Navegando por Palavras-chave "Deglutition disorders"

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    Avaliação clínica e videofluoroscópica de pacientes com distúrbios da deglutição - estudo comparativo em dois grupos etários: adultos e idosos
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2006-09-01) Suzuki, Heloisa Sawada [UNIFESP]; Nasi, Ary [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Bilton, Tereza [UNIFESP]; Sanches, Elaine Palinkas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: The abnormalities of swallowing process have multifactor and complex etiologies. The videofluoroscopy has been pointed as the exam of greater utility in diagnostic investigation for these cases. This method, when preceded of an adequate anamnesis, can characterize conveniently the level of the dysfunction and usually identify the cause of abnormality with great precision. AIMS: To study the clinical complaints and findings of the videofluoroscopy examination in patients with deglutition disorders and no clinical evidence associated with neurological disorder, classified into two age groups: adults and older people, and to analyze: symptomatic manifestations, kinds of disorders (oropharyngeal or esophageal) and the capacity of clarifying the clinical complaints through the method of images. MATERIALS AND METHODS: Seventy patients with complaint of the capacity of deglutition were analyzed. They had no clinical evidence of associated neurological syndromes or disorders and were classified into two age groups: adults (GI) - £65 years (n = 36) and older (GII) >65 years (n = 34). All patients were submitted to anamnesis to obtain the information about their complaints concerning deglutition. The complaints were characterized as high or low, according to their predominant location of manifestation. All the patients were submitted to videofluoroscopy of the deglutition; these alterations were characterized as oropharyngeal or esophageal. The capacity of clarifying the clinical complaints by videofluoroscopy was evaluated in both groups. RESULTS: Among the complaints analyzed, the only one in which the statistical analysis presented a significant difference between the groups was the complaint of heartburn, which occurred more often in the group GI - eight patients (22.2%) and GII - one patient (2.9%). In the study of videofluoroscopy, it was observed a higher incidence in the oropharyngeal disorder in group GII - 41.2% while in group GI - 13.9%. As for the esophageal disorder, the incidence was similar in both groups GI - 35.3% and GII - 33.3%. Nineteen patients (52.8%) in GI and 23 (67.6%) in GII had their complaints clarified through the videofluoroscopy. CONCLUSIONS: Under the conditions of this study, it can be concluded that: 1.The clinical complaints associated with the difficulty of deglutition occur at a similar frequency in adults and older people, with the exception of heartburn that occurs in larger number among adults; 2. Older people present a higher incidence of oropharyngeal deglutition problems; 3. The videofluoroscopy of the deglutition represents a method of great importance for the diagnosis, because it allows the identification of morphofunctional disorders that cannot be adequately identified by anamnesis; 4. The capacity of clarifying diagnosis of the videofluoroscopy of the deglutition is higher in the older people group.
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    Avaliação da disfagia e do refluxo laringofaringeo em pacientes com apnéia obstrutiva do Sono
    (Universidade Federal de São Paulo (UNIFESP), 2018-06-28) Caparroz, Fabio de Azevedo [UNIFESP]; Haddad, Fernanda Louise Martinho [UNIFESP]; http://lattes.cnpq.br/2110917250638917; http://lattes.cnpq.br/6982046861974842; Universidade Federal de São Paulo (UNIFESP)
    Objectives: to evaluate whether the presence of signs and symptons suggestive of laryngopharingeal reflux are associated with the presence of dysphagia in patients with moderate and severe obstructive sleep apnea (OSA), and also evaluate whether endoscopic signs of dysphagia could be reverted by treatment with CPAP in patients with OSA. Methods: 70 patients among 18 and 70 years old with moderate or severe OSA were included in the study. The following questionnaries were applied: RSI (Reflux Sympton Index) and Quality of Life in Swallowing Disorders (Swal-Qol). Functional Endoscopy Evaluation of Swallowing Safety (FEESS) and video-laryngoscopy, in order to obtain Reflux Finding Score (RFS), were also performed. The patients with diagnosis of dysphagia on FEESS were followed-up to 3 months, and then reavaluated according to the same protocol. Results: the prevalence of laryngopharingeal reflux on our sample was 59,7%, and the prevalence of dysphagia was 27,3%, inferior than previous studies. Association between laryngopharingeal reflux and dysphagia was found on 17,1% of the patients, with no statistical significance. Lower quality of life scores were observed in only one domain of Swal-Qol in patients with dysphagia and OSA. There was a significantly improvement of deglutition disorders on FEESS after treatment with CPAP (p=0,004), as well as quality of life measured by Swal-Qol (global score, p = 0,028), in patients with dysphagia and OSA, after 3 months. Conclusions: There was no association between laryngopharingeal reflux and dysphagia in patients with OSA on the present study. Prevalence of dysphagia, showed mostly by premature oral leakage, was 27,3% on our sample, inferior to previous studies. It seems to be a lower additional impact on quality of life, measured by Swal-Qol, in patients with dysphagia and OSA. Treatment with CPAP was capable of reverting endoscopic signs of dysphagia on FEESS in patients with OSA.
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    Benefícios da aplicação de toxina botulínica associada à fonoterapia em pacientes disfágicos graves
    (Sociedade Brasileira de Fonoaudiologia, 2012-06-01) Menezes, Fernanda Teixeira [UNIFESP]; Rodrigues, Katia Alonso [UNIFESP]; Oliveira Neto, Isabella Christina de [UNIFESP]; Chiari, Brasilia Maria [UNIFESP]; Manrique, Dayse; Gonçalves, Maria Inês Rebelo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Case report with the aim to characterize the benefits of botulinum toxin injection into salivary glands in association with swallowing therapy in patients with severe dysphagia. The medical records of five neurological patients (four male and one female, aged between 17 and 70 years) who exclusively used alternative feeding were analyzed. Four patients were tracheostomized. Inclusion criterion was to present severe dysphagia associated to clinical manifestations of drooling and/or sialorrhea with significant aspiration of saliva, restricting the improvement in swallowing rehabilitation. Data were collected before and after intervention associated with botulinum toxin injection, regarding the following aspects: mobility and strength of oropharyngeal structures (lips, tongue and cheeks), laryngeal elevation, severity degree of dysphagia, use of alternative tube feeding and tracheostomy. After swallowing therapy, four patients showed improvement in mobility and strength of the lips, tongue, cheeks and larynx. Four patients presented functional swallowing and one of them modified had the severity degree of dysphagia changed. Therefore, most patients were able to receive exclusive oral feeding, and only one remained on mixed feeding, that is, gastrostomy and oral feeding with pasty consistence. All tracheostomized patients had the tracheostomy cannula removed. The study showed that the treatment described contributed to swallowing rehabilitation, reintroduction of oral feeding, and withdrawal of the tracheostomy cannula.
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    Consumo alimentar de crianças e adolescentes com disfagia decorrente de estenose de esôfago: avaliação com base na pirâmide alimentar brasileira
    (Pontifícia Universidade Católica de Campinas, 2011-04-01) Marciano, Renata [UNIFESP]; Speridião, Patrícia da Graça Leite [UNIFESP]; Kawakami, Elisabete [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: This study assessed food intake by patients with dysphagia due to esophageal stricture and compared liquid, soft and solid diets based on the Brazilian Food guide pyramid. METHODS: This cross-sectional study consecutively included 31 patients with esophageal stricture, of which 18 (58.0%) were caustic, 7 (22.6%) were postoperative, 3 (9.7%) were peptic and 3 (9.7%) were of unknown etiology. The 24-hour dietary recall was used and the foods were converted into servings according to the eight food groups, as recommended by Philippi. The Kruskal-Wallis and Fisher's Exact Test were used and the significance level was set at 5%. RESULTS: The ages of the patients varied from 15 to 176 months (median: 56 months). There were 28 children and 3 adolescents, of which 28 were males. Twenty-nine patients (93.5%) presented dysphagia, of which 34.4% (10/29) were severe, 41.3% (12/29) were moderate and 24.1% (7/29) were mild. The median intake of grain, legume and fat servings was smaller in the liquid diet group (p<0.005). This group also had a significantly greater proportion of patients whose intakes were below those recommended by the food pyramid (p<0.05). CONCLUSION: Nutritional support is extremely important in the treatment of patients with esophageal stricture, especially those with severe dysphagia. These patients need a liquid diet because of the nutritional risk associated with inadequate food intake, which also allows early introduction of the dietary treatment.
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    Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool - EAT-10
    (Sociedade Brasileira de Fonoaudiologia, 2013-12-16) Gonçalves, Maria Inês Rebelo [UNIFESP]; Remaili, Carla Bogossian; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Centro de Estudos da Voz
    The Eating Assessment Tool (EAT-10) was conceptually developed in the United States from data collected from 482 patients, for use as a self-administered survey regarding risk identification of dysphagia and symptoms related to clinical response to treatment. The purpose of this study is to present the cultural equivalence of the Brazilian version of the EAT-10. The process followed the Scientific Advisory Committee of Medical Outcome Trust (SACMOT). The questionnaire was translated by two Brazilian bilingual speech-language pathologists, aware of the purpose of this study. A back translation was performed by a third Brazilian speech-language pathologist, bilingual and English teacher that had not participated in the previous stage. After comparing both translations, a final version of the questionnaire was produced and called Instrumento de Autoavaliação da Alimentação (EAT-10). It was administered to 107 adult inpatients of the Hospital São Paulo, cwith request for bedside clinical evaluation of swallow. During the process of translation and cultural adaptation, no item was modified and/or suppressed. The EAT-10 maintained the same structure as the original American English version with ten questions, of which three of functional domain, three of emotional domain and four of physical symptoms domain. The cultural equivalence of the Brazilian version of the EAT-10 was demonstrated, being a score of three points or above it the cutoff for dysphagia risk, also for the Brazilian population.
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    Deglutição de parkinsonianos pré e pós riboflavina: queixa, aspectos funcionais e impacto na vida diária
    (Universidade Federal de São Paulo (UNIFESP), 2009-01-28) Silvério, Carolina Castelli [UNIFESP]; Gonçalves, Maria Inês Rebelo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: verificar a relação entre queixa, aspectos funcionais da deglutição e impacto na qualidade de vida referente à voz e à deglutição, em pacientes portadores da doença de Parkinson, submetidos à administração de riboflavina, no período de um ano. Métodos: participaram do estudo 16 pacientes portadores da Doença de Parkinson, com média de idade de 67,25 anos, média do nível de severidade da doença de II para III e média de tempo de diagnóstico da doença de Parkinson de 3,5 anos. As avaliações videofluoroscópicas da deglutição foram realizadas antes e após um ano da administração de riboflavina e restrição de carne vermelha e de aves. Foram realizadas a análise qualitativa da deglutição, a verificação da presença de queixa com relação à deglutição e aplicação de dois protocolos de qualidade de vida sendo relacionados um com o impacto da alteração vocal, e outro com o impacto da alteração na deglutição. A análise quantitativa compreendeu a realização de medidas de deslocamento do osso hióide, de abertura do esfíncter esofágico superior e de constrição da faringe. Resultados: foram observadas redução da queixa e discreta piora na qualidade de vida relacionada à voz e à deglutição, maior freqüência de ocorrência de deglutição normal, no momento pós-riboflavina. Não foram observadas diferenças significativas entre as medidas quantitativas. Conclusões: Conclui-se neste estudo que: houve melhora, apesar de não significativa, da queixa relacionada à deglutição; não ocorreram pioras significativas na dinâmica da deglutição, com exceção do deslocamento da cartilagem cricóidea na consistência de líquido fino após um ano de estudo; não houve piora com relação ao impacto na qualidade de vida, tanto relacionado à deglutição, quanto ao aspecto vocal; os pacientes que não apresentavam queixas de deglutição no momento pré apresentaram melhora na dinâmica da deglutição, com exceção da constrição da faringe; os pacientes com queixa de deglutição no momento pré apresentaram melhora nos índices de qualidade de vida e na auto-avaliação vocal segundo o QVV, no momento pós.
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    Descrição da dinâmica de alimentação de idosas institucionalizadas
    (Sociedade Brasileira de Fonoaudiologia, 2010-01-01) Roque, Francelise Pivetta; Bomfim, Fernanda Maria Santana; Chiari, Brasilia Maria [UNIFESP]; Universidade Estadual de Ciências da Saúde de Alagoas Faculdade de Fonoaudiologia; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To describe the feeding dynamics of institutionalized elderly women regarding the clinical aspects of deglutition, cognition, behavioral and environmental factors related to feeding. METHODS: It was carried out a prospective observational cross-sectional study of the feeding dynamics of 30 elderly women, residents at a long-stay nursing home. Some of the evaluated aspects were recorded by the observers at the time of feeding, and others by the analysis of the videotaped register of their mealtime. Data were descriptively presented and compared to literature findings. RESULTS: Mean age was 83.7 years. The most prevalent medical diagnoses were dementia and systemic arterial hypertension. Poor oral intake was observed in 73.3% of the subjects, as well as an average time of feeding of 10.1 minutes. Attitudinal alterations were observed in 16.7%, and behavioral alterations, in 40% of the elderly. The subjects showed inappropriate positioning in 46.7% of the meals. Assistance was required by 56,6% of the women: in 70.6% of the cases, it was provided, and in 66.6%, it was judged inadequate. Edentulism was verified in 44.4% of the elderly, of which 46.1% used total denture. Inadequacy of denture adaptation, conservation and hygiene status was predominant (83.4%). The prevalence of swallowing alterations was 23.3%, with predominance of the following alterations: food residue after deglutition, cough during feeding, and vocal alterations after deglutition. CONCLUSION: Environmental, cognitive and behavioral factors related to feeding were significantly present among the subjects of the study, putting deglutition at risk. Other specific deglutition difficulties were also identified. Managing these difficulties is important, in order to avoid health complications for elderly women.
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    Disfagia após ressecção de tumor de fossa posterior em pacientes pediátricos: queixa, incidência, caracterização e fatores de risco
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-24) Correa, Cláudia Carolina da Silva [UNIFESP]; Goncalves, Maria Ines Rebelo [UNIFESP]; Honsi, Nathalia Oliveira Bortolatto; http://lattes.cnpq.br/0516074277172162; http://lattes.cnpq.br/9327083927146744; Universidade Federal de São Paulo (UNIFESP)
    Objetivos: Verificar as incidências de queixa de deglutição e de disfagia, caracterizar o grau de gravidade da disfagia e identificar fatores de risco para a disfagia em casos de ressecção de tumor fossa posterior na população pediátrica. Métodos: Foram analisados prontuários médicos e fonoaudiológicos de pacientes pediátricos submetidos à ressecção de tumor de fossa posterior no Instituto de Oncologia Pediátrica – Grupo de Apoio ao Adolescente e à Criança com Câncer (IOP-GRAACC/Unifesp). Os pacientes foram classificados quanto à presença ou ausência de queixa de deglutição referida no pós-operatório. Em seguida, independente da presença ou ausência de queixa, foram classificados como deglutição normal ou disfágicos; foram considerados disfágicos quando, no registro médico e/ou fonoaudiológico, houve presença de disfagia com avaliação clínica e/ou objetiva da deglutição. O grau de gravidade da disfagia foi estabelecido pela escala DOSS e foram levantados dados do pós-operatório para associar a disfagia com possíveis fatores de risco. Resultados: 120 ressecções de tumor de fossa posterior foram levantadas em 100 prontuários de pacientes. A amostra foi caracterizada por indivíduos do sexo feminino (36%) e do sexo masculino (64%), com idade entre 8 meses e 16 anos e 8 meses, média de 7 anos. A maioria das queixas relacionadas à deglutição foram apresentadas por pacientes com disfagia, mas indivíduos com deglutição normal também a referiram; houve necessidade de via alternativa de alimentação em 34,2% dos pós-operatórios, sendo que destes 77,1% apresentavam distúrbio de deglutição. Dos pacientes disfágicos, mais da metade evoluiu com disfagia de grau grave. Dentre os fatores de risco estudados verificamos que os indivíduos com distúrbio de deglutição apresentaram: mediana de idade menor, média de tempo de intubação orotraqueal de 3,94 dias, necessidade de suporte ventilatório após desintubação e, evoluíram com acometimento de pares cranianos associados ou isolados (77,1%), paralisia facial (66,7%) e alteração vocal (62,5%). Conclusões: A incidência de queixa de deglutição foi de 13,3%, seguida de uma incidência de 40% de disfagia; o distúrbio de deglutição foi caracterizado como de grau grave na maioria dos pacientes; foram considerados fatores de risco: crianças com idade menor, maior tempo de intubação orotraqueal, ressecção cirúrgica parcial, localização tumoral em IV ventrículo e tronco cerebral, presença de disartria, acometimento de pares cranianos associados ou isolados, utilização de suporte ventilatório e acometimento motor.
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    Eating practices, nutritional status and constipation in patients with Rett syndrome
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2008-12-01) Schwartzman, Flavia [UNIFESP]; Vítolo, Márcia Regina; Schwartzman, José Salomão; Morais, Mauro Batista de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Federal Faculty of Medical Sciences Department of Public Health; Mackenzie Presbyterian University Program on Development Disorders
    BACKGROUND: Disturbance in chewing, swallowing and digestive motility may predispose to feeding and nutritional abnormalities in patients with Rett syndrome. OBJECTIVE: To evaluate the dietary habits, nutritional status and the prevalence of constipation in patients with classical Rett syndrome. METHODS: Twenty seven female patients between the ages of 2.6 and 21.8 years were studied. The following parameters were evaluated: food register, weight, height and intestinal movement characteristics. Weight and height were compared with the National Center for Health Statistics standards. RESULTS: The inability to ingest solid foods was observed in 80.8% of the patients. A height-to-age deficit was observed in 13 (48.1%) of the girls, being more intense in patients at stage IV. Weight-for-height deficit was found in 10 (37.0%) patients, 15 (55.6%) showed normal weight and 2 (7.4%) were overweight for their height. The median ingestion of energy, according to weight-for-height, was equal to 106.6%. Insufficient iron ingestion was observed in 63.0% and insufficient calcium in 55.6% of the patients. Constipation was verified in 74.1% of the patients and did not show a relationship with the quantity of fiber in the diet. CONCLUSION: Various nutritional problems, as well as, intestinal constipation were observed in these patients with Rett syndrome, and they must be considered in the multidisciplinary therapeutic planning of these individuals.
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    Esofagectomia trans-hiatal no tratamento do megaesôfago chagásico avançado
    (Colégio Brasileiro de Cirurgiões, 2003-06-01) Batista Neto, João [UNIFESP]; Fontan, Alberto Jorge; Nepomuceno, Marcos Da Costa; Lourenço, Laércio Gomes [UNIFESP]; Ribeiro, Laércio Tenório; Ramos, Carmen Pereira; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Alagoas; UFAL; UFAL Hospital Universitário Prof. Alberto Antunes Serviço de Clínica Cirúrgica; UFAL HUPAA
    BACKGROUND: To analize the clinical results, radiologic and endoscopic findings of the transhiatal esophagectomy on Chaga's disease megaesophagus. METHODS: A retrospective study was performed from 1982-2000. Twenty-eight chagasic patients, sixteen female and twelve male, were treated at the General Surgery Service of Hospital da Universidade Federal de Alagoas. The disease was diagnosed by serologic trials and epidemiological or anatomopathological information. Variables studied were: a) pre and postoperative surgery patients complaints as dysphagia, regurgitation, pyrosis, diarrhea, dumping, postprandial fullness, pneumonia and weight status; b) post surgery X Rays series (upper GI) evaluation of the cervical esophagogastric anastomosis and the transposed stomach; c) post surgery endoscopic evaluation to analyze the esophagus stump and the anastomotic suture. The follow-up quantitative variable was expressed by medium and error pattern. The Chi-square test was applied to the dysphagia, regurgitation and pyrosis resolution variables considering p<0,05 values significant. The qualitative variables by percentage and the trusting interval calculated within 95% (IC-95%), with the EpiInfo software. RESULTS: Mean follow-up was 58,2 months (from to 4 - 192). Mean age was 36,5 years (from to 16-67). There was no mortality in this series. There was complete resolution of dysphagia in the majority of the patients (21/28 - 71,4%, p<0,05); 7/28 (25%) needed one or more dilatation sessions. Pyrosis was the most important late follow-up symptom (35,7%) and stump esophagitis the most significant endoscopic finding. The majority of X Rays studies findings were normal. CONCLUSIONS: Transhiatal esophagectomy was efficient to the treatment of chagasic megaesophagus dysphagia however the morbidity was high (78,6%). The mortality in this series was none.
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    Estudo prospectivo da deglutição na Mucopolissacaridose II (síndrome de Hunter) antes e após tratamento enzimático
    (Sociedade Brasileira de Fonoaudiologia, 2011-06-01) Ferreira, Ana Carolina Rocha Gomes [UNIFESP]; Guedes, Zelita Caldeira Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Ciências da Saúde de Alagoas Faculdade de Fonoaudiologia
    Case study with the aim to evaluate swallowing pre- and post-enzyme treatment of an individual with Mucopolysaccharidosis, and to analyze whether this treatment caused swallowing improvement. It was carried out a descriptive study of a male subject with 9 years and 6 months with the severe type of the disease. The subject was observed in three distinct moments: one pre-treatment and two post-treatment assessments. It was carried out a speech-language pathology assessment of dysphagia, a pneumologist's respiratory assessment, a clinical otorhinolaryngology assessment, and a fiberoptic endoscopic examination of swallowing. After that, results were interpreted according to the Functional Oral Intake Scale (FOIS), and data were descriptively analyzed. Results showed presence of dysphagia with impact on oral feeding in the pre-treatment and the first post-treatment assessments. The second post-treatment assessment did not show any signs of dysphagia, with possibilities for all consistencies, however with restriction to solid consistency due to a significant occlusal alteration. Moreover, the fiberoptic endoscopic examination of swallowing was normal in this assessment, and there was a gradual improvement on the swallowing dynamics along the treatment. The study showed that dysphagia was present and had a negative impact on food dynamics for the subject studied, and also that the enzyme treatment for over a year improved swallowing, with positive impact on food dynamics.
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    Fatores que interferem no desempenho da deglutição de pacientes com traumatismo cranioencefálico
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-21) Saurim, Juliana Boza [UNIFESP]; Goncalves, Maria Ines Rebelo [UNIFESP]; http://lattes.cnpq.br/9327083927146744; http://lattes.cnpq.br/7215701114373637; Universidade Federal de São Paulo (UNIFESP)
    Traumatic Brain Injury (TBI) is one of the leading causes of disability and mortality. Dysphagia can be highlighted as a sequel due to neurological impairment, which is an alteration of the swallowing process and can rehabilitated by a speech therapist, along with a multi professional staff. Aim: Analyze factors that interferes in the swallowing performance of TBI's patients admitted in the intensive care unit (ICU). Method: Medical records from August 2007 to May 2016 of TBI's patients, who underwent speech pathologist clinical evaluation at the bedside in the ICU of São Paulo Hospital – H.U. São Paulo Federal University were analyzed. The patients were divided into two groups: G1 = were discharged from the hospital or died due to at least one oral food consistency feeding and G2 = were discharged from the hospital or died due to feeding exclusively by an alternate via. The cases were identified through demographic, clinical and radiological data. The initial and final swallowing performance was measured using the Functional Oral Intake Scale (FOIS), Dysphagia Outcome Severity Scale (DOSS) and ASHA-NOMS Scale. Results: 62% of the patients presented oral feeding reintroduction. The G2 group was significantly older, IOT days, tracheostomy individuals, cognitive status altered, severe dysphagia diagnosis, severe traumas according to ECG and secondary lesions associated. The swallowing functional performance of G1 group evolved from level 2 to level 5 on the applied scales and oral feeding reintroduction started in the second therapy session. Conclusions: Age, IOT time, TQT, cognitive status altered, trauma severity and secondary lesions influenced negatively in swallowing. It was possible to reintroduce oral feeding in the majority of the patients and these progressed significantly in the performance.
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    High-Resolution Manometry Evaluation of Pressures at the Pharyngo-upper Esophageal Area in Patients with Oropharyngeal Dysphagia Due to Vagal Paralysis
    (Springer, 2017) Pinna, Bruno Rezende [UNIFESP]; Herbella, Fernando A. M. [UNIFESP]; de Biase, Noemi [UNIFESP]; Vaiano, Thays C. G. [UNIFESP]; Patti, Marco G.
    The motility of the pharynx, upper esophageal sphincter (UES), and proximal esophagus in patients with oropharyngeal dysphagia is still not entirely understood. High-resolution manometry (HRM) was recently added to the armamentarium for the study of this area. This study aims to describe HRM findings in patients with vagal paralysis. Sixteen patients (mean age 54 years, 69% females) with oropharyngeal dysphagia due to unilateral vagal paralysis were prospectively studied. All patients underwent HRM. Motility of the UES and at the topography of the velopharynx and epiglottis were recorded. (1) UES relaxation is compromised in a minority of patients, (2) epiglottis pressure does not follow a specific pattern, (3) vellum is hypotonic in half of the patients, (4) dysphagia is related to a low pharyngeal pressure, not to a flow obstruction at the level of the UES, and (5) aspiration is related to low pressures at the level of the UES and epiglottis and higher pressures at the level of the vellum. Pharyngeal motility is significantly impaired in patients with oropharyngeal dysphagia and unilateral vagal paralysis. In half of the cases, UES resting pressure is preserved due to unilateral innervation and relaxation is normal in most patients. Dysphagia therapy in these patients must be directed toward improvement in the oropharyngeal motility not at the UES.
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    Incidence of tracheal aspiration in tracheotomized patients in use of mechanical ventilation
    (Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2009-12-01) Simão, Mariana De Almeida; Alacid, Camila Albuquerque Nobre; Rodrigues, Katia Alonso; Albuquerque, Christiane [UNIFESP]; Furkim, Ana Maria; Universidade Federal de São Paulo (UNIFESP); Hospital Universitário Pedro Ernesto
    CONTEXT: Many patients in use of mechanical ventilation show clinical complications due to tracheal aspiration. Assessment and early methods are necessary, so that preventive and safety measures apply to this patients OBJECTIVE: To study the incidence of tracheal aspiration of saliva in tracheotomized patients treated in intensive care unit using two modes of mechanical ventilation and with different sedation levels. METHOD: Prospective study with 14 tracheotomized non-neurological patients using mechanical ventilation. The sample was divided into two groups based on ventilation mode: pressure support ventilation and pressure controlled ventilation. Those two groups were subdivided into two others according to sedation level. The speech pathology evaluation was completed via the blue dye test in order to analyze the incidence of tracheal aspiration of saliva. RESULTS: Sedation levels and mechanical ventilation time related to tracheal aspiration were not statistically significant in this study. On the other hand, ventilation mode and tracheal aspiration showed statistical significance, and there was a higher incidence of tracheal aspiration in the pressure controlled ventilation mode. CONCLUSION: It was possible to observe a significant relationship between tracheal aspiration incidence and pressure controlled ventilation mode, which means the inclusion of those patients in the risk group for oropharyngeal dysphagia and their insertion in prevention protocols. The relationship between tracheal aspiration and sedation level, as well as tracheal aspiration and mechanical ventilation, were not statistically significant in this sample, needing further research.
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    Incidência de disfagia orofaríngea em pacientes com paralisia cerebral do tipo tetraparéticos espásticos institucionalizados
    (Sociedade Brasileira de Fonoaudiologia, 2009-01-01) Lucchi, Carla; Flório, Carla Patrícia Frigério; Silvério, Carolina Castelli [UNIFESP]; Reis, Thaís Maria Dos; Associação de Assistência à Criança Deficiente; Associação Cruz Verde de São Paulo; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To verify the incidence of oropharyngeal dysphagia in institutionalized patients with spastic tetraparetic cerebral palsy, correlating the findings with food consistency and type of hydration. METHODS: A total of 140 patients, with an average of 28 years old, participated in the study. The following data were gathered from their medical records: swallowing impairment, as classified according to the ROGS protocol; feeding type and food consistencies; hydration type. RESULTS: It was observed the presence of different degrees of oropharyngeal dysphagia, and most of the patients (40%) had functional deglutition. From the patients with functional deglutition and mild dysphagia, the majority, 65% and 50% respectively, were put on a doughy-consistency-based diet. From the patients with moderate dysphagia, 66.7% were put on a semi-liquid-consistency-based diet, and 94.7% of the patients with severe dysphagia used alternative feeding means. From the total number of patients, 63.6% had a liquid diet, and 10.7% received gelatin as hydration. CONCLUSION: The incidence of oropharyngeal dysphagia, adding its different impairment degrees, was high among patients with spastic tetraparetic cerebral palsy, although functional deglutition was the most often found. Doughy consistency food was more common among patients diagnosed with functional deglutition and mild dysphagia. Most patients with severe dysphagia used alternative feeding means. Fine liquid was more often found as the hydration type for most patients, and it was frequently substituted by gelatin depending on the severity of the swallowing impairment.
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    Marcadores clínicos fonoaudiológicos como modelo prognóstico nas funções orofaringolaringeais em pacientes com doença do neurônio motor
    (Universidade Federal de São Paulo (UNIFESP), 2016-12-16) Oda, Adriana Leico [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]; http://lattes.cnpq.br/3911841387107665; http://lattes.cnpq.br/8976619669743557; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To identify clinical markers of bulbar alterations during progressive dysfunction of the oropharyngolaryngeal musculature in patients with Amyotrophic Lateral Sclerosis (ALS) and to compare the patients with Progressive Bulbar Paralysis (PBP). Methods: 89 (74.17%) patients with ALS, with a mean age of 58.19 years (51.68% male and 48.32% female), and patients with PBP, mean age 62.71 years (32.26% male and 67.74% female). The evaluation instruments were: speech-language clinical evaluation, peak cough flow, speech intelligibility scale, FOIS food consistency scale, ALSFRS-R and EGELA functional scales, and quality of life scale. Results: Patients with PBP differed from patients with ALS in the bulbar domains of the functional scales (p <0.01) and quality of life (p <0.01). The fatigue index is a clinical marker that showed a significant correlation (p <0.01) with the bulbar domains (r = 0.843) and the sum of the functional (r = 0.423) and quality of life scales (r = 0.493) (R = 0.741), speech intelligibility (r = 0.866) and peak cough flow (r = 0.581). 38.2% of patients with appendicular onset had a need for changes in food consistency or in the alimentary route, in contrast to 71% of patients with bulbar onset. Patients with ALS had median values of: 7.0 in the Speech Intelligibility Scale, 190 liters / minute in the Peak Cough Flow and Fatigue Index of 9.0 movements, for almost all muscle groups evaluated. Patients with bulbar onset had a median of: 4.0 on the Speech Intelligibility scale, 170 liters / minute on the Peak Cough Flow and Fatigue Index of 4.0 movements for most of the muscle groups evaluated. Orofacial muscles severity, Fatigue Index, besides diagnosis and age, are factors related to survival. Conclusion: Changes in the orofacial musculature and dysphagia were predictors of the outcomes analyzed, increasing the risk of death in patients with Motor Neuron Disease. Fatigability proved to be a consistent marker of clinical severity and prognosis.
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    Parâmetros de duração dos sinais acusticos da deglutição de indivíduos sem queixa
    (Universidade Federal de São Paulo (UNIFESP), 2009-01-28) Patatas, Olivia Helena Gomes [UNIFESP]; Chiari, Brasilia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Aim: To investigate the duration of acoustical events related to the swallowing of individuals without complaints, and to determine reference values of related parameters considering the different ages and genders of the subjects. Materials and methods: The sample was constituted by 164 individuals (88 women and 76 men, with ages between 6 and 85 years), without both swallowing complaints and risk or history of dysphagia. With a microphone touching the neck and connected to a computer, each individual performed 9 swallowings of saliva, of 5 ml of water and of 10 ml of water, respectively. Results: The duration of the interval between the peaks of the two main swallowingswallowing clicks (T), the swallowing apnea (dA), and the relation between them (T/dA) were analyzed. The average durations of T were: 201.3 ± 12.8 ms, 179.6 ± 11.9 ms, and 176.5 ± 12.9 ms for the swallowing of saliva, of 5 ml of water and of 10 ml of water, respectively; for dA they were: 1174 ± 128.2 ms, 1436 ± 140.3 ms, and 1531 ± 125.8 ms for the swallowing of saliva, of 5 ml of water and of 10 ml of water, respectively; and for T/dA they were: 0.152 ± 0.012, 0.177 ± 0.018, and 0.158 ± 0.016, for the swallowing of saliva, of 5 ml of water and of 10 ml of water, respectively. Due to the recording order, there was no statistical difference among the results for the different bolus volumes. Also, there was no correlation between age and the measured parameters. However, only for T/dA for the swallowing of 5 ml of water, a significant difference between genders was found: for men this index was greater than for women. Conclusions: There was no difference among different ages or between genders (except for T/dA of the swallowing of 5 ml of water) with regard to the duration between the peaks of the two swallowing clicks (T), to the duration of the swallowing apnea (dA), and to the relationship T/dA.
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    Reabilitação fonoaudiológica da disfagia em pacientes pediátricos com tumor encefálico
    (Universidade Federal de São Paulo (UNIFESP), 2010-02-24) Radzinsky, Tatiana Couto [UNIFESP]; Gonçalves, Maria Inês Rebelo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To verify the efficacy of the dysphagia therapy performed by speech pathologists in pediatric patients with brain tumors using the Functional Oral Intake Scale (FOIS; Crary et al, 2005). Materials and Methods: The sample consisted children and adolescents with central nervous system tumors (23 male and 8 female), ages ranging from 11 months to 22 years old. Was performed a retrospective charts review of patients with central nervous system tumors and diagnosed oropharyngeal dysphagia, that were submitted to swallowing rehabilitation during internment period at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP) in the period from September 2003 to July 2009. To obtain the data, an evolution chart protocol was created, comprising patient’s identification, gender, initial diagnosis, underlying disease, injury site, speech-language diagnosis, specific tumor treatment, speech-language evaluation date, speech-language discharge date, number of speech-language therapy sessions, complications during the therapy period, respiratory conditions, and intubation period. Was used the Functional Oral Intake Scale (FOIS), a functional feeding evaluation scale, enabling to classify the patient according to the feeding intake (Crary, 2005). In addition, for speech-language diagnosis definition, and modified version of the Dysphagia Outcome and Severity Scale (O’Neil, 1999) was utilized. The scores were registered during the pre therapy period (speech-language functional evaluation) and post therapy. Improvement was considered when there was a change in the score to level 5 or higher, and decline when the score changed level 5 or lower. Results: All 31 patients showed improvement in the FOIS scale level after speech-language therapy. Level 5 or higher was achieved by 17 (54.8%) and was observed that 14 patients (45.2%) maintained the same FOIS level, not evolving as adequately. Results show that 19 patients (61.7%) presented severe dysphagia during the pre therapy period, out of those 11 (57.9%) managed to evolve to mild dysphagia, functional deglutition or normal deglutition. The dysphagia severity degree lowered in the post therapy on 21 patients (67.7%) while 10 (32.3%) maintained the same score. Conclusion: The patients that showed major improvement on the FOIS level had few clinical complications, tumors with better prognosis, and mean age of 12 years, whereas the patients that evolved in a less significant manner all presented clinical complications (decreased level of alertness and/or worsening of the clinical picture), tumors with bad prognosis (glioblastoma multiform stage IV, anaplasic ependymoma stage II, high-grade meduloblastoma, and brainstem glioma), in addition to mean age of 7.8 years.
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    Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy
    (Elsevier B.V., 2009-09-01) Manrique, Dayse [UNIFESP]; Sato, Juliana [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the outcome of surgical saliva reduction to decrease pulmonary aspiration in children with cerebral palsy and its repercussions in respiratory infection control.Methods: Twenty-nine children with neurological impairment and diagnosis of chronic pulmonary aspiration were submitted to bilateral submandibular gland excision and bilateral parotid duct ligation at the Association for the Welfare of Physically Handicapped Children, from December 2001 to December 2004. Postoperative frequency of lower respiratory tract infection, hospitalization rate due to pulmonary infection and airway secretion level after the surgery were compared to preoperative period.Results: Twenty-nine children with cerebral palsy aged 18 months to 9 years were submitted to submandibular glands excision and parotid ducts ligation. All children had gastrostomy and no oral intake. There were no major complications; two children had reopening of one parotid duct. Frequency of lower respiratory tract infections, rate of hospitalization for treatment of pulmonary infections and level of airway secretion were statistically reduced. Preoperative mean rate of lower respiratory tract infection was 6.9/year: in postoperative period, rate was 2.4/year(p < 0.001). Pneumonia hospitalization mean rate was 63.4 days/year preoperatively and 17.5 days/year postoperatively (p < 0.001). There was also a significant improvement in the need for suctioning of upper airway secretion (mean 11 times/day in preoperative period and 3.1 times/day in the postoperative period; p < 0.001).Conclusion: in children with cerebral palsy, surgical saliva reduction by submandibular glands excision and parotid ducts ligation is an effective and safe technique for frequency reduction of lower respiratory tract infection and level of airway secretion. (c) 2009 Elsevier Ireland Ltd. All rights reserved.
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    Swallowing dysfunction related to obstructive sleep apnea: a nasal fibroscopy pilot study
    (Springer, 2011-05-01) Valbuza, Juliana Spelta [UNIFESP]; Oliveira, Marcio Moyses de [UNIFESP]; Zancanella, Edilson [UNIFESP]; Conti, Cristiane Fiquene [UNIFESP]; Prado, Lucila Bizari F. [UNIFESP]; Carvalho, Luciane B. C. [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Patients with obstructive sleep apnea (OSA) may have subclinical swallowing abnormalities due to progressive mechanical trauma of the pharyngeal tissues caused by snoring. There are few trials on swallowing among OSA patients, and most of them used videoradiography. the aim of this trial was to show swallowing function in OSA patients by nasal fibroscopy.Eleven patients with OSA diagnosed by polysomnography, with a mean age of 48 +/- 14 years, without spontaneous complaints of swallowing, and 14 non-snoring volunteers, with a mean age of 47 +/- 12 years, without spontaneous complaints of swallowing, participated in the study. the participants were evaluated using nasal fibroscopy. Each participant was offered diet boluses (5 and 10 ml) such as thin liquids, pur,e, and solids, and their swallowing function was determined according to the following criteria: (1) premature oral leakage to the pharynx; (2) laryngeal penetration; (3) tracheal aspiration; and (4) pharyngeal stasis.Sixty-four percent of the OSA patients presented premature oral leakage, 55% presented pharyngeal stasis of the bolus after swallowing, and we did not observe laryngeal penetration or tracheal aspiration. There were no subclinical manifestations in the control group.OSA patients presented subclinical manifestations of abnormal swallowing, when analyzed using nasal fibroscopy, possibly associated with neuromuscular injury caused by snoring.