[Videofluoroscopy quantification of laryngotracheal aspiration outcome in traumatic brain injury-related oropharyngeal dysphagia].
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Terré
R
R
Unidad de Rehabilitación Funcional Digestiva, Institut Guttman, Hospital de Neuro-rehabilitación, Instituto Universitario adscrito a la UAB, Barcelona, Spain. metges@guttmann.com
Mearin
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007830:Larynx; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014132:Trachea; D014741:Video Recording