Quantitative classification of pediatric swallowing through accelerometry.
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BACKGROUND: Dysphagia or swallowing disorder negatively impacts a child's health and development. The gold standard of dysphagia detection is videofluoroscopy which exposes the child to ionizing radiation, and requires specialized clinical expertise and expensive institutionally-based equipment, precluding day-to-day and repeated assessment of fluctuating swallowing function. Swallowing accelerometry is the non-invasive measurement of cervical vibrations during swallowing and may provide a portable and cost-effective bedside alternative. In particular, dual-axis swallowing accelerometry has demonstrated screening potential in older persons with neurogenic dysphagia, but the technique has not been evaluated in the pediatric population. METHODS: In this study, dual-axis accelerometric signals were collected simultaneous to videofluoroscopic records from 29 pediatric participants (age 6.8 +/- 4.8 years; 20 males) previously diagnosed with neurogenic dysphagia. Participants swallowed 3-5 sips of barium-coated boluses of different consistencies (normally, from thick puree to thin liquid) by spoon or bottle. Videofluoroscopic records were reviewed retrospectively by a clinical expert to extract swallow timings and ratings. The dual-axis acceleration signals corresponding to each identified swallow were pre-processed, segmented and trimmed prior to feature extraction from time, frequency, time-frequency and information theoretic domains. Feature space dimensionality was reduced via principal components. RESULTS: Using 8-fold cross-validation, 16-17 dimensions and a support vector machine classifier with an RBF kernel, an adjusted accuracy of 89.6% +/- 0.9 was achieved for the discrimination between swallows with and with out airway entry. CONCLUSIONS: Our results suggest that dual-axis accelerometry has merit in the non-invasive detection of unsafe swallows in children and deserves further consideration as a pediatric medical device. (+info)
Cadaveric position of unilateral vocal cord: a case of cricoid fracture with ipsilateral arytenoid dislocation.
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Cricoid pressure: ritual or effective measure?
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Cricoid pressure has been long used by clinicians to reduce the risk of aspiration during tracheal intubation. Historically, it is defined by Sellick as temporary occlusion of the upper end of the oesophagus by backward pressure of the cricoid cartilage against the bodies of the cervical vertebrae. The clinical relevance of cricoid pressure has been questioned despite its regular use in clinical practice. In this review, we address some of the controversies related to the use of cricoid pressure. (+info)
Prognostic significance of thyroid or cricoid cartilage invasion in laryngeal or hypopharyngeal cancer treated with organ preserving strategies.
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Sudden glottic stenosis caused by cricoarytenoid joint involvement due to rheumatoid arthritis.
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A woman with rheumatoid arthritis (RA) experienced glottic stenosis approximately two months after switching from etanercept to tocilizumab. Cricoarytenoid joint (CAJ) arthritis due to RA was diagnosed. An awake tracheostomy saved the relievable airway, and the administration of methylprednisolone and infliximab ameliorated the flare-up and glottic stenosis. A follow-up examination revealed the recovery of the patient's normal voice and good control of RA with infliximab and methotrexate. Although general physicians do not frequently encounter patients with symptomatic CAJ arthritis, this condition should be considered as it can be life-threatening. Therefore, when detected, it should be diagnosed and treated immediately. (+info)