USING "BARIUM-PUDDING" TO EVALUATE THE SWALLOWING DISORDER IN STROKE PATIENTS
Hsin-Shui Chen (National Taiwan University, Taipei, Taiwan), Tyng-Guey Wang (National Taiwan University, Taipei, Taiwan), Yeun-Chung Chang (National Taiwan University, Taipei, Taiwan), Jin-Shin Lai (National Taiwan University, Taipei, Taiwan), I-Nan Lien (National Taiwan University, Taipei, Taiwan)
Purpose: Using a new-designed medium, barium-pudding, in videofiuoroscopic examination (VFE) to evaluate the swallowing disorder in stroke patients.
Methods: Forty-nine stroke patients with dysphagia (mean age of 67±15 year-old; men 29; women 20) were referred for VFE within a period of one and half years. In addition to modified barium swallow test by Logamann which was thin, thick, and paste barium, barium-pudding, made by pudding powder and barium with good taste, well visible in fluoroscopic examination and similar nature food, was performed on all patients. The picture of swallow among different medium was compared to define the clinical meaning of barium-pudding in VFE.
Result: Twenty-four of 49 patients (40%) had aspiration in VFE study. Of the 24 patients with aspiration, six (25%) had aspiration of thin and thick medium and spare of paste and barium pudding. Six (25%) of those with aspiration experienced aspiration of barium-pudding and paste medium simultaneously. There were 12 patients (50%) aspirated paste medium and free of barium-pudding. In previous modified barium swallow VEF, the patients with aspiration of paste medium would be thought to be incapable of eating solid food. In this circumstance, underestimation of the swallowing ability in stroke patients may occur and delay their oral intake. However, the paste medium was less similar solid food than barium-pudding in some points, and the 12 patients should start oral feeding at least pudding like food.
Conclusion: Barium-pudding is an alternative and reliable medium for detecting the swallowing ability of solid food in stroke patients, and it should become the regular test medium in doing VFE.
EVALUATION OF DYSPHAGIA IN PATIENTS WITH MYOTONIC DYSTROPHY -A STUDY WITH VIDEOFLUOROGRAPHY-
Kozo Hanayama, M. Sako, Y. Sugimoto, T. Otsuka (National Higashisaitama Hospital, Saitama, Japan), M. Liu, N. Chino (Keio University, Japan)
Purpose: Swallowing abnormalities in myotonic dystrophy patients have been reported and they often progress insidiously. The purpose of this study is to demonstrate the swallowing abnormalities in oral and pharyngeal phases and to correlate the severity of dysphagia with other clinical factors.
Methods: Videofluorography (VF) was performed in fourteen subjects with myotonic dystrophy, most of whom were having standard meals. The VF findings were compared with age, symptoms, duration of illness, degree of motor impairment and respiratory function.
Results: All patients showed some kind of abnormalities, especially pooling of material in the pyriform sinus. Four out of 14 showed laryngeal penetration and/or aspiration. Videofluorographic abnormalities tended to be severe in patients with hypercapnea, but not correlated with other physical states.
Conclusion: Swallowing abnormalities in myotonic dystrophy patients are common. Dysphagia may progress along with deterioration of respiratory function.