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R060: Breathing-Swallowing Pattern in Tracheostomy vs. Controls
P170
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
RESULTS: Cox-2 was expressed in benign and malignant laryngeal SCC but was higher in malignant tumors. Supraglottic tumors showed high up-regulation. It is known to be an invasive and fast-growing tumor compared to glottic SCC. Cox-2 expressions also varied with clinico-pathologic variables such as TNM stage of SCC of the larynx. CONCLUSION: Cox-2 was found not to be a useful marker for Laryngeal SCC since it is expressed in benign tumors. Cox-2 up-regulated in laryngeal SCC. The expression of Cox-2 was related to site, T and N stages of the laryngeal SCC. These results support the evidence that Cox-2 may be involved in carcinogenesis and the behavior of laryngeal SCC. SIGNIFICANCE: Significance of molecular receptors and their modulation in carcinoma of the larynx treatment. This study forms a basis on which many studies can be pursued. The use of Cox-2 inhibitors as a chemopreventive and or chemotheraputic agent in the near future can be expected. Cox-2 inhibitor has been tried as an inhaler in lung cancer.
R059 Vocal Cord Medialization in the Lung Transplant Population Shawn C Ciecko, MD (presenter) PROBLEM: True vocal cord paralysis and medialization in the lung transplant population. METHODS: Patients who had undergone bilateral orthotopic lung transplant (BOLT) or heart-lung transplant (HLT) with resultant true vocal cord paralysis (TVC paralysis) and were medialized were included in the analysis between 2001 and 2006. Charts were retrospectively reviewed and data were collected. Age, reason for transplant, type of medialization procedure, pre- and post-op evaluation of swallow, improvement/correction of aspiration, timing of medialization, incidence of pneumonia, and other criteria were analyzed. RESULTS: Thirty-two patients underwent medialization thyroplasty or direct laryngoscopy with injection for correction of unilateral true vocal cord paralysis due to BOLT (31) or HLT (1). All 32 patients suffered left-sided TVC paralysis; 62.5% received medialization thyroplasty as there primary treatment while 37.5% received DL with injection. Of those receiving injection, less than half (41.7%) returned for further intervention; 90.5% (19/21) of patients with objective preoperative evaluations had documented aspiration. Medialization was successful in eliminating aspiration in 84.2% (16/19), and improving aspiration in 100% (19/19) of transplant patients based on objective preoperative and postoperative evaluations. Patients medialized greater than 14 days after transplant were at a statistically significant greater risk of pneumonia within two months (0% vs. 28.1%). CONCLUSION: Some 90.5% of lung transplant patients with TVC paralysis aspirate. Using objective preoperative and postoperative swallowing evaluations, 84.2% of patients had complete resolution of aspiration after DL with injection or medialization
thyroplasty; 100% of the patients had improved swallowing. There was a statistically significant increased incidence of pneumonia in those patients medialized after two weeks. SIGNIFICANCE: Lung transplant patients with vocal cord paralysis are at significant risk of aspiration. Medialization thyroplasty and DL with injection are highly effective at correcting aspiration. Lung transplant patients medialized later may be at increased risk of pneumonia.
R060 Breathing-Swallowing Pattern in Tracheostomy vs. Controls Roxann Diez Gross, PhD (presenter); Miroslav Tedla, MD; Sheryl B Ross, MA PROBLEM: Healthy adults almost exclusively exhibit an exhale-swallow-exhale pattern while eating. Deviation from the normal pattern could place individuals at risk for aspiration. Should inhalation take place after the swallow, aspiration of any residue remaining is more likely to occur. The importance of timing swallows with exhalation is apparent in non-neurologically impaired tracheostomy patients in whom it has been shown that aspiration and dysphagia can occur. The hypothesis is that persons with open, indwelling tracheostomy tubes would show a disorganization of the normal coordination of breathing and swallowing while eating. METHODS: The investigation was a prospective, repeated measures design. Two groups were studied: one with an indwelling tracheostomy tube and a healthy, control group. Respiratory inductance plethysmography and thermistry distinguished exhalation from inhalation. Swallows were detected with submental surface EMG electrodes. Participants sat at a table and ate ten, 5ml, semi-solid boluses (pudding) and nine, 25g cookie portions. Data were analyzed using the test for binomial proportions with alpha set at p less than 0.05. RESULTS: The proportion of swallows that were followed by inhalation was significantly greater in the tracheostomy group (p⫽0.009). Within the healthy group, the proportion of cookie swallows that occurred during inhalation was significantly smaller than pudding swallows (p⫽0.0004). The proportion of swallows that occurred during inhalation (cookie vs. pudding) did not differ in the tracheostomy group (p⫽0.06). CONCLUSION: Unlike those with an indwelling tracheostomy, healthy persons were less likely to swallow during inhalation if the bolus required mastication. Tracheostomy subjects had a significantly higher proportion of swallows that were followed by inhalation which may place them at increased risk for prandial aspiration. SIGNIFICANCE: The omission of respiratory information in today’s clinical practice may result in reduced diagnostic accuracy and treatment effectiveness if normal respiratory patterning during deglutition is shown to be critical to safe swallowing. SUPPORT: Funded by VA RR&D Merit Review.
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
RESULTS: Cox-2 was expressed in benign and malignant laryngeal SCC but was higher in malignant tumors. Supraglottic tumors showed high up-regulation. It is known to be an invasive and fast-growing tumor compared to glottic SCC. Cox-2 expressions also varied with clinico-pathologic variables such as TNM stage of SCC of the larynx. CONCLUSION: Cox-2 was found not to be a useful marker for Laryngeal SCC since it is expressed in benign tumors. Cox-2 up-regulated in laryngeal SCC. The expression of Cox-2 was related to site, T and N stages of the laryngeal SCC. These results support the evidence that Cox-2 may be involved in carcinogenesis and the behavior of laryngeal SCC. SIGNIFICANCE: Significance of molecular receptors and their modulation in carcinoma of the larynx treatment. This study forms a basis on which many studies can be pursued. The use of Cox-2 inhibitors as a chemopreventive and or chemotheraputic agent in the near future can be expected. Cox-2 inhibitor has been tried as an inhaler in lung cancer.
R059 Vocal Cord Medialization in the Lung Transplant Population Shawn C Ciecko, MD (presenter) PROBLEM: True vocal cord paralysis and medialization in the lung transplant population. METHODS: Patients who had undergone bilateral orthotopic lung transplant (BOLT) or heart-lung transplant (HLT) with resultant true vocal cord paralysis (TVC paralysis) and were medialized were included in the analysis between 2001 and 2006. Charts were retrospectively reviewed and data were collected. Age, reason for transplant, type of medialization procedure, pre- and post-op evaluation of swallow, improvement/correction of aspiration, timing of medialization, incidence of pneumonia, and other criteria were analyzed. RESULTS: Thirty-two patients underwent medialization thyroplasty or direct laryngoscopy with injection for correction of unilateral true vocal cord paralysis due to BOLT (31) or HLT (1). All 32 patients suffered left-sided TVC paralysis; 62.5% received medialization thyroplasty as there primary treatment while 37.5% received DL with injection. Of those receiving injection, less than half (41.7%) returned for further intervention; 90.5% (19/21) of patients with objective preoperative evaluations had documented aspiration. Medialization was successful in eliminating aspiration in 84.2% (16/19), and improving aspiration in 100% (19/19) of transplant patients based on objective preoperative and postoperative evaluations. Patients medialized greater than 14 days after transplant were at a statistically significant greater risk of pneumonia within two months (0% vs. 28.1%). CONCLUSION: Some 90.5% of lung transplant patients with TVC paralysis aspirate. Using objective preoperative and postoperative swallowing evaluations, 84.2% of patients had complete resolution of aspiration after DL with injection or medialization
thyroplasty; 100% of the patients had improved swallowing. There was a statistically significant increased incidence of pneumonia in those patients medialized after two weeks. SIGNIFICANCE: Lung transplant patients with vocal cord paralysis are at significant risk of aspiration. Medialization thyroplasty and DL with injection are highly effective at correcting aspiration. Lung transplant patients medialized later may be at increased risk of pneumonia.
R060 Breathing-Swallowing Pattern in Tracheostomy vs. Controls Roxann Diez Gross, PhD (presenter); Miroslav Tedla, MD; Sheryl B Ross, MA PROBLEM: Healthy adults almost exclusively exhibit an exhale-swallow-exhale pattern while eating. Deviation from the normal pattern could place individuals at risk for aspiration. Should inhalation take place after the swallow, aspiration of any residue remaining is more likely to occur. The importance of timing swallows with exhalation is apparent in non-neurologically impaired tracheostomy patients in whom it has been shown that aspiration and dysphagia can occur. The hypothesis is that persons with open, indwelling tracheostomy tubes would show a disorganization of the normal coordination of breathing and swallowing while eating. METHODS: The investigation was a prospective, repeated measures design. Two groups were studied: one with an indwelling tracheostomy tube and a healthy, control group. Respiratory inductance plethysmography and thermistry distinguished exhalation from inhalation. Swallows were detected with submental surface EMG electrodes. Participants sat at a table and ate ten, 5ml, semi-solid boluses (pudding) and nine, 25g cookie portions. Data were analyzed using the test for binomial proportions with alpha set at p less than 0.05. RESULTS: The proportion of swallows that were followed by inhalation was significantly greater in the tracheostomy group (p⫽0.009). Within the healthy group, the proportion of cookie swallows that occurred during inhalation was significantly smaller than pudding swallows (p⫽0.0004). The proportion of swallows that occurred during inhalation (cookie vs. pudding) did not differ in the tracheostomy group (p⫽0.06). CONCLUSION: Unlike those with an indwelling tracheostomy, healthy persons were less likely to swallow during inhalation if the bolus required mastication. Tracheostomy subjects had a significantly higher proportion of swallows that were followed by inhalation which may place them at increased risk for prandial aspiration. SIGNIFICANCE: The omission of respiratory information in today’s clinical practice may result in reduced diagnostic accuracy and treatment effectiveness if normal respiratory patterning during deglutition is shown to be critical to safe swallowing. SUPPORT: Funded by VA RR&D Merit Review.