Deglutition after near-fatal choking episode: radiologic evaluation

Article Abstract:

Choking on food and liquids is a common occurrence that most of us have experienced to one degree or another. It can be a serious or even fatal event if the obstruction is not quickly removed. Little research has focused on deglutition (swallowing) in people who have experienced near-fatal choking episodes to see if any underlying abnormalities were responsible. This study examined swallowing with videofluoroscopy (internal X-ray technique with results imaged on a fluorescent screen) and static imaging to see if such abnormalities existed. Subjects examined were 75 adults who had near-fatal choking episodes. Normal results were found in 17 of the patients. Abnormalities were found in the swallowing process in the other 58 subjects. These abnormalities could be grouped into four stages of swallowing. Abnormalities were seen to occur during the oral stage in 32 patients, the pharyngeal stage in 19 patients, the pharyngoesophageal stage in 28 patients, and the esophageal stage in 23 patients. Aspiration (inhaling) or bolus misdirection (''going down the wrong tube'') was seen in 40 of the subjects. Structural abnormalities were found to arrest or delay transit of a barium pill in 17 of the 43 subjects who were able to take the pill. These results show a number of abnormalities in all four stages of swallowing in subjects who had near-fatal choking episodes. Forty-three of the subjects had abnormalities in more than one of the stages. These abnormalities appear to affect control and motility in swallowing rather than being specific obstructions. Radiologic evaluation of patients who have near-fatal choking episodes can be important in diagnosing and correcting abnormalities that affect swallowing and put the patients at increased risk for choking episodes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Diagnosis, Causes of, Esophagus, Asphyxia, Deglutition, Pharynx, Deglutition disorders

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Controlled trials of radiologic contrast media: issues in quality assessment and synthesis

Article Abstract:

Contrast media are materials ingested or injected into patients to facilitate imaging techniques; they help define and delineate the tissues and organs being examined. High-osmolality media (HOM), which tend to attract fluids, have been traditionally used in imaging, but recently low-osmolality media (LOM) have begun to be used more frequently. Because LOM are much more expensive, their use must be justified on some basis, such as the incidence of side effects. It has been suggested that LOM cause fewer side effects than HOM, which may cause nausea, vomiting, and urticaria (hives and severe itching). A study by these authors, reported in the February 1989 issue of Radiology, found no significant difference between HOM and LOM in producing side effects. Brismar et al. re-examined the data and report in the April 1991 issue of Radiology that when LOM were distinguished by ionic properties and data from the various clinical reports were pooled, HOM could be shown to cause significantly more of side effects than nonionic LOM (NIM). These authors appreciate their findings, but take exception on several points. The original study did not differentiate LOM because of the difficulties involved in doing so and the fact that such differentiation was not thought to be important. The group sizes were small, making statistical significance difficult to obtain, but pooling data leads to questionable statistical results when patients and methods of imaging may not be similar. The clinical trials upon which the data were obtained were not well designed, which was part of the focus of the original research. This is a common problem with such trials and future research should emphasize the need for carefully designed clinical trials to facilitate reliable analysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Complications and side effects, Contrast media, Contrast media (Chemicals), Diagnostic imaging, editorial, Iohexol, Nonionic contrast media

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