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Botulinum toxin and drooling – how much, how often and where?

This was an incredibly useful article covering all aspects of the use of botulinum toxin as a treatment modality in sialorrhoea. The article starts by outlining why treating sialorrhoea is important and describes the non-pharmacological and pharmacological options, highlighting that...

Grading dysphagia as a toxicity in treating head and neck cancer

Common Terminology Criteria for Adverse Events (CTCAE) is a system used by clinicians to grade the toxicity of oncology treatments in a standardised manner. Dysphagia is perhaps the most common long-term toxicity of head and neck cancer treatment. Currently, a...

Factors affecting the occurrence of salivary fistula after total laryngectomy

It is generally believed that patients should be fed by nasogastric tube for 7-10 days after undergoing total laryngectomy or laryngopharyngectomy to avoid the occurrence of post-operative salivary fistula. This study challenges this belief and looks into various factors that...

Do nasogastric tubes affect aspiration risk?

A nasogastric tube (NGT) is frequently used for patients who are at risk of endotracheal aspiration of oral diet. However, this cannot eliminate the aspiration of saliva. The incidence of aspiration pneumonia in patients with NGT therefore remains high. Some...

All videoswallows are not performed equally…

Videofluoroscopy is one of the main instrumental tools used to assess swallowing biomechanics and physiology. In the UK, it is mainly within the remit of speech and language therapists (SLT) to perform videoswallows but there is considerable variability in both...

What characterises dysphagia in unilateral vocal fold impairment?

The closure of the vocal folds during swallowing is known to contribute to airway protection along with epiglottic inversion and closure of the false vocal folds. It is therefore plausible to expect that unilateral vocal fold impairment without complete closure...

How well do different assessments of swallowing correlate with one another?

Swallowing (dys)function may be assessed by three key measures: 1. instrumental swallowing techniques such as the modified barium swallow (MBS) or videofluoroscopy; 2. functional measures of diet texture that patients can eat comfortably (usually rated by the clinician); and 3....

Analysing videofluroscopy: does it matter how it’s done?

Videofluoroscopy, as a tool that assesses the process of swallowing, has transformed our understanding of dysphagia. Clinicians can observe the biomechanics of a bolus moving from the oral cavity through the pharynx and oesophagus and into the stomach. Over the...

Measuring radiation fibrosis in patients with head and neck cancer

People treated with radiotherapy for head and neck cancer experience several acute and chronic effects of this treatment, of which fibrosis is perhaps the most common. Fibrosis occurs as a wound healing response and leads to scarring and reduced range...

Symptom Oriented Otolaryngology: Head & Neck Surgery – Three Volume Set

Symptom Oriented Otolaryngology is a three-volume set covering an extensive range of symptoms in otorhinolaryngology, head and neck surgery. The editorial team of Randal Payne Morton, Zahoor Ahmad and Malcolm Giles from New Zealand, have been supported by an illustrious...

Swallow toxicity score (DIGEST) and its clinical utility in oncology practice

The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST, graded from 0–4) was developed as a tool for clinicians to grade dysphagia from modified barium swallow studies (MBSS). The purpose is to provide a common terminology for adverse events of pharyngeal...

Adolescence, drug use and body image

Teenagers are notoriously conscious of how they are perceived by others. Dr Saraiva and colleagues explain how this can lead to problems with substance abuse for both boys and girls, and discuss the different substances they may encounter. Adolescence is...