Objective: Neuromuscular electrical stimulation (NMES) has been proposed in the treatment of laryngopharyngeal dysfunctions (dysphonia, dyspnoea, dysphagia) for more than 40 years. Several studies have investigated possible therapeutic effects. Some researchers described favourable results, whereas others did not find relevant benefits. This article aims to review available studies to give an overview regarding the current state of knowledge. Methods: We conducted a selective literature search using PubMed. Results: In total, 356 papers were identified: 6 case reports, 11 reviews, 43 prospective clinical trials and 3 retrospective trials were found. Conclusion: Due to different stimulation protocols, electrode positioning and various underlying pathological conditions, summarizing the present studies appears to be difficult. However, there is evidence that NMES is a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. Nevertheless, more empirical data is needed to fully understand the benefits provided by NMES. Further research suggestions are put forward.
Disturbances of the swallowing process can occur at any age and might lead to choking. However, the risk of dysphagia increases with advanced age. This is not only due to a higher incidence of diseases that cause dysphagia, but also to age-related changes in the mechanisms of swallowing. Aging affects all of the anatomic structures involved in the swallowing process. Important changes include limitations to mastication, delayed triggering of the swallowing reflex, expansion of pharyngeal structures, prolonged pharyngeal propulsion, loss of pharyngeal sensitivity, increased rigidity of the esophageal wall and reduced esophageal contractility. Changes in swallowing function caused by aging alone are termed presbyphagia. If these changes are so severe that their compensation is no longer possible, presbydysphagia occurs. For diagnostic and therapeutic purposes it is mandatory to evaluate presbyphagic and presbydysphagic changes in the swallowing process, and to distinguish these from other non-age-related causes of dysphagia.
The sole use of the autotransfuser DIDECO BT 795/P during osteosarcoma surgery is not recommended because of the potential danger of retransfusion of malignant cells. In combination with the leukocyte depletion filter PALL BPF 4, no osteosarcoma cells were identified in the red cell concentrate. Since the adhesiveness of tumor cells from established cell lines may be different from that of tumor cells in the intraoperative salvaged blood, further studies with blood from the surgical field are necessary to determine the efficacy of white cell depletion filters to eliminate osteosarcoma cells.
The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When opened, the UES allows the food bolus to pass into the esophagus, as well as permitting emesis and eructation. The basal sphincter tone constitutes a barrier function which serves to prevent reflux and passive aerophagia in the case of deep breathing. Basal sphincter tone is dependent on several influencing factors; during swallowing, sphincter opening and closure follow a complex multiphase pattern. This article presents an overview of the current understanding of UES physiology.
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