Objective To investigate the combined effects of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training for dysphagia in patients who underwent aortic arch surgery. Methods Forty-two consecutive patients with dysphagia after aortic arch surgery between October 2014 and November 2017 were divided into two groups including an observation group and a control group. There were 21 patients in each group. There were 17 males and 4 females at age of 51.0±6.5 years in the observation group, while 18 males and 3 females at age of 49.8±7.3 years in the control group. The patients in the observation group underwent electroacupuncture therapy and voice training (20 min per day for each therapy, 2 weeks), while the patients in the control group only received safe swallowing education and rehabilitation guidance (2 weeks). The test results, such as fibrolaryngoscope and functional oral intake scale (FOIS) score, and the data of computer phonatory detection, before and after the intervention were compared. Results The fibrolaryngoscope of vocal cords significantly decreased and the FOIS score significantly increased after digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training in the observation group(6.30 vs. 4.60, P<0.05). Bucking was obviously reduced. The indicators of hoarse degree, such as median pitch, fundamental frequency, jitter (0.60%±0.96%vs. 1.99%±1.86%, P=0.033), shimmer (2.47%±4.26% vs. 5.89%±3.66%, P=0.043), maximum phonation time (15.31±9.10 s vs. 3.72±8.83 s, P=0.006), maximum and loud phonation time (9.30±5.73 s vs. 2.32±2.99 s, P=0.039), mean noise-to-harmonics ratio (23.99±10.17 vs .9.98±9.37, P=0.006) and mean harmonics-to-noise ratio (0.03±0.02 vs. 0.17±0.23, P=0.019) improved after the treatment in both groups. But the improvement in the observation group was significantly better than that in the control group. Conclusion The combination of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training on dysphagia in patients who underwent aortic arch surgery can significantly improve the swallowing function of patients. Meanwhile, it also helps the recovery of phonic function and improves the ability of feeding and communication in these patients.
ObjectiveTo compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF).MethodsBetween April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF.ResultsDysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group (χ2=7.940, P=0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS (P>0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up (P>0.05). The differences in O-EAa and nPAS were significant (P<0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group (P>0.05); the difference in the O-C2a was significant (t=2.470, P=0.016). At last follow-up, the differences in the above imaging indicators were significant (P<0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups (P<0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS (P<0.05). The dO-C2a≤−5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia (P<0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤−5° with a significant OR of 14.4.ConclusionThe dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.
Objective To analyze the application value of swallowing function therapeutic instrument in dysphagia after stroke. Methods Stroke patients with dysphagia treated in the Department of Rehabilitation Medicine of Qinghai University Affiliated Hospital between July 2018 and April 2020 were selected. The patients were randomly divided into experimental group and control group. The control group was treated with comprehensive rehabilitation treatment, and the experimental group was treated with comprehensive rehabilitation treatment and swallowing function therapeutic instrument. The improvement of dysphagia and the changes of clinical indexes were observed in the two groups. Results A total of 100 patients were included, with 50 patients in each group. Before the intervention, there was no significant difference between the two groups in Standardized Swallowing Assessment (SSA), video fluoroscopy swallowing study (VFSS), ultrasonic exercise amplitude and duration (P>0.05). After 4 weeks of intervention, the SSA score, VFSS score, ultrasonic exercise amplitude and duration of the two groups were improved compared with those before intervention (P<0.05), and the experimental group was better than the control group (P<0.05). The improvement of dysphagia between the two groups was statistically significant (Z=−2.452, P=0.014). The total effective rate of dysphagia improvement in the experimental group (92.00%) was higher than that in the control group (82.00%), but there was no significant difference between the two groups (χ2=2.210, P=0.137). Conclusion The application of swallowing function therapeutic instrument in the adjuvant treatment of dysphagia after stroke is helpful to improve the clinical symptoms of patients and obtain ideal therapeutic effect, which is worth popularizing.
ObjectiveTo introduce a new occipitocervical angle parameter, occipito-odontoid angle (O-Da), for predicting dysphagia after occipitocervical fusion (OCF) in patients with C2, 3 Klippel-Feil syndrome (KFS) and analyze its effectiveness. Methods A total of 119 patients met selective criteria between April 2010 and November 2019 were retrospectively included as the study subjects. There were 56 males and 63 females. The age ranged from 14 to 76 years, with a median age of 51 years. There were 44 cases of basilar invagination and 75 cases of atlantoaxial subluxation. Forty patients were combined with C2, 3 KFS. Seven patients underwent anterior decompression combined with posterior OCF and 112 patients underwent posterior OCF. The fixed segments were O-C2 in 36 cases, O-C3 in 51 cases, O-C4 in 25 cases, and O-C5 in 7 cases. All patients were followed up 21-136 months, with a median time of 79 months. The lateral cervical X-ray films before operation and at last follow-up were used to measure the occipital to C2 angle (O-C2a), the occipital and external acoustic meatus to axis angle (O-EAa), the occipital protuberance to axial angle (Oc-Axa), the O-Da, and the narrowest oropharyngeal airway space (nPAS). The differences of the above parameters between the last follow-up and the preoperative values were calculated (represented as dO-C2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS). Patients were divided into two groups according to whether they suffered dysphagia after operation, and the differences in clinical data and radiographic parameters were compared between the two groups. The correlation between occipitocervical angle parameters and nPAS in 40 patients with C2, 3 KFS was analyzed respectively. In addition, sensitivity and specificity analyses were used to assess the effectiveness of dO-Da≤−5° for the prediction of postoperative dysphagia. ResultsThirty-one patients (26.1%) suffered dysphagia after OCF (dysphagia group), including 10 patients with C2, 3 KFS; no dysphagia occurred in 88 patients (non-dysphagia group). There was no significant difference in age, follow-up time, fixed segment, proportion of patients with rheumatoid arthritis, proportion of patients with atlantoaxial subluxation, and proportion of patients with C2, 3 KFS between the two groups (P>0.05). The proportion of female patients was significantly higher in dysphagia group than in non-dysphagia group (χ2=7.600, P=0.006). The difference in preoperative O-C2a between the two groups was significant (t=2.528, P=0.014). No significant differences were observed in preoperative O-EAa, Oc-Axa, O-Da, and nPAS (P>0.05). There was no significant difference in dO-C2a, dO-EAa, dOc-Axa, dO-Da, and dnPAS between the two groups (P>0.05). The dO-C2a, dO-EAa, dOc-Axa, and dO-Da were positively correlated with dnPAS in 40 patients with C2, 3 KFS (r=0.604, P<0.001; r=0.649, P<0.001; r=0.615, P<0.001; r=0.672, P<0.001). Taking dO-Da≤−5° as the standard, the sensitivity and specificity of dO-Da to predict postoperative dysphagia in patients with C2, 3 KFS were 80.0% (8/10) and 93.3% (28/30), respectively. ConclusionThe dO-Da is a reliable indicator for predicting dysphagia after OCF in patients with C2, 3 KFS.
Objective To observe the clinical effect of repetitive transcranial magnetic stimulation (rTMS) combined with balloon dilatation and routine swallowing training on dysphagia caused by cricopharyngeal dysfunction (CPD) after stroke. Methods Patients with dysphagia after stroke who were hospitalized at Hubei Provincial Hospital of Integrated Chinese and Western Medicine between January 2022 and February 2023 were selected. The patients were divided into the trial group and the control group by random number table method. The control group received balloon dilatation and routine swallowing training, and the trial group received rTMS based on the treatment plan of the control group. All patients were treated for 3 weeks. The videofluoroscopic swallowing study (VFSS), Penetration Aspiration Scale (PAS), and Functional Oral Intake Scale (FOIS) were used at pre-therapy and 3 weeks after treatment to assess the improvement of swallowing function. Results A total of 49 patients were included, including 25 in the trial group and 24 in the control group. There was no statistically significant difference in age, gender, course of disease, stroke type, and swallowing function before treatment between the two groups of patients (P>0.05). After 3 weeks of treatment, the VFSS dysphagia scores (Z=−4.465, −4.327, P<0.001) of the trial group and the control group were higher than those before treatment, and the trial group was better than that in the control group (t=2.099, P=0.041). The PAS scores (Z=−4.179, −3.729, P<0.001) and FOIS scores (Z=−4.476, −4.419, P<0.001) of the trial and control groups were improved after treatment, and the improvement of the PAS score (t=−2.088, P=0.042) and FOIS score (Z=−2.134, P=0.033) in the trial group were more significant (P<0.05). No serious adverse reactions were observed in patients during the study process. Conclusion The rTMS combined with balloon dilatation and routine swallowing training can significantly improve the swallowing function of patients with dysphagia caused by CPD after stroke, and further improve its clinical efficacy, worthy of clinical application.