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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One of the disabilities in patients with cerebral palsy (CP) is dysphagia. To establish the prevalence of dysphagia in a population of children with CP, and to determine if any factors are related to dysphagia, we studied 56 CP patients, 5-21 years, enrolled in a primary school for the disabled. Fifteen patients (27%) had either radiographic or clinical evidence of dysphagia. These 15 patients were compared to the remaining 41 patients without dysphagia. Using data obtained from chart review and interviews with speech pathologists, several factors that contributed to dysphagia were found. These included: bite reflexes, slowness of oral intake, poor trunk control, inability to feed independently, anticonvulsant medication, coughing with meals, choking, and pneumonia. We also noted trends in the following factors: presence of tongue thrusting, presence of drooling, severity of CP, poor head control, severity of mental retardation, seizures, and speech disorders. Factors not related to the presence of dysphagia include: subject age, cause of CP, and type of CP. Early, aggressive work-up and identification in CP patients with the risk factors outlined above can reduce the associated pulmonary complications.
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PMID:Swallowing disorders in a population of children with cerebral palsy. 139 5

An eleven month old girl was admitted to a county hospital because of persistent low grade fever, cough, vomitus and food and oral fluids rejection. A small radiopaque, button sized, round object was seen impacted in the upper esophageal third on X ray examination and later extracted by endoscopy, corresponding to an electric cell, from a father's handwatch, which had been ingested by the baby without knowledge of parents about 30 h before. After 12 h fasting, oral feedings were resumed being apparently well tolerated, but in the following day fever and respiratory distress reappeared, together with drooling, cianosis, abdominal distention and pale skin. Patient was transferred to a regional hospital where extensive bilateral pneumonia and anemia were documented. Gastric drainage via nasogastric tube, antibiotic treatment, blood transfusion and oxygen therapy were given from admission, but she died within a few hours. At necropsy a 3 per 2.5 cm diameter orifice of sharp borders was seen in the upper third of the esophagus, communicating to tracheal lumen through its upper six cartilages. Extensive, severe, bilateral pneumonia was confirmed. When this kind of electric cells become impacted into the esophagus, wall necrosis may occur within 4 h and perforation within 8 to 12 h and can be prevented by immediate endoscopic extraction. Otherwise fistulae should be suspected and patients managed accordingly. Emergency room medical staff must always be aware of this potentially lethal condition and its proper management. Infants should not be permitted to play with such apparently innocent objects as battery operated handwatches.
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PMID:[Tracheoesophageal fistula secondary to ingestion of a button battery]. 184 45

There are three phases of swallowing: oral, where the food is chewed; pharyngeal, where the bolus begins to move downward; and esophageal, where the bolus enters the esophagus. Signs of difficulty in swallowing may include difficulty initiating the swallow, packing food into cheeks, drooling, cough after a swallow or absent or weak cough, or fluid leaking from the nose after swallowing. Take your time when feeding patients and do not wash food down with liquids. Also, remember to position the patient properly and teach both the patient and his family effective feeding techniques.
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PMID:When it's hard to swallow. Feeding techniques for dysphagia management. 232 36

A 3-year-old child weighing 16 kg was given 1/2 of a Centrum Multivitamin tablet. He began choking and gagging and was taken to an emergency department. He was alert and speaking without difficulty but was drooling, gagging, coughing, and unable to swallow. He was transferred to a children's hospital where he continued to drool but had bilaterally clear and equal breath sounds and no stridor, cough, or wheeze. A lateral neck x-ray was negative. The following morning, esophagoscopy revealed tablet material identified as a granular paste at the level of the cricopharyngeus. A large amount of the paste was encountered at the crossing of the aorta where the mucosa was extremely erythematous and edematous. Smaller amounts of the paste were observed until a larger amount was found at the lower esophageal junction. The material was removed with NSS irrigation, suction, and optical peanut forceps. A significant circumferential burn was present. Repeat esophagoscopy 7 days postingestion showed mucosal edema and some scarring. Nine (9) days postingestion the child's diet was normal and he was discharged.
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PMID:Drug induced esophageal injury. 260 Sep 90

To identify which clinical findings serve to differentiate acute epiglottitis from laryngotracheitis and also to evaluate the role of direct inspection of the epiglottis in the evaluation of children initially thought to have laryngotracheitis, we prospectively evaluated 155 children presenting to the emergency room with acute stridor. Three of the findings on physical examination were associated with epiglottitis: absence of spontaneous cough, drooling, and agitation. The diagnosis assigned prior to inspection of the epiglottis was incorrect in two of six patients with epiglottitis and in three of 149 patients with laryngotracheitis. The diagnosis made after inspection was correct in all 155 patients. Minor complications of inspection were seen in seven patients with laryngotracheitis. No complications were seen in the children with epiglottitis. We conclude that drooling, agitation, and absence of cough are predictors of epiglottitis, but clinical findings alone cannot exclude epiglottitis in every child who appears to have laryngotracheitis. When laryngotracheitis is the suspected diagnosis, inspection of the epiglottis by a pediatrician in a hospital emergency room is an effective aid to the evaluation of the child with acute stridor.
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PMID:Differentiation of epiglottitis from laryngotracheitis in the child with stridor. 336 10

Epiglottitis may occur at any age. The typical presentation in the young child and young adult is well known, but the presentation in patients at the extremes of age has not been characterized. At our locale, from 1974 to 1984, 19 children 24 months of age or less and, from 1979 to 1984, 9 adults 50 years of age or greater with epiglottitis were seen in the emergency department. In the infantile group, rapidly progressive interference with swallowing, vocalization, and respiration was encountered in less than half the patients. Symptoms were often prolonged before parents sought attention for their child. No preference was shown for maintenance of the upright position while at rest, as recumbency did not promote stridor or initiate respiratory distress. Respiratory complaints were common and included cough, tachypnea, and retractions. Drooling or retention of pharyngeal secretions was uncommon. The adult population had a history of symptoms that spanned several days. Extreme sore throat, pooling of oral secretions, muffled voice, and elevated temperature were uncommon. Dysphagia and mild respiratory complaints were frequent. Upper airway obstruction did occur. At both extremes of age, exceptions to the classic clinical pattern of epiglottitis occurred with significant frequency. Despite this, diagnosis and management in the emergency department were appropriate in most cases.
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PMID:Epiglottitis at the extremes of age. 337 97

Fifteen incidents of infectious bovine rhinotracheitis (IBR) were studied in herds distributed widely throughout northern Britain. Fattening beef animals (10 outbreaks), dairy cattle (four outbreaks) and suckler beef cows (one outbreak) were affected and all bar one incident occurred in housed cattle during the winter. The first signs of illness noticed were a reduced appetite, dullness, coughing and oculonasal discharge. In 13 of the incidents they were observed in cattle purchased from a market within the previous four weeks. In every outbreak, affected animals developed a serous nasal discharge which became purulent in severe cases. In the early stages the nasal mucosa was congested but later yellow-brown diphtheritic plaques developed. In such animals halitosis was always detected. Soft coughing was frequently heard but pneumonia was rarely confirmed ante mortem. Conjunctivitis and ocular discharge were a major finding in 13 incidents and, in severely affected cases, conjunctival oedema was seen. The drooling of saliva was noticed in 14 incidents but congestion of the oral mucous membranes was the only abnormality found on examination of the oral cavity. Diarrhoea was a consistent feature in one outbreak. As a result of contracting this disease beef cattle failed to put on weight for a period of one to eight weeks and the milk yield of lactating dairy cattle decreased markedly. The morbidity rate was high, being more than 90 per cent in 10 incidents. The mortality rate varied considerably but 7 to 8 per cent of the animals died, or were culled, in three outbreaks. The clinical signs were most severe on intensive units with a high turnover of cattle.
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PMID:Clinical and epidemiological features of 15 incidents of severe infectious bovine rhinotracheitis. 745 95

To identify behaviors associated with the onset of gastroesophageal reflux episodes in infants both systematically and prospectively, each of 10 patients (aged 2 to 32 weeks) was studied during 2 hours of intraluminal esophageal pH probe monitoring, using a split-screen audiovisual recording technique. Videotape analysis of eight infants who had scoreable reflux events revealed six discrete behaviors closely associated temporally (P < .001 to < .05) with the onset of reflux events: "discomfort" (crying or frowning), "emission" (of liquid or gas, i.e., regurgitation, drooling, or burping), yawning, stridor, stretching, and mouthing. Three behaviors (hiccuping, sneezing, and thumb-sucking) were infrequent but were significantly associated with onset of reflux events in one or two patients each. A tenth behavior, coughing or gagging, was significantly associated with onset of reflux events in two patients, but not in the rest, despite relatively frequent occurrence. Exploration of temporal relations between reflux and each behavior suggested that discomfort, emission, mouthing, and cough-gag may have caused reflux episodes, and that all 10 of the behaviors may have been caused by reflux episodes. These findings and a "quiet period" immediately preceding episodes in six of the infants suggest interesting pathophysiologic mechanisms in infants which require further evaluation.
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PMID:Behaviors associated with onset of gastroesophageal reflux episodes in infants. Prospective study using split-screen video and pH probe. 785 24

Neurogenic dysphagia results from sensorimotor impairment of the oral and pharyngeal phases of swallowing due to a neurologic disorder. The symptoms of neurogenic dysphagia include drooling, difficulty initiating swallowing, nasal regurgitation, difficulty managing secretions, choke/cough episodes while feeding, and food sticking in the throat. If unrecognized and untreated, neurogenic dysphagia can lead to dehydration, malnutrition, and respiratory complications. The symptoms of neurogenic dysphagia may be relatively inapparent on account of both compensation for swallowing impairment and diminution of the laryngeal cough reflex due to a variety of factors. Patients with symptoms of oropharyngeal dysphagia should undergo videofluoroscopy of swallowing, which in the case of neurogenic dysphagia typically reveals impairment of oropharyngeal motor performance and/or laryngeal protection. The many causes of neurogenic dysphagia include stroke, head trauma, Parkinson's disease, motor neuron disease and myopathy. Evaluation of the cause of unexplained neurogenic dysphagia should include consultation by a neurologist, magnetic resonance imaging of the brain, blood tests (routine studies plus muscle enzymes, thyroid screening, vitamin B12 and anti-acetylcholine receptor antibodies), electromyography/nerve conduction studies, and, in certain cases, muscle biopsy or cerebrospinal fluid examination. Treatment of neurogenic dysphagia involves treatment of the underlying neurologic disorder (if possible), swallowing therapy (if oral feeding is reasonably safe to attempt) and gastrostomy (if oral feeding is unsafe or inadequate).
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PMID:Dysphagia associated with neurological disorders. 820 77

Patients with developmental disorders, including adolescents, comprise a large and heterogeneous group of individuals who vary in underlying diagnosis and degree of disability. The largest numbers of patients are those with cerebral palsy and with traumatic brain injury. While these conditions themselves do not directly cause airway or parenchymal lung dysfunction, consequences of neuromuscular dysfunction, especially aspiration and ineffective cough, may lead to lung damage. Poor nutritional status, impairment of airway clearance by muscular weakness or incoordination and poor pulmonary reserve (due to chest wall or spine deformity) increase the risk of significant morbidity and mortality from respiratory infections. Individuals who were premature infants or who had prolonged neonatal courses may also have residual chronic lung disease (bronchopulmonary dysplasia) contributing to their pulmonary problems. This review discusses conditions that have adverse effects on the airway and lung (drooling, feeding problems, gastroesophageal reflux, aspiration, spasticity, scoliosis) and some of the consequences of these insults (disordered airway clearance, pneumonia, sleep apnea). Also discussed are issues important to the prevention or amelioration of respiratory difficulties, including preventive care, the effects of exercise, dental hygiene, and surgical intervention.
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PMID:Respiratory problems in the adolescent with developmental delay. 1106 May 58


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