The analysis included consecutive patients treated at the McGill University Health Centre in Montreal from January 2015 through December 2022. Eligibility required curative-intent radiotherapy to 70 Gy with concurrent systemic therapy, a prophylactic percutaneous endoscopic gastrostomy or radiologically inserted gastrostomy placed either before treatment or within the first week of radiotherapy, and complete clinical, dosimetric and follow-up information. Patients receiving palliative treatment, without prophylactic tube placement, or with synchronous distant metastases were excluded. Of 213 eligible patients, nine were removed from the time-to-independence analysis because their records listed tube removal after the date of death, a logical inconsistency that investigators could not resolve. The resulting cohort had a median age of 64 years; 77% were male, 65% had an oropharyngeal primary tumor, 54% had T3–T4 disease and 80% had nodal involvement.

All patients received intensity-modulated radiotherapy or volumetric-modulated arc therapy with concurrent platinum-based chemotherapy, or cetuximab in selected cases. The radiation plans specified 70 Gy to high-risk target volumes, 63 Gy to intermediate-risk volumes and 56 Gy to low-risk volumes, delivered in 33–35 fractions. Investigators extracted mean and maximum doses to organs at risk, including the oral cavity, lips, mandible, parotid glands, larynx and the superior, middle and inferior pharyngeal constrictors. Gastrostomy removal was not governed by a written institutional protocol, but followed a consistent dietitian-led practice: removal was requested once a patient was eating and drinking exclusively by mouth and body weight had remained stable for four weeks.

Among the 204 patients analyzed, 199 had a documented feeding-tube removal and five died before achieving independence. Because death prevents the recovery event from occurring, investigators treated it as a competing risk. They used Kaplan–Meier estimates and multivariable cause-specific Cox regression to model the continuous time from the start of radiotherapy to tube removal, while also fitting a Fine–Gray subdistribution-hazard model as a sensitivity analysis. For overall survival, the researchers used landmark analyses at three, six and 12 months. Patients alive at each landmark were classified by their tube status at that point, and survival from the landmark onward was compared between groups. This approach was intended to avoid immortal-time bias, which can arise when survival is compared using a tube-status category defined only after patients have remained alive long enough to reach that category.

Smoking history was the strongest independent clinical predictor of time to independence. In the main cause-specific model, ever-smokers reached tube independence more slowly than never-smokers, with a hazard ratio of 0.60, a 95% confidence interval of 0.42–0.84 and a p-value of 0.004. Higher baseline Karnofsky Performance Status was associated with faster independence, with a hazard ratio of 1.02 per point, a 95% confidence interval of 1.01–1.04 and a p-value of 0.006. The continuous time-to-event model also identified mean radiation dose to the middle pharyngeal constrictor: each additional Gy was associated with a 2% lower rate of reaching independence, corresponding to a hazard ratio of 0.98 per Gy, a 95% confidence interval of 0.96–1.00 and a p-value of 0.048. Mean oral-cavity dose showed a similar but nonsignificant trend in the primary model, with a hazard ratio of 0.98 per Gy, a 95% confidence interval of 0.95–1.00 and a p-value of 0.067. Doses to the superior constrictor, lips and mandible were not significant.

The Fine–Gray sensitivity model produced consistent effect sizes and statistically significant associations for smoking history, middle-constrictor dose and oral-cavity dose, with p-values of 0.010, 0.011 and 0.019, respectively. A separate six-month analysis gave a less definitive statistical picture. Of 188 patients with gastrostomies who survived beyond six months and had complete predictor data, 49, or 26.1%, remained tube-dependent. In multivariable logistic regression, baseline performance status was the only clearly significant predictor: each additional Karnofsky point was associated with slightly lower odds of persistent dependence at six months, with an odds ratio of 0.96, a 95% confidence interval of 0.92–1.00 and a p-value of 0.037. Smoking history, middle-constrictor dose and oral-cavity dose pointed in the same directions as in the time-to-event analysis but were not significant in this smaller model, which had approximately seven events per predictor.

The landmark survival analysis showed that the timing of persistent dependence mattered. At three months, 106 of 200 patients with complete covariate data were still dependent, but the unadjusted difference in subsequent survival did not reach conventional statistical significance: the hazard ratio for death was 1.71, with a 95% confidence interval of 0.98–3.00 and a p-value of 0.059. At six months, 51 of 194 patients remained dependent. Their subsequent survival was worse, with an unadjusted hazard ratio of 1.78, a 95% confidence interval of 1.01–3.13 and a p-value of 0.048. At 12 months, 27 of 186 patients were still dependent, and the unadjusted hazard ratio for death was 2.53, with a 95% confidence interval of 1.30–4.91 and a p-value of 0.006. These estimates compare the hazard of death after each landmark, not a directly measured probability of dying within a specified period.

Adjustment altered the early results but not the one-year association. After accounting for baseline Karnofsky Performance Status, T classification, N classification, smoking history and age, the three-month hazard ratio was 1.35, with a 95% confidence interval of 0.76–2.42 and a p-value of 0.305. The six-month estimate was similarly attenuated and nonsignificant, with an adjusted hazard ratio of 1.48, a 95% confidence interval of 0.81–2.70 and a p-value of 0.199. At 12 months, however, the adjusted hazard ratio was 2.20, with a 95% confidence interval of 1.05–4.58 and a p-value of 0.036. The pattern suggests that early tube dependence largely reflected baseline illness severity and functional status, while dependence persisting to one year marked a smaller group whose survival difference was not fully explained by the measured factors. The one-year estimate remains imprecise because only 27 patients were still dependent; its events-per-variable ratio was 7.3, below the conventional threshold of about 10.

The observational design cannot determine whether continued tube dependence contributes directly to mortality, and several unmeasured or incompletely measured features could affect the findings. Speech-language pathology referral was left to the treating clinician rather than standardized, and the dataset did not record prophylactic swallowing exercises, rehabilitation intensity or patient compliance. Differences in access to or engagement with swallowing therapy could therefore contribute to the observed associations with smoking and radiation dose. Local, regional and distant recurrence data were also unavailable, leaving open the possibility that persistent or recurrent disease both prolonged tube dependence and independently reduced survival. Other potentially important variables included alcohol intake, sarcopenia and more detailed smoking exposure, such as pack-years and the interval since cessation. The findings may also not generalize beyond patients receiving a uniform prophylactic-gastrostomy protocol at one institution to settings using reactive tube placement, surgery-based treatment or different radiotherapy regimens.

The study identifies potential targets for further investigation without demonstrating that changing them will improve survival. Smoking history and dose to the middle pharyngeal constrictor were independently associated with slower recovery, while the oral-cavity estimate was weaker but directionally consistent. The investigators did not derive a clinical dose threshold from the cohort, and the data do not establish that a particular radiation constraint would shorten tube use. Similarly, the survival analysis identifies one-year dependence as a prognostic marker but does not show that ending tube use earlier would change outcomes. The authors argue for prospective, externally validated studies that also capture swallowing-rehabilitation intensity, recurrence, patient-reported swallowing outcomes and detailed dosimetry, allowing testing of structured smoking-cessation support and dysphagia-optimized radiotherapy planning as potential ways to reduce prolonged feeding-tube dependence.

Subject of Research: Clinical and dosimetric predictors of feeding-tube independence and survival in locally advanced head and neck cancer

Article Title: Predictors of time to feeding-tube independence in locally advanced head and neck cancer

Article References: Salman, S., Heppell, N., Salman, N. D., Shirron, N., Joseph, A., Tsien, C., & Shenouda, G. (2026). Predictors of time to feeding-tube independence in locally advanced head and neck cancer. Frontiers in Oncology, 16, Article 1956034. https://doi.org/10.3389/fonc.2026.1956034

Image Credits: AI Generated

DOI: 10.3389/fonc.2026.1956034

Keywords: head and neck cancer, feeding-tube independence, chemoradiotherapy, dysphagia, gastrostomy, overall survival, smoking history, radiation dosimetry, pharyngeal constrictors, retrospective cohort, Predictors, time

The analysis used a secondary, publicly accessible dataset originally collected at Miyanomori Memorial Hospital in Sapporo, Japan. Patients entered the study between January 2014 and January 2017, had severe dysphagia and a documented history of stroke, and received either gastrostomy feeding or total parenteral nutrition. A multidisciplinary team of physicians, nurses and speech-language pathologists diagnosed dysphagia through clinical assessment and videofluoroscopic swallowing studies. Of 253 patients in the original cohort, 133 had post-stroke dysphagia; one was excluded because the lymphocyte count needed to calculate PNI was missing, leaving 132 complete cases.

The participants had a mean age of 80.7 years and standard deviation of 10.3 years; 78 were women and 54 were men. Overall, 107 patients received gastrostomy and 25 received total parenteral nutrition. Blood samples used to calculate PNI and the C-reactive protein-to-albumin ratio were collected within seven days before nutritional support began. Follow-up started when nutritional support was initiated and continued until death or the study’s conclusion on February 28, 2018. The primary endpoint was all-cause mortality.

PNI was divided into three groups: below 36.7, 36.7–42.8 and 42.8 or higher. During a median follow-up of 714 days, 61 of the 132 patients died. Observed mortality was 65.9% in the lowest PNI group, 54.5% in the middle group and 18.2% in the highest group. After adjustment for age, sex, feeding modality, severe dementia, aspiration pneumonia, ischemic heart disease and Clinical Frailty Scale score, the highest PNI group had a 75% lower mortality hazard than the lowest group (HR 0.25; 95% CI 0.10–0.60; p=0.002).

Median survival was 247 days in the lowest PNI group and 699 days in the middle group, while it had not been reached in the highest group by the maximum follow-up of 1,463 days. An analysis that did not rely on the proportional-hazards assumption showed increasing restricted mean survival time across the PNI groups. At one year, the difference between the highest and lowest groups was 134 days (95% CI 88–178), and at two years it was 333 days (95% CI 236–424). Restricted cubic spline models found no evidence of a nonlinear association, and Firth penalized Cox regression retained the inverse association between PNI and mortality.

For one-year mortality, the time-dependent area under the receiver operating characteristic curve was numerically higher for PNI alone than for the C-reactive protein-to-albumin ratio, or CAR: 0.771 versus 0.712, although the difference was not statistically significant (p=0.16). Adding PNI to a clinical model significantly improved discrimination and reclassification, with an integrated discrimination improvement of 0.055 (95% CI 0.010–0.104; p<0.001) and a continuous net reclassification improvement of 0.471 (95% CI 0.126–0.957). The clinical model included age, sex, feeding modality, severe dementia, aspiration pneumonia, ischemic heart disease and frailty.

Adding PNI improved model fit and discrimination, raising the C-index from 0.800 to 0.821 and reducing the Brier score from 0.160 to 0.145. PNI also added significant information to a model that already contained CAR (likelihood-ratio χ²=8.00; p=0.005). By contrast, CAR did not significantly improve a PNI-containing model (χ²=0.25; p=0.62), indicating that the analysis did not detect additional information from CAR once PNI was included. Bootstrap internal validation with 500 resamples showed minimal optimism, with an apparent C-index of 0.821 and an optimism-corrected C-index of 0.810.

The inverse association between PNI and mortality was consistent in subgroup analyses based on age, sex, gastrostomy status, severe dementia, aspiration pneumonia and ischemic heart disease, with no significant interactions. Results were also similar in sensitivity analyses using an alternative PNI cutoff and after excluding deaths within the first 30 days. The authors noted that albumin and lymphocyte counts are influenced by inflammation, infection, hydration, chronic illness and acute stress, so PNI should be interpreted as an integrative marker rather than a pure measure of nutrition.

The findings are limited by the selected single-center population, which included older Japanese patients with severe dysphagia: 81% received gastrostomy and 86% had a Clinical Frailty Scale score of at least 8. PNI was measured only once, and data on stroke subtype, severity, timing and lesion location were unavailable. Because cerebrovascular disease was recorded only as a binary variable, the analysis could not establish that stroke was the sole cause of dysphagia or exclude competing contributors such as dementia, neurodegeneration or deconditioning. Residual confounding also cannot be ruled out. With 61 deaths relative to the number of covariates, the estimates require cautious interpretation, and the authors state that prospective and external validation are needed before PNI can be considered for risk stratification in this population.

Subject of Research: Association of prognostic nutritional index with mortality in older adults with severe post-stroke dysphagia

Article Title: Association between prognostic nutritional index and mortality in older Japanese patients with severe post-stroke dysphagia requiring nutritional support: a retrospective cohort study

Article References: Wu, W., & Wang, J. (2026). Association between prognostic nutritional index and mortality in older Japanese patients with severe post-stroke dysphagia requiring nutritional support: a retrospective cohort study. Frontiers in Neurology, 17, Article 1902644. https://doi.org/10.3389/fneur.2026.1902644

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1902644

Keywords: prognostic nutritional index, post-stroke dysphagia, mortality, older adults, nutritional support, dysphagia, C-reactive protein, albumin, retrospective cohort, Association, between, prognostic

Researchers analyzed consecutive patients admitted with acute ischemic stroke between January 1, 2019, and June 30, 2025. Eligible patients were at least 18 years old, arrived within seven days of symptom onset and were primarily admitted to the neurology service. Cases were identified from discharge diagnoses and then verified through medical records and neuroimaging. Patients with transient ischemic attack, hemorrhagic stroke, cerebral venous thrombosis, infection already present at admission, or major missing outcome data were excluded. For patients with multiple admissions, the investigators used the first eligible hospitalization to preserve the independence of the observations.

The team defined stroke-associated pneumonia as new-onset pneumonia occurring within seven days of admission. Pneumonia already present on admission was ruled out using chest imaging obtained during the routine stroke workup and the record of treatment and diagnoses. A case required three simultaneous elements: new or progressive infiltrates or consolidation on chest radiography or computed tomography; at least one systemic inflammatory-response criterion, including a temperature of at least 38.0 degrees Celsius or no more than 36.0 degrees Celsius, or a white blood cell count above 10 × 10⁹/L or below 4 × 10⁹/L; and at least one respiratory manifestation, such as new cough, purulent sputum, rales, or room-air oxygen saturation of no more than 90% or an increase in oxygen requirement. Two investigators blinded to outcome data independently assessed suspected cases, and a senior physician resolved disagreements.

Of the 428 patients who developed pneumonia, 55.1% received the diagnosis during the first three hospital days. Day 3 alone accounted for 25.5% of all events, while 13.3% occurred on days 6 and 7 combined. Patients who developed pneumonia had a different clinical profile from those who did not. Their median admission National Institutes of Health Stroke Scale score was 11, compared with 4 among patients without pneumonia, and their median Glasgow Coma Scale score was 14 rather than 15. Dysphagia was present in 54.0% of the pneumonia group but 11.9% of the comparison group. Nasogastric tube insertion within 48 hours occurred in 40.4% of patients with pneumonia and 6.5% of those without it. Cardioembolic stroke was also more frequent among patients with pneumonia, while the pneumonia group was older and had more comorbidity, poorer pre-stroke function, lower albumin and higher inflammatory markers.

Multivariable Cox models identified several factors independently associated with the hazard of pneumonia. Each additional year of age was associated with a 2% higher hazard, with a hazard ratio of 1.02 and 95% confidence interval of 1.01–1.03. A pre-stroke modified Rankin Scale score of 3–5 was associated with a hazard ratio of 1.39, chronic obstructive pulmonary disease with 1.69, and cardioembolic stroke with 1.71 compared with small-artery occlusion. Dysphagia had an adjusted hazard ratio of 2.02, and nasogastric tube insertion within 48 hours had a ratio of 2.31; the 95% confidence intervals were 1.59–2.57 and 1.80–2.97, respectively. The tube-insertion result cannot be interpreted as evidence that tube feeding causes pneumonia. Placement was a clinical decision based on swallowing impairment, neurological severity, impaired consciousness and aspiration risk, so it may reflect severe illness while also forming part of the pathway leading to aspiration.

Restricted cubic splines showed that three continuous measures were not related to pneumonia risk in a simple linear fashion. Higher admission NIHSS scores were associated with progressively greater risk, with the gradient becoming steeper at more severe scores. The neutrophil-to-lymphocyte ratio showed an accelerating association at higher values. Lower serum albumin was associated with increased risk, and the increase appeared particularly pronounced below approximately 35 grams per liter. Tests for departure from linearity were significant for all three measures. These results show why a single effect per unit may inadequately represent the risk across the full clinical range: the modeled relationship changes more sharply within particular ranges of neurological severity, inflammation and albumin concentration.

For the prognostic analysis, the investigators used time-dependent Cox models to account for the fact that pneumonia was acquired during hospitalization rather than being present at admission. Patients were coded as unexposed before pneumonia onset and exposed afterward. This approach was intended to avoid immortal-time bias, which can arise when a later complication is incorrectly treated as present from the start of follow-up. The models adjusted for age, sex, pre-stroke disability, admission NIHSS and Glasgow Coma Scale scores, dysphagia, infarct location, stroke subtype, atrial fibrillation, diabetes, chronic obstructive pulmonary disease, albumin, glucose, thrombolysis, thrombectomy and nasogastric tube insertion. Even with this adjustment, pneumonia remained associated with all three time-to-event outcomes assessed in the overall cohort.

Among survivors, the median hospital stay was 17 days for patients with pneumonia and 9 days for those without it. The adjusted ratio of means was 1.35, with a 95% confidence interval of 1.27–1.44, indicating a 35% relative increase in hospitalization duration associated with pneumonia. At discharge, 64.1% of surviving pneumonia patients had a modified Rankin Scale score of 3–5, compared with 31.7% of survivors without pneumonia. The adjusted odds ratio for poor functional outcome was 1.90, with a 95% confidence interval of 1.43–2.52. For the time-to-event outcomes, the adjusted hazard ratios were 2.34 for in-hospital death, 2.81 for intensive-care transfer and 3.47 for invasive mechanical ventilation; all three confidence intervals excluded one, and all p-values were below 0.001.

Complete-case analyses produced estimates close to those from the primary models, including an adjusted hazard ratio of 2.29 for death among 3,236 patients with complete data. A second sensitivity analysis included only patients hospitalized for at least three days, treated pneumonia within the first three days as a fixed exposure and began follow-up on day 3. In that analysis, pneumonia remained associated with death, intensive-care transfer and mechanical ventilation, with adjusted hazard ratios of 2.18, 2.63 and 3.12, respectively. These checks support the internal robustness of the findings, but several limitations constrain interpretation. The cohort came from one tertiary hospital and may not represent other hospitals or healthcare systems. Diagnosis depended partly on documentation quality, and unmeasured factors such as precise infarct volume and location, sedative use, oral-care intensity and early rehabilitation could contribute to residual confounding. Ventilator-associated pneumonia was not analyzed separately, and follow-up ended at discharge or death rather than extending to 30-day, 90-day or longer-term outcomes.

The timing of the events gives the results practical relevance for acute stroke care. The authors identify the first days of hospitalization as a period when surveillance for pneumonia should be concentrated, especially for patients with severe neurological deficits, impaired swallowing, chronic obstructive pulmonary disease, cardioembolic stroke, elevated inflammation, low albumin or prior disability. They discuss early swallowing assessment, careful selection of feeding pathways, airway-protection measures and nutritional optimization, and they call for prospective multicenter studies with standardized surveillance and follow-up beyond discharge. They also propose trials testing whether interventions directed at modifiable factors, including nutritional status and airway protection, can reduce pneumonia incidence. The cohort does not establish that any particular bundle prevents pneumonia or improves outcomes, and the nasogastric-tube association cannot be used to withhold clinically necessary feeding. Instead, it identifies a concentrated early period of risk and quantifies the pneumonia’s independent association with acute-care escalation, prolonged hospitalization and poorer function at discharge.

Subject of Research: Temporal patterns, risk factors and in-hospital prognostic associations of stroke-associated pneumonia after acute ischemic stroke

Article Title: Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact

Article References: Zhang, S., Yan, Q., Wang, Z., Xie, R., Tao, Y., Jin, Y., & Zuo, W. (2026). Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact. Frontiers in Neurology, 17, Article 1841237. https://doi.org/10.3389/fneur.2026.1841237

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1841237

Keywords: stroke-associated pneumonia, acute ischemic stroke, pneumonia incidence, early hospital onset, dysphagia, stroke severity, nonlinear risk factors, in-hospital mortality, intensive care, functional outcome, Stroke-associated, pneumonia

But how good is that advice? A new cross-sectional study published in Frontiers in Digital Health offers the most systematic answer yet, and the verdict is sobering. A team of rehabilitation researchers based in Shanghai and Jinan retrieved 800 candidate videos from the four major Chinese short-video platforms using six keyword combinations pairing dysphagia or swallowing with feeding, diet, or nutrition. After rigorous screening—removing duplicates, irrelevant content, non-Chinese videos, poor-quality recordings, commercial material, and videos with unidentifiable creators—278 videos remained. Each was scored by two qualified rehabilitation therapists using three established instruments: the Global Quality Score (GQS) for overall educational quality, the JAMA Benchmark Criteria for source transparency, and the modified DISCERN (mDISCERN) scale for information reliability.

The results reveal a deep mismatch between what is popular and what is trustworthy. The overall quality of feeding guidance videos was mediocre at best, with a median GQS score of just 2 on a 5-point scale. Professional identity mattered in revealing ways: videos uploaded by healthcare professionals scored significantly higher than those from non-professionals on both source transparency and reliability, with differences reaching statistical significance at P < .001 for both the JAMA and mDISCERN scales. Yet on the GQS measure of perceived overall quality, the gap between professional and amateur content essentially disappeared—a finding suggesting that viewers cannot reliably distinguish sound medical guidance from plausible-looking improvisation.

The study’s granularity exposes how uneven the ecosystem is. Among healthcare uploaders, rehabilitation nurses delivered the strongest overall quality scores, likely because nursing work emphasizes patient education, plain language, and procedural demonstration. Healthcare professionals from related clinical departments achieved the highest reliability ratings, while individual science communicators scored lowest on mDISCERN, reflecting systematic weaknesses in content balance, source citation, and disclosure of uncertainty. Perhaps most striking was the fate of videos posted by people with dysphagia themselves: these clips attracted the highest engagement—a median of 112 likes and 21 comments—but carried the lowest source transparency, with a median JAMA score of just 1 out of 4.

Platform ecosystems proved equally consequential, and the effects were dimension-dependent. Differences in overall quality across platforms were modest; only Bilibili and Kwai differed significantly on GQS. Source transparency showed moderate variation, with Rednote, Douyin, and Bilibili all significantly outperforming Kwai, which imposes weaker requirements on author attribution and credential verification. Reliability showed the starkest divergence of all: Douyin’s videos achieved mDISCERN scores significantly higher than every other platform, with an effect size (ε² = .503) that the authors describe as the most pronounced platform-level difference in the study—likely reflecting Douyin’s creator certification and institutional account mechanisms, which force upfront disclosure of who is speaking.

Beyond quality, the study mapped what the videos actually covered against a ten-domain framework built from clinical guidelines, including recommendations from the American Speech-Language-Hearing Association and the 2023 Chinese guideline for rehabilitation management of swallowing disorders. The coverage map is lopsided in a dangerous way. Food texture adjustment—thickened liquids, appropriate bolus sizes—was the most covered domain at 77 percent, followed by swallowing posture adjustment at 52 percent. These are visually demonstrable, easily replicated techniques, perfectly suited to the short-video format, which explains their popularity.

The safety-critical domains fared far worse. More than 70 percent of videos never mentioned feeding environment adjustment, feeding risk control, oral care, nutritional management, or medication management. Nutritional management appeared in only 21 percent of videos and oral care in 17 percent. Most alarming of all, medication management—the knowledge of which pills can safely be crushed, dissolved, or mixed with food—was covered by a mere 4 percent of the sample. The clinical stakes here are enormous: crushing an extended-release or enteric-coated formulation can trigger dose dumping or drug inactivation, potentially precipitating severe hypotension, respiratory depression, seizures, or death, and medication administration errors are already significantly more common among patients with dysphagia than without.

The researchers also documented a troubling disconnect between virality and veracity. Rehabilitation therapists’ videos were short—a median of 67 seconds—yet earned the most likes and shares, demonstrating that concise, practical professional content can win the attention economy. Conversely, the high-engagement, low-reliability pattern seen in patient-uploaded content echoes earlier findings that interaction traffic and information quality frequently diverge on health topics. The search process itself exposed platform dysfunction: over 58 percent of initially retrieved videos were irrelevant to dysphagia feeding guidance, a failure the authors attribute to algorithmic confusion of medical terms with entertainment content such as eating-challenge videos, keyword semantic drift, and the mismatch between lay search phrases like choking while eating and clinical vocabulary like dysphagia.

The study’s authors are careful about its limits. The sample reflects only what recommendation algorithms surfaced for fresh, history-free accounts in Shanghai over three days in September 2025, and the personalized, dynamic nature of those algorithms makes replication difficult. Cross-platform comparisons of raw engagement counts are complicated by differences in user base size and traffic distribution, and the domain-coverage framework, developed by the team, awaits external validation. The design also captures content, not consequences—causal links between video quality and outcomes such as aspiration pneumonia or unplanned readmissions remain unproven.

Even so, the implications are actionable. The authors call for clinicians to curate and recommend certified video resources as an extension of patient education, for platforms to introduce credential verification, tiered labeling of medically certified accounts, quality-weighted recommendation algorithms, and semantic mapping between everyday and medical search terms, and for the field to adopt multidimensional assessment combining tools like GQS, JAMA, and mDISCERN. The central lesson is one that health communicators have been learning across platforms and diseases: in the short-video era, reach is not reliability, and a confident sixty-second demonstration about something as deceptively simple as a safe swallow can either extend clinical care beyond the hospital wall—or quietly undermine it.

Subject of Research: Quality and reliability of short-video health information on feeding guidance for dysphagia across Chinese social media platforms

Article Title: Quality, source transparency, information reliability, and domain coverage of short video-based information on feeding guidance for people with dysphagia: a cross-sectional study on 4 major Chinese social media platforms

Article References: Chen, J., Xiong, T., Li, Y., Wang, Y., Yang, C., Huang, J., & Fang, F. (2026). Quality, source transparency, information reliability, and domain coverage of short video-based information on feeding guidance for people with dysphagia: a cross-sectional study on 4 major Chinese social media platforms. Frontiers in Digital Health, 8, Article 1919212. https://doi.org/10.3389/fdgth.2026.1919212

Image Credits: AI Generated

DOI: 10.3389/fdgth.2026.1919212

Keywords: dysphagia, feeding guidance, short-video platforms, health information quality, social media, rehabilitation, aspiration pneumonia, medication safety, JAMA benchmark, DISCERN, Douyin, health communication

A new randomized controlled trial published in Supportive Care in Cancer offers some of the clearest evidence to date that a structured, nurse-led program can change that picture. Researchers at the First Affiliated Hospital of Soochow University in Suzhou, China, enrolled 120 brain tumor patients with dysphagia admitted between January and May 2024, and randomly assigned them in stratified fashion to two groups of sixty. The control group received conventional nursing care and standard treatment protocols. The intervention group received a nurse-led multimodal program combining personalized swallowing training, nutritional support, psychological care, and a family-participatory rehabilitation component, designed and dynamically adjusted by a team of nurses, rehabilitation therapists, and dietitians.

The technical logic behind the intervention reflects a growing consensus in neurogenic dysphagia research: no single therapy works in isolation. Personalized swallowing training targets the motor patterns of the oropharyngeal phase, strengthening muscle groups and retraining the timing of the swallow reflex. Nutritional support addresses the caloric deficit and dehydration that accompany impaired swallowing, which otherwise accelerate physical decline and reduce the capacity for rehabilitation. Psychological care tackles the anxiety and social isolation that often make patients avoid eating altogether, while family participation extends therapy into daily life beyond the hospital ward, where most recovery actually happens.

To measure outcomes, the researchers used validated bedside assessments. The Kubota drinking test, in which patients swallow water under observation, screens for aspiration risk and functional swallowing capacity. Saito’s swallowing function grading provides a structured clinical classification of swallowing impairment severity. Quality of life instruments captured the broader patient experience. Before-and-after comparisons within each group were analyzed with paired t-tests or Wilcoxon signed-rank tests, while between-group differences were assessed using independent samples t-tests or the Mann-Whitney U test, depending on data distribution.

The results were unambiguous. Both groups improved over time, which is expected as patients recover and receive baseline care, but the intervention group improved significantly more. Scores on the Kubota drinking test, Saito’s grading, and the quality of life measures all showed statistically significant enhancement in the intervention group compared with the control group, with P values below 0.05. Within both groups, scores improved progressively as the intervention continued, but the trajectory of improvement was steeper for patients receiving the nurse-led program.

What makes this finding clinically important is the role assigned to nurses. In many hospitals, swallowing rehabilitation is initiated by speech-language pathologists or rehabilitation physicians, with nurses relegated to monitoring and medication delivery. This study flips that hierarchy, positioning nurses as the architects and coordinators of a multidisciplinary plan. Because nurses have the most continuous contact with patients, they are ideally placed to detect subtle changes in swallowing performance, adjust feeding strategies in real time, reinforce training exercises between formal therapy sessions, and coach family members who will support the patient after discharge.

The trial was prospectively registered at the Chinese Clinical Trial Registry on January 5, 2024, under registration number ChiCTR240001265, and was conducted in accordance with the Declaration of Helsinki with formal exemption approval from the hospital’s ethics committee. All participants provided written informed consent. The authors, Yaping Lu and Haifeng Wu of the Department of Neurosurgery, report no competing interests, and the study received no dedicated funding.

The broader context strengthens the case for this approach. Previous research has documented that dysphagia in brain tumor patients differs from post-stroke dysphagia in important ways, often involving tumor location in the posterior fossa, surgical sequelae, and the cumulative effects of radiation and chemotherapy on neural tissue. Studies of inpatient rehabilitation have shown that swallowing outcomes in this group can be meaningful but require sustained, coordinated effort. Meanwhile, a 2025 scoping review of rehabilitation nursing for brain tumor patients highlighted how fragmented care remains, and separate surveys from Saudi Arabia and low- and middle-income countries have revealed persistent gaps in nurses’ knowledge and practices around dysphagia screening and management.

Multimodal interventions have already shown promise in adjacent fields. A multi-center randomized controlled trial published in the International Journal of Nursing Studies in 2024 demonstrated that nurse-delivered stepwise swallowing training improved dysphagia in patients with Alzheimer’s disease. Individualized nutritional support has produced significant benefits in stroke patients with oropharyngeal dysphagia, and enhanced dysphagia assessment combined with dietary guidance has improved outcomes in post-stroke populations. The Soochow study extends this evidence base into neuro-oncology, a setting where rehabilitation needs have historically been overshadowed by the urgency of tumor treatment itself.

The authors conclude that nurse-led multimodal intervention is significantly effective in improving both swallowing function and quality of life in brain tumor patients, providing comprehensive rehabilitation support through multidisciplinary collaboration and personalized care, and carrying genuine clinical promotion value. For a patient population facing enormous therapeutic challenges, the message is quietly radical: recovery of something as fundamental as eating does not have to wait for a cure. With trained nurses orchestrating swallowing therapy, nutrition, psychological support, and family involvement, patients can reclaim a measure of dignity and health even in the midst of serious illness. As health systems worldwide grapple with growing neuro-oncology caseloads, this study suggests that one of the most effective tools may already be on the ward, wearing scrubs.

Subject of Research: Nurse-led multimodal rehabilitation of dysphagia in brain tumor patients

Article Title: Assessment of the role and effectiveness of nurse-led multimodal intervention in the rehabilitation of dysphagia in patients with brain tumors

Article References: Lu, Y., & Wu, H. (2026). Assessment of the role and effectiveness of nurse-led multimodal intervention in the rehabilitation of dysphagia in patients with brain tumors. Supportive Care in Cancer, 34(10), Article 953. https://doi.org/10.1007/s00520-026-11203-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11203-x

Keywords: brain tumor, dysphagia, swallowing rehabilitation, nurse-led intervention, randomized controlled trial, multimodal intervention, quality of life, nutritional support, neurogenic dysphagia, supportive cancer care, rehabilitation nursing, multidisciplinary care

The scale of the study is what sets it apart. Between June 2021 and May 2025, the research team screened 1,093 patients admitted to stroke units at four Swedish hospitals: Umeå University Hospital, a tertiary care centre serving northern Sweden, along with Danderyd Hospital, Stockholm South General Hospital, and Kungälv Hospital. The cohort included 468 women, or 42.8 percent of participants, and had a median age of 75 years. By recruiting consecutive admissions rather than selected cases, the investigators minimised the selection bias that has plagued earlier studies, which often excluded the sickest patients—the very people most likely to have swallowing problems.

At the heart of the methodology lies the Gugging Swallowing Screen, known as GUSS, administered in its validated Swedish version by six trained research speech-language pathologists. Unlike simple water-swallow tests, GUSS is a step-wise instrument that evaluates vigilance, saliva management, voluntary cough, and the ability to swallow semi-solid, liquid, and solid boluses in a predefined hierarchical order. Total scores range from 0 to 20, with 20 indicating no dysphagia and progressively lower scores signalling mild, moderate, or severe impairment. The tool has demonstrated excellent sensitivity and specificity against instrumental gold standards such as videofluoroscopic swallowing studies and flexible endoscopic evaluation of swallowing—assessments that would have been impossible to deploy across a cohort of this size.

Even with such careful design, acute stroke medicine poses a practical dilemma: many patients in the first days after a stroke are too drowsy, aphasic, or cognitively impaired to cooperate with formal screening. To avoid excluding them, the researchers applied an ethically approved proxy method—a bedside water-swallowing assessment performed by stroke unit nurses using the Standardized Swallowing Assessment, which correlates strongly with GUSS. In total, 57 percent of patients were assessed directly with GUSS-S, while 43 percent entered the study through the proxy route. The mean time from admission to assessment was 37 hours, well within the 96-hour window that defines the acute phase.

Beyond establishing the headline incidence figure, the study identified which patients are most at risk. In multivariable regression models that adjusted for multiple factors simultaneously, five independent predictors of dysphagia emerged. Dysarthria—slurred or weakened speech resulting from damage to the motor speech network—carried an adjusted odds ratio of 1.85, meaning affected patients were nearly twice as likely to have swallowing impairment. This makes physiological sense: the muscles and neural circuits governing speech and swallowing overlap substantially, so impaired articulation can serve as a visible clinical flag for hidden swallowing dysfunction. Greater stroke severity, measured per point on the National Institutes of Health Stroke Scale, raised the odds by 16 percent with each increment, reflecting the wider disruption of cortical and subcortical swallowing networks as brain injury extends.

The remaining predictors were equally telling. Women faced 39 percent higher odds of dysphagia than men, a finding consistent with some prior research suggesting sex differences in stroke outcomes and swallowing physiology, though the authors note the literature remains mixed. Strokes located infratentorially—below the tentorium, in the brainstem and cerebellum—doubled the odds compared with supratentorial lesions, a result that aligns with decades of neuroanatomical evidence showing that the brainstem houses critical swallowing centres. Older age, modelled with a flexible cubic spline to capture its non-linear relationship with risk, was also independently associated with dysphagia, consistent with age-related decline in the strength and coordination of swallowing musculature. Notably, reperfusion therapies such as thrombolysis and thrombectomy, delivered to a substantial share of patients at the comprehensive stroke centre, were not independently linked to dysphagia once other factors were accounted for.

The consequences of dysphagia proved as consequential as its causes. Patients with swallowing impairment remained in hospital on average 1.64 times longer than those who could swallow normally—a difference that ripples through both individual recovery and healthcare economics. They were more than seven times as likely to require tube feeding, whether via nasogastric, nasoduodenal, nasojejunal, or surgically inserted gastrostomy tubes. Their odds of being discharged anywhere other than home were dramatically elevated: 4.84-fold for nursing homes, 4.69-fold for short-term care facilities, and roughly two to three times higher for transfers to other hospitals or wards. Most sobering of all, in-hospital death was associated with a 16.67-fold increase in odds among patients with dysphagia, even after adjustment for age, stroke severity, sex, and treatment centre.

Pneumonia, the most feared complication of swallowing impairment, told a similar story. When saliva, food, or liquid slips past the vocal folds into the trachea—a process called aspiration—bacteria can seed the lungs and ignite infection. In this cohort, pneumonia developed in 5.1 percent of all patients, but the burden fell unevenly: roughly one in ten patients with dysphagia developed pneumonia, compared with just 2 percent of those with normal swallowing, and dysphagia remained independently associated with the infection after adjustment. The overall pneumonia rate is lower than in many older studies, which the authors attribute partly to modern stroke care, including early mobilisation and routine dysphagia screening—practices that previous research has shown to reduce pneumonia rates when performed by trained staff.

Placed in historical context, the findings carry a subtle but important message. More than two decades ago, a landmark review by Martino and colleagues reported dysphagia rates of 37 to 45 percent when screening-based assessments were used, and 64 to 78 percent with instrumental methods. Despite revolutionary advances since then—acute reperfusion therapy, early mobilisation, coordinated multidisciplinary stroke unit care—the incidence observed in 2020s Sweden sits within that same screening-based range. This suggests that while stroke survival and acute management have improved enormously, the early burden of swallowing impairment has remained largely unchanged, likely because the underlying neuroanatomy of swallowing is highly individual and lesion-dependent, defying both generalisation and precise prediction of individual outcomes.

The authors are candid about their study’s limitations. Assessors could not be blinded to clinical information, since verifying eligibility required reviewing medical records that contained swallowing-related data, creating a potential for observer bias. Screening tools, however well validated, are less sensitive than instrumental videofluoroscopic or endoscopic examinations, so the true incidence may be somewhat higher. Some variables, including stroke severity scores, reperfusion data, and body-mass index, were missing for portions of the cohort, and tube feeding was identified solely through procedure codes, which may have led to underestimation. Yet sensitivity analyses using penalised regression produced consistent results, and the sheer scale, prospective design, and multicentre scope of the work make it one of the most robust estimates available. For clinicians, the takeaway is unambiguous: dysphagia affects more than a third of acute stroke patients, it announces itself through recognisable warning signs such as dysarthria and severe neurological deficits, and it demands early identification and targeted management to shorten hospital stays, prevent pneumonia, and keep patients on the path back home.

Subject of Research: Incidence and predictors of post-stroke dysphagia in acute stroke patients

Article Title: Incidence of dysphagia in acute stroke patients—a prospective multicentre cohort study

Article References: Selg, J., Mirkoska, V., Holmlund, T., Jäghagen, L., Wester, P., & Hägglund, P. (2026). Incidence of dysphagia in acute stroke patients—a prospective multicentre cohort study. Frontiers in Neurology, 17, Article 1886254. https://doi.org/10.3389/fneur.2026.1886254

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1886254

Keywords: stroke, dysphagia, swallowing disorders, aspiration, pneumonia, GUSS screening, speech-language pathology, stroke severity, NIHSS, dysarthria, brainstem stroke, cohort study

The review, led by Jiayi Xia and Song Pei with colleagues at Shanghai Second Rehabilitation Hospital, Renhe Hospital of Baoshan District, and Huashan Hospital of Fudan University, synthesizes peer-reviewed human studies on airflow-restoration strategies in tracheostomized adults with acquired neurological disease. Its central insight is physiological rather than technological. In a healthy person, swallowing is embedded in breathing: a bolus is transferred during a brief respiratory pause, typically followed by expiration that helps sweep residual material away from the airway. Subglottic pressure—the pressure below the vocal folds—provides both a mechanical force and a sensory signal during pharyngeal swallowing. An open tracheostomy circuit disrupts this loop entirely: expiration bypasses the upper airway, laryngopharyngeal airflow and subglottic pressure drop, and the sensory information that normally organizes swallowing and airway protection becomes blunted.

This matters particularly after stroke, where pharyngeal sensory impairment is itself strongly associated with dysphagia severity. The authors propose a four-part model of the aerodigestive sensorimotor loop: pressure generation, laryngopharyngeal sensation, respiratory-swallow coordination, and airway protection. Disruption at any one point amplifies problems elsewhere. Reduced airflow lessens sensory input; fewer spontaneous swallows allow secretions to accumulate; weak cough limits clearance; and repeated suctioning interrupts purposeful practice. In daily care, each failure appears under a different label—aspiration, wet voice, secretion burden, poor cough, or delayed tube removal—making the underlying loop easy to miss.

The review is careful to distinguish several overlapping but non-interchangeable airflow-restoration strategies. Cuff deflation, tube occlusion, and one-way speaking valves all redirect expiratory air through the larynx when the upper airway is patent and ventilation is stable. A small randomized study in patients with acquired brain injury found that two weeks of Passy-Muir valve use improved penetration-aspiration scores, velopharyngeal pressure, upper-esophageal sphincter relaxation duration, and modeled subglottic pressure compared with a control condition. But earlier physiological work showed that cuff deflation and valve placement did not produce uniform changes across all swallowing measures, and a speaking valve cannot compensate for severe pharyngeal weakness, absent laryngeal sensation, unstable respiratory status, or critical upper-airway obstruction.

For patients who cannot yet tolerate cuff deflation, above-cuff vocalization and related methods deliver gas through the subglottic suction port while the cuff remains inflated, directing flow upward across the vocal folds. A systematic review found signals of benefit for communication and, in four studies, swallowing, but the underlying evidence was low quality, dose was inadequately described in most reports, and adverse events were reported in nine studies. The swallowing evidence is small but increasingly relevant: in ten patients with severe brain injury, external subglottic airflow at 3 liters per minute increased spontaneous swallowing during a five-minute observation and reduced the volume of secretions collected above the cuff.

A 2026 randomized crossover study in 20 tracheotomized patients after stroke tested continuous subglottic oxygen at 3, 5, and 7 liters per minute during fiberoptic endoscopic evaluation of swallowing. Penetration-aspiration scores were lower at 5 and 7 liters per minute than during cuff deflation or capping, and pharyngeal residue improved at 5 liters per minute. A separate 2026 randomized clinical trial enrolled 47 patients with post-stroke dysphagia and tracheostomy, finding that a modified, endoscopy-mediated air-pulse program added to standard therapy improved secretion measures, swallowing safety, spontaneous swallowing frequency, pulmonary infection scores, and nutritional indicators more than a conventional air-pulse approach. But the trial was single-center and follow-up was short, and replication is needed.

An unresolved question is whether oxygen is the active ingredient. Earlier studies used medical air, whereas the crossover trial used oxygen. No direct comparison has isolated oxygen concentration from flow, pressure, humidity, temperature, or the sensory effect of gas moving through the larynx. Until such a trial is performed, the authors argue, the intervention is best described as subglottic airflow or gas-pulse stimulation, with oxygen specified only when it was actually delivered. Calling it oxygen therapy implies a mechanism that has not yet been demonstrated.

The review’s most distinctive proposal is that airflow should be used not as an isolated device intervention but as phenotype-guided sensory priming immediately before or during task-specific feeding. The goal is not merely to trigger more swallows but to reconnect sensation with bolus preparation, airway closure, respiratory timing, and clearance. In practice, the priming interval can be short: after airway clearance and a tolerance check, airflow is introduced under the selected condition; the clinician then observes secretion response and spontaneous swallows before moving to saliva management or small, endoscopy-guided bolus trials. Food texture, volume, posture, and cueing are adjusted to the instrumentally defined swallowing pattern. If airway protection deteriorates, the task is stepped back rather than forcing a predetermined dose.

To make this approach reproducible, the authors propose a five-stage pathway from stabilization to decannulation. The first stage establishes respiratory stability, airway patency, secretion burden, and the dominant dysphagia mechanism, using flexible endoscopic evaluation of swallowing (FEES) when feasible. The second stage restores afferent input through the safest tolerated route—cuff deflation and valve use for patients with a patent airway, or carefully controlled above-cuff airflow for those who remain cuff-dependent. The third stage couples the tolerated airflow condition with task-specific swallowing practice, progressing from saliva to measured boluses to meal components. The fourth stage addresses decannulation readiness as a multidimensional decision integrating airway anatomy, secretion burden, cough strength, and capping tolerance, with pragmatic reference values including suctioning no more than twice per eight hours, peak cough flow of at least 160 liters per minute, and maximum expiratory pressure of at least 40 centimeters of water when testing is reliable. The fifth stage maintains gains through the transition to real meals at ward, rehabilitation, and home levels.

The evidence remains promising rather than definitive. Samples are small, patient groups are mixed, device settings are poorly reported, and many outcomes are immediate physiological surrogates rather than clinical events. The authors call for future trials to report gas composition, flow, pressure, pulse timing, humidity, cuff condition, and concurrent feeding tasks, and to prioritize oral intake, pneumonia, and decannulation alongside physiological outcomes. They also suggest modest technology with a clear clinical purpose: neck-worn acoustic sensing has shown the feasibility of monitoring spontaneous swallows after tracheostomy, and future systems could combine airflow, neck sound, or surface electromyography to time a pulse to a respiratory phase or swallowing attempt. Such closed-loop dosing is not ready for routine care, but it offers a testable route from fixed stimulation to responsive rehabilitation. For now, the most defensible clinical approach is careful and staged: define the phenotype, restore airflow through the safest feasible route, pair it with task-specific swallowing, reassess under the condition used for eating, and follow the patient beyond decannulation. The endpoint is not airflow for its own sake; it is a safer return to eating, communication, and life without an unnecessary tube.

Subject of Research: Airflow-based swallowing rehabilitation and decannulation after tracheostomy in acquired neurological disease

Article Title: Airflow-enabled swallowing rehabilitation after tracheostomy in acquired neurological disease: mechanisms, current evidence, and a stage-based clinical pathway

Article References: Xia, J., Pei, S., Qin, H., Lu, Y., Zhou, S., & Bai, Y. (2026). Airflow-enabled swallowing rehabilitation after tracheostomy in acquired neurological disease: mechanisms, current evidence, and a stage-based clinical pathway. Frontiers in Neurology, 17, Article 1982780. https://doi.org/10.3389/fneur.2026.1982780

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1982780

Keywords: tracheostomy, dysphagia, decannulation, subglottic airflow, speaking valve, cuff deflation, FEES, stroke rehabilitation, sensory priming, neurorehabilitation, aspiration pneumonia, oral feeding

The research, conducted at Shanxi Province Cancer Hospital in China, followed 120 patients who underwent radical surgery for laryngeal squamous cell carcinoma between June 2019 and June 2023. Using propensity score matching to balance age, sex, tumor stage, and surgical method, the team compared 60 patients who received systematic combined voice and swallowing rehabilitation against 60 who received routine postoperative care. The rehabilitation program began within 24 to 48 hours after nasogastric tube removal and included graded voice exercises, swallowing training, nutritional management, pain control, and psychological support tailored to each patient.

The scale of the functional deficit after laryngeal cancer surgery is substantial. According to prior research cited in the study, roughly 30 to 50 percent of patients develop dysphagia, experiencing choking during eating and aspiration that raises the risk of malnutrition and aspiration pneumonia. More than 60 percent suffer long-term voice abnormalities such as hoarseness and vocal fatigue, which can drive communication limitations and social avoidance. Laryngeal squamous cell carcinoma accounts for about 95 percent of laryngeal malignancies and roughly 5 percent of all malignancies, making these functional consequences a major public health concern.

The researchers measured outcomes using validated instruments at 6, 12, and 24 months after surgery. Voice function was assessed with the Chinese version of the Voice Handicap Index, a 30-item questionnaire spanning functional, physical, and emotional domains with scores from 0 to 120. Swallowing was evaluated with the Standardized Swallowing Assessment, which scores clinical examination and water-swallow tests from 18 to 46, with higher scores indicating worse function. Dysphagia risk was screened with the Eating Assessment Tool-10, and quality of life was measured with the EuroQol five-dimension questionnaire, converted to a utility index where 1 represents full health.

The results were striking. At 12 months postoperatively, the rehabilitation group scored 35.25 on the Voice Handicap Index compared with 58.70 in the routine care group, a difference that was highly statistically significant. Dysphagia incidence was 10 percent in the rehabilitation group versus 30 percent in the control group. The EQ-5D utility index reached 0.82 in the rehabilitation group compared with 0.68 in the routine care group, and total complication rates fell from 26.67 percent to 11.67 percent. Patient satisfaction scores were also markedly higher, at 87.80 versus 72.21 on a 100-point scale.

Crucially, multivariate regression analysis confirmed that rehabilitation training remained an independent protective factor even after adjusting for age, sex, TNM stage, surgical method, and postoperative radiotherapy. The training was associated with better voice function, better swallowing function, improved quality of life, an 82.4 percent reduction in the risk of long-term dysphagia, and a significantly lower overall risk of complications. Higher TNM stage and total laryngectomy emerged as independent risk factors for poorer functional recovery, while radiotherapy was linked to worse voice and swallowing scores but did not significantly increase dysphagia or complication risk.

The mechanisms behind these gains are rooted in neuromuscular reorganization. Breathing support training, such as abdominal breathing, enhances subglottic pressure and improves vocal efficiency, partially compensating for postoperative changes in vocal fold structure. Laryngeal relaxation techniques reduce compensatory muscle hypertonicity and vocal fatigue, while tracheoesophageal puncture training reconstructs the vibration source for patients after total laryngectomy. On the swallowing side, resistance exercises such as tongue protrusion against resistance strengthen the hyolaryngeal complex, the Mendelsohn maneuver prolongs laryngeal elevation to open the upper esophageal sphincter, and sensory stimulation may lower the swallowing reflex threshold by modulating cortical excitability.

The complication findings carry particular clinical weight. Swallowing posture training, including chin tuck swallowing at 15 to 30 degrees, physically elevates the epiglottis to protect the airway and reduce the risk of pulmonary infection. Dynamic nutritional management based on swallowing assessments interrupts the vicious cycle in which swallowing disorder leads to malnutrition, weakened immunity, and infection. The authors argue that this multimodal approach, addressing voice, swallowing, nutrition, and psychological support together, reflects the World Health Organization’s three-dimensional model of functional, psychological, and social rehabilitation.

Quality of life data tell perhaps the most compelling story. By 12 and 24 months, the EQ-5D utility index in the rehabilitation group had surpassed preoperative levels, with the 24-month value of 0.84 approaching that of the general population. The authors suggest this reflects a virtuous cycle of functional recovery, psychological adaptation, and social participation, in which restored communication and safe eating break the spiral of social withdrawal and anxiety that often follows laryngeal surgery.

The study’s authors caution that the retrospective, single-center design and modest sample size limit the strength of the conclusions, and that physiological differences between partial and total laryngectomy patients complicate direct score comparisons. They call for multicenter randomized controlled trials with larger samples and subgroup analyses stratified by surgical type. Still, the findings offer real-world evidence that structured, early, and sustained voice and swallowing rehabilitation could become a standard component of postoperative care pathways for laryngeal cancer patients, potentially transforming long-term survival into genuinely functional survival.

Subject of Research: Long-term effects of combined voice and swallowing rehabilitation on functional recovery after laryngeal cancer surgery

Article Title: Long-term effects of voice training and swallowing function exercises on postoperative functional recovery in laryngeal cancer patients: a retrospective cohort study

Article References: Liu, J., Fan, G., & Li, W. (2026). Long-term effects of voice training and swallowing function exercises on postoperative functional recovery in laryngeal cancer patients: a retrospective cohort study. Supportive Care in Cancer, 34(11), Article 1112. https://doi.org/10.1007/s00520-026-11302-9

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11302-9

Keywords: laryngeal cancer, voice training, swallowing rehabilitation, dysphagia, quality of life, postoperative complications, laryngectomy, Voice Handicap Index, rehabilitation, head and neck surgery, supportive care, retrospective cohort study

Researchers from Ankara University, Dokuz Eylul University, and affiliated Turkish hospitals set out to map which parameters gathered during a Comprehensive Geriatric Assessment best predict dysphagia risk in people still living at home. They deliberately excluded participants with severe cognitive impairment, Parkinson’s disease, nursing home residence, and acute medical conditions, narrowing the lens onto a population that often slips through the cracks: older adults who appear reasonably well but may already be on a dangerous trajectory.

Dysphagia risk was screened with the Eating Assessment Tool-10, a validated ten-item questionnaire in which a score of 3 or more signals elevated risk. Probable sarcopenia was defined using the 2019 criteria of the European Working Group on Sarcopenia in Older People, which rely on low muscle strength — typically measured by handgrip dynamometry — or reduced physical performance, such as chair-stand testing, before full body-composition imaging confirms the diagnosis. Depressive symptoms were quantified with the 15-item Geriatric Depression Scale, and nutritional status was scored with the Mini Nutritional Assessment–Short Form.

When the team fed these variables into a multivariate logistic regression model, three signals stood out with striking clarity. Probable sarcopenia more than doubled the odds of dysphagia risk, carrying an odds ratio of 2.654 with a 95 percent confidence interval spanning 1.184 to 5.947 and a p-value of 0.018. Each additional point on the Geriatric Depression Scale raised the odds by roughly 15.5 percent, with an odds ratio of 1.155 (95 percent CI: 1.063 to 1.255, p = 0.001), meaning that mood and swallowing risk rose together in a steady, dose-dependent fashion.

Nutrition worked in the opposite direction. Treated as a continuous variable, each one-point improvement in the Mini Nutritional Assessment–Short Form score cut the odds of dysphagia risk by nearly a third, with an odds ratio of 0.684 (95 percent CI: 0.521 to 0.897, p = 0.006). In practical terms, better-nourished older adults were substantially more likely to swallow safely than their undernourished peers, independent of their muscle status and mood.

The biological logic linking these findings is plausible. Swallowing is a motor act orchestrated by more than thirty pairs of muscles in the mouth, pharynx, and larynx, and the same age-related loss of skeletal muscle mass and strength that defines sarcopenia does not spare the swallowing apparatus. When handgrip weakens and chair stands slow, the pharyngeal muscles that propel a bolus of food past the airway may be weakening in parallel, leaving residue in the throat and opening the door to silent aspiration.

Depression plausibly compounds the problem through several routes. Low mood blunts appetite, slows eating, and reduces the motivation to chew thoroughly or maintain hydration, while certain antidepressant medications can dry the mouth and impair bolus formation. Depression is also intertwined with sarcopenia and malnutrition in a self-reinforcing loop: sadness saps the drive to cook and eat, poor intake erodes muscle, weaker muscles curtail activity and social engagement, and the resulting isolation deepens the mood disorder. The present study cannot untangle causality in this loop, but it demonstrates that depressive symptoms flag swallowing risk even after accounting for other clinical variables.

Nutrition’s protective effect fits the same physiological framework. Adequate protein and energy intake preserve not only limb and respiratory muscle but also the buccal and pharyngeal musculature, keep saliva production healthier, and maintain the connective tissue resilience that protects the airway during swallowing. The Mini Nutritional Assessment–Short Form itself captures appetite, weight loss, mobility, and neuropsychological problems, so a high score reflects an older adult whose overall physiological reserve remains intact.

What makes the study clinically significant is its setting and its preventive framing. Dysphagia in older adults is often detected only after a choking episode or a bout of aspiration pneumonia, by which time the complications have already taken hold. By screening community-dwelling outpatients with a simple questionnaire, the researchers show that risk is identifiable upstream, in a routine geriatric clinic, using tools that require no imaging, endoscopy, or specialist referral. The EAT-10 takes minutes to complete; handgrip strength, the GDS-15, and the MNA-SF are equally quick and cheap.

The authors conclude that optimizing muscle strength, mood, and nutritional status before dysphagia and its complications develop is essential for maintaining swallowing safety in the outpatient setting. For clinicians, the message is to treat a positive sarcopenia screen, an elevated depression score, or a slipping MNA-SF result as prompts to ask about swallowing. For older adults and their families, the takeaway is more visceral: keeping muscles strong, moods lifted, and plates well filled may be among the most effective ways to keep every swallow safe.

Subject of Research: Independent predictors of dysphagia risk, including sarcopenia, depression, and nutritional status, in community-dwelling older adults

Article Title: Probable sarcopenia, depressive symptoms, and nutritional status as independent predictors of dysphagia risk in community-dwelling older adults

Article References: Atmis, V., Dost, F. S., Gumuscubuk, O., Yesin, H., Güngör, A. A., & Isik, A. T. (2026). Probable sarcopenia, depressive symptoms, and nutritional status as independent predictors of dysphagia risk in community-dwelling older adults. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08456-w

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08456-w

Keywords: dysphagia, sarcopenia, depression, nutrition, older adults, geriatrics, EAT-10, swallowing disorders, aspiration pneumonia, comprehensive geriatric assessment, BMC Geriatrics, malnutrition

The research, published in Frontiers in Physiology, was conducted by a multidisciplinary team spanning the departments of physiology, geriatric medicine, internal medicine, and medical gastroenterology at the gastrointestinal motility laboratory of a tertiary care center in western India. Led by Deepanjan Dey and colleagues, the study enrolled 176 consecutive patients aged over 65 years who presented with esophageal dysphagia. The investigators deliberately excluded patients with structural lesions, mixed oropharyngeal dysphagia, recent proton pump inhibitor use, systemic sclerosis, and those with severe functional dependence as measured by the Katz Activities of Daily Living index. This careful selection process was designed to isolate esophageal motility as the primary variable of interest, free from confounding by reflux-related motility changes or severe functional impairment.

Each patient underwent high-resolution manometry, the current gold standard for assessing esophageal motor function. The technique involves passing a catheter equipped with 16 channels through the esophagus to measure pressure at multiple points simultaneously, generating detailed esophageal pressure topography maps. Patients fasted for at least eight hours before the procedure, which was performed in the morning by the same gastrointestinal physiologist using a water-perfused manometry system. Standardized 5-milliliter water swallows were administered in the supine and upright positions, and the resulting swallows were classified according to the Chicago Classification version 4.0, the internationally recognized diagnostic framework for esophageal motility disorders.

The findings were striking. Normal high-resolution manometry findings were present in 57 of the 176 patients, representing 32.4 percent of the cohort. This means that nearly one-third of symptomatic older adults complaining of difficulty swallowing had entirely normal contraction metrics when objectively tested. Among those with definable esophageal motility disorders, achalasia was the most common finding, affecting 44 patients or 25 percent of the cohort, followed closely by absent contractility in 36 patients or 20.5 percent. Fragmented peristalsis accounted for 15.9 percent, while ineffective esophageal motility was the rarest disorder, affecting only 4.55 percent of elderly patients. Notably, no patient in the study showed evidence of distal esophageal spasm or jackhammer esophagus, the hypercontractile disorders that are sometimes seen in younger populations.

Within the achalasia subgroup, type II achalasia predominated, accounting for 31 of the 44 cases, or 70.45 percent of all achalasia diagnoses. Type I achalasia was found in 9 patients and type III in 4 patients. This distribution is particularly interesting when compared to a study conducted in the same demographic area but in adults aged 18 to 60 years, where type II achalasia represented only 43.9 percent of cases and type III represented 24.4 percent. In the geriatric cohort, type II achalasia was almost three times more common and type III was nearly two and a half times less frequent than in the younger population from the same region of western India. This suggests that the subtype distribution of achalasia shifts with age, an observation that could have important implications for treatment selection, since different achalasia subtypes respond differently to pneumatic dilatation and surgical myotomy.

The manometric metrics themselves revealed meaningful differences between patients with normal findings and those with motility disorders. Median basal lower esophageal sphincter pressure was 15.3 millimeters of mercury in the normal group compared with 20.5 millimeters of mercury in the disorder group. Integrated relaxation pressure, a key metric reflecting how well the esophagogastric junction relaxes during swallowing, was 6.0 millimeters of mercury in the normal group versus 11.0 millimeters of mercury in those with disorders. Distal contractile integral, which quantifies contraction vigor, was also lower in the disorder group. These values suggest that patients with normal manometry findings had adequate esophagogastric junction relaxation during normal swallows, and that the lower esophageal sphincter pressures in this geriatric cohort were lower than those typically reported in younger healthy adults.

On multivariable logistic regression analysis, two independent predictors of esophageal motility disorders emerged. Male sex carried an odds ratio of 1.92, meaning men were nearly twice as likely as women to have a definable motility disorder. The younger geriatric age band of 66 to 70 years carried an odds ratio of 2.07 compared with patients over 75 years, meaning the youngest geriatric patients were also more likely to have abnormal findings. By contrast, Katz Activities of Daily Living scores and symptom duration were not significantly associated with abnormal manometry. Correlations between chronological age and continuous manometric metrics were uniformly weak, with Pearson correlation coefficients all falling below 0.3. This finding is particularly important because it suggests that ageing per se does not produce statistically significant changes in the measured manometric parameters, undermining the notion that dysphagia in the elderly is simply a manometric expression of normal ageing.

The distribution of normal versus abnormal findings across the three geriatric age subgroups was unexpectedly non-linear. Among patients aged 66 to 70 years, 38.33 percent had normal manometry findings. This proportion increased to 66.67 percent in the 71 to 75 years group, then declined to 46.15 percent in those over 75 years. The pattern is therefore heterogeneous rather than steadily increasing with age, suggesting that factors beyond chronological age, such as symptom perception, referral patterns, or underlying pathophysiology, may vary across geriatric bands. An interesting gender observation was that normal manometry findings were twice as common among elderly women as among elderly men, despite nearly equal gender-wise referrals. The authors suggest that esophageal hypervigilance, a phenomenon wherein individuals pay excessive attention to esophageal sensations, might partially explain this disparity, although the data could not establish causality.

The study has important implications for clinical practice. Because available manometry systems measure only the contraction characteristics of the esophagus, they capture only part of the entire deglutition process. The esophageal body does not have a resting tone, so relaxation or distension-related mechanisms cannot be assessed by conventional manometry. This means that some patients with dysphagia and normal contraction metrics may have distension-related issues that explain their symptoms. The authors recommend prospective multimodal studies using techniques such as functional luminal imaging probe and impedance manometry to evaluate noncontractile mechanisms and refine referral algorithms. They also acknowledge limitations including single-center data, the use of water-perfused rather than solid-state catheters, and the absence of measures assessing frailty, sarcopenia, muscle strength, or nutritional status, which may be more closely associated with swallowing dysfunction than chronological age.

Ultimately, this relatively large geriatric manometry series provides novel regional data with a clear clinical message. Dysphagia in older patients should not be reflexively attributed to ageing. Early, structured evaluation with high-resolution manometry can identify treatable disorders such as achalasia and absent contractility, which accounted for most pathologic findings in this cohort. For primary care clinicians and gastroenterologists deciding whether to pursue manometry, complementary physiologic testing, or empiric management, the study provides actionable evidence that objective functional testing should be pursued rather than assuming that swallowing difficulty in the elderly is an inevitable consequence of growing older. The findings emphasize that appropriate referral can identify treatable conditions, improving outcomes for a vulnerable population at risk of serious complications from undiagnosed esophageal motility disorders.

Subject of Research: High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors

Article Title: High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors

Article References: Dey, D., Manral, R., Manrai, M., Jayapalan, A., Behal, P., & Singh, S. K. (2026). High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors. Frontiers in Physiology, 17, Article 1961993. https://doi.org/10.3389/fphys.2026.1961993

Image Credits: AI Generated

DOI: 10.3389/fphys.2026.1961993

Keywords: dysphagia, high-resolution manometry, achalasia, esophageal motility, geriatric medicine, Chicago Classification, High-resolution, manometry, elderly, patterns, functional, subtypes