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Biomedical subjects

Joseph Donzelli

Publications and source records attributed to Joseph Donzelli.

5 recordsLinked to original sources
PubMed2005

Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES).

This study investigated the effects, if any, that the presence of a tracheotomy tube has on the incidence of laryngeal penetration and aspiration in patients with a known or suspected dysphagia. This was a prospective, repeated-measure design study. A total of 37 consecutive patients with a tracheotomy tube underwent a fiberoptic endoscopic evaluation of swallowing (FEES). Patients were first provided with pureed food boluses with the tracheotomy tube in place. The tracheotomy tube was then removed and the tracheostoma site was covered with gauze and gentle hand pressure was applied. The patients were then evaluated without the tracheotomy tube in place with additional puree. Aspiration status was in agreement with and without the tracheotomy tube in place in 95% (35/37) of the patients. The two patients who demonstrated a different swallowing pattern with regard to aspiration demonstrated aspiration only when the tracheotomy tube was removed. Laryngeal penetration status was in agreement with and without the tracheotomy tube in place in 78% (29/37) of the patients. For the majority of the patients, the removal of the tracheotomy tube made no difference in the incidence of aspiration and/or laryngeal penetration. Results of this study do not support the clinical notion that the patient's swallowing function will improve once the tracheotomy tube has been removed.

Aged↗
PubMed2004

The effects of breath-holding on vocal fold adduction: implications for safe swallowing.

OBJECTIVE: To determine the effects, if any, of 3 different breath-holding techniques on a person's ability to attain vocal fold closure (VFC) to successfully complete swallowing maneuvers. DESIGN: Prospective, randomized study. SETTING: Private practice. PATIENTS: A total of 150 healthy volunteers recruited from private practice patients and community volunteers. Intervention Group 1 received the easy breath-hold instruction; group 2 received the inhale/easy breath-hold instruction; and group 3 received the hard breath-hold instruction. MAIN OUTCOME MEASURE: Closure of true and false vocal folds following the breath-hold instruction. RESULTS: In the easy breath-hold group, true VFC occurred in 82% of the subjects, and closure of both the true and false vocal folds occurred in 30%. In the inhale/easy breath-hold group, true VFC occurred in 62%, and closure of both folds occurred in 46%. In the hard breath-hold group, true VFC occurred in 86%, and closure of both folds occurred in 64%. The differences among the 3 groups were significant for true VFC (chi2=9.242; P=.01) and for closure of both folds (chi2=11.625; P=.003). CONCLUSIONS: The hard breath-hold instruction was the most effective method to attain full laryngeal closure, and the inhale/easy breath-hold instruction was the least effective method to attain true VFC for safe swallowing.

Adolescent↗
PubMed2003

Predictive value of accumulated oropharyngeal secretions for aspiration during video nasal endoscopic evaluation of the swallow.

The purpose of this prospective study was to investigate the predictive value of oropharyngeal secretions by use of 5-point and modified 3-point secretion scales for aspiration of food or liquid and diet recommendation outcomes. One hundred consecutive patients and 4 control subjects participated. The 5-point secretion severity scale correlated highly to aspiration (Spearman's rho = .516, p < .0001) and to diet recommendation outcomes (Spearman's rho = .72, p < .0001). Patients who received tube feedings were more likely to demonstrate a higher secretion level than patients who received oral feedings (Pearson chi squared analysis value = 25.461, p < .0001). Patients with a tracheotomy tube tended to demonstrate higher secretion levels than patients without a tracheotomy tube (Spearman's rho = .446, p < .0001). The relationship of the 3-point secretion severity scale level with aspiration was .488, p < .0001 (Spearman's rho), and that with diet recommendation outcomes was .746, p < .0001 (Spearman's rho).

Adolescent↗
PubMed2002

A comparison of tonsillectomy with the harmonic scalpel versus electrocautery.

OBJECTIVE: We sought to test whether the use of the harmonic scalpel would cause less pain and more rapid recovery in tonsillectomy patients versus the use of electrocautery. DESIGN AND SETTING: In a private practice community hospital, we conducted a prospective nonrandomized comparison of 156 pediatric tonsillectomy cases. Local anesthetic infiltrations and steroids were used at the discretion of the surgeon. Outcome variables consisted primarily of immediate- and mid-term pain, pain medications required, time to eating, morbidities and charges. RESULTS: There were no differences between the groups on an intention-to-treat basis except for costs, which were higher in the harmonic scalpel group. When rescue use of electrocautery was required to control bleeding in the in the harmonic scalpel patients, more pain and longer times to taking food were noted. CONCLUSIONS: Used with discretion the harmonic scalpel is equivalent to electrocautery for tonsillectomy. SIGNIFICANCE: The harmonic scalpel does not provide a major benefit over more conventional methods of tonsillectomy.

Adolescent↗