analysis.Result:Wide probability ranges(＞0.2)can be observed between different swallowing tasks for 7 physiologi-cal components:oral residue,initiation of pharyngeal swallow,laryngeal elevation,laryngeal vestibular clo-sure,pharyngeal contraction,tongue base retraction,and pharyngeal residue.The risk of penetration and aspira-tion increased with lower viscosity.There was a significant positive correlation between the penetration aspira-tion scale and epiglottic movement,laryngeal vestibular closure,bolus transpor,initiation of pharyngeal swal-low and tongue base retraction.Conclusion:The performance of swallowing physiological components in patients with dysphagia after NPCR are closely related to the viscosity of the bolus being swallowed.

Objective:To observe the maximum tongue pressure and study the oropharyngeal activity during swallowing of patients with nasopharyngeal carcinoma (NPC) after radiotherapy so as to correlate the maximum tongue pressure with swallowing function.Methods:The mean maximum tongue pressure of nineteen NPC patients with dysphagia was measured at the anterior (TA), middle (TM) and posterior (TP) positions, followed by video fluoroscopy. Oral transit time (OTT), upper esophageal sphincter(UES)opening time (UOT) and UES opening range (UOR) were correlated with the mean maximum tongue pressures.Results:The maximum pressure at the TM and TP positions was significantly negatively correlated with OTT, but there was no significant correlation with the anterior readings. The maximum pressures at all three tongue positions were, however, positively correlated with UOT and UOR.Conclusion:The maximum pressure at the TA, TM and TP positions is strongly correlated with the swallowing function of NPC patients.

Objective:To explore the sensitivity and specificity of the simplified cough provoking test in predicting aspiration among patients with dysphagia.Methods:A total of 115 aspirating patients were evaluated using the simplified cough provoking test. Based on the overt and silent aspiration observed through video fluorography, the sensitivity and specificity of the test for predicting each type were quantified.Results:The subjects presented 44 cases of overt aspiration and 71 of silent aspiration. The simplified cough provoking test found that 36 had a normal cough reflex, 22 had a weakened reflex and 57 had none. When the cough′s strength indicated a normal cough reflex, the sensitivity of the simplified cough provoking test predicting silent aspiration was 70.4% and its specificity was 84.1%. The Youden coefficient was 0.545. When the cough reflex was adjudged as abnormal, the test′s sensitivity was 85.9% in predicting silent aspiration and its specificity was 59.1% with a Youden coefficient of 0.45.Conclusion:The simplified cough provoking test has good sensitivity and specificity in identifying silent aspiration. It can effectively screen populations at risk of dysphagia.

Objective:To investigate the incidence of anxiety and depression after radiotherapy for nasopharyngeal carcinoma among persons suffering from dysphagia, and to analyze the related factors.Methods:A total of 143 persons with dysphagia after radiotherapy for nasopharyngeal carcinoma were studied. They completed a general information questionnaire and were evaluated using the hospital anxiety and depression scale.Results:Anxiety was detected in 52 of the subjects (36.3%) and depression in 61 (42.7%). Multivariate regression analysis showed that the average total anxiety score was significantly related to whether the respondent used a gastric tube and whether they lived in a religious household. The average total depression score was related to gastric tube use and to the respondent′s district of residence.Conclusion:Persons with dysphagia after radiotherapy for nasopharyngeal carcinoma often suffer anxiety and depression. The use of a gastric tube increases the risk. The depression of rural residents and those with religious beliefs tends to be milder.

Objective:To explore the clinical utility of tongue pressure resistance feedback training in the treatment of post-stroke dysphagia.Methods:Twenty stroke survivors with dysphagia were randomly divided into an experimental group and a control group. Both groups were given conventional swallowing rehabilitation training, while the experimental group was additionally provided with tongue pressure resistance feedback training. Before and after the treatment, MBSImp analysis and the Rosenbek penetration aspiration scale were used to quantify the control of the tongue, food delivery, oral residue, laryngeal elevation, hyoid bone movement, epiglottis turnover, larynx closure, vestibular larynx closure, pharyngal peristalsis and contraction, opening of the upper esophageal sphincter UES, contraction of the base of the tongue, pharyngeal residue and aspiration.Results:No significant differences were observed between the two groups before the intervention. Afterward the average pharyngeal period and aspiration score of the experimental group had decreased significantly compared with the control group′s values.Conclusions:Tongue pressure resistance feedback training is effective in improving pharyngeal swallowing and reducing the risk of aspiration after swallowing.

Objective:To observe the immediate effect of neuromuscular electrical stimulation (NMES) on the initiation of swallowing among stroke survivors with dysphagia.Methods:Forty-two patients with delayed swallowing initiation were asked to eat 3 boluses of a thin liquid before and during NMES stimulation. The process was recorded and analyzed using a digital data acquisition and analysis system, including the initiation of the pharyngeal swallow (IPS), oral transit time (OTT), larynx closure duration (LCD), and pharynx transit time (PTT). They were also evaluated using the Rosenbek penetration-aspiration scale (PAS).Results:During NMES, significant improvement was observed in the average IPS, PAS and OTT results compared to before the intervention. There was, however, no significant difference in the average LCD or PTT. No obvious adverse reactions were observed during the stimulation.Conclusion:NMES has an immediate effect on improving IPS, PAS and OTT, and can be used as a new compensatory early treatment for stroke survivors with dysphagia.

Objective: To identify the pathophysiological characteristics of cortical stroke survivors′ swallowing. Methods: Sixty cortical stroke survivors with dysphagia and cognitive impairment were enrolled into the observation group, while another 16 with dysphagia but without cognitive impairment formed the unimpaired control group and 16 healthy counterparts were selected for a normal control group. Each subject was recorded videofluoroscopically while swallowing 5ml of a liquid of medium consistency. The occurrence of refusing to eat, mouth opening difficulty, incomplete oral closure, residue in the oral cavity, residue in the pharyngeal cavity, leakage and aspiration were observed. Each subject′s swallowing time and kinematic parameters were analyzed from the fluoroscopic videos. Results: The incidence of refusing to eat (37.5%) and/or incomplete mouth closure (68.75%) were significantly higher in the observation group than in the other two groups. The incidence of difficulty in opening the mouth (37.5%), residue in the oral cavity (81.25%), residue in the pharyngeal cavity (56.25%), leakage (56.25%) and aspiration (50%) of the observation group were significantly higher in the observation group than among the normal controls, but were not significantly different from those incidences among the group without cognitive impairment. The average oral transit time and soft palate elevation time of the observation group were significantly longer than those of the other two groups. The observation group′s average hyoid movement time was significantly longer than that of the normal control group, but not significantly different from that of the group without cognitive impairment. There were no significant differences among the groups in average upper esophageal sphincter opening time, larynx closure time or the kinematic parameters. Conclusions Stroke survivors with dysphagia and cognitive impairment present dysphagia characteristic of oral phase swallowing difficulties.

Objective: To compare a new agar thickener with xanthan gum as a thickener in treating dysphagia patients with nasopharyngeal carcinoma after radiotherapy. Methods: Twenty nasopharyngeal carcinoma patients with dysphagia after radiotherapy were asked to swallow moderately and extremely thick liquids thickened with the agar and xanthan gum, and their swallowing was recorded with a videofluoroscope. Results: The average pharyngeal constriction ratio when swallowing agar thickener was significantly lower than when swallowing the traditional thickener. The average oral transit time, the initiation of pharyngeal swallowing were both significantly quicker. There was no significant difference in the average penetration aspiration scale scores between the two thickeners. In the subjective evaluation, the agar thickener was adjudged smoother and with better residual mouthfeel than the xanthan gum, but the scent of the xanthan gum was preferred. Conclusion The new agar thickener is smooth and not sticky. It produces faster transport with less oropharyngeal residue. It can be widely used among nasopharyngeal carcinoma patients with dysphagia after radiotherapy.

Objective To evaluate the effect of radiotherapy on the swallowing ability of persons with nasopharyngeal carcinoma (NPC) when swallowing food with different consistencies.Methods Twenty NPC patients were monitored fluoroscopically while swallowing materials with three different consistencies after radiotherapy.The oral transit time,oral residue,pharyngeal residue,penetration-aspiration and cricopharyngeal muscle function were observed.Results There were significant differences in all of the measurements when swallowing the three different foods.There were significant differences in all of the measurements between swallowing paste and liquids,but only in the oral transit time,oral residue and pharyngeal residue between swallowing thin and thick liquids.Conclusions The severity of swallowing dysfunction varies in NPC patients after radiotherapy.Foods with different consistencies have different effects on swallowing ability.Videofluoroscopy can evaluate swallowing objectively and provide an objective basis for food preparation.