稲本 陽子

Abstract Background Pill‐swallowing difficulty is common yet under‐recognised, and patients rarely seek or receive support from healthcare professionals. Lubricating jelly pastes are widely available in Japan, yet evidence for their effectiveness in pill administration remains limited. The PILL‐5 enables validated, self‐reported screening of clinically relevant pill‐swallowing difficulty. Aim This study aimed to explore whether a lubricating jelly paste reduced self‐reported pill‐swallowing difficulties using the Japanese version of the PILL‐5 questionnaire. Method In a pilot randomised, parallel‐group trial, 24 participants with PILL‐5 scores ≥2 were stratified and randomised 1:1 to one‐week pill intake using a lubricating jelly paste (IDDSI Level 4) (intervention group) or pill intake as usual (control group). The PILL‐5 was administered at baseline, Day 1, and Day 7. The primary outcome was change in total PILL‐5; between‐group differences were tested with the exact Mann–Whitney U test. Ethical approval was granted by the Ethics Review Committee of Fujita Health University (Reference no: HM20‐076; HM20‐619) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants via the distribution of project information and completion of written consent forms. The study was registered in the UMIN Clinical Trials Registry (UMIN‐CTR) (Registration ID: UMIN000057324). Results The median PILL‐5 scores at baseline were 4.5 and 5.5 for the intervention and control groups, respectively (p = 0.525). At Day 1, median scores were 3.0 and 4.5 in the intervention group and control group, respectively and on Day 7, median scores were 3.0 and 4.0 in the intervention and control groups, respectively. From baseline to Day 1, the between‐group median difference in change (intervention minus control) was 2 (95% confidence interval [CI] 0–2, p = 0.037), indicating a greater reduction in the intervention group. On Day 7, the between‐group difference was 1 (95% CI 0–2, p = 0.119) and not significant. Conclusion Lubricating jelly paste use was associated with an early, self‐reported reduction in PILL‐5 scores at Day 1, with a significant between‐group difference. By Day 7, the between‐group difference was not significant, likely due to floor effects from low baseline severity. Future studies with stricter inclusion criteria and larger sample sizes are warranted to further clarify the potential benefits.

ABSTRACT To evaluate dysphagia, pharyngeal high‐resolution impedance manometry (P‐HRM‐I) is used in conjunction with videofluoroscopic examination of swallowing (VF) or videoendoscopic evaluation of swallowing to obtain additional objective data that cannot be captured by conventional assessment methods. Based on the Leuven Consensus of the International Pharyngeal Manometry Working Group for diagnosing pharyngeal and upper esophageal sphincter (UES) motility disorders, we present a case series of two patients illustrating the recovery process of dysphagia following lateral medullary syndrome. Two patients with severe dysphagia due to lateral medullary infarction caused by vertebral artery dissection were evaluated. In both patients, the initial P‐HRM‐I showed profound impairment of the UES opening and bolus passage, preventing oral intake. Balloon dilation of the UES, laryngeal elevation exercises, tongue strengthening exercises, and direct swallowing training were performed, and the functions of the pharynx and UES were regularly evaluated using VF and P‐HRM‐I. Following UES dilation, PHRM‐I revealed improved UES opening, enhanced pharyngeal contraction, and restoration of pharyngeal peristalsis. Both patients regained sufficient swallowing function to resume a regular diet. P‐HRM‐I may be a useful tool for quantitatively assessing UES function and bolus propulsion, identifying the pathophysiological components of dysphagia, guiding individualized treatment, and monitoring post‐intervention recovery.

Abstract Objective Oral frailty, the age‐related decline in oral and pharyngeal function, is associated with physical frailty, sarcopenia, and cognitive decline. The Oral Frailty Index‐8 (OFI‐8) is a patient‐reported outcome measure developed in Japan to assess oral frailty risk. This study aimed to culturally and linguistically adapt the OFI‐8 for English‐speaking older adults in the United States. Study Design Cross‐cultural and cross‐linguistic adaptation of the OFI‐8 by an expert committee, followed by administration of the adapted OFI‐8 and structured cognitive interviews with 22 English‐speaking adults aged 65 years and older. Setting Outpatient tertiary academic voice and swallowing center in New York City. Methods Following the Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines, the OFI‐8 underwent forward translation, back translation, expert committee review, and reconciliation. Cognitive interviews were then conducted with 22 participants aged 65 years and older. A think‐aloud and verbal‐probing approach was used to evaluate comprehension, clarity, and cultural appropriateness. Interviews were transcribed and analyzed using thematic analysis. Results Several cultural adaptations were made, including replacing Japanese food examples with US‐familiar foods of similar texture. Three questionnaire items and the instructions were refined following participant feedback to improve syntactic flow, clarity, and understanding. The final US‐English version maintained conceptual equivalence of the original OFI‐8 while adapting language and examples for US cultural relevance. Conclusion A culturally adapted US‐English version of the OFI‐8 was developed through structured translation, expert review, and cognitive interviews. Further validation studies are necessary to establish its clinimetric properties and support clinical application for early detection of oral frailty in US older adults.

The super-supraglottic swallow (SSGS) improves laryngeal closure, and head flexion compensates for inadequate closure of the airway. These two procedures are typically utilized by speech-language pathologists for specific patient populations. This study compared the effect of the SSGS with head flexion (i.e., modified SSGS [mSSGS]) on laryngeal closure with that of usual swallowing and the SSGS in healthy individuals. Twenty-one healthy volunteers were instructed to swallow 4 ml of thin liquid barium in a sitting position during usual swallowing, SSGS, and mSSGS under X-ray fluoroscopy. The primary outcome was the distance between the epiglottis and arytenoid (DEA) at onset of the swallowing reflex. The secondary outcomes were DEA before onset of the swallowing reflex, the head flexion angle before and at onset of the swallowing reflex, and the Penetration-Aspiration Scale (PAS) score. The relative ease of performing the mSSGS compared with the SSGS was evaluated using a 7-point Likert scale. DEA at onset of the swallowing reflex was significantly shorter with mSSGS than with usual swallowing (P < 0.001) or the SSGS (P = 0.006). DEA before swallowing was also significantly shorter with the mSSGS than with usual swallowing (P < 0.001) and the SSGS (P = 0.006). PAS score was 1 in all trials. The median Likert score was 3, indicating that the SSGS was easier than the mSSGS. The findings suggest that the mSSGS maneuver enhances laryngeal closure more than the SSGS maneuver and usual swallowing.