title: Post-operative swallowing in multiple system atrophy.
abstract: BACKGROUND
  Some patients with multiple system atrophy (MSA) require surgical interventions such as tracheostomy and aspiration prevention. Few studies have investigated the postoperative clinical course of MSA patients. The aim of this study was to determine a management strategy for dysphagia and respiratory disorder in MSA.
  
  
  METHODS
  From 2001 to 2014, 18 MSA patients (13 males and 5 females, 52-76 years) underwent tracheostomy (TR, n = 11) or laryngeal closure (LC, n = 12). Five patients underwent LC following TR. Vocal fold impairment, the degree of dysphagia and pre/post-operative oral ingestion, and postoperative survival time were evaluated retrospectively. Swallowing function was assessed using the penetration aspiration scale (PAS).
  
  
  RESULTS
  TR was performed due to respiratory disorder in seven patients and due to dysphagia in four patients. PAS scores ranged 1-8 in TR patients and 7-8 in LC patients. Seven of 11 patients who underwent TR displayed worsened PAS scores, and no patients displayed improved PAS scores following TR. All patients who underwent LC regained complete or partial oral intake after surgery. There were no significant differences in postoperative survival time between the two groups.
  
  
  CONCLUSIONS
  Considering the impacts of TR and LC on survival time, postoperative feeding and swallowing, LC is a good option for treating MSA patients with dysphagia.
authors.affiliation: Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Ueha
authors.affiliation: Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nito
authors.affiliation: Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Otolaryngology, Sanraku Hospital, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Yamauchi
authors.affiliation: Department of Artificial Organs and Otolaryngology, National Institute of Sensory Organs, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tsunoda
authors.affiliation: Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamasoba
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D058753:Laryngoplasty / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology*; D014139:Tracheostomy / Q000009:adverse effects; D016896:Treatment Outcome
keywords: aspiration prevention; laryngeal closure; multiple system atrophy; post-operative swallowing; tracheostomy