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Effects of Reduced Saliva Production on Swallowing in Patients with Sjogren’s Syndrome

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Abstract

This study aimed to further characterize the nature of swallowing dysfunction in patients with Sjogren’s syndrome (SS). Subjects filled out a perception of swallow function form. Measures of stimulated salivary flow rate were also taken, and videofluoroscopic evaluation of swallowing was completed. The amount of saliva produced by patients with SS was significantly less than that produced by normal age-matched controls, and these patients perceived their swallowing to be impaired. Few statistically significant differences were found between the SS group and normal age-matched controls on temporal measures of swallowing, and 96% of swallows in the SS group were judged to be functional. There was no correlation between perception of swallowing and amount of saliva produced. No strong correlations were found between temporal measures of swallowing and salivary flow rate. Results indicated that patients with SS tend to perceive their swallowing to be worse than physiologic swallowing measures indicate. The decreased saliva production in these patients does not appear to be the cause of their perceived swallowing difficulty but may affect their sensory judgment of swallow function. Future studies will focus on how quality of saliva affects swallowing in these patients.

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References

  1. Levine RS. Saliva: 3. Xerostomia—aetiology and management. Dental Update. 1989;16:197–201.

    PubMed  CAS  Google Scholar 

  2. Navazesh M, Ship I. Xerostomia: diagnosis and treatment. Am J Otolaryngol. 1983;4(4):283–92.

    Article  PubMed  CAS  Google Scholar 

  3. Wolowski A, Runte C, Helms S. Oral dryness: subjective perceptions and objective causes. J Am Geriatr Soc. 2003;51(11):1678–9.

    Article  PubMed  Google Scholar 

  4. Won S, Kho H, Kim Y, Chung S, Lee S. Analysis of residual saliva and minor salivary gland secretions. Arch Oral Biol. 2001;46(7):619–24.

    Article  PubMed  CAS  Google Scholar 

  5. Schubert MM, Izutsu KK. Iatrogenic causes of salivary gland dysfunction. J Dent Res. 1987;66:680–8.

    PubMed  Google Scholar 

  6. Mossman KL, Scheer AC. Complications of radiotherapy of head and neck cancer. Ear Nose Throat J. 1977;56(3):145–9.

    PubMed  CAS  Google Scholar 

  7. Lazarus C. Effects of radiation therapy and voluntary maneuvers on swallow functioning in head and neck cancer patients. Clin Commun Disord. 1993;3(4):11–20.

    PubMed  CAS  Google Scholar 

  8. Pauloski B, Logemann JA, Rademaker AW, McConnel FM, Heiser MA, Cardinale S, Shedd D, Lewin J, Baker SR, Graner D, Cook B, Milianti F, Collins S, Baker T. Speech and swallowing function after anterior tongue and floor of mouth resection with distal flap reconstruction. J Speech Lang Hear Res. 1993;36(2):267–76.

    CAS  Google Scholar 

  9. Lazarus C, Logemann JA, Kahrilas PJ, Mittal BB. Swallow recovery in an oral cancer patient following surgery, radiotherapy, and hyperthermia. Head Neck. 1994;16:259–65.

    Article  PubMed  CAS  Google Scholar 

  10. Pauloski B, Logemann JA, Rademaker AW, McConnel F, Stein D, Beery Q, Johnson J, Heiser MA, Cardinale S, Shedd D, Graner D, Cook B, Milianti F, Collins S, Baker T. Speech and swallowing function after oral and oropharyngeal resections: one-year follow-up. Head Neck. 1994;16:313–22.

    Article  PubMed  CAS  Google Scholar 

  11. Rhodus N, Colby S, Moller K, Bereuter J. Quantitative assessment of dysphagia in patients with primary and secondary Sjogren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 1995;79:305–10.

    Article  CAS  Google Scholar 

  12. Rhodus N, Moller K. Dysphagia in patients with three different etiologies of salivary gland dysfunction. Ear Nose Throat J 1995;74 (1):39–42, 45–48.

    Google Scholar 

  13. Lazarus CL, Logemann JA, Pauloski BR, Colangelo LA, Kahrilas PJ, Mittal BB, Pierce M. Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy. Laryngoscope. 1996;106:1157–66.

    Article  PubMed  CAS  Google Scholar 

  14. Hamlet S, Faull J, Klein B, Aref A, Fontanesi J, Stachler R, Shamsa F, Jones L, Simpson M. Mastication and swallowing in patients with postirradiation xerostomia. Int J Radiat Oncol Biol Phys. 1997;37(4):789–96.

    Article  PubMed  CAS  Google Scholar 

  15. Logemann J, Pauloski BR, Rademaker AW, Colangelo LA. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19:535–40.

    Article  PubMed  CAS  Google Scholar 

  16. Newman LA, Vieira F, Schwiezer V, Samant S, Murry T, Woodson G, Kumar P, Robbins KT. Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 1998;124(5):589–92.

    PubMed  CAS  Google Scholar 

  17. Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg. 1998;118(5):616–24.

    PubMed  CAS  Google Scholar 

  18. Kotz T, Abraham S, Beitler JJ, Wadler S, Smith RV. Pharyngeal transport dysfunction consequent to an organ-sparing protocol. Otolaryngol Head Neck Surg. 1999;125(4):410–3.

    CAS  Google Scholar 

  19. Kendall KA, Leonard RJ, McKenzie SW, Jones CU. Timing of swallowing events after single-modality treatment of head and neck carcinomas with radiotherapy. Ann Otol Rhinol Laryngol. 2000;109:767–75.

    PubMed  CAS  Google Scholar 

  20. Pauloski B, Logemann JA. Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck. 2000;22:120–31.

    Article  PubMed  CAS  Google Scholar 

  21. Newman L, Robbins KT, Logemann JA, Rademaker AW, Lazarus CL, Hamner A, Tusant S, Fang Huang C. Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation. Head Neck. 2002;24:68–77.

    Article  PubMed  Google Scholar 

  22. Mittal B, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE, Rademaker A, Logemann JA. Swallowing dysfunction—preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol Biol Phys. 2003;57(5):1219–30.

    Article  PubMed  Google Scholar 

  23. Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, MacCracken E, Haraf DJ, Vokes EE, Newman LA, Dachao L. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck. 2005;28(1):64–73.

    Article  Google Scholar 

  24. Logemann JA, Smith CH, Pauloski BR, Rademaker AW, Lazarus CL, Colangelo LA, Mittal B, MacCracken E, Gaziano J, Stachowiak L, Newman LA. Effects of xerostomia on perception and performance of swallow function. Head Neck. 2001;23:317–21.

    Article  PubMed  CAS  Google Scholar 

  25. Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Mittal B, Gaziano J, Stachowiak L, MacCracken E, Newman LA. Xerostomia: 12-month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation. Head Neck. 2003;25:432–7.

    Article  PubMed  Google Scholar 

  26. Talal N. Salivary and oral conditions. In: Carsons S, Harris EK, editors. The New Sjogren’s Syndrome Handbook. New York: Oxford University; 1998. p. 3–10.

    Google Scholar 

  27. Fox RI. Epidemiology, pathogenesis, animal models, and treatment of Sjogren’s syndrome. Curr Opin Rheumatol. 1994;6:501–8.

    Article  PubMed  CAS  Google Scholar 

  28. Fox RI. Salivary and oral conditions. In: Carsons S, Harris EK, editors. The New Sjogren’s Syndrome Handbook. New York: Oxford University; 1998. p. 11–23.

    Google Scholar 

  29. Bloch KJ, Buchanan WW, Wohl MJ, Bunim JJ. Sjogren’s syndrome: a clinical, pathological, and serological study of sixty-two cases. Medicine. 1965;44(3):187–231.

    Article  PubMed  CAS  Google Scholar 

  30. Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Bernstein RM, Bjerrum KB, Braga S, Coll J, DeVita S, Drosos AA, Ehrenfeld M, Hatron PY, Hay EM, Isenberg D, Janin A, Kalden J, Kater L, Konttinen YT, Maddison P, Maini RN, Manthorpe R, Meyer O, Ostuni P, Pennec Y, Prause JU, Richards A, Sauvezie B, Schiodt M, Sciuto M, Scully C, Shoenfeld Y, Skopouli FN, Smolen J, Snaith M, Tishler M, Todesco S, Valesini G, Venables P, Wattiaux M, Youinou P. Preliminary criteria for the classification of Sjogren’s syndrome. Arthritis Rheum. 1993;36(3):340–7.

    Article  PubMed  CAS  Google Scholar 

  31. Daniels TE, Silverman S, Michalski JP, Greenspan JS, Sylvester RA, Talal N. The oral component of Sjogren’s syndrome. Oral Med. 1975;39(6):875–85.

    CAS  Google Scholar 

  32. Robinson DA, Meyer CF. Primary Sjogren’s syndrome associated with recurrent sinopulmonary infections and bronchiectasis. J Allergy Clin Immunol. 1994;94:263–4.

    PubMed  CAS  Google Scholar 

  33. Kohler PF, Winter ME. A quantitative test for xerostomia. The Saxon test, an oral equivalent of the Schirmer test. Arthritis Rheum. 1985;28:1128.

    Article  PubMed  CAS  Google Scholar 

  34. Daniels TE. Labial salivary gland biopsy in Sjogren’s syndrome. Arthritis Rheum. 1984;27(2):147–56.

    Article  PubMed  CAS  Google Scholar 

  35. Chisholm DM, Beeley JA, Mason DK. Salivary proteins in Sjogren’s syndrome: separation by isoelectric focusing in acrylamide gels. Oral Surg Oral Med Oral Pathol Oral Radiol Edodontol. 1973;35(5):620–30.

    CAS  Google Scholar 

  36. Mandel ID, Baurmash H. Biochemical profile in salivary gland disease. J Dent Res 1973;52: abstr No. 672.

  37. Kalk WW, Vissink A, Spijkervet FK, Bootsma H, Kallenberg CG, Nieuw Amerongen AV. Sialometry and sialochemistry: diagnostic tools for Sjogren’s syndrome. Ann Rheum Dis. 2001;60:1110–6.

    Article  PubMed  CAS  Google Scholar 

  38. Caruso AJ, Sonies BC, Atkinson JC, Fox PC. Objective measures of swallowing in patients with primary Sjogren’s syndrome. Dysphagia. 1989;4:101–5.

    Article  PubMed  CAS  Google Scholar 

  39. Anselmino M, Zaninotto G, Constantini M, Ostuni P, Ianniello A, Boccu C, Doria A, Todesco S, Ancona E. Esophageal motor function in primary Sjogren’s syndrome: correlation with dysphagia and xerostomia. Dig Dis Sci. 1997;42(1):113–8.

    Article  PubMed  CAS  Google Scholar 

  40. Volter F, Fain O, Mathieu E, Thomas M. Esophageal function and Sjogren’s syndrome. Dig Dis Sci. 2004;49:248–53.

    Article  PubMed  Google Scholar 

  41. Palma R, Freire A, Freitas J, Morbey A, Costa T, Saraiva F, Queiros F, Carvalhinhos A. Esophageal motility disorders in patients with Sjogren’s syndrome. Dig Dis Sci. 1994;39(4):758–61.

    Article  PubMed  CAS  Google Scholar 

  42. Kjellen G, Fransson SG, Lindstrom F, Sokjer H, Tibbling L. Esophageal function, radiography, and dysphagia in Sjogren’s syndrome. Dig Dis Sci. 1986;31(3):225–9.

    Article  PubMed  CAS  Google Scholar 

  43. Grande L, Lacima G, Ros E, Font J, Pera C. Esophageal motor function in primary Sjogren’s syndrome. Am J Gastroenterol. 1993;88(3):378–81.

    PubMed  CAS  Google Scholar 

  44. Logemann J. Evaluation and treatment of swallowing disorders. 2nd ed. San Diego: College Hill; 1998.

    Google Scholar 

  45. Dawes C. Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res. 1987;66:648–53.

    PubMed  Google Scholar 

  46. Logemann JA. Manual for videofluoroscopic study of swallowing. 2nd ed. Austin, TX: Pro-Ed; 1993.

    Google Scholar 

  47. Pauloski BR, Rademaker AW, Logemann JA, Newman L, MacCracken E, Gaziano J, Stachowiak L. Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy. Head Neck. 2006;28(12):1069–76.

    Article  PubMed  Google Scholar 

  48. Logemann JA, Williams RB, Rademaker AW, Pauloski BR, Lazarus CL, Cook I. The relationship between observations and measures of oral and pharyngeal residue from videofluorography and scintigraphy. Dysphagia. 2005;20:226–31.

    Article  PubMed  Google Scholar 

  49. Daggett A, Logemann JA, Rademaker A, Pauloski B. Laryngeal penetration during deglutition in normal subjects of various ages. Dysphagia. 2006;21(4):270–4.

    Article  PubMed  Google Scholar 

  50. Engelen L, van den Keybus PA, de Wijk RA, Veerman EC, Amerongen AV, Bosman F, Prinz JF, van der Bilt A. The effect of saliva composition on texture perception of semi-solids. Arch Oral Biol. 2007;52(6):518–25.

    Article  PubMed  CAS  Google Scholar 

  51. Almstahl A, Wikstrom M, Groenink J. Lactoferrin, amylase, and mucin MUC5B and their relation to the oral microflora in hyposalivation of different origins. Oral Microbiol Immunol. 2001;16:345–52.

    Article  PubMed  CAS  Google Scholar 

  52. Pillemer SR, Matteson EL, Jacobsson LT, Martens PB, Melton LJ. Incidence of physician-diagnosed primary Sjogren syndrome in residents of Olmsted County, Minnesota. Mayo Clin Proc. 2001;76(6):593–9.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Nicole M. Rogus-Pulia.

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Rogus-Pulia, N.M., Logemann, J.A. Effects of Reduced Saliva Production on Swallowing in Patients with Sjogren’s Syndrome. Dysphagia 26, 295–303 (2011). https://doi.org/10.1007/s00455-010-9311-3

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  • DOI: https://doi.org/10.1007/s00455-010-9311-3

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