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  • 1
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    Online Resource
    Costs of post-stroke dysphagia during acute hospitalization from a health-insurance perspective
    SAGE Publications ; 2023
    In:  European Stroke Journal Vol. 8, No. 1 ( 2023-03), p. 361-369
    Details
    In: European Stroke Journal, SAGE Publications, Vol. 8, No. 1 ( 2023-03), p. 361-369
    Abstract: Oropharyngeal dysphagia is a common and complication-prone symptom after stroke and is assumed to increase medical expenses. The purpose of this study was therefore to examine acute hospitalization costs associated with post-stroke dysphagia. Method: This retrospective study included patients with acute stroke who had been examined by Flexible Endoscopic Evaluation of Swallowing (FEES). Health insurance expenditures were determined for the patient cases according to the 2021 revenue criteria. Multiple linear regression was used to examine predictors of health insurance spending including age, sex, stroke severity, stroke characteristics, comorbidity, therapeutic interventions, duration of artificial ventilation, length of hospital stay, and severity of dysphagia, as assessed by the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), ranging from 1 (best) to 6 (worst). Findings: Six hundred seventy four patients (men/women: 367/307; mean age: 71.1 ± 12.8 years; mean National Institute of Health Stroke Scale: 11.2 ± 6.2; FEDSS 1/2/3/4/5/6: 113/73/144/119/124/101; mean health-insurance costs 11,521.5 ± 12,950.5€) were included in the analysis. Advanced age ( p = 0.007; B = 57.6), catheter interventions ( p  〈  0.001; B = 4105.6), tracheotomy ( p = 0.006; B = 5195.2), duration of artificial ventilation ( p  〈  0.001; B = 388.6), length of hospital stay ( p  〈  0.001; B = 441.9), and severe dysphagia with an FEDSS of 6 ( p = 0.004, B = 2554.3) were independent predictors of increased health insurance expenditures ( p  〈  0.001, R-squared = adjusted-R-squared = 0.83). Discussion and conclusion: The results of this study show an association between severe dysphagia and health care costs for acute hospitalization from a health-insurance perspective. Therefore, therapies that target severe dysphagia with impaired secretion management may have the potential to reduce costs.
    Type of Medium: Online Resource
    ISSN: 2396-9873 , 2396-9881
    URL: Article
    DOI: 10.1177/23969873221147740
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2851287-X
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  • 2
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    Targeting the sensory feedback within the swallowing network—Reversing artificially induced pharyngolaryngeal hypesthesia by central and peripheral stimulation strategies
    Wiley ; 2021
    In:  Human Brain Mapping Vol. 42, No. 2 ( 2021-02), p. 427-438
    Details
    In: Human Brain Mapping, Wiley, Vol. 42, No. 2 ( 2021-02), p. 427-438
    Abstract: Pharyngolaryngeal hypesthesia is a major reason for dysphagia in various neurological diseases. Emerging neuromodulation devices have shown potential to foster dysphagia rehabilitation, but the optimal treatment strategy is unknown. Because functional imaging studies are difficult to conduct in severely ill patients, we induced a virtual sensory lesion in healthy volunteers and evaluated the effects of central and peripheral neurostimulation techniques. In a sham‐controlled intervention study with crossover design on 10 participants, we tested the potential of (peripheral) pharyngeal electrical stimulation (PES) and (central) transcranial direct current stimulation (tDCS) to revert the effects of lidocaine‐induced pharyngolaryngeal hypesthesia on central sensorimotor processing. Changes were observed during pharyngeal air‐pulse stimulation and voluntary swallowing applying magnetoencephalography before and after the interventions. PES induced a significant ( p 〈 .05) increase of activation during swallowing in the bihemispheric sensorimotor network in alpha and low gamma frequency ranges, peaking in the right premotor and left primary sensory area, respectively. With pneumatic stimulation, significant activation increase was found after PES in high gamma peaking in the left premotor area. Significant changes of brain activation after tDCS could neither be detected for pneumatic stimulation nor for swallowing. Due to the peripheral cause of dysphagia in this model, PES was able to revert the detrimental effects of reduced sensory input on central processing, whereas tDCS was not. Results may have implications for therapeutic decisions in the clinical context.
    Type of Medium: Online Resource
    ISSN: 1065-9471 , 1097-0193
    URL: Issue
    URL: Article
    DOI: 10.1002/hbm.v42.2
    DOI: 10.1002/hbm.25233
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1492703-2
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  • 3
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    Online Resource
    Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson's Disease
    Wiley ; 2021
    In:  Movement Disorders Vol. 36, No. 8 ( 2021-08), p. 1815-1824
    Details
    In: Movement Disorders, Wiley, Vol. 36, No. 8 ( 2021-08), p. 1815-1824
    Abstract: Pharyngeal dysphagia in Parkinson's disease (PD) is a common and clinically relevant symptom associated with poor nutrition intake, reduced quality of life, and aspiration pneumonia. Despite this, effective behavioral treatment approaches are rare. Objective The objective of this study was to verify if 4 week of expiratory muscle strength training can improve pharyngeal dysphagia in the short and long term and is able to induce neuroplastic changes in cortical swallowing processing. Methods In this double‐blind, randomized, controlled trial, 50 patients with hypokinetic pharyngeal dysphagia, as confirmed by flexible endoscopic evaluation of swallowing, performed a 4‐week expiratory muscle strength training. Twenty‐five participants used a calibrated (“active”) device, 25 used a sham handheld device. Swallowing function was evaluated directly before and after the training period, as well as after a period of 3 month using flexible endoscopic evaluation of swallowing. Swallowing‐related cortical activation was measured in 22 participants (active:sham; 11:11) using whole‐head magnetencephalography. Results The active group showed significant improvement in the flexible endoscopic evaluation of swallowing–based dysphagia score after 4 weeks and after 3 months, whereas in the sham group no significant changes from baseline were observed. Especially, clear reduction in pharyngeal residues was found. Regarding the cortical swallowing network before and after training, no statistically significant differences were found by magnetencephalography examination. Conclusions Four‐week expiratory muscle strength training significantly reduces overall dysphagia severity in PD patients, with a sustained effect after 3 months compared with sham training. This was mainly achieved by improving swallowing efficiency. The treatment effect is probably caused by peripheral mechanisms, as no changes in the cortical swallowing network were identified. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
    Type of Medium: Online Resource
    ISSN: 0885-3185 , 1531-8257
    URL: Issue
    URL: Article
    DOI: 10.1002/mds.v36.8
    DOI: 10.1002/mds.28552
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2041249-6
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  • 4
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    Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy
    Wiley ; 2021
    In:  Muscle & Nerve Vol. 63, No. 6 ( 2021-06), p. 874-880
    Details
    In: Muscle & Nerve, Wiley, Vol. 63, No. 6 ( 2021-06), p. 874-880
    Abstract: Oropharyngeal dysphagia is a clinical hallmark of idiopathic inflammatory myopathy (IIM). This study investigated predictors, outcome, and characteristics of oropharyngeal dysphagia in patients with different types of IIM. Methods Flexible endoscopic evaluation of swallowing (FEES) videos of 71 IIM patients were retrospectively analyzed for bolus spillage, penetration, aspiration, and pharyngeal residue. Based on these findings, dysphagia severity was rated. Regression analyses were performed to investigate demographic and disease‐specific predictors of dysphagia severity and pneumonia as outcome‐relevant complications of dysphagia. A score was developed to rate the quality of the endoscopic white‐out as a surrogate marker for pharyngeal muscle weakness with consecutive residue. Results Our analysis revealed no independent predictors of dysphagia severity. Dysphagia severity, however, was an independent predictor for pneumonia, which occurred in 24% of patients. Pharyngeal residue with risk of postdeglutitive aspiration was the most common dysphagia pattern. Attenuation of the endoscopic white‐out was related to residue severity. Discussion Dysphagia in IIM assessed with FEES is associated with relevant complications, such as aspiration pneumonia, and must be considered independently of peripheral muscle weakness and disease duration. Swallowing impairment mainly presents with pharyngeal residue. The quality of the white‐out may serve as a semi‐quantitative surrogate marker for pharyngeal contractility.
    Type of Medium: Online Resource
    ISSN: 0148-639X , 1097-4598
    URL: Issue
    URL: Article
    DOI: 10.1002/mus.v63.6
    DOI: 10.1002/mus.27225
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1476641-3
    SSG: 12
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  • 5
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    Dysphagia in Patients With Severe Coronavirus Disease 2019—Potential Neurologic Etiologies
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Critical Care Explorations Vol. 3, No. 1 ( 2021-01), p. e0332-
    Details
    In: Critical Care Explorations, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 1 ( 2021-01), p. e0332-
    Type of Medium: Online Resource
    ISSN: 2639-8028
    URL: Article
    DOI: 10.1097/CCE.0000000000000332
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 3015728-6
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  • 6
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    Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients – a prospective evaluation
    Springer Science and Business Media LLC ; 2021
    In:  Neurological Research and Practice Vol. 3, No. 1 ( 2021-12)
    Details
    In: Neurological Research and Practice, Springer Science and Business Media LLC, Vol. 3, No. 1 ( 2021-12)
    Abstract: Removal of a tracheostomy tube in critically ill neurologic patients is a critical issue during intensive care treatment, particularly due to severe dysphagia and insufficient airway protection. The “Standardized Endoscopic Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) is an objective measure of readiness for decannulation. This protocol includes the stepwise evaluation of secretion management, spontaneous swallowing, and laryngeal sensitivity during fiberoptic endoscopic evaluation of swallowing (FEES). Here, we first evaluated safety and secondly effectiveness of the protocol and sought to identify predictors of decannulation success and decannulation failure. Methods A prospective observational study was conducted in the neurological intensive care unit at Münster University Hospital, Germany between January 2013 and December 2017. Three hundred and seventy-seven tracheostomized patients with an acute neurologic disease completely weaned from mechanical ventilation were included, all of whom were examined by FEES within 72 h from end of mechanical ventilation. Using regression analysis, predictors of successful decannulation, as well as decannulation failure were investigated. Results Two hundred and twenty-seven patients (60.2%) could be decannulated during their stay according to the protocol, 59 of whom within 24 h from the initial FEES after completed weaning. 3.5% of patients had to be recannulated due to severe dysphagia or related complications. Prolonged mechanical ventilation showed to be a significant predictor of decannulation failure. Lower age was identified to be a significant predictor of early decannulation after end of weaning. Transforming the binary SESETD into a 4-point scale helped predicting decannulation success in patients not immediately ready for decannulation after the end of respiratory weaning (optimal cutoff ≥1; sensitivity: 64%, specifity: 66%). Conclusions The SESETD showed to be a safe and efficient tool to evaluate readiness for decannulation in our patient collective of critically ill neurologic patients.
    Type of Medium: Online Resource
    ISSN: 2524-3489
    URL: Article
    DOI: 10.1186/s42466-021-00124-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2947493-0
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  • 7
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    Online Resource
    Sarcopenic Dysphagia Revisited: A Cross-Sectional Study in Hospitalized Geriatric Patients
    MDPI AG ; 2023
    In:  Nutrients Vol. 15, No. 12 ( 2023-06-07), p. 2662-
    Details
    In: Nutrients, MDPI AG, Vol. 15, No. 12 ( 2023-06-07), p. 2662-
    Abstract: Oropharyngeal dysphagia (OD) is a frequent finding in older patients with potentially lethal complications such as aspiration pneumonia, malnutrition, and dehydration. Recent studies describe sarcopenia as a causative factor for OD, which is occasionally referred to as “sarcopenic dysphagia” in the absence of a neurogenic etiology. In most of the previous studies on sarcopenic dysphagia, the diagnosis was based only on clinical assessment. In this study, flexible endoscopic evaluation of swallowing (FEES) was used as an objective method to evaluate the presence of OD, its association with sarcopenia, and the presence of pure sarcopenic dysphagia. In this retrospective cross-sectional study, 109 acute care geriatric hospital patients with suspected OD received FEES examination and bioimpedance analysis (BIA) in clinical routine. 95% of patients had at least one neurological disease, 70% fulfilled the criteria for sarcopenia, and 45% displayed moderate or severe OD. Although the prevalence of sarcopenia and OD was high, there was no significant association between OD and sarcopenia. Considering these results, both the association between sarcopenia and OD and pure sarcopenic dysphagia appear questionable. Further prospective studies are needed to elucidate if sarcopenia is merely an epiphenomenon of severe disease or whether it plays a causative role in the development of OD.
    Type of Medium: Online Resource
    ISSN: 2072-6643
    URL: Article
    DOI: 10.3390/nu15122662
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2518386-2
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  • 8
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    Online Resource
    Detecting myasthenia gravis as a cause of unclear dysphagia with an endoscopic tensilon test
    SAGE Publications ; 2021
    In:  Therapeutic Advances in Neurological Disorders Vol. 14 ( 2021-01), p. 175628642110355-
    Details
    In: Therapeutic Advances in Neurological Disorders, SAGE Publications, Vol. 14 ( 2021-01), p. 175628642110355-
    Abstract: The flexible endoscopic evaluation of swallowing-tensilon test (FTT) was developed to diagnose myasthenia gravis (MG) in patients with unclear pharyngeal dysphagia. The purpose of this study was to determine sensitivity and specificity of the FTT and compare its diagnostic validity with that of other diagnostic markers. Methods: In this single-centre pragmatic clinical cohort study, a total of 100 patients with unclear pharyngeal dysphagia were eligible to undergo FTT. All patients were subjected to FTT and subsequently followed up clinically. FTT was considered positive if a significant improvement of pharyngeal swallowing function could be objectified endoscopically upon administration of edrophonium chloride. In addition, repetitive nerve stimulation test and serum MG antibody analysis were conducted. Results: All subjects (mean age 62.5 ± 14.1 years, female 33) underwent FTT without any complications. According to the results of the diagnostic procedures and based on long-term clinical follow-up for at least 3 years, 51 patients were finally diagnosed with MG. The sensitivity and specificity for the FTT was 88.2% and 95.9%, respectively. Application of the Cochran’s Q test showed statistically significant heterogeneity among the diagnostic tests, with results indicating FTT performance to be more accurate than the repetitive nerve stimulation results ( p  〈  0.001) and comparable with serum antibody tests ( p  〉  0.99). Conclusion: FTT has excellent clinical properties to be used routinely in the assessment of dysphagia with isolated or predominant pharyngeal muscle involvement allowing rapid and accurate diagnosis of MG.
    Type of Medium: Online Resource
    ISSN: 1756-2864 , 1756-2864
    URL: Article
    DOI: 10.1177/17562864211035544
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2442245-9
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  • 9
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    Online Resource
    Dysphagia in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody disease as a surrogate of brain involvement?
    Wiley ; 2021
    In:  European Journal of Neurology Vol. 28, No. 5 ( 2021-05), p. 1765-1770
    Details
    In: European Journal of Neurology, Wiley, Vol. 28, No. 5 ( 2021-05), p. 1765-1770
    Abstract: Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are demyelinating disorders that typically affect the optic nerves and the spinal cord. However, recent studies have demonstrated various forms of brain involvement indicating encephalitic syndromes, which consequently are included in the diagnostic criteria for both. Swallowing is processed in a distributed brain network and is therefore disturbed in many neurological diseases. The aim of this study was to investigate the occurrence of oropharyngeal dysphagia in NMOSD and MOGAD using flexible endoscopic evaluation of swallowing (FEES) as a surrogate parameter of brain involvement. Methods Thirteen patients with NMOSD and MOGAD (mean age 54.2 ± 18.6 years, six men) who received FEES during clinical routine were retrospectively reviewed. Their extent of oropharyngeal dysphagia was rated using an ordinal dysphagia severity scale. FEES results were compared to a control group of healthy individuals. Dysphagia severity was correlated with the presence of clinical and radiological signs of brain involvement, the Expanded Disability Status Scale (EDSS) and the occurrence of pneumonia. Results Oropharyngeal dysphagia was present in 8/13 patients, including six patients without other clinical indication of brain involvement. Clinical or subclinical swallowing impairment was significantly more severe in patients with NMOSD and MOGAD compared to the healthy individuals ( p  = 0.009) and correlated with clinical signs of brain involvement ( p  = 0.038), higher EDSS ( p  = 0.006) and pneumonia ( p  = 0.038). Conclusion Oropharyngeal dysphagia can occur in NMOSD and MOGAD and might be associated with pneumonia and disability. FEES may help to detect subclinical brain involvement.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    URL: Article
    DOI: 10.1111/ene.v28.5
    DOI: 10.1111/ene.14691
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2020241-6
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  • 10
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    Dysphagiemanagement verbessert Lebensqualität und senkt Mortalität
    Springer Science and Business Media LLC ; 2019
    In:  InFo Neurologie & Psychiatrie Vol. 21, No. 3 ( 2019-3), p. 36-47
    Details
    In: InFo Neurologie & Psychiatrie, Springer Science and Business Media LLC, Vol. 21, No. 3 ( 2019-3), p. 36-47
    Type of Medium: Online Resource
    ISSN: 1437-062X , 2195-5166
    URL: Article
    DOI: 10.1007/s15005-019-0026-1
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2529407-6
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