Swallow Solutions (United States)

An Adult Cochlear Implant Aural Rehabilitation Special Interest Group was formed in 2023. Members represent interdisciplinary collaborators, including audiologists, speech-language pathologists, surgeons, nonclinical administrators, manufacturer/industry representatives, and researchers. Current perspectives of adult cochlear implant (CI) recipients regarding aural rehabilitation (AR) remain unknown and understudied. The aim of this study is to survey adult CI recipients to determine their perspectives on the AR process. A web-based national survey was sent to adult CI recipients through multiple channels. The survey asked recipients about their demographics, state of residence, hearing loss history, and device configuration. Questions probed recipients' experiences of learning about AR options, services used, definitions of AR, and perceived value of services received. Questions were also asked about barriers to AR services, preoperative counseling, and satisfaction with their decision to pursue a CI. A total of 115 CI recipients responded to the survey. Results revealed a relative lack of information provided to many CI recipients regarding AR services. Many CI recipients reported wishing they had received additional resources in the areas of music training and equipment troubleshooting. Most participants reported that both one-on-one clinician-guided AR and independent listening practice were effective methods of AR. Findings shed light on current gaps in providing the most effective AR services, which will need to be addressed to optimize hearing health care and outcomes for adult CI recipients. Future work should include outreach to a broader representation of CI users to expand our understanding of AR resources, education, and limitations.

Idiopathic inflammatory myopathies (IIM), including inclusion body myositis (IBM), dermatomyositis (DM), and polymyositis (PM), are rare autoimmune disorders often associated with dysphagia and respiratory dysfunction. Respiratory muscle strength training (RMST) has demonstrated benefits in other neuromuscular conditions, but evidence in myositis is limited. The primary aim of this study was to examine the effects of expiratory muscle strength training (EMST) using the EMST150® device on expiratory function and self-reported swallowing in individuals with myositis. Nineteen participants (7 males, 12 females; mean age 62.7 years) completed 25 RMST repetitions per day, 5 days per week, for 5 weeks at 70% of maximum expiratory pressure (MEP). Outcome measures included the Eating Assessment Tool (EAT-10), peak expiratory flow (PEF), and MEP. Pre- and post-intervention changes were analyzed using paired-samples t-tests. Statistically significant improvements were observed for all outcomes. EAT-10 scores decreased from 17.95 (SD = 10.51) to 11.63 (SD = 9.03), p < .001. PEF increased from 297.63 L/min (SD = 83.39) to 338.16 L/min (SD = 107.56), p < .001. MEP increased from 81.26 cm H₂O (SD = 20.86) to 87.95 cm H₂O (SD = 18.46), p = .004. Exploratory correlations revealed a moderate, non-significant association between improvements in MEP and reductions in EAT-10 scores (r = –0.37, p = 0.13). Changes in PEF demonstrated a moderate-to-strong, statistically significant association with EAT-10 improvement (r = 0.53, p = 0.02), suggesting that enhanced expiratory airflow may relate to reduced dysphagia symptom burden. This pilot study provides preliminary evidence that expiratory muscle strength training may improve expiratory pressure generation, expiratory airflow, and self-reported swallowing symptoms in individuals with myositis. The significant relationship between PEF gains and reductions in EAT-10 scores suggests a potential functional link between expiratory airflow and perceived swallowing improvement. Although the MEP–EAT-10 association did not reach significance and the study was not powered for correlational inference, the observed patterns support further investigation of the respiratory–swallowing relationship in myositis. Larger, controlled studies incorporating instrumental swallowing measures are needed to confirm these findings and clarify underlying mechanisms.

Purpose: The goal of this clinical focus article was to explore the utility of a mathematical prediction model (Bayes' theorem) in dysphagia management. Conclusions: Bayes' theorem shows promise as a means of incorporating evidence-based care into individual patient consultations by predicting both the risk of pneumonia and the impact of speech-language pathology and care team interventions on that risk. However, more research is needed on risk factors for pneumonia and the prevalence of pneumonia before the model can be accurately applied to clinical decision-making for patients with dysphagia. Supplemental Material: https://doi.org/10.23641/asha.19393802

Abstract The British Swallowtail, Papilio machaon britannicus , is an iconic flagship for its unique but now restricted and fragmented fenland ecosystem in the UK's Norfolk Broads. Occurrence in 1 km 2 recording squares fell by 56% over the period of 1974–2014 and by 13% in 2005–2014, but the breeding populations, mainly confined to reserves, have increased in size. Climate change‐induced sea‐level rise and consequent seawater incursion into the Norfolk Broads represent a significant existential threat to the butterfly. Translocation to more secure fenland sites is recommended; several are being restored or recreated through stakeholder partnerships in East Anglia and Somerset. Well‐researched introduction and management of the foodplant, Milk‐parsley, is essential for such translocations to succeed. A better understanding is needed of the genetic structuring of the British Swallowtail populations using modern sequencing technologies, in particular to elucidate the significance of gene flow in relation to the viability of introductions to small or isolated sites. In a species in which hybridisation is commonplace across the Holarctic, the continued influx and future spread in Britain of the continental subspecies Papilio machaon gorganus may present a threat to the genetic integrity of subspecies britannicus , despite their differences in habitat and larval foodplants.

Dysphagia following extubation is common in intensive care unit (ICU) patients. Diagnosing postextubation dysphagia allows identification of patients who are at highest risk for aspiration and its associated adverse outcomes. Older adults are at an increased risk of postextubation dysphagia and its complications due to multiple comorbidities, a higher baseline risk of dysphagia, and increased risk of pneumonia. We aimed to investigate the association between postextubation dysphagia and 1-year mortality in older patients. Secondary outcomes included ICU and hospital lengths of stay, ICU readmission, and place of discharge. We performed a retrospective cohort study from January 1 to December 31, 2013. ICU patients, aged 65 years and older, who were successfully extubated and underwent a formal swallow evaluation by a speech and language pathologist (SLP) were included. Dysphagia was graded using a seven-point scale, and those with at least mild-moderate dysphagia were labeled as having clinically significant dysphagia. Of 1075 patients who were screened, 359 were survivors, aged 65 years and older; and of these survivors, 111 had a swallow evaluation performed by an SLP after liberation from mechanical ventilation. Mean age was 73.8 years (SD = 7.0 years), and 41.4% had clinically significant dysphagia. In a multivariable regression model, there was no significant association between dysphagia and 1-year mortality. Furthermore, there was no statistically significant difference in ICU or hospital length of stay, ICU readmission, or place of discharge of those with clinically significant dysphagia compared to those without. Among mechanically ventilated ICU patients, aged 65 years and older, who underwent a swallow evaluation following extubation, dysphagia was not associated with mortality, ICU and hospital lengths of stay, ICU readmission, and place of discharge. Given conflicting evidence in the literature, larger prospective studies are needed to clarify whether postextubation dysphagia is associated with worse outcomes in older patients admitted to the ICU. J Am Geriatr Soc 67:1895-1901, 2019.

Cervical esophageal stenosis is often diagnosed with a qualitative evaluation of a barium esophagram. Although the esophagram is frequently the initial screening exam for dysphagia, a clear objective standard for stenosis has not been defined. In this study, we measured esophagram diameters in order to establish a quantitative standard for defining cervical esophageal stenosis that requires surgical intervention. Single institution case-control study. Patients with clinically significant cervical esophageal stenosis defined by moderate symptoms of dysphagia (Functional Outcome Swallowing Scale > 2 and Functional Oral Intake Scale < 6) persisting for 6 months and responding to dilation treatment were matched with age, sex, and height controls. Both qualitative and quantitative barium esophagram measurements for the upper, mid-, and lower vertebral bodies of C5 through T1 were analyzed in lateral, oblique, and anterior-posterior views. Stenotic patients versus nonstenotic controls showed no significant differences in age, sex, height, body mass index, or ethnicity. Stenosis was most commonly at the sixth cervical vertebra (C 6) lower border and C7 upper border. The mean intraesophageal minimum/maximum ratios of controls and stenotic groups in the lateral view were 0.63 ± 0.08 and 0.36 ± 0.12, respectively (P < 0.0001). Receiver operating characteristic analysis of the minimum/maximum ratios, with a <0.50 ratio delineating stenosis, demonstrated that lateral view measurements had the best diagnostic ability. The sensitivity of the radiologists' qualitative interpretation was 56%. With application of lateral intraesophageal minimum/maximum ratios, we observed improved sensitivity to 94% of the esophagram, detecting clinically significant stenosis. Applying quantitative determinants in esophagram analysis may improve the sensitivity of detecting cervical esophageal stenosis in dysphagic patients who may benefit from surgical therapy. IIIb. Laryngoscope, 128:2022-2028, 2018.

Swallowing disorders (dysphagia) are associated with malnutrition, aspiration pneumonia, and mortality in older adults. Strengthening interventions have shown promising results, but the effectiveness of treating dysphagia in older adults remains to be established. The Swallow STRengthening OropharyNGeal (Swallow STRONG) Program is a multidisciplinary program that employs a specific approach to oropharyngeal strengthening-device-facilitated (D-F) isometric progressive resistance oropharyngeal (I-PRO) therapy-with the goal of reducing health-related sequelae in veterans with dysphagia. Participants completed 8 weeks of D-F I-PRO therapy while receiving nutritional counseling and respiratory status monitoring. Assessments were completed at baseline, 4, and 8 weeks. At each visit, videofluoroscopic swallowing studies were performed. Dietary and swallowing-related quality of life questionnaires were administered. Long-term monitoring for 6-17 months after enrollment allowed for comparison of pneumonia incidence and hospitalizations to the 6-17 months before the program. Veterans with dysphagia confirmed with videofluoroscopy (N = 56; 55 male, 1 female; mean age 70) were enrolled. Lingual pressures increased at anterior (effect estimate = 92.5, P < .001) and posterior locations (effect estimate = 85.4, P < .001) over 8 weeks. Statistically significant improvements occurred on eight of 11 subscales of the Quality of Life in Swallowing Disorders (SWAL-QOL) Questionnaire (effect estimates = 6.5-19.5, P < .04) and in self-reported sense of effort (effect estimate = -18.1, P = .001). Higher Functional Oral Intake Scale scores (effect estimate = 0.4, P = .02) indicated that participants were able to eat less-restrictive diets. There was a 67% reduction in pneumonia diagnoses, although the difference was not statistically significant. The number of hospital admissions decreased significantly (effect estimate = 0.96; P = .009) from before to after enrollment. Findings suggest that the Swallow STRONG multidisciplinary oropharyngeal strengthening program may be an effective treatment for older adults with dysphagia.

Surgical treatment of gastroesophageal reflux disease (GERD) is indicated for patients with moderate to severe signs and symptoms or a need for increasing doses of antisecretory drugs. Long segment Barrett's metaplasia is another indication, especially in young patients. Preoperative evaluation differs somewhat depending on whether the patient's symptoms are typical or atypical of GERD. Laparoscopic fundoplication is described. Follow-up of as long as 8 years indicates that more than 90% of patients are satisfied with the results, although 14% are using antisecretory drugs regularly. Recurrent symptoms or dysphagia may indicate surgical failure, and medical therapy, esophageal dilatation, or surgery may be appropriate. Laparoscopic surgery in these patients takes longer than the original procedure but has many benefits if performed by an experienced surgeon.

This report builds upon the authors' previous report on relationship marketing in the financial services industry. It is based on:—research commissioned by the Royal Mail into the state of relationship marketing in the UK automotive industry and the use of mail in managing customer relationships—our wider research programme in which we examine how companies in many sectors are managing customer relationships and their use of different media and systems to do so—consulting and training engagements in the automotive industry.The paper is published in three parts. This first part deals with the authors' research aims, methodology and findings. The findings relating to the ten automotive companies interviewed for the study are then reported in more detail. Part 1 concludes with an overview of the modelling process. Part 2 (to be published in the next issue of the Journal) takes the examination of modelling further with a description of acquisition modelling and a time series approach to relationship marketing modelling called approach management. A discussion on how to manage the future customer concludes this part of the paper. Part 3 (to be published in Vol. 8, No. 3 of the Journal) uses relationship stage analysis to examine how mail is used in selling cars and makes recommendations for future practice.