The FILS seems to have fair reliability and validity as a practical tool for assessing the severity of dysphagia. Further study on the reliability, validity, and sensitivity of the FILS compared with the FOIS is needed.

The tartaric acid nebulizer is a well-known cough test to evaluate cough function. This study aimed to evaluate the effectiveness of a cough-inducing method using tartaric acid (CiTA). Patients with dysphagia examined by videofluoroscopic examination of swallowing (VF) at a single institution from May 2017 to August 2017 were included in this retrospective observational study. Although undergoing VF, patients who had aspirated without reflexively coughing or who had coughed insufficiently, were instructed to cough voluntarily. Patients who could not cough voluntarily or had expectorated insufficiently underwent the CiTA method. The rate of cough induction and the effectiveness of expectoration using the CiTA method were evaluated. One hundred fifty-four patients (mean age 69.2 ± 16.8 years) were evaluated. Eighty-seven patients aspirated during VF. Of those patients, 15 were able to expectorate via the cough reflex, 18 were able to expectorate with a voluntary cough, and 12 required suctioning for removal of aspirated material. The remaining 42 patients underwent the CiTA method. Thirty-eight patients (90.4%) could reflexively cough, and 30 (71.4%) could expectorate the aspirated material. This novel method, CiTA, was effective for cough induction in patients with dysphagia, especially for those with silent aspiration.

The aim of this study was to confirm the response in patients stimulated at the trigger point (K-point). Since we have already clinically encountered patients with hyperactive bite reflexes who were able to open their mouth and swallow after stimulation of the trigger point, we investigated this response in other brain-damaged patients. The trigger point lies on the mucosa lateral to the palatoglossal arch and medial to the pterygomandibular fold at the height of the postretromolar pad. A total of 57 brain-damaged patients, including patients with pseudobulbar palsy due to bilateral upper motor neuron disease and bulbar palsy due to medulla oblongate. Other supratentorial brain-damaged patients and 20 non-brain-damaged subjects were also examined. The subjects were gently stimulated at the trigger point by a finger or a tongue depressor. We found that the pseudobulbar palsy patients with a hyperactive bite reflex responded by mouth opening and swallowing after a jaw movement similar to mastication elicited by the stimulation. The other pseudobulbar palsy patients, who did not have hyperactive bite reflexes and could open their mouth spontaneously, responded by swallowing with jaw movements similar to mastication after the stimulation. The bulbar palsy patients and the supratentorial brain-damaged patients showed no response to the stimulation. The non-brain-damaged subjects also did not respond, but all of the subjects reported a strange sensation after the stimulation. We concluded that stimulating the trigger point was useful for opening the mouth and facilitating swallowing in pseudobulbar palsy patients and that this technique may be of help in these patients in terms of oral health care and feeding.

No abstract

No abstract