Swallowing

Transnasal oesophagoscopy in a tertiary care setting: a retrospective evaluation of clinical efficacy, cost-effectiveness, and diagnostic value

A. S. Kumar1, T. M. Nolli2, A. Campbell2, S. Majumdar2                                                                                                                     doi: 10.48095/ccorl2025S1_96

1 University of Dundee, Dundee, UK

2 ENT Department, NHS Tayside, Dundee, UK

Transnasal oesophagoscopy (TNO) is an increasingly recognised, minimally-invasive diagnostic technique that enables real-time evaluation of oesophageal and upper aerodigestive tract pathologies without the need for sedation. Compared to conventional oral endoscopy, TNO reduces procedural risks, optimises resource utilisation, and enhances throughput. This study evaluates the indications, diagnostic yield, and procedural success rate of TNO in a tertiary outpatient setting. Additionally, we assess referral patterns, patient demographics, post-procedural discharge rates, and the overall cost-effectiveness of this approach. A retrospective analysis was conducted on TNO patients at our centre between 2023 and 2025. Data collection included patient demographics, smoking status, referral source, clinical indication, endoscopic findings, and outcomes. The procedural completion rate, diagnostic utility, and cost-saving implications relative to sedated endoscopy were analyzed. Of the 76 TNO procedures performed, 12 (15.8%) were abandoned, while 3 (3.9%) were successfully converted to oral endoscopy. The primary referral indications included oropharyngeal reflux (35.6%) and dysphagia (30.3%). A significant proportion of patients (34.2%) exhibited normal endoscopic findings. Diagnosed conditions included gastro-oesophageal reflux disease (18.4%), structural abnormalities (polyps, vocal cord lesions, ectopic gastric mucosa) (11.8%), and hiatus hernia (10.5%). Referrals mainly originated from local ENT specialists, supplemented by tertiary and primary care referrals. Notably, 78.9% of patients were discharged without the need for further investigation or specialist follow-up. The cost-effectiveness of TNO is its ability to provide rapid, office-based diagnostic assessments, reducing the need for hospital-based sedated endoscopy. Our findings reaffirm the value of TNO as a first-line investigative tool for evaluating upper aerodigestive tract and oesophageal symptoms. Its minimally-invasive nature, high diagnostic yield, and ability to rapidly exclude pathology contribute to significant cost savings by reducing the need for sedated endoscopy, imaging, and prolonged follow-up. As such, TNO should be considered the preferred modality for selected patients with upper GI symptoms in outpatient and tertiary settings.

Feeding and swallowing disorder associated to esophageal atresia

P. D. Borrego, M. L. Ruiz, M. M. Catedra, B. R. Romero, J. A. Conejero Casares, M. Rodriguez-Piñero Duran                                                                                                                             doi: 10.48095/ccorl2025S1_97

Physical Medicine and Rehabilitation, Virgen Macarena University Hospital, Seville, Spain

Introduction: Esophageal atresia (EA) is a congenital defect where the upper esophagus is not connected to the lower esophagus. Feeding and swallowing disorders (SD) are common in infants and children after esophageal atresia repair (approximately 80%). Despite the high prevalence of SD in EA, there are limited studies in the literature. Delayed oral feeding due to either structural or functional anomalies, may cause delayed development of deglutition functions. Aims: Describe the feeding and oropharyngeal swallowing disorders associated in children with esophageal atresia treated in our Dysphagia unit. Materials and Method: Retrospective revision (January 2023 – June 2024) of EA Phoniatric Clinic history from our Dysphagia unit. Data collection: gender, age, atresia classification, impaction or stenosis detected, reason for consultation, malformation association, instrumental diagnostic test performed (GT – gastroesophageal transit, manometry, phmetry, videofluoroscopy, FEES – fiberendoscopic evaluation of swallowing) and principal results from them, intake observation, FOIS classification, evolution. Results: 5 children, mean age 2,3 years, 60% women, 80% III type (1 case long gap), 80% stenosis post-surgical repair and food impaction episode. 80% another malformation association. Reason for consultation: difficulties in feeding progression (100% cases). Anomalies are found in most instrumental test performed: 80% difficult esophageal transit, 90% contractibility decreased, 60% gastroesophageal reflux, 60% oropharyngeal swallowing phase problems in videofluoroscopy, FEES and intake observation. Discussion: The esophageal motility problems are the most common and the most challenging struggle with no definitive treatment in EA patients. Despite those findings, we observed oropharyngeal disfunctions associated to esophageal problems that they could worsen feeding difficulties. Perhaps EA type is related to oropharyngeal dysphagia developments, future research is needed.

Lingual ultrasound evaluation in amyotrophic lateral sclerosis

P. D. Borrego1, C. R. Muñoz2, E. M. Martinez Fernandez3, J. F. Sanchez Gomez2, R. R. Garcia4, R. F. Murillo1, M. G. Mariñas5                                                                                                                                                                                         doi: 10.48095/ccorl2025S1_98

1 Physical Medicine and Rehabilitation, Virgen Macarena University Hospital, Seville, Spain

2 Pneumology, Virgen Macarena University Hospital, Seville, Spain

3 Neurology, Virgen Macarena University Hospital, Seville, Spain

4 Endocrinology, Virgen Macarena University Hospital, Seville, Spain

5 Physical Medicine and Rehabilitation, Juan Ramon Jimenez University Hospital, Huelva, Spain

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting upper and lower motor neurons of unknown cause. Consequently, muscle control is lost with the development of musculature weakness, atrophy and paralysis. Among them, the tongue atrophies associate speaking and swallowing difficulties. Ultrasound is a tool of recent application in the evaluation of swallowing and its use in the analysis of the tongue could be very useful. Aim: Describe tongue ultrasound characteristics in patients with ALS and their relationship with the disease evolution, as well as with the presence of dysphagia and malnutrition. Material and Method: Retrospective review of the medical records of ALS patients evaluated by our Multidisciplinary unit. Data included: age, sex, type of ALS, time since diagnosis, presence of oropharyngeal dysphagia, Functional oral intake scale (FOIS), nutritional status (measured with MNA), tongue thickness measured with ultrasound, presence of gastrostomy (PEG) and time since placement. Results: 20 patients, men 60%, average age: 66 years. Condition duration was over two years: 55%, and the most common presentation was spinal (60%). Oropharyngeal dysphagia: 65%, with malnutrition: 20% (10% PEG and 50% had made diet modifications). Average tongue thickness: 4.61 cm (0.72 cm genioglossus). We observed an inverse correlation between age and tongue thickness, with total tongue thickness directly correlated with genioglossus measurement. We observed a moderate correlation among feeding level, dysphagia presence and tongue thickness. There was no correlation with the type of ALS or with the duration of the condition. Conclusions: Ultrasonography is a simple and portable method that allows the lingual evaluation of the ALS patient in any context, facilitating decision making in the case of suspicion and/or presence of oropharyngeal dysphagia. Smaller lingual thicknesses are observed in cases of greater disease involvement that correlates with their ability to feed.

The key timing of pharyngeal reflux in patients with laryngopharyngeal reflux

Y. Eun, H. J. Lee, S. I. Kim, Y. Ch. Lee                                                                                                              doi: 10.48095/ccorl2025S1_99

Kyung Hee University, Seoul, Korea

Objective: To analyze the incidence of pharyngeal reflux in laryngopharyngeal reflux patients over a 24-hour period and find out the key timing of pharyngeal reflux. Methods: We reviewed 69 patients who visited our clinic with LPR-related symptoms and were proven to have pharyngeal reflux via 24-hour multichannel intraluminal impedance-pH (24-hr MII-pH) monitoring. Quantitative analysis was conducted for the LPR profiles, such as the acidity of reflux, nighttime reflux, and positional reflux. The time series of pharyngeal reflux episodes and mealtimes were analyzed over a 24-hour period. Also, we recruited 26 normal controls. We compared the timing of pharyngeal reflux between LPR patients and asymptomatic controls. Results: The quantitative analysis revealed that pharyngeal reflux occurred 4.88 ± 4.59-times over 24 hours. Weakly acidic pharyngeal reflux was more abundant than acidic or weakly alkaline reflux. Pharyngeal reflux occurred mainly during daytime in the upright position. The most frequent timing of pharyngeal reflux episodes was within 2 hours after meals. Additionally, there was no significant difference of the timing of post-prandial reflux between LPR patients and asymptomatic controls. Conclusion: The key timing of pharyngeal reflux in patients with LPR was post-prandial 2 hours.

Dysphagia in post-SARS-CoV-2 patients: clinical manifestations during the pandemic versus manifestations in post-pandemic cases, a study 2022/2025

G. Guerra1, E. Romero1, R. Hernández-Villoria2                                                                                                                                       doi: 10.48095/ccorl2025S1_100

1 Departamento de Foniatría, Audiología y Otoneurología, Hospital Luis Razzetti, Barcelona, Venezuela

2 Foniatría, Centro Clínico de Audición y Lenguaje Cealca, Caracas, Venezuela

Introduction: The SARS-CoV-2 pandemic of 2020–2022 generated oropharyngeal dysphagia syndromes among its multiple consequences. The frequency and severity statistics of these cases were proportionally higher during the pandemic stage, but now that the infection occurs with a lower prevalence and incidence in the population, the sequelae of dysphagia also seem to have decreased. Is this a subjective assessment or did the reduction in virulence and the expansion of vaccination really reduce the impact on swallowing? Aims: To establish the prevalence of swallowing disorders using the EAT10 questionnaire and other instruments in patients who suffered proven SARS-CoV-2 infection. To describe the characteristics of the dysphagic disorder in these patients through clinical examination and FEES. Materials and Methods: Study of two cross-sectional stages, one in 2022 and another in 2024–2025 with 100 patients distributed in two groups (pandemic group and post-pandemic group) analyzed with EAT-10, Functional oral intake score and FEES. The results obtained were processed using statistical analysis measures to compare the two groups in terms of significance of the differences. Results: It is found that there are significant differences in the presentation of dysphagic manifestations of post-SARS-CoV-2 infection patients during the pandemic and today. Conclusion: Factors that influence individual and collective immunity could have played an important role in reducing the impact of SARS-CoV-2 on dysphagic symptoms. However, there are other factors of interest, specific to the affected population, such as age, sex, comorbidity, which can be determining factors, independently of the immunological protection factors. This demonstrates the need to continually closely monitor possible dysphagia syndromes in patients with SARS-CoV-2 infection.

Effects of injection laryngoplasty for aspiration and swallowing timing measures in unilateral vocal fold paralysis

Y. Ryu                                                                                                                                                                   doi: 10.48095/ccorl2025S1_101

National Cancer Center, Goyang, Korea

Introduction: Injection laryngoplasty is a common surgical treatment for unilateral vocal fold paralysis (UVFP). UVFP can affect voice, airway protection, and quality of life. While the effects of injection laryngoplasty on voice in UVFP are well documented, its impact on swallowing remains unclear. Aims: This study aims to better understand the effect of injection laryngoplasty on swallowing function in UVFP. Materials and Methods: A retrospective chart review was conducted on 14 patients with UVFP, who completed swallowing evaluations before and after injection laryngoplasty. Clinical swallowing evaluations were analyzed, comparing penetration-aspiration (PA) scores and swallowing timing measures in video fluoroscopic swallowing studies preand post-injection. Swallowing was assessed with different consistencies, including small and large liquid barium, yogurt, soft blended diet, and normal regular diet. Results: The PA score for yogurt significantly improved between preand post-injection (Z = –2.375; P = 0.018). While swallowing function showed improvement in small liquid, yogurt, and SBD post-injection, these changes were not statistically significant. Timing measures did not differ significantly after injection laryngoplasty. Out of fourteen patients, eleven exhibited improved swallowing function following the injection, whereas three showed no change. Conclusion: Injection laryngoplasty is an effective option for treating swallowing impairment caused by UVFP. However, the results indicated that swallowing function may be affected by factors beyond the vocal fold, such as pharyngeal muscle weakness, pressure changes, and decreased sensation.