Dysphagia最新文献

{"title":"Dysphagia and Muscle Weakness Caused by Botulinum Toxin Poisoning after Cosmetic Injection: Three Case Reports and Clinical Warnings.","authors":"Lei Wu, Yangshan Fu, Fenshuang Zheng, Jialong Chen, Xingcheng Li","doi":"10.1007/s00455-025-10839-x","DOIUrl":"https://doi.org/10.1007/s00455-025-10839-x","url":null,"abstract":"<p><p>Botulinum toxin (BoNT), a neurotoxic protein produced by Clostridium botulinum, is widely used for cosmetic and therapeutic purposes, including managing muscle hyperactivity, movement disorders, and chronic migraines by blocking acetylcholine release at neuromuscular junctions. While generally safe, it can cause localized adverse effects (erythema, ptosis, pain) and rare systemic complications (dysphagia, dysarthria, respiratory distress), particularly with improper dosing. From August 2024, This case report presents three female patients, aged 25, 50, and 49, in the Affiliated Hospital of Yunnan University, who experienced severe complications following the injection of botulinum toxin. The first patient, developed dysarthria and dysphagia 18 days post-injection, with a history of administration in northern Myanmar. The second patient, reported similar symptoms 3 days after a lesser dosage was injected into her masseter muscles. The third patient, exhibited fatigue and difficulty in eye opening and swallowing 7 days after receiving botulinum toxin. The symptoms of all patients were significantly improved after receiving symptomatic treatment in our hospital. The three cases presented are significant as they highlight the potential complications arising from botulinum toxin injections, particularly when used for cosmetic purposes. Botulinum toxin, though effective for cosmetic and therapeutic applications, carries risks of localized (muscle weakness, ptosis, bone loss) and systemic complications (generalized weakness, botulism), particularly near critical anatomical structures. Dysphagia and dysarthria, observed in cases post-injection, likely arise from toxin diffusion causing unintended muscle impairment. Treatment outcomes vary, with supportive care or invasive interventions often yielding limited improvement, highlighting management challenges. Clinicians must prioritize patient education, informed consent, and vigilant post-treatment monitoring for neurological symptoms. Future guidelines should standardize safe administration practices-optimizing dosage, injection sites, and follow-up-while enhanced practitioner training and multidisciplinary approaches are critical to mitigating risks and improving outcomes. This underscores the imperative for heightened clinical awareness and robust safety protocols to safeguard patient welfare.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acoustic Correlation with Dysphagia in Stroke Patients.","authors":"Gang Fang, Ren Zhuang, Chaolan Wang, Mengye Zhou, Yi Zhang","doi":"10.1007/s00455-025-10830-6","DOIUrl":"https://doi.org/10.1007/s00455-025-10830-6","url":null,"abstract":"<p><p>Swallowing disorder or dysphagia is one of the common functional disorders in stroke survivors, and its early screening is important for reducing patient dependence, pneumonia incidence, mortality, and shortening the hospital stay. However, the commonly used methods to examine dysphagia, which include Toronto bedside swallowing screening test, volume viscosity swallowing test, and swallowing angiography screening/examination, are all invasive with the risk of aspiration. Here we have undertaken a detailed voice analysis on stroke patients with dysphagia by monitoring a series of acoustic parameters including maximum volume, maximum pitch, glottal noise excitation ratio, fundamental frequency perturbation, amplitude perturbation (Shimmer), maximum pronunciation time, irregularity, breath sound, overall severity, and voice disorder severity index. We show that all these acoustic parameters change significantly for the stroke patients with dysphagia compared with the healthy group as well as stroke group with no dysphagia, and the changes are correlated with the severity of pharyngeal residue especially for Shimmer and overall severity of the voice. Our findings suggest that voice analysis, which is quick and non-invasive, may give an important initial indication on the severity of dysphagia and cross-validate results from swallowing tests that clinicians may further pursue for a thorough diagnosis of dysphagia.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Machine Learning Pipeline for Automated Bolus Segmentation and Area Measurement in Swallowing Videofluoroscopy Images of an Infant Pig Model.","authors":"Max Sarmet, Elska Kaczmarek, Alexane Fauveau, Kendall Steer, Alex-Ann Velasco, Ani Smith, Maressa Kennedy, Hannah Shideler, Skyler Wallace, Thomas Stroud, Morgan Blilie, Christopher J Mayerl","doi":"10.1007/s00455-025-10829-z","DOIUrl":"https://doi.org/10.1007/s00455-025-10829-z","url":null,"abstract":"<p><p>Feeding efficiency and safety are often driven by bolus volume, which is one of the most common clinical measures of assessing swallow performance. However, manual measurement of bolus area is time-consuming and suffers from high levels of inter-rater variability. This study proposes a machine learning (ML) pipeline using ilastik, an accessible bioimage analysis tool, to automate the measurement of bolus area during swallowing. The pipeline was tested on 336 swallows from videofluoroscopic recordings of 8 infant pigs during bottle feeding. Eight trained raters manually measured bolus area in ImageJ and also used ilastik's autocontext pixel-level labeling and object classification tools to train ML models for automated bolus segmentation and area calculation. The ML pipeline trained in 1h42min and processed the dataset in 2 min 48s, a 97% time saving compared to manual methods. The model exhibited strong performance, achieving a high Dice Similarity Coefficient (0.84), Intersection over Union (0.76), and inter-rater reliability (intraclass correlation coefficient = 0.79). The bolus areas from the two methods were highly correlated (R² = 0.74 overall, 0.78 without bubbles, 0.67 with bubbles), with no significant difference in measured bolus area between the methods. Our ML pipeline, requiring no ML expertise, offers a reliable and efficient method for automatically measuring bolus area. While human confirmation remains valuable, this pipeline accelerates analysis and improves reproducibility compared to manual methods. Future refinements can further enhance precision and broaden its application in dysphagia research.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts from the 33rd Meeting of the Dysphagia Research Society.","authors":"","doi":"10.1007/s00455-025-10828-0","DOIUrl":"https://doi.org/10.1007/s00455-025-10828-0","url":null,"abstract":"","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Concerns Regarding GPi DBS and Mild Dysphagia in Parkinson's Disease.","authors":"May Smith-Hublou, Nicole Herndon, Joshua K Wong, Adolfo Ramirez-Zamora, Karen Wheeler-Hegland","doi":"10.1007/s00455-025-10827-1","DOIUrl":"https://doi.org/10.1007/s00455-025-10827-1","url":null,"abstract":"","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Swallowing Function After Reconstruction of Cervical Esophagus with Jejunum, Ileocolon or Skin Flap: Method of Physiotherapy for Deglution and Long Term Follow-Up.","authors":"Katie Kai-Yuan Lin, Hung-Chi Chen, Shih-Heng Chen, Chi-Wen Huang","doi":"10.1007/s00455-025-10813-7","DOIUrl":"https://doi.org/10.1007/s00455-025-10813-7","url":null,"abstract":"<p><p>The swallowing function is a major goal of reconstruction for the patients who had hypopharyngeal cancer and received total pharyngolaryngectomy with or without voice reconstruction. We would like to share our experience in reconstruction of swallowing function using jejunum, ileocolon, or anterolateral thigh flap for cervical esophagus. In this study, we proposed that the jejunum flap is the most suitable option for restoring swallowing function, owing to its physiological characteristics. A retrospective study was conducted in 36 patients undergoing reconstruction of cervical esophagus with free jejunum flap (7 cases), ileocolon flap (21 cases), or anterolateral flap (8 cases). Esophagography, time required to achieve swallowing of semisolid diet without tube feeding, changes in body weight before and after the surgery, and ^99mTc for transit scan to evaluate pharyngeal clearance were used to evaluate the swallowing function of the patients. Patients with jejunum flap had the best swallowing function, followed by ileocolon and then ALT flap. Besides, no conduits needed to be modified in jejunum and ileocolon flap. Regarding swallowing function, for patients with longer life expectancy and no contraindication of laparotomy, jejunum flap should be the first choice to obtain optimal swallowing function for cervical esophagus. Anterolateral flap is the easiest and most commonly used flap and provides fair swallowing function if there is no leakage. However, the anterolateral thigh flap tends to develop narrowing on long-term following-up. Based on completeness of pharyngeal transit of bolus and lack of complications, patients with jejunal flap reconstruction showed best swallowing function, followed by ileocolon and then ALT flaps.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Letter to the Editor on Presbyphagia: A Conceptual Analysis of Contemporary Proposals and their Influences on Clinical Diagnosis.","authors":"Francelise Pivetta Roque, Ana Beatriz Ferreira Monteiro, Patrick Alexander Wachholz, Roberta Gonçalves da Silva","doi":"10.1007/s00455-025-10825-3","DOIUrl":"https://doi.org/10.1007/s00455-025-10825-3","url":null,"abstract":"<p><p>The author identified three main operational definitions of presbyphagia in the specialized literature: (1) changes in healthy older people's swallowing, (2) a swallowing disorder compensated by physiological reserves, and (3) a synonym of dysphagia. As the author stated in the conclusion, presbyphagia should be considered an etiology of oropharyngeal dysphagia (OD). However, significant methodological flaws were found, including selecting only one person to screen and analyze articles in the systematic review, not using any keywords or MeSH terms in the search, not presenting a search strategy, limiting the search term to \"presbyphagia\", and omitting details about screening, inclusion, and exclusion criteria. The operational definitions describe that aging inherently causes swallowing impairment. However, they disregard age-related changes without significant functional impact, as found by a previous study, reviewed in the current research, but analyzed inconsistently by the author. This recent study showed that presbyphagia is the opposite of OD, framing both the \"negative\" aspects of swallowing and the \"compensatory positives\" as natural consequences of aging, consistent with the World Health Organization's concept of intrinsic capacity. This perspective positions aging as an adaptive process-not a disease or cause of disease-, although it may increase vulnerability due to cumulative factors. Since OD is a symptom, attributing it to aging frames aging itself as a disease, contradicting current geriatrics and gerontology paradigms.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance.","authors":"Erin Kamarunas, Kelsey Murray, Teresa Drulia, Sarah Szynkiewicz, Lindsay Griffin, Rachel Mulheren","doi":"10.1007/s00455-024-10751-w","DOIUrl":"10.1007/s00455-024-10751-w","url":null,"abstract":"<p><p>Rehabilitative exercises require precise movement coordination and target accuracy for optimal effectiveness. This paper explores the impact of tongue strength exercises (TSE) performance accuracy on exercise outcomes, adherence, and participant confidence and motivation. An 8-week randomized clinical trial included 84 typically aging participants divided into four groups defined by access to biofeedback (present/absent) and TSE intensity dosing (maximal/submaximal) during a home exercise program (HEP). Retention, training, and HEP accuracy were tracked at biweekly visits and during HEP for participants with access to a biofeedback device. Associations with tongue strength outcomes, participant factors, biofeedback, and intensity dosing were analyzed. Exercise accuracy measures did not contribute to tongue strength outcomes at the end of 8 weeks. Increased training accuracy (less practice required to achieve competency) was associated with higher participant confidence and better adherence to the HEP. The presence of biofeedback was associated with reduced adherence but better retention accuracy, while maximal intensity was associated with improvements in all accuracy measures compared to submaximal intensity exercise. These findings in typically aging participants suggest the need for tailored approaches in swallowing-related exercise programs, given the effects of biofeedback and exercise intensity on motor learning and exercise retention. Accuracy performance and its effect on clinical outcomes warrants study in clinical populations with dysphagia and with various rehabilitative approaches.Trial Registration Clincialtrials.gov: NCT04809558.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"489-500"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.","authors":"Leen Van den Steen, Edwig Goossens, Martijn van Gemst, Geertrui Vlaemynck, Bart Geurden, Gwen Van Nuffelen","doi":"10.1007/s00455-024-10752-9","DOIUrl":"10.1007/s00455-024-10752-9","url":null,"abstract":"<p><p>The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"501-509"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Statistical Practices for Longitudinal Group Comparison of the Penetration-Aspiration Scale on Power and Effect Size Estimation: A Monte Carlo Simulation Study.","authors":"James C Borders, Alessandro A Grande, Carly E A Barbon, Katherine A Hutcheson, Michelle S Troche","doi":"10.1007/s00455-024-10738-7","DOIUrl":"10.1007/s00455-024-10738-7","url":null,"abstract":"<p><p>Multiple bolus trials are administered during clinical and research swallowing assessments to comprehensively capture an individual's swallowing function. Despite valuable information obtained from these boluses, it remains common practice to use a single bolus (e.g., the worst score) to describe the degree of dysfunction. Researchers also often collapse continuous or ordinal swallowing measures into categories, potentially exacerbating information loss. These practices may adversely affect statistical power to detect and estimate smaller, yet potentially meaningful, treatment effects. This study sought to examine the impact of aggregating and categorizing penetration-aspiration scale (PAS) scores on statistical power and effect size estimates. We used a Monte Carlo approach to simulate three hypothetical within-subject treatment studies in Parkinson's disease and head and neck cancer across a range of data characteristics (e.g., sample size, number of bolus trials, variability). Different statistical models (aggregated or multilevel) as well as various PAS reduction approaches (i.e., types of categorizations) were performed to examine their impact on power and the accuracy of effect size estimates. Across all scenarios, multilevel models demonstrated higher statistical power to detect group-level longitudinal change and more accurate estimates compared to aggregated (worst score) models. Categorizing PAS scores also reduced power and biased effect size estimates compared to an ordinal approach, though this depended on the type of categorization and baseline PAS distribution. Multilevel models should be considered as a more robust approach for the statistical analysis of multiple boluses administered in standardized swallowing protocols due to its high sensitivity and accuracy to compare group-level changes in swallowing function. Importantly, this finding appears to be consistent across patient populations with distinct pathophysiology (i.e., PD and HNC) and patterns of airway invasion. The decision to categorize a continuous or ordinal outcome should be grounded in the clinical or research question with recognition that scale reduction may negatively affect the quality of statistical inferences in certain scenarios.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"388-398"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}