Year 2007 / Volume 99 / Number 1
Original
Videofluoroscopy quantification of laryngotracheal aspiration outcome in traumatic brain injury-related oropharyngeal dysphagia

pp. 7-12

Terré, R. / Mearin, F.

Abstract
Introduction: swallowing impairments are frequent after severe traumatic brain injury (TBI).

Objective: to define and prospectively quantify the videofluoroscopic symptoms in patients after TBI, and to evaluate the evolution of patients with laryngotracheal aspiration.

Method: we studied 10 patients with TBI, and a clinical suspicion of aspiration confirmed by means of a videofluoroscopic exploration (VDF). VDF was repeated at 1, 3, 6, and 12 months thereafter.

Results: 30% of patients had an impaired gag reflex, and 40% cough during oral feeding. In the first VDF exploration the following was observed: increased oral transit time (OTT) in 70% (average: 3.8 sec.; range: 0.8-15 sec.), altered lingual control in 60%, and dysfunctional palatoglossal closure in 20%. Mean pharyngeal transit time (PTT) was 0.72 sec. (range: 0.34-1.50 sec.), and time to swallowing reflex (TSR) was 0.32 sec. (range: 0.10-0.80 sec.). After one year only 3 patients had aspiration –with a normal OTT in 7 patients, a normal PTT in 9, and a normal TSR in all; 80% had an exclusively oral diet, and 20% combined oral intake and gastrostomy feeding.

Conclusion: videofluoroscopic evaluation allows to confirm and quantite swallowing dysfunction in patients with severe TBI. Most frequent early findings included an increase in OTT and alterations in lingual control; aspirations were quite frequent, and more than half were silent. After one year the majority of patients showed a favorable outcome.
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Terré, R. / Mearin, F.. Videofluoroscopy quantification of laryngotracheal aspiration outcome in traumatic brain injury-related oropharyngeal dysphagia. 7-12


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