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1
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Weiland AC, Samant S, Clain AE, Martin‐Harris B. Short- and Long-Term Swallowing Outcomes in Head and Neck Cancer Patients Receiving TORS and Adjuvant Therapy. Head Neck 2025; 47:1345-1354. [PMID: 39714099 PMCID: PMC12038223 DOI: 10.1002/hed.28033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 11/29/2024] [Accepted: 12/02/2024] [Indexed: 12/24/2024] Open
Abstract
BACKGROUND Dysphagia (difficulty swallowing) is a common morbidity resulting from the treatment of head-and-neck squamous-cell carcinoma (HNSCC) due to surgery and chemoradiation. Transoral robotic surgery (TORS) is a minimally invasive surgical technique for the management of HNSCC, which ideally avoids many of the known complications of open surgery. Research describing physiologic swallowing impairment after surgery using videofluoroscopy is lacking. METHODS We evaluated videofluoroscopic swallowing studies of 37 patients who received TORS for head and neck cancer using a validated scoring tool, the Modified Barium Swallow Impairment Profile (MBSImP), at three time points including baseline. RESULTS Patients had worsened physiologic impairments in the immediate post-operative and late post-operative periods, particularly in components related to airway protection. Many patients also had baseline swallowing impairment. CONCLUSIONS Further research is required to elucidate dysphagia at discrete time points before and after treatment as well as with different and evolving adjuvant therapy protocols.
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Affiliation(s)
- Abigail C. Weiland
- Department of MedicineMcGaw Medical Center of Northwestern UniversityChicagoIllinoisUSA
| | - Sandeep Samant
- Department of Otolaryngology‐Head and Neck SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Alex E. Clain
- Roxelyn and Richard Pepper Department of Communication Sciences and DisordersSchool of CommunicationEvanstonIllinoisUSA
| | - Bonnie Martin‐Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and DisordersSchool of CommunicationEvanstonIllinoisUSA
- Otolaryngology‐Head and Neck Surgery and Radiation OncologyFeinberg School of MedicineChicagoIllinoisUSA
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Fransson J, Thorén S, Selg J, Bergström L, Hägglund P. Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES). Dysphagia 2025; 40:343-352. [PMID: 39046477 PMCID: PMC11893719 DOI: 10.1007/s00455-024-10732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs = 0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study's results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.
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Affiliation(s)
- Johanna Fransson
- Speech and Language Pathology, Department of Clinical Sciences, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden.
| | - Sofia Thorén
- Speech and Language Pathology, Department of Clinical Sciences, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden
| | - Jenny Selg
- Speech and Language Pathology, Department of Clinical Sciences, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden
| | - Liza Bergström
- Division of Neurology, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
- Remeo Stockholm, Torsten Levenstams Väg 8, Sköndal, Stockholm, Sweden
| | - Patricia Hägglund
- Speech and Language Pathology, Department of Clinical Sciences, Faculty of Medicine, Umeå University, 90187, Umeå, Sweden
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Barbon CEA, Warneke CL, Ledger B, Rogus-Pulia N, Cunningham L, Coyle JL, Levesque-Boissonneault C, Alvarez C, Valencia D, Hutcheson KA. Reliability and Confidence of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Rating Among Research and Clinical Speech Pathologists Before and After Implementation of a Training Manual: A Multi-site Study. Dysphagia 2025; 40:353-362. [PMID: 39181934 PMCID: PMC11847951 DOI: 10.1007/s00455-024-10733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 07/05/2024] [Indexed: 08/27/2024]
Abstract
DIGEST is a validated, open-source method to grade the severity of pharyngeal dysphagia from the modified barium swallow (MBS) study. Dissemination and implementation of DIGEST is rising, making it critical to understand reliability and facilitators of accurate implementation among users. The aim was to assess reliability of the tool among speech-language pathology (SLP) raters practicing at multiple sites before and after review of a DIGEST training manual and evaluate confidence of DIGEST use pre-and post-training. Thirty-two SLPs from 5 sites participated in a blinded longitudinal DIGEST rating study. Raters were provided a standardized training set of MBS (n = 19). Initial SLP ratings (round 1, R1) were followed by a 2-4 week break before raters rated a re-keyed MBS set (round 2, R2). A minimum 4-8 week wash-out period then preceded self-study of the DIGEST training manual which was followed by a final rating (round 3, R3) and a post-manual survey afterwards. Baseline reliability (R1) of overall DIGEST was on average k = 0.70, reflecting agreement in the substantial range. Seventy-five percent of raters (24/32) demonstrated reliability ≥ 0.61 in the substantial to almost perfect range prior to training. Inter-rater reliability significantly improved from R1 to R3 after review of the DIGEST manual, with the largest change in DIGEST-Efficiency (mean change: DIGEST k = .04, p = .009, DIGEST-Safety k = .07, p = 0.03, and DIGEST-Efficiency k = .14, p = 0.009). Although DIGEST reliability at baseline was adequate in the majority of raters, self-study of the DIGEST training manual significantly improved inter-rater reliability and rater confidence using the DIGEST method, particularly when assigning DIGEST-Efficiency grade. These early data show promise that provider training may be useful to aid in fidelity of DIGEST implementation among SLP clinical users with varying DIGEST experience.
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Affiliation(s)
- C E A Barbon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C L Warneke
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ledger
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, USA
| | - N Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - L Cunningham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - C Alvarez
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Valencia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Oshima Y, Nanto T, Eimoto K, Uchiyama Y, Domen K. Long-Term Swallowing Rehabilitation for Muscle-Specific Tyrosine Kinase Antibody-Positive Myasthenia Gravis: A Case Report. Cureus 2025; 17:e80544. [PMID: 40225522 PMCID: PMC11993821 DOI: 10.7759/cureus.80544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2025] [Indexed: 04/15/2025] Open
Abstract
Muscle-specific tyrosine kinase antibody-positive myasthenia gravis (MuSK-MG) often presents with severe dysphagia. However, effective strategies for swallowing rehabilitation in these patients have not been well established. We report a case of a MuSK-MG patient with severe dysphagia who underwent swallowing rehabilitation for approximately 12 months alongside drug therapy and showed improvement in swallowing function. The patient was a 67-year-old woman treated with high-dose intravenous methylprednisolone pulse therapy, high-dose intravenous immunoglobulin, and plasma exchange (PE) therapy. She required ventilator management and tracheotomy. The patient subsequently developed recurrent pneumonia, and rituximab was administered due to a poor response to previous treatments. Although the primary disease had apparently stabilized, the patient continued to experience severe dysphagia with silent aspiration, delayed swallowing reflexes, and pharyngeal residues. To address these issues, intensive and prolonged swallowing rehabilitation was implemented, including regular swallowing assessments, progressive muscle-strengthening exercises with controlled load levels, and interferential current stimulation to address sensory disturbances. Consequently, the patient successfully achieved oral intake without experiencing a myasthenic crisis or recurrence of aspiration pneumonia. These findings suggest that long-term swallowing rehabilitation, combined with appropriate treatment of the underlying disease, may effectively improve swallowing function in patients with MuSK-MG and persistent severe dysphagia.
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Affiliation(s)
- Yuki Oshima
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, JPN
| | - Tomoki Nanto
- Department of Speech-Language-Hearing Therapy, Faculty of Rehabilitation, Morinomiya University of Medical Sciences, Osaka, JPN
| | - Kazuki Eimoto
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, JPN
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
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Yalabık MF, Arslan SS, Boybeyi Ö, Demir N, Soyer T. Evaluation of Swallowing Function in Patients With H-type Tracheoesophageal Fistula. J Pediatr Surg 2025; 60:162065. [PMID: 39615149 DOI: 10.1016/j.jpedsurg.2024.162065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 10/22/2024] [Accepted: 11/08/2024] [Indexed: 01/20/2025]
Abstract
AIM Although esophageal atresia (EA) patients can present with dysphagia, the swallowing function of patients with H-type tracheoesophageal fistula (H-TEF) has not been systematically assessed. Therefore, a retrospective study was carried out to evaluate the swallowing function of patients with H-TEF. METHODS Children operated for H-TEF with videofluoroscopic swallowing evaluation (VFSE) were included. Penetration-aspiration score, oral phase efficacy, delay in swallowing reflex, velopharyngeal closure, and esophageal dysmotility during liquid and solid food swallowing were assessed by using VFSE recordings. Penetration-aspiration score <6 was considered as 'no aspiration', whereas scores ≥6 was assessed as 'aspiration'. Oral phase efficacy, delay in swallowing reflex and esophageal dysmotility were scored as 0 (normal) to 3 (severe problem), and delay in swallowing reflex was ranged from 0 (no delay) to 3 (severe delayed, >5 s). RESULTS Among eleven patients, ten patients who met the inclusion criteria were included. The mean age of the patients was 3.4 years (min = 1, max = 9). Two (20 %) patients had aspiration in liquids and none of them had in solids. One patient had minimum and the other one had mild problem in oral phase efficacy (n = 2, 20 %). Delay in swallowing reflex and velopharyngeal closure were normal in all patients. In five of the patients (50 %), there was mild (n = 1) to severe (n = 4) esophageal dysmotility. CONCLUSION Children with H-TEF had modest swallowing impairment in all phases. Although, it is not as severe as in EA patients, evaluation of the swallowing function should be part of the clinical practice of patients with H-TEF.
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Affiliation(s)
- Mehmet Furkan Yalabık
- Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkiye
| | - Selen Serel Arslan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkiye
| | - Özlem Boybeyi
- Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkiye
| | - Numan Demir
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkiye
| | - Tutku Soyer
- Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkiye.
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Tosun S, Topbaş SS, Aksoy E. A Tool for the Assessment of Swallowing Safety and Efficiency in Adults: Turkish Adaptation of Boston Residue and Clearance Scale. Dysphagia 2025; 40:88-97. [PMID: 38703232 PMCID: PMC11762592 DOI: 10.1007/s00455-024-10706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/08/2024] [Indexed: 05/06/2024]
Abstract
The objective of this study was to create a Turkish language adaptation of the Boston Residue and Clearance Scale (BRACS), a validated and reliable tool. The BRACS scale was first translated into Turkish and a Turkish version was subsequently developed. Fiberoptic endoscopic examination of swallowing (FEES) was administered to collect data from 25 dysphagic patients who were hospitalized after a stroke. The recorded films were subjected to editing procedures to ensure their appropriateness for the assessment of swallowing disorders and were then dispatched to a panel of five speech and language therapists for evaluation using the adaptation of the BRACS instrument. The scoring by the experts was evaluated using both explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity, item reliability, and construct (composite) reliability were measured by calculating the average variance extracted (AVE) values. For the 12 location items, EFA revealed 3 main latent factors: the laryngeal vestibule and the oropharynx and hypopharynx. The Turkish BRACS had excellent inter-rater reliability (Krippendorff's alpha coefficient values ranged from 0.93 to 0.95) and high internal consistency (Cronbach's alpha values ranged from 0.88 to 0.93). Inter-rater ICCs for the first and second sessions were 0.83 and 0.85, respectively. CFA showed that all fitted criteria reached acceptable or perfect fit levels. The findings indicated that the proposed factor structure was validated. The AVE values are between 0.61 and 0.73 which was taken as evidence of convergent validity. The Turkish adaptation of the BRACS tool demonstrates both reliablity and validity, rendering it a useful and credible tool for assessing residual severity, particularly in clinical settings.
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Affiliation(s)
- Samet Tosun
- Faculty of Health Sciences, Department of Speech and Language Therapy, Biruni University, İstanbul, Turkey.
| | - Saime Seyhun Topbaş
- School of Health Sciences, Department of Speech and Language Therapy, İstanbul Medipol University, İstanbul, Turkey
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Hashimoto Y, Umemoto Y, Suzuki S, Miyazaki Y, Nishimura Y, Kouda K. Immediate effects of simple palatal augmentation prosthesis in maximum tongue pressure and swallowing functions for acute stroke patients: An observational study. J Prosthodont Res 2025; 69:76-81. [PMID: 39019592 DOI: 10.2186/jpr.jpr_d_23_00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
PURPOSE Acute stroke often leads to dysphagia. In the oral stage of dysphagia, there is a potential for immediate benefit from using a palatal augmentation prosthesis (PAP). We investigated whether our quickly fabricated, simple, and expedited version of PAP would result in an immediate improvement in swallowing function after an acute stroke. METHODS We analyzed the records of stroke patients that were hospitalized between October 2019 and March 2022 and met the following criteria: they had a rehabilitation prescription and had paralysis of facial or hypoglossal nerves and either repeated salivary swallowing test ≤2 times or modified water swallow test ≤3, they were fasting, were within 3 weeks of onset, and had a simple PAP made for them. Outcomes included with/without PAP, maximum tongue pressure, repeated salivary swallowing test, and modified water swallow test on the day after starting to wear PAP was started. In addition, within one week, a videofluoroscopic examination was performed to measure the oral transit time, pharyngeal transit time, and penetration aspiration scale. Statistical analyses were performed using Wilcoxon signed-rank tests. Statistical significance was set at P < 0.05. RESULTS Fifteen patients met the inclusion criteria and were included in this study. The mean age of the subjects was 76.9 ± 9.0 years. The use of PAP significantly increased maximum tongue pressure (P < 0.0001*) and shortened oral transit time (P < 0.0091*). There were no significant differences among the other items. CONCLUSIONS Simple PAP immediately increased the maximum tongue pressure and improved swallowing function during the oral stage.
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Affiliation(s)
- Yuu Hashimoto
- Department of Rehabilitation Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shigeru Suzuki
- Department of Dental Oral Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuri Miyazaki
- Department of Rehabilitation Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Yahaba, Japan
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
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Demir N, Pişiren B, Arslan SS, Boybeyı-Turer O, Soyer T. Dynamic Imaging Grade of Swallowing Toxicity in Children with Esophageal Atresia. Eur J Pediatr Surg 2024; 34:392-397. [PMID: 37748722 DOI: 10.1055/a-2181-2293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale was developed to evaluate the safety, efficiency, and overall pharyngeal swallowing performance in patients with dysphagia (DIGESTs, DIGESTe, and DIGESTt, respectively). Although various types of swallowing dysfunction are encountered in children with esophageal atresia (EA), oropharyngeal dysphagia poses risk for aspiration. Therefore, a retrospective study was performed to evaluate the safety and efficacy of swallowing by using DIGEST score in children with EA. PATIENTS AND METHODS Thirty-nine EA patients were included. The demographic features, respiratory problems, results, and outcomes of surgical treatment were evaluated from medical records. The videofluoroscopic swallowing evaluation investigated for both airway protection and bolus residuals at the level of vallecula, posterior pharyngeal wall, and pyriform sinus at liquid and pudding consistencies. The penetration and aspiration scale (PAS) was used to define penetration and aspiration severity, and DIGEST was used to evaluate DIGESTs, DIGESTe, and DIGESTt. RESULTS The median age of the patients were 13 months (7-39 months), and male-to-female ratio was 25:14. Sixty-seven percent of patients were type-C EA and 61% of them has associated anomalies; 38% of patients had aspiration (PAS = 6-8) in liquids and 10% in pudding consistency. Life-threatening/profound swallowing dysfunction in DIGESTe (DIGEST = 4) was seen in 13% (n = 5) of patients; 40% of EA patients showed severe problems in DIGESTt. CONCLUSION DIGEST is a valid and reliable tool to define the efficacy and safety of swallowing in children with EA.
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Affiliation(s)
- Numan Demir
- Faculty of Physical Medicine and Rehabilitation, Hacettepe Universitesi, Ankara, Turkey
| | - Begüm Pişiren
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selen Serel Arslan
- Faculty of Physical Medicine and Rehabilitation, Hacettepe Universitesi, Ankara, Turkey
| | - Ozlem Boybeyı-Turer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Aii S, Fujishima I, Shigematsu T, Ohno T, Kunieda K, Yamawaki M. Sliced Jelly Whole Swallowing Reduces Deglutition Risk: A Novel Feeding Method for Patients with Dysphagia. Dysphagia 2024; 39:940-947. [PMID: 38568345 DOI: 10.1007/s00455-024-10674-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/18/2024] [Indexed: 04/24/2024]
Abstract
Texture modification in the form of gels or jellies is used for patients with dysphagia. For over 20 years, our group has been using gelatin jellies, a type of gel, as a starting diet for patients with dysphagia. Gelatin jellies are served in a small-sliced form and swallowed whole. In sliced jelly whole swallowing (SJWS), sliced gelatin jelly (SGJ) passes through the pharynx in one lump without collapsing. This study aimed to examine the usefulness of SJWS. We analyzed the images of videofluoroscopic swallowing studies performed using the normalized residue ratio scale (NRRSv: vallecula, NRRSp: pyriform sinus), the penetration-aspiration scale (PAS), and pharyngeal transit time (PTT) in 50 patients with dysphagia and compared the results in a prospective study. SJWS had significantly less residue in both NRRSv and NRRSp than in moderately thickened liquid swallowing. No significant differences in PAS scores were found between SGJ and moderately thickened liquid. Additionally, no significant differences in PTT scores were noted between the two. This study demonstrated the usefulness of SJWS in improving swallowing safety in patients with dysphagia. Further studies are needed to evaluate the reproducibility of the test, the comparison of SGJ with other thickened liquids, and the safety of SJWS for different diseases.
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Affiliation(s)
- Seijiro Aii
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan.
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu City, Shizuoka, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masanaga Yamawaki
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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Burdick RJ, Dallal-York J, Shapira-Galitz Y. Flexible Endoscopic Evaluation of Swallowing: A Proposed Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-10. [PMID: 39151055 DOI: 10.1044/2023_ajslp-22-00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE Flexible endoscopic evaluation of swallowing (FEES) is not only a well-recognized and ubiquitous tool in dysphagia research but also possesses features that make the assessment vulnerable to shortcomings in transparency and rigor in published literature. Therefore, FEES was considered an important addition to the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a multisite collective effort to establish a tool for the critical appraisal of reporting in all forms of dysphagia and swallowing-related research on human subjects. METHOD From the FRONTIERS collective, a team of three clinician researchers completed a review of FEES-related literature to determine all components crucial for generalizable and reproducible reporting of FEES research. These components were developed and refined through an iterative process. RESULTS This review culminated in a 26-item series of "yes/no" questions, forming the FEES section of FRONTIERS. These questions are grouped into the following five components: (a) Equipment, (b) Rater(s), (c) Rating Process, (d) Outcome Metrics, and (e) Miscellaneous Factors. CONCLUSION The results of this review support that FEES possesses unique characteristics to other aspects of dysphagia research and is consequently a crucial addition to FRONTIERS to ensure that clinical researchers have access to critical appraisal of FEES-related research inquiry.
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Affiliation(s)
- Ryan J Burdick
- Swallowing & Salivary Bioscience Lab, Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison
| | - Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral SciencesTeachers College, Columbia University, New York City, NY
| | - Yael Shapira-Galitz
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel
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11
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Kravietz A, Crosby T, Yang J, Balou S, Dion GR, Logan A, Amin MR. A Large Cohort Analysis of Epiglottic Phenotypes and Pharyngeal Residue. Ann Otol Rhinol Laryngol 2024; 133:375-383. [PMID: 38197379 DOI: 10.1177/00034894231218892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To describe the phenotypic characteristics of the epiglottis at rest and their impact on vallecular residue. METHODS Videofluoroscopic studies (VFSS) were pooled from 2 Laryngology practices, and Image J was used to measure epiglottic anatomic features at rest. Studies were rated by the MBSImp and presence of vallecular residue following swallow of thin and puree boluses. A conditional inference tree analysis was performed to isolate which epiglottic parameters were risk factors for presence of vallecular reside followed by logistic regression. RESULTS The majority of patients had a normal shaped epiglottis, followed by omega shape. The mean angle of the epiglottis from the hyoid was approximately 90°. Only abnormal epiglottic movement was associated with increased risk of residue for thin boluses (OR 35.09, CI 10.93-158.66, P < .001). However, in those with normal epiglottic movement, age >70 years old was associated with increased risk of residue (OR 3.98, CI 1.73-9.23, P = .001). For puree boluses, a normal or omega shaped epiglottis was associated with residue (OR 5.19, CI 2.41-11.51, P < .001), and this relationship was further modulated by increased distance of the epiglottic tip from the posterior pharyngeal wall. No other anatomic features of the resting epiglottis were associated with residue. Comorbidities potentially affecting swallow were infrequent in the cohort and were not associated with residue. CONCLUSION Abnormal epiglottic movement is associated with aspiration, and in this study we find that abnormal epiglottic movement increases the risk of vallecular residue and that older age is a risk factor for residue. The resting properties of the epiglottis do not appear to be associated with abnormal epiglottic movement or residue.
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Affiliation(s)
- Adam Kravietz
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Tyler Crosby
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jackie Yang
- New York University Grossman School of Medicine, New York, NY, USA
| | - Stamatela Balou
- New York University Grossman School of Medicine, New York, NY, USA
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley Logan
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Milan R Amin
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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12
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Eimoto K, Nagai K, Nakao Y, Uchiyama Y, Domen K. Swallowing Rehabilitation With Neuromuscular Electrical Stimulation for Sarcopenic Dysphagia: A Case Report. Cureus 2024; 16:e59256. [PMID: 38813342 PMCID: PMC11136547 DOI: 10.7759/cureus.59256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing-related muscles. We present a case of sarcopenic dysphagia with improved swallowing function after strength training of swallowing-related muscles using neuromuscular electrical stimulation (NMES). A 78-year-old man was admitted to our hospital with an intraductal papillary mucinous tumor of the pancreatic duct. After admission, the patient developed aspiration pneumonia and was placed on strict bed rest without oral intake, which resulted in progressive malnutrition. At the start of swallowing rehabilitation, he had whole-body sarcopenia, nutritional impairment, and weakness in swallowing-related muscles, with a maximum tongue pressure of 21.4 kPa and an opening force of 5.1 kg. In the videofluoroscopic swallowing study, he aspirated 3 cc of a moderately thick liquid. Consequently, as part of swallowing rehabilitation, strengthening training of swallowing-related muscles with NMES was undertaken for about three weeks. As a result, the maximum tongue pressure and opening force improved to 28.4 kPa and 6.8 kg, respectively. A subsequent videofluoroscopic swallowing study showed no obvious aspiration during any procedure. The patient was discharged on the 86th day on a regular diet. As a component of swallowing rehabilitation, NMES may offer therapeutic benefits for patients with sarcopenic dysphagia.
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Affiliation(s)
- Kazuki Eimoto
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, JPN
| | - Koutatsu Nagai
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, JPN
| | - Yuta Nakao
- Department of Rehabilitation, Yamato University, Suita, JPN
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
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13
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Soyer T, Arslan SS, Pişiren B, Boybeyi Ö, Yalcın E, Demir N. The Role of Bolus Residue and Its Relation with Respiratory Problems in Children with Esophageal Atresia. Dysphagia 2023; 38:1546-1550. [PMID: 37138140 DOI: 10.1007/s00455-023-10582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
Bolus residue is significant risk factor for postswallow aspiration. A retrospective study was performed to evaluate the role of bolus residue and its relation with respiratory problems in children with esophageal atresia. Children were evaluated for demographic features, type of esophageal atresia, associated anomalies, and respiratory problems. The videofluoroscopic swallowing evaluation (VFSE) was performed, and scored by using the penetration aspiration scale (PAS), bolus residual score (BRS) and normalized residual ratio scale (NRRS). Children with and without respiratory problems were also compared in terms of aspiration and bolus residue. Forty-one children with a median age of 15 months (1-138 months), male:female ratio of 26:15 was included. 65.9% (n = 27) of children were type-C and 24.4% (n = 10) were type-A EA. In 61% (n = 25) of children had liquid aspiration (PAS ≥ 6) and 9.8% (n = 4) had aspiration in pudding consistencies. Children with aspiration in liquids had significantly higher NRRS and BRS scores in vallecular residue for pudding consistencies when compared to children without aspiration (p < 0.05). No difference was detected in terms of PAS scores and bolus residual parameters between children with and without respiratory problems (p > 0.05). Children with aspiration in liquids have higher scores of BRS and NRRS at the level of vallecular especially in pudding consistencies. VFSE findings for bolus residue did not show significant relation with respiratory problems. Respiratory morbidity in children with EA is multifactorial and may not only explained by bolus residuals and aspiration.
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Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Begüm Pişiren
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özlem Boybeyi
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcın
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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14
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Krekeler BN, Yee J, Kurosu A, Osman F, Peña-Chávez R, Leverson G, Young B, Sattin J, Knigge M, Thibeault S, Rogus-Pulia N. Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial. Dysphagia 2023; 38:1551-1567. [PMID: 37195518 PMCID: PMC10615659 DOI: 10.1007/s00455-023-10583-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/21/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Swallowing impairments resulting from stroke have few rehabilitative options. Prior evidence suggests lingual strengthening exercise may provide some benefit, but more randomized controlled trials are required. The purpose of this study was to examine efficacy of progressive lingual resistance training on lingual pressure generative capacity and swallowing outcomes for individuals with dysphagia after stroke. METHODS Participants with dysphagia within 6 months of acute stroke were randomly assigned to: (1) treatment: progressive resistance tongue exercise using pressure sensors for 12 weeks with usual care; or (2) control: usual care only. Outcomes were measured at baseline, 8 and 12 weeks to assess group differences in lingual pressure generation, swallow safety, efficiency, oral intake, and swallowing quality of life. RESULTS Final sample included 19 participants [treatment (N = 9) and control (N = 10)] with 16 males and 3 females (mean age = 69.33). Functional Oral Intake Scale (FOIS) scores improved significantly (p = 0.04) in the treatment group from baseline to 8 weeks compared to usual care (control). No significant differences between treatment groups were identified for other outcomes; large effect sizes were detected for group differences in lingual pressure generative capacity from baseline to 8 weeks at the anterior sensor (d = .95) and posterior sensor (d = 0.96), and vallecular residue of liquids (baseline to 8-week d = 1.2). CONCLUSIONS Lingual strengthening exercise resulted in significant improvements in functional oral intake for patients with post-stroke dysphagia as compared to usual care after 8 weeks. Future studies should include a larger sample size and address treatment impact on specific aspects of swallow physiology.
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Affiliation(s)
- Brittany N Krekeler
- Department of Otolaryngology Head & Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Atsuko Kurosu
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Rodolfo Peña-Chávez
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
- Departamento de Ciencias de la Rehabilitación en Salud, Facultad de Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Concepción, Chile
| | - Glen Leverson
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Brittany Young
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Justin Sattin
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Molly Knigge
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Susan Thibeault
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Nicole Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA.
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison GRECC (11G), Room D4240, Madison, WI, 53705, USA.
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15
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Griffin L, Kamarunas E, Smith JB, Kuo C, O'Donoghue C. Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2676-2690. [PMID: 37669615 DOI: 10.1044/2023_ajslp-23-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. METHOD In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. RESULTS Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. CONCLUSION These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.
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Affiliation(s)
- Lindsay Griffin
- Department of Communication Sciences & Disorders, School of Communication, Emerson College, Boston, MA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Julian Bergen Smith
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven
| | - Christina Kuo
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
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16
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Steele CM, Bayley MT, Bohn MK, Higgins V, Peladeau-Pigeon M, Kulasingam V. Reference Values for Videofluoroscopic Measures of Swallowing: An Update. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3804-3824. [PMID: 37669617 PMCID: PMC10713020 DOI: 10.1044/2023_jslhr-23-00246] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE It is essential that clinicians have evidence-based benchmarks to support accurate diagnosis and clinical decision making. Recent studies report poor reliability for diagnostic judgments and identifying mechanisms of impairment from videofluoroscopy (VFSS). Establishing VFSS reference values for healthy swallowing would help resolve such discrepancies. Steele et al. (2019) released preliminary reference data for quantitative VFSS measures in healthy adults aged < 60 years. Here, we extend that work to provide reference percentiles for VFSS measures across a larger age span. METHOD Data for 16 VFSS parameters were collected from 78 healthy adults aged 21-82 years (39 male). Participants swallowed three comfortable sips each of thin, slightly, mildly, moderately, and extremely thick barium (20% w/v). VFSS recordings were analyzed in duplicate by trained raters, blind to participant and task, using the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) Method. Reference percentiles (p2.5, 5, 25, 50, 75, 95, and 97.5) were determined as per Clinical and Laboratory Standards Institute EP28-A3c guidelines. RESULTS We present VFSS reference percentile tables, by consistency, for (a) timing parameters (swallow reaction time; the hyoid burst-to-upper esophageal sphincter (UES)-opening interval; UES opening duration; time-to-laryngeal vestibule closure (LVC); and LVC duration) and (b) anatomically scaled pixel-based measures of maximum UES diameter, pharyngeal area at maximum pharyngeal constriction and rest, residue (vallecular, pyriform, other pharyngeal locations, total), and hyoid kinematics (X, Y, XY coordinates of peak position; speed). Clinical decision limits are proposed to demarcate atypical values of potential clinical concern. CONCLUSION These updated reference percentiles and proposed clinical decision limits are intended to support interpretation and reliability for VFSS assessment data. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24043041.
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Affiliation(s)
- Catriona M. Steele
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Canada Research Chair in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Ontario
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mary Kathryn Bohn
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Victoria Higgins
- DynaLIFE Medical Labs, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | | | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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17
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Martin-Harris B, Kantarcigil C, Reedy EL, McFarland DH. Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions. Dysphagia 2023; 38:1049-1058. [PMID: 36378345 PMCID: PMC10266896 DOI: 10.1007/s00455-022-10538-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
Swallowing occurs preferentially in the expiratory phase of the quiet breathing cycle and at mid-to-low tidal volume. This coordinative pattern imparts important biomechanical advantages to swallowing and airway protection and facilitate laryngeal elevation, laryngeal vestibular and vocal fold closure, and cricopharyngeal sphincter opening. This preferred coordinative relationship between breathing and swallowing is impaired in a variety of patient populations, including head and neck cancer survivors with dysphagia. We developed a training protocol to re-establish more optimal phasing of swallowing with breathing in these patients with striking outcomes, including reduced swallowing physiological impairments and improved airway protection. This motivated us to continue to refine and expand this training protocol and develop new assistive technologies for swallowing monitoring outside of the lab. In this review, we highlight the origins of our optimal respiratory-swallowing coordination hypothesis, describe the biomechanical advantages it provides, carefully describe our training protocol and findings, and chart a course for the next phase of this work. Our overall goal is to harness technology combined with carefully constructed learning paradigms to improve the lives of patients with impaired respiratory-swallowing coordination consequent to a variety of pathologies including head and neck cancer and degenerative neurological conditions such as Parkinson's disease.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
- Otolaryngology - Head & Neck Surgery, Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA.
| | - Cagla Kantarcigil
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
| | - Erin L Reedy
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA
| | - David H McFarland
- Faculties of Medicine, Université de Montréal and McGill University, Montreal, CA, USA
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, CA, USA
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18
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Chesney N, Khwaounjoo P, Huckabee ML, Cakmak YO. Non-Contact Assessment of Swallowing Dysfunction Using Smartphone Captured Skin Displacements. SENSORS (BASEL, SWITZERLAND) 2023; 23:5392. [PMID: 37420560 DOI: 10.3390/s23125392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/09/2023]
Abstract
Early and accurate dysphagia diagnosis is essential for reducing the risk of associated co-morbidities and mortalities. Barriers to current evaluation methods may alter the effectiveness of identifying at-risk patients. This preliminary study evaluates the feasibility of using iPhone X-captured videos of swallowing as a non-contact dysphagia screening tool. Video recordings of the anterior and lateral necks were captured simultaneously with videofluoroscopy in dysphagic patients. Videos were analyzed using an image registration algorithm (phase-based Savitzky-Golay gradient correlation (P-SG-GC)) to determine skin displacements over hyolaryngeal regions. Biomechanical swallowing parameters of hyolaryngeal displacement and velocity were also measured. Swallowing safety and efficiency were assessed by the Penetration Aspiration Scale (PAS), Residue Severity Ratings (RSR), and the Normalized Residue Ratio Scale (NRRS). Anterior hyoid excursion and horizontal skin displacements were strongly correlated with swallows of a 20 mL bolus (rs = 0.67). Skin displacements of the neck were moderately to very strongly correlated with scores on the PAS (rs = 0.80), NRRS (rs = 0.41-0.62), and RSR (rs = 0.33). This is the first study to utilize smartphone technology and image registration methods to produce skin displacements indicating post-swallow residual and penetration-aspiration. Enhancing screening methods provides a greater chance of detecting dysphagia, reducing the risk of negative health impacts.
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Affiliation(s)
- Nikyta Chesney
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch 8140, New Zealand
| | - Prashanna Khwaounjoo
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Maggie-Lee Huckabee
- Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch 8140, New Zealand
| | - Yusuf Ozgur Cakmak
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Centre for Bioengineering and Nanotechnology, University of Otago, Dunedin 9054, New Zealand
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19
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Kim JY, Davenport PW, Mou Y, Hegland K. Primary site of constriction during the compression phase of cough in healthy young adults. Respir Physiol Neurobiol 2023; 311:104033. [PMID: 36764504 PMCID: PMC10067529 DOI: 10.1016/j.resp.2023.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Glottal closure has been considered as the primary constriction point during the compression phase (CP); however, vocal fold adduction alone cannot resist the high pressures, providing motivation to explore other mechanisms contributing to that resistance. The goal of this study was to identify site(s) and degree of constriction during the CP of cough of varying types in healthy young adults. Twenty-five healthy young participants participated in this study. The experimental protocol was comprised of: 1) baseline pulmonary function measures; 2) cough practice to establish weak, moderate and strong coughs; 3) voluntary and reflex cough assessments with fluoroscopy and airflow measures. We used a repeated measures ANOVA to identify whether there are differences in constriction ratio between cough types. There was a significant difference in constriction of varying cough types. Degree of constriction in all cough strengths showed that the glottis was the most constricted area, followed by the laryngeal vestibule, nasopharynx, hypopharynx, oropharynx, and cervical trachea, in order, but stronger cough resulted in more constriction in all areas compared to weaker cough. Degree of constriction in reflex cough showed a similar pattern though there was greater constriction in the oropharynx than the hypopharynx. Airflow measures in voluntary cough were consistent with previous findings. Differences in upper airway constriction during the compression phase of cough may be attributed to differences in motor control between reflex and voluntary cough, and the increased constriction seen during strong cough may reflect increased muscle recruitment during that task. In the future, we can use this knowledge to develop novel methods for cough rehabilitation.
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Affiliation(s)
- Ja Young Kim
- Graduate Program in Speech-Language Pathology, Yonsei University, Yonsei-ro 50, Seodaemun-gu, Seoul, South Korea 03722.
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA.
| | - Yuhan Mou
- Department of Rehabilitation Science, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA.
| | - Karen Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA.
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20
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Liou HH, Hsieh MHC, Tsai SH, Hung DSY, Chen YJ, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. Relationship Between Pharyngeal Residues Assessed by Bolus Residue Scale or Normalized Residue Ratio SCALE and Risk of Aspiration in Head and Neck Cancer Who Underwent Videofluoroscopy. Dysphagia 2023; 38:700-710. [PMID: 35953736 DOI: 10.1007/s00455-022-10501-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
Abstract
Dysphagia affects 60-75% of patients treated for head and neck cancer (HNC). We aimed to evaluate the association between residue severity and airway invasion severity using a videofluoroscopic swallowing study and identify risk factors for poor penetration-aspiration outcomes in patients with dysphagia treated for HNC. Penetration-Aspiration Scale (PAS) was used to assess airway invasion severity, while residue severity was assessed using both the Bolus Residue Scale (BRS) for residue location and the Normalized Residue Ratio Scale (NRRS) for residue amount. Relevant covariates were adjusted in the logistic regression models to account for potential confounding. Significantly higher abnormal PAS was reported for increased piriform sinus NRRS (NRRSp) [odds ratio (OR), 4.81; p = 0.042] with liquid swallowing and increased BRS value (OR, 1.52; p = 0.014) for semi-liquid swallowing in multivariate analysis. Tumor location, older age, and poorer Functional Oral Intake Scale (FOIS) were significant factors for abnormal PAS in both texture swallowings. After adjusting for confounding factors (sex, age, and FOIS score), NRRS model in liquid swallowing (area under the curve [AUC], 0.83; standard error = 0.04, 95% confidence interval [CI]: 0.75, 0.91) and BRS in semi-liquid swallowing (AUC, 0.83; SE = 0.04; 95% CI: 0.76, 0.91) predicted abnormal PAS. The results indicate that while assessing residue and swallowing aspiration in patients with HNC, it is important to consider age, tumor location, and functional swallowing status. The good predictability of abnormal PAS with BRS and NRRS indicated that residue location and amount were both related to the aspiration event in patients with HNC.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Han Tsai
- Division of General Medicine, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Yi-Jen Chen
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan.
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21
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Garand KL(F, Grissett A, Corbett MM, Molfenter S, Herzberg EG, Kim HJ, Choi D. Quantifying Pharyngeal Residue Across the Adult Life Span: Normative Values by Age, Gender, and Swallow Task. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:820-831. [PMID: 36720117 PMCID: PMC10205106 DOI: 10.1044/2022_jslhr-22-00413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 11/10/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE We quantified pharyngeal residue using pixel-based methods in a normative data set, while examining influences of age, gender, and swallow task. METHOD One hundred ninety-five healthy participants underwent a videofluoroscopic swallow study following the Modified Barium Swallow Impairment Profile (MBSImP) protocol. ImageJ was used to compute Normalized Residue Ratio Scale and the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) pharyngeal residue measures. Reliability was established. Descriptive statistics were performed for all residue measures. Inferential statistics were performed using ASPEKT total scores (i.e., %C2-42). Logistic regression models explored predictors of residue versus no residue. Generalized linear mixed models explored predictors of nonzero residue. Spearman rho explored relationships between ASPEKT total residue scores and MBSImP Component 16 (Pharyngeal Residue) scores. RESULTS Majority of swallows (1,165/1,528; 76.2%) had residue scores of zero. Residue presence (%C2-42 > 0) was influenced by age (more in older [F = 9.908, p = .002]), gender (more in males [F = 18.70, p < .001]), viscosity (more in pudding, nectar, and honey [F = 25.30, p < .001]), and volume (more for cup sip [F = 37.430, p < .001]). When residue was present (363/1,528 = 23.8%), amounts were low (M = 1% of C2-42, SD = 2.4), and only increasing age was associated with increased residue (F = 9.008, p = .007) when controlling for gender and swallow task. Increasing residue was incremental (0.01% of C2-42 per year). As ASPEKT total residue values increased, MBSImP Component 16 scores also increased. CONCLUSIONS Pharyngeal residue amounts were very low in healthy adults. Residue presence can be influenced by age, gender, and swallow task. However, when present, the amount of pharyngeal residue was only associated with increasing age. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21957221.
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Affiliation(s)
| | - Addison Grissett
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile
| | - Mary Mason Corbett
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile
| | - Sonja Molfenter
- Communicative Sciences and Disorders Department, New York University, New York
| | | | - Han Joe Kim
- Department of Psychological, Health, and Learning Sciences, University of Houston, TX
| | - Dahye Choi
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile
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22
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Hirasaki M, Takagi D, Umeda Y, Moriwaki M, Katagiri N, Nomoto A, Ohno T, Fujishima I. A Case of Dysphagia and Dysarthria Improved by Flexible-palatal Lift/augmentation Combination Prosthesis. Prog Rehabil Med 2023; 8:20230006. [PMID: 36866153 PMCID: PMC9970843 DOI: 10.2490/prm.20230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
Background Palatal augmentation prosthesis (PAP) and palatal lift prosthesis (PLP) have been used to improve dysphagia and dysarthria. However, to date, there are few reports on their combined use. We report a quantitative evaluation of the effectiveness of a flexible-palatal lift/augmentation combination prosthesis (fPL/ACP) based on videofluoroscopic swallowing study (VFSS) and speech intelligibility testing. Case An 83-year-old woman was admitted to our hospital with a hip fracture. She developed aspiration pneumonia at 1 month after partial hip replacement. Oral motor function tests revealed a motor deficit of the tongue and soft palate. VFSS showed delayed oral transit, nasopharyngeal reflux, and excessive pharyngeal residue. The cause of her dysphagia was assumed to be pre-existing diffuse large B-cell lymphoma and sarcopenia. To improve the dysphagia, an fPL/ACP was fabricated and applied. It improved the patient's oral and pharyngeal swallowing and speech intelligibility. In addition to prosthetic treatment, rehabilitation and nutritional support allowed her to be discharged. Discussion The effects of fPL/ACP in the present case were similar to those of flexible-PLP and PAP. f-PLP assists in elevation of the soft palate and improved the nasopharyngeal reflux and hypernasal speech. PAP promotes tongue movement and results in improved oral transit and speech intelligibility. Therefore, fPL/ACP may be effective in patients with motor deficits in both the tongue and soft palate. To maximize the effect of the intraoral prosthesis, a transdisciplinary approach with concurrent swallowing rehabilitation, nutritional support, and physical and occupational therapy is necessary.
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Affiliation(s)
- Mami Hirasaki
- Department of Rehabilitation, Mikatahara Bethel-home, Shizuoka, Japan
| | - Daisuke Takagi
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Yoshiko Umeda
- Department of Dentistry, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Motoki Moriwaki
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Norimasa Katagiri
- Department of Rehabilitation Medicine, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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23
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Nordio S, Maistrello L, D’Imperio D, Favaretto N, Dellai A, Montino S, Agostinelli A, Ramacciotti G, Gheller F, Berta G, Koch I, Zanoletti E, Battel I, Cazzador D. Validity and reliability of the Italian translation of the Yale Pharyngeal Residue Severity Rating Scale. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:12-19. [PMID: 36860145 PMCID: PMC9978297 DOI: 10.14639/0392-100x-n2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/18/2022] [Indexed: 03/03/2023]
Abstract
Objective In the dysphagic patient, pharyngeal residues (PR) are associated with aspiration and poor quality of life. The assessment of PR using validated scales during flexible endoscopic evaluation of swallowing (FEES) is crucial for rehabilitation. This study aims to validate and test the reliability of the Italian version of the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS). The effects of training and experience in FEES on the scale were also determined. Methods The original YPRSRS was translated into Italian according to standardised guidelines. Thirty FEES images were selected after consensus and proposed to 22 naive raters who were asked to assess the severity of PR in each image. Raters were divided into two subgroups by years of experience at FEES, and randomly by training. Construct validity, inter-rater, and intra-rater reliability were assessed by kappa statistics. Results IT-YPRSRS showed substantial to almost perfect agreement (kappa > 0.75) in validity and reliability for both the overall sample (660 ratings), and valleculae/pyriform sinus sites (330 ratings each). No significant differences emerged between groups considering years of experience, and variable differences were observed by training. Conclusions The IT-YPRSRS demonstrated excellent validity and reliability in identifying location and severity of PR.
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Affiliation(s)
| | | | | | - Niccolò Favaretto
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Angela Dellai
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 6 Euganea, Ospedale di Conselve, Padua, Italy
| | - Silvia Montino
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Anna Agostinelli
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Giulia Ramacciotti
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Flavia Gheller
- Department of Developmental Psychology and Socialisation (DPSS), University of Padua, Padua, Italy
| | | | | | - Elisabetta Zanoletti
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Irene Battel
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 3 Serenissima, Ospedale Civile di Venezia, Venice, Italy, Department of Clinical Speech & Language Studies, University of Dublin, Trinity College, College Green, Dublin 2, Ireland
| | - Diego Cazzador
- Department of Neuroscience, Section of Otolaryngology, Azienda Ospedale-Università Padova, Padua, Italy,Correspondence Diego Cazzador Department of Neuroscience, Section of Otolaryngology, University of Padova, via Giustiniani 2, 35128 Padua, Italy Tel. +39 049 821 8778. Fax +39 049 821 1994 E-mail:
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24
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Leonard R, Miles A, Allen J. Bolus Clearance Ratio Elevated in Patients With Neurogenic Dysphagia Compared With Healthy Adults: A Measure of Pharyngeal Efficiency. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:107-114. [PMID: 36378903 DOI: 10.1044/2022_ajslp-22-00199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Postswallow pharyngeal residue is a risk factor for aspiration, implies swallowing inefficiency, and increases the work of eating. The Bolus Clearance Ratio (BCR) is a derived metric that relates quantities of bolus material observed in the pharynx at two different points: before and after a swallow. The ratio provides a percentage estimate of bolus clearance. In healthy adults, mean BCR is < .05; that is, less than 5% of an ingested bolus is retained in the pharynx. The aim of this study was to compare BCR measures from patients referred for videofluoroscopic swallow studies with concerns related to stroke (n = 100) or other neurological conditions (n = 131, including Parkinson's disease and dementia) with BCRs for 139 healthy adults across the age range. METHOD BCR for a 20 ml of thin liquid barium bolus was measured. Additional metrics included age, penetration-aspiration scale (PAS) score, and quantitative measures of timing and displacement. Correlations were explored between BCR and pharyngeal constriction ratio (PCR), pharyngoesophageal segment opening (PESmax), maximum hyoid displacement (HMax), and total pharyngeal transit time (TPT). RESULTS BCR values for patients with stroke (Mdn = 9%, interquartile range [IQR]: 19%, range: 0%-73%) and other neurological conditions (Mdn = 9%, IQR: 16%, range: 0%-96%) were significantly higher than in healthy norms (Mdn = 2%, IQR: 4%, range: 0%-16%, p < .001). BCR was significantly correlated with age (R s = .23, p < .01), TPT (R s = .20, p < .01), PCR (R s = .55, p < .01), PESmax (R s = -.17, p < .01), HMax (R s = -.16, p < .01), and PAS (R s = .38, p < .01). CONCLUSIONS BCR was elevated in patients with neurogenic dysphagia in comparison with healthy norms and was significantly associated with increased aspiration severity (i.e., PAS). BCR was also correlated with pharyngeal timing and displacement parameters, with the strongest correlation with pharyngeal constriction-a measure of pharyngeal strength. The BCR offers clinicians a simple, quantitative measure of bolus residue and, therefore, pharyngeal efficiency and may be used to assess change in patients over time and with treatment.
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Affiliation(s)
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, New Zealand
| | - Jacqui Allen
- Speech Science, School of Psychology, The University of Auckland, New Zealand
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25
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Omari T, Cock C, Wu P, Szczesniak MM, Schar M, Tack J, Rommel N. Using high resolution manometry impedance to diagnose upper esophageal sphincter and pharyngeal motor disorders. Neurogastroenterol Motil 2023; 35:e14461. [PMID: 36121685 DOI: 10.1111/nmo.14461] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 08/24/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oro-pharyngeal pathophysiology, including upper esophageal sphincter (UES) and pharyngeal disorders, can be assessed by pharyngeal high-resolution manometry impedance (P-HRM-I). We aimed to establish methodology to diagnose disorders utilizing P-HRM-I, hypothesizing that the objective measures could be used to diagnose disordered deglutition evidenced by greater aspiration scores. METHODS Patients (n = 509, 18-91 years) were compared to controls (n = 120, 20-94 years). Variables measuring UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contractile strength were derived for 10 ml liquid swallows. Three associated pharyngeal pressurization patterns, which may be indicative of obstructed flow, were characterized: pan-pressurization (Type 1), distal compartmentalized pressurization (Type 2), and transient pressurization (Type 3). Deglutitive aspiration was determined from video fluoroscopy. RESULTS UES relaxation pressure was best able to differentiate patients from controls (T 6.528, p < 0.0001). Patients with abnormal relaxation pressure (>8 mmHg) more frequently exhibited pharyngeal pressurization patterns and had adjunct evidence of reduced luminal distensibility (high intrabolus pressure and/or reduced UES opening). Utilizing this information, a diagnostic scheme was devised identifying 138 patients with UES disorder. A further 96 patients without evidence of UES disorder had abnormally weak pharyngeal pressures, confirming propulsive disorder. Amongst a sub-sample of 320 patients undergoing video fluoroscopy, those with pharyngeal pressurizations and adjunct evidence of reduced UES relaxation and/or distensibility had higher aspiration scores (Chi-square 60.169, p < 0.0001). CONCLUSION P-HRM-I can provide evidence for UES disorder based on pharyngeal pressurization patterns and abnormal findings for UES relaxation pressure, UES opening, and intrabolus pressure. Measuring pharyngeal contractility requires further optimization.
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Affiliation(s)
- Taher Omari
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Peter Wu
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Michal Marcin Szczesniak
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Mistyka Schar
- Flinders Health and Medical Research Institute and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jan Tack
- Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Leuven, Belgium
| | - Nathalie Rommel
- Department of Gastroenterology, Neurogastroenterology & Motility, University Hospitals Leuven, Leuven, Belgium.,Translational Research Centre Gastrointestinal Disease (TARGID), KU Leuven, Leuven, Belgium.,Deglutology, Department of Neurosciences, ExpORL, University of Leuven, Leuven, Belgium
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26
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Effect of Intensive Oropharyngeal Training on Radiotherapy-Related Dysphagia in Nasopharyngeal Carcinoma Patients. Dysphagia 2022; 37:1542-1549. [PMID: 35175419 DOI: 10.1007/s00455-022-10419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the effect of intensive oropharyngeal functional training on swallowing in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma. METHODS Fourteen patients with nasopharyngeal carcinomas and dysphagia after radiotherapy received intensive oropharyngeal training for two weeks. The Functional Oral Intake Scale (FOIS) and videofluoroscopic swallowing studies (VFSS) were used to evaluate swallowing function before and after intensive oropharyngeal training. Spatiotemporal parameters of the VFSS were analyzed using a digital image analysis system. RESULTS After training, the FOIS, Rosenbek penetration-aspiration score, DIGEST, normalized residue ratio scale, and spatiotemporal parameters of VFSS were significantly improved (P < 0.05). CONCLUSIONS This study indicated that intensive oropharyngeal training improves swallowing function after radiotherapy in patients with nasopharyngeal carcinoma.
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27
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Accuracy of High-Resolution Pharyngeal Manometry Metrics for Predicting Aspiration and Residue in Oropharyngeal Dysphagia Patients with Poor Pharyngeal Contractility. Dysphagia 2022; 37:1560-1575. [PMID: 35182246 DOI: 10.1007/s00455-022-10417-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
Abstract
Several physiological metrics can be derived from pharyngeal high-resolution impedance manometry (HRPM), but their clinical relevance has not been well established. We investigated the diagnostic performance of these metrics in relation to videofluoroscopic (VFS) assessment of aspiration and residue in patients with oropharyngeal dysphagia. We analyzed 263 swallows from 72 adult patients (22-91 years) with diverse medical conditions. Metrics of contractility, upper esophageal sphincter (UES) opening and relaxation, flow timing, intrabolus distension pressure, and a global Swallow Risk Index (SRI) were derived from pressure-impedance recordings using pressure-flow analysis. VFS data were independently scored for airway invasion and pharyngeal residue using the Penetration-Aspiration Scale and the Normalized Residue Ratio Scale, respectively. We performed multivariate logistic regression analyses to determine the relationship of HRPM metrics with radiological outcomes and receiver-operating characteristic (ROC) analysis to evaluate their diagnostic accuracy. We identified aspiration in 25% and pharyngeal residue in 84% of the swallows. Aspiration was independently associated with hypopharyngeal peak pressure < 65 mmHg (HypoPeakP) [adjusted odds ratio (OR) 5.27; 95% Confidence Interval (CI) (0.99-28.1); p = 0.051], SRI > 15 [OR 4.37; 95% CI (1.87-10.2); p < 0.001] and proximal esophageal contractile integral (PCI) < 55 mmHg·cm·s [OR 2.30; 95% CI (1.07-4.96); p = 0.034]. Pyriform sinus residue was independently predicted by HypoPeakP < 65 mmHg [OR 7.32; 95% CI (1.93-27.7); p = 0.003], UES integrated relaxation pressure (UES-IRP) > 3 mmHg [OR 2.96; 95% CI (1.49-5.88); p = 0.002], and SRI > 15 [OR 2.17; 95% CI (1.04-4.51); p = 0.039]. Area under ROC curve (AUC) values for individual HRPM metrics ranged from 0.59 to 0.74. Optimal cut-off values were identified. This study demonstrates the diagnostic value of certain proposed and adjunct HRPM metrics for identifying signs of unsafe and inefficient bolus transport in patients with oropharyngeal dysphagia.
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Go YI, Kim GW, Won YH, Park SH, Ko MH, Seo JH, Kim DS. Aggravation of dysphagia after surgical removal of anterior cervical osteophytes: a case report. J Int Med Res 2022; 50:3000605221125098. [PMID: 36127824 PMCID: PMC9502249 DOI: 10.1177/03000605221125098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dysphagia induced by anterior cervical osteophytes (ACOs) is frequently reported in older individuals. Surgical resection of ACOs is considered when conservative treatment fails, but its effectiveness is controversial owing to side effects after surgery. We present the case of a 78-year-old man who complained of progressive dysphagia that started 10 months previously. A videofluoroscopic swallow study (VFSS) showed prominent ACOs along C2-C6, which translocated the upper hypopharynx anteriorly, impinging the lumen and impairing epiglottic folding and laryngeal closure. Aspiration of a soft diet was observed. Despite conservative therapy, the symptoms persisted, and ACO resection surgery was performed. Unexpectedly, the patient's dysphagia worsened immediately post-surgery. A VFSS on postoperative day (POD) 2 showed improvement in epiglottic folding. However, prevertebral soft tissue swelling and dysfunction of opening of the upper esophageal sphincter newly arose. Laryngeal aspiration was observed during 5 cc and a large amount of liquid swallowing trials. The patient was provided a modified diet and rehabilitative dysphagia therapy. A VFSS on PODs 6 and 14 showed a gradual improvement in the prevertebral soft tissue swelling. This report suggests that a serial VFSS is effective for evaluating the different mechanisms of dysphagia and for devising an appropriate treatment plan.
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Affiliation(s)
- Young-In Go
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Yu-Hui Won
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sung-Hee Park
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jeong-Hwan Seo
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Da-Sol Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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29
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Donohue C, Robison R, DiBiase L, Anderson A, Vasilopoulos T, Plowman EK. Comparison of Validated Videofluoroscopic Outcomes of Pharyngeal Residue: Concordance Between a Perceptual, Ordinal, and Bolus-Based Rating Scale and a Normalized Pixel-Based Quantitative Outcome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2510-2517. [PMID: 35749660 PMCID: PMC9584126 DOI: 10.1044/2022_jslhr-21-00659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study compared the concordance between two validated videofluoroscopic pharyngeal residue outcome scales used in clinical and research settings: the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) and the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) percent residue metric. METHOD Two trained raters completed independent and blinded videofluoroscopic ratings of both DIGEST efficiency and ASPEKT percent pharyngeal residue outcomes for bolus trials of 5 cc Varibar thin liquid (n = 223), thin liquid comfortable cup sips (n = 223), and 5 cc Varibar thin honey (n = 223). Spearman's rho and Kruskal-Wallis analyses were performed for each bolus type. RESULTS Significant associations between DIGEST and ASPEKT pharyngeal residue outcomes were noted for 5 cc thin (r = .54, p < .001), cup sip thin (r = .41, p < .001), and 5 cc thin honey (r = .60, p < .001) bolus trials. ASPEKT percent residue increased across worsening DIGEST efficiency ordinal scale levels, with a main effect for each bolus type. Post hoc analysis revealed significant differences in the ASPEKT percent residue values between each DIGEST pairwise comparison for the thin cup sip bolus trial and for each pairwise comparison except between the moderate-to-severe (less than half vs. majority) ordinal levels for the 5 cc thin and 5 cc honey bolus trials, p < .05. CONCLUSIONS Perceptual, ordinal (DIGEST) and quantitative, pixel-based (ASPEKT) videofluoroscopic pharyngeal residue outcomes were associated in this data set of 669 bolus trials. Future research is warranted to confirm these results.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
| | - Raele Robison
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Medicine, University of Wisconsin–Madison
| | - Lauren DiBiase
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Amber Anderson
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | | | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Center, University of Florida, Gainesville
- Department of Neurology, University of Florida, Gainesville
- Department of Surgery, University of Florida, Gainesville
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30
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Nakamura T, Kita Y, Fujimoto J, Ayuzawa K, Ozawa H. Oral support for patients with severe motor and intellectual disabilities. Pediatr Int 2022; 64:e15028. [PMID: 34655262 DOI: 10.1111/ped.15028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/15/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral support during feeding was clinically provided to patients with severe motor and intellectual disabilities (SMID) for the prevention of dysphasia. The present study investigated the advantages of oral support anatomically and functionally. METHODS A videofluoroscopic swallowing study was conducted on nine patients with SMID (age = 5-41 years; mean age = 15.0; four males, five females) and 24 healthy adults (age = 26-67 years; mean age = 44.3; 16 males, eight females). The movements of the hyoid bone and mandible during pharyngeal swallowing were tracked, and the pharyngeal residues were evaluated. The temporal and spatial features of the movements were compared between patients with and without oral support as well as healthy adults. RESULTS The mandible moved downward earlier and showed larger displacement in the patients with SMID. The patients also had insufficient anterior displacement of the hyoid, which was associated with the pharyngeal residue. This displacement was enhanced, and the pharyngeal residue decreased with oral support. CONCLUSIONS Oral support to hold the mandible successfully improved hyoid excursion and reduced pharyngeal residue during swallowing, which is a simple and reliable strategy for the prevention of dysphasia in patients with SMID.
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Affiliation(s)
- Tatsuya Nakamura
- Department of Rehabilitation, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Hachioji, Tokyo, Japan
| | - Yosuke Kita
- Mori Arinori Center for Higher Education and Global Mobility, Hitotsubashi University, Kunitachi, Tokyo, Japan.,Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Junpei Fujimoto
- Department of Rehabilitation, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Hachioji, Tokyo, Japan
| | - Koichi Ayuzawa
- Department of Rehabilitation, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Hachioji, Tokyo, Japan
| | - Hiroshi Ozawa
- Department of Pediatrics, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Hachioji, Tokyo, Japan
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31
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Nakamura T, Kita Y, Fujimoto J, Ayuzawa K, Ozawa H. Hyoid bone movement during swallowing and mechanism of pharyngeal residue in patients with profound intellectual and multiple disabilities. Int J Pediatr Otorhinolaryngol 2021; 149:110849. [PMID: 34329832 DOI: 10.1016/j.ijporl.2021.110849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Dysphagia is linked to mortality risk among patients with profound intellectual and multiple disabilities (PIMD); the present study therefore aimed to clarify the characteristics of hyoid movements during swallowing and to examine the mechanism of dysphagia in patients with PIMD. METHODS A retrospective video fluoroscopic swallowing study was conducted on 43 patients with PIMD (mean age = 25.4; 25 males, 18 females) and 24 healthy adults (mean age = 44.3; 16 males, 8 females). The movements of the hyoid bone and mandible were tracked frame by frame in the video footage, and their range of movements and trajectories were analyzed. RESULTS Most patients showed atypical movement trajectories of the hyoid, such as insufficient anterior movement and increased range of mandibular downward movement, compared with normal adults. Moreover, the mechanism of dysphagia was revealed by structural equation modeling, indicating that insufficient anterior movement could lead to pharyngeal residue in the pyriform sinus. CONCLUSION The insufficient anterior movement of the hyoid could be caused by weak ventral suprahyoid muscles and atypical head and neck posture characteristic of patients with PIMD. It may be useful to predict pharyngeal residue from the range of hyoid movements and trajectories for the prevention of aspiration.
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Affiliation(s)
- Tatsuya Nakamura
- Department of Rehabilitation, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Japan.
| | - Yosuke Kita
- Mori Arinori Center for Higher Education and Global Mobility, Hitotsubashi University, Japan; Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Japan
| | - Junpei Fujimoto
- Department of Rehabilitation, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Japan
| | - Koichi Ayuzawa
- Department of Rehabilitation, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Japan
| | - Hiroshi Ozawa
- Department of Pediatrics, Shimada Ryoiku Medical Center Hachioji for Challenged Children, Japan
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32
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Takagi D, Ohno T, Moriwaki M, Katagiri N, Umeda Y, Tohara H, Nomoto A, Fujishima I. Effect of dentures on pharyngeal swallowing function in patients with dysphagia. Geriatr Gerontol Int 2021; 21:907-912. [PMID: 34355487 DOI: 10.1111/ggi.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/02/2021] [Accepted: 07/18/2021] [Indexed: 01/09/2023]
Abstract
AIM Dentures play an important role in improving masticatory and oropharyngeal swallowing functions in some edentulous patients without dysphagia. However, few studies have been conducted on patients with dysphagia. This study investigated the effect of dentures on pharyngeal swallowing function in patients with dysphagia. METHODS Older inpatients with dysphagia who used well-fitting dentures were included in the study. Videofluoroscopic swallowing study findings with and without dentures were compared. Pharyngeal residue and area as spatial, the distance between the maxilla and mandible, hyoid bone/laryngeal displacement, and upper esophageal sphincter opening as kinematics, oral/pharyngeal transit time as temporal measurements, and patient-reported symptoms were evaluated. The primary outcome was the pharyngeal residue measured using the normalized residue ratio scale. Comparisons were made using the paired t-test, Wilcoxon signed-rank test and Fisher's exact test. RESULTS The mean age of the 27 participants was 86.1 ± 6.8 years. The vallecular residue was more in those without dentures (with dentures: 0.01 [0-0.02], without dentures: 0.03 [0-0.08]; P = 0.003). The pyriform sinus residue showed no significant difference. Denture removal significantly increased the pharyngeal area. The distance between the maxilla and mandible decreased in the absence of dentures, and other kinematic measurements showed no significant differences. Oral/pharyngeal transit time was prolonged without dentures. CONCLUSIONS Morphological changes caused by the removal of dentures led to pharyngeal expansion, which may result in increased vallecular residue. A treatment plan that considers the effect of dentures on pharyngeal swallowing function may provide rehabilitation that is more effective. Geriatr Gerontol Int 2021; 21: 907-912.
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Affiliation(s)
- Daisuke Takagi
- Department of Rehabilitation, Seirei Mikatahata General Hospital, Hamamatsu, Japan.,Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Motoki Moriwaki
- Department of Rehabilitation, Seirei Mikatahata General Hospital, Hamamatsu, Japan
| | - Norimasa Katagiri
- Department of Rehabilitation Medicine, Seirei Mikatahata General Hospital, Hamamatsu, Japan
| | - Yoshiko Umeda
- Department of Dentistry, Seirei Mikatahata General Hospital, Hamamatsu, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akiko Nomoto
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
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33
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Pu D, Lee VHF, Chan KMK, Yuen MTY, Quon H, Tsang RKY. The Relationships Between Radiation Dosage and Long-term Swallowing Kinematics and Timing in Nasopharyngeal Carcinoma Survivors. Dysphagia 2021; 37:612-621. [PMID: 33909131 PMCID: PMC9072442 DOI: 10.1007/s00455-021-10311-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the relationship between intensity-modulated radiation therapy (IMRT) dosimetry and swallowing kinematic and timing measures. Thirteen kinematic and timing measures of swallowing from videofluoroscopic analysis were used as outcome measures to reflect swallowing function. IMRT dosimetry was accessed for thirteen swallowing-related structures. A cohort of 44 nasopharyngeal carcinoma (NPC) survivors at least 3 years post-IMRT were recruited. The cohort had a mean age of 53.2 ± 11.9 years, 77.3% of whom were male. There was an average of 68.24 ± 14.15 months since end of IMRT; 41 (93.2%) had undergone concurrent chemotherapy. For displacement measures, female sex and higher doses to the cricopharyngeus, glottic larynx, and base of tongue were associated with reduced hyolaryngeal excursion and pharyngeal constriction, and more residue. For timing measures, higher dose to the genioglossus was associated with reduced processing time at all stages of the swallow. The inferior pharyngeal constrictor emerged with a distinctly different pattern of association with mean radiation dosage compared to other structures. Greater changes to swallowing kinematics and timing were observed for pudding thick consistency than thin liquid. Increasing radiation dosage to swallowing-related structures is associated with reduced swallowing kinematics. However, not all structures are affected the same way, therefore organ sparing during treatment planning for IMRT needs to consider function rather than focusing on select muscles. Dose-response relationships should be investigated with a comprehensive set of swallowing structures to capture the holistic process of swallowing.
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Affiliation(s)
- Dai Pu
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Hong Kong, China.,School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Victor H F Lee
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Karen M K Chan
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Hong Kong, China
| | - Margaret T Y Yuen
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Oncology and Otolaryngology and Head and Neck Surgery, Johns Hopkins University, Baltimore, USA
| | - Raymond K Y Tsang
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. .,Department of Surgery and Department of ENT, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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34
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Schar MS, Omari TI, Woods CM, Ferris LF, Doeltgen SH, Lushington K, Kontos A, Athanasiadis T, Cock C, Chai Coetzer CL, Eckert DJ, Ooi EH. Altered swallowing biomechanics in people with moderate-severe obstructive sleep apnea. J Clin Sleep Med 2021; 17:1793-1803. [PMID: 33904392 DOI: 10.5664/jcsm.9286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Dysphagia is a common but under-recognized complication of obstructive sleep apnea (OSA). However, the mechanisms remain poorly described. Accordingly, the aim of this study was to assess swallowing symptoms and use high-resolution pharyngeal manometry (HRPM) to quantify swallowing biomechanics in patients with moderate-severe OSA. METHODS Nineteen adults (4 female, mean age 46±26-68y) with moderate-severe OSA underwent HRPM testing with 5,10 & 20 ml volumes of thin and extremely thick liquids. Data were compared to 19 age- and sex-matched healthy controls (mean age 46±27-68y). Symptomatic dysphagia was assessed using the Sydney Swallow Questionnaire (SSQ). Swallow metrics were analyzed using the online application swallowgateway.com. General linear mixed model analysis was performed to investigate potential differences between people with moderate-severe OSA and controls. Data presented are means (95% CI). RESULTS 26% (5/19) of the OSA group but none of the controls reported symptomatic dysphagia (SSQ>234). Compared to healthy controls, the OSA group had increased upper esophageal sphincter (UES) relaxation pressure (-2 [-1] vs. 2 [1]mmHg, F = 32.1, p <0.0001), reduced UES opening (6 vs. 5mS, F = 23.6, p<0.0001) and increased hypopharyngeal intrabolus pressure (2 [1] vs 7 [1]mmHg, F= 19.0, p <0.05). Additionally, upper pharyngeal pressures were higher, particularly at the velopharynx (88 [12] vs. 144 [12]mmHg.cm.s, F = 69.6, p<0.0001). CONCLUSIONS HRPM identified altered swallowing biomechanics in people with moderate-severe OSA, which is consistent with a subclinical presentation. Potential contributing mechanisms include UES dysfunction with associated upstream changes of increased hypopharyngeal distension pressure and velopharyngeal contractility.
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Affiliation(s)
- Mistyka S Schar
- Department of Speech Pathology & Audiology, Flinders Medical Centre.,Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Taher I Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
| | - Lara F Ferris
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University
| | - Sebastian H Doeltgen
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University
| | - Kurt Lushington
- Psychology, Justice & Society Academic Unit, University of South Australia
| | - Anna Kontos
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Department of Gastroenterology & Hepatology, Flinders Medical Centre
| | - Ching-Li Chai Coetzer
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Respiratory & Sleep Services, Flinders Medical Centre
| | - Danny J Eckert
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
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35
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Tadavarthi Y, Hosseini P, Reyes SE, Focht Garand KL, Pisegna JM, Pearson WG. Pilot Study of Quantitative Methods for Differentiating Pharyngeal Swallowing Mechanics by Dysphagia Etiology. Dysphagia 2021; 36:231-241. [PMID: 32410203 PMCID: PMC7666098 DOI: 10.1007/s00455-020-10123-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Quantitative analysis of modified barium swallow (MBS) imaging is useful to determine the impact of various disease states on pharyngeal swallowing mechanics. In this retrospective proof of concept study, kinematic analysis and computational analysis of swallowing mechanics (CASM) were used to demonstrate how these methods differentiate swallowing dysfunction by dysphagia etiology. Ten subjects were randomly selected from four cohorts of dysphagic patients including COPD, head and neck cancer (HNC), motor neuron disease, and stroke. Each subject was age- and gender-matched with healthy, non-dysphagic controls. MBS videos of 5 ml thin and 5 ml thick bolus trials from each subject were used. A MATLAB tracker tool was adapted and updated to collect and compile data for each video (n = 160). For kinematic measurements, a MANOVA was performed with post-hoc analyses to determine group differences. For CASM measurements, a morphometric canonical variate analysis with post hoc analysis was performed to determine group differences. Kinematic analyses indicated statistically significant differences between HNC cohort and controls in distance measurements for hyolaryngeal approximation (p = .001), laryngeal elevation (p = 0.0001), pharyngeal shortening (p = 0.0002), and stage transition duration timing (p = 0.002). Timing differences were noted between the stroke cohort and controls for pharyngeal transit time (p = 0.007). Multivariate morphometric canonical variate analysis showed significant differences between etiology groups (p < 0.0001) with eigenvectors indicating differing patterns of swallowing mechanics. This study demonstrated that swallowing mechanics among cohorts of dysphagic patients can be differentiated using kinematics and CASM, providing different but complementary quantitative methods for investigating the impact of various disease states on swallowing function.
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Affiliation(s)
| | - Pouria Hosseini
- Medical College of Georgia (MCG), Augusta University, Augusta, Georgia
| | - Stephanie E Reyes
- College of Allied Health Sciences, Augusta University, Augusta, Georgia
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia
| | - Kendrea L Focht Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL, USA
| | - Jessica M Pisegna
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, USA
| | - William G Pearson
- Department of Cellular Biology and Anatomy, MCG, Augusta University, Augusta, Georgia.
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia.
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36
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Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment. Parkinsonism Relat Disord 2021; 86:124-132. [PMID: 33839029 DOI: 10.1016/j.parkreldis.2021.03.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 12/18/2022]
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure plus cerebellar syndrome and/or parkinsonism. Dysphagia is a frequent and disabling symptom in MSA and its occurrence within 5 years of motor onset is an additional diagnostic feature. Dysphagia can lead to aspiration pneumonia, a recognized cause of death in MSA. Guidelines for diagnosis and management of dysphagia in MSA are lacking. An International Consensus Conference among experts with methodological support was convened in Bologna to reach consensus statements for the diagnosis, prognosis, and treatment of dysphagia in MSA. Abnormalities of the oral and pharyngeal phases of swallowing, esophageal dysfunction and aspiration occur in MSA and worsen as the disease progresses. According to the consensus, dysphagia should be investigated through available screening questionnaires and clinical and instrumental assessment (videofluoroscopic study or fiberoptic endoscopic evaluation of swallowing and manometry) at the time of MSA diagnosis and periodically thereafter. There is evidence that dysphagia is associated with poor survival in MSA, however effective treatments for dysphagia are lacking. Compensatory strategies like diet modification, swallowing maneuvers and head postures should be applied and botulinum toxin injection may be effective in specific conditions. Percutaneous endoscopic gastrostomy may be performed when there is a severe risk of malnutrition and pulmonary complications, but its impact on survival is undetermined. Several research gaps and unmet needs for research involving diagnosis, prognosis, and treatment were identified.
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37
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Dharmarathna I, Miles A, Allen J. Quantifying Bolus Residue and Its Risks in Children: A Videofluoroscopic Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:687-696. [PMID: 33736451 DOI: 10.1044/2020_ajslp-20-00275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Postswallow residue is a clinical sign of swallow impairment and has shown a strong association with aspiration. Videofluoroscopy (videofluoroscopic study of swallowing [VFSS]) is commonly used to visualize oropharyngeal swallowing and to identify pharyngeal residue. However, subjective binary observation (present or absent) fails to provide important information on volume or location and lacks objectivity and reproducibility. Reliable judgment of changes in residue over time and with treatment is therefore challenging. We aimed to (a) determine the reliability of quantifying pharyngeal residue in children using the bolus clearance ratio (BCR), (b) determine associations between BCR and other timing and displacement measures of oropharyngeal swallowing, and (c) explore the association between BCR and penetration-aspiration in children. Method In this single-center retrospective observational study, we obtained a set of quantitative and descriptive VFSS measures from 553 children (0-21 years old) using a standard protocol. VFSS data were recorded at 30 frames per second for quantitative analysis using specialized software. Results Good interrater (ICC = .86, 95% CI [.74, .961], p < .001) and excellent intrarater reliability was achieved for BCR (ICC = .97, 95% CI [.91, 1.000], p = 001). Significant correlations between BCR and pharyngeal constriction ratio and total pharyngeal transit time were reported (p < .05). Using binomial logistic regression modeling, we found BCR was predictive of penetration-aspiration in children, χ2(13) = 58.093, p < .001, 64.9%. Children with BCR of ≥ 0.1 were 4 times more likely to aspirate. Conclusion BCR is a reliable, clinically useful measure to quantify postswallow residue in children, which can be used to identify and treat children with swallow impairments, as well as to measure outcomes of intervention.
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Affiliation(s)
- Isuru Dharmarathna
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Anna Miles
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Jacqui Allen
- Department of Surgery, The University of Auckland, New Zealand
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38
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Impact of Thickened Liquids on Laryngeal Movement Velocity in Patients with Dysphagia. Dysphagia 2021; 37:207-215. [PMID: 33709290 DOI: 10.1007/s00455-021-10267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
Considering that thickened liquids are frequently used for patients with dysphagia, elucidating their impact on laryngeal dynamics is important. Although studies have investigated the impact of thickened liquids on laryngeal movement velocity among healthy young adults, no study has examined the same among patients with dysphagia. We aimed to elucidate the influence of bolus consistency on laryngeal movement velocity and surface electromyographic activity of the suprahyoid muscles in patients with dysphagia. Participants included 18 male, poststroke patients with dysphagia, whereas patients with true bulbar paralysis, head and neck cancer, neuromuscular disease, or recurrent nerve paralysis were excluded. A video fluoroscopic swallowing study (VFSS) was performed while swallowing 3 mL of moderately thick and thin liquids. Quantitative VFSS analysis, including factors such as laryngeal peak velocity, laryngeal mean velocity, laryngeal movement distance, duration of the laryngeal elevation movement, and the temporal location of laryngeal vestibule closure within the laryngeal elevation movement was performed. Muscle activity was evaluated using integrated muscles activity values obtained from electromyography (iEMG) of the suprahyoid muscle during swallowing. VFSS analysis showed that laryngeal peak velocity and laryngeal mean velocity were significantly faster while swallowing moderately thick than while swallowing thin liquids. Laryngeal movement distance was significantly greater while swallowing moderately thick than while swallowing thin liquids. iEMG was significantly higher while swallowing moderately thick liquids than while swallowing thin liquids. Compared to thin liquids, moderately thick induced an increase in laryngeal movement velocity and in suprahyoid muscle activity among patients with dysphagia, a finding consistent with that of a previous study among healthy adults.
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39
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Curtis JA, Laus J, Schneider SL, Troche MS. Examining the Relationships Between Lingual Strength, Perihyoid Strength, and Swallowing Kinematics in Dysphagic Adults: A Retrospective Cross-Sectional Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:405-416. [PMID: 33439740 DOI: 10.1044/2020_jslhr-20-00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to examine the relationships of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics and swallowing safety in a heterogenous group of dysphagic adults. Method A retrospective analysis was completed of videofluoroscopic swallow studies of consecutive dysphagic outpatient adults presenting to a tertiary swallowing center from January 1, 2015, to December 31, 2017. Videofluoroscopic swallow study records were included if containing displacement swallowing kinematics of a 20-ml single liquid swallow and clinical measures of anterior (L-MIPA) or posterior (L-MIPP) lingual maximal isometric press, saliva mean swallowing pressures (S-MSP), and/or open mouth-maximal isometric press (OM-MIP). Regression analyses were used to examine the relationships between clinical measures of lingual (L-MIPA, L-MIPP, S-MSP) and perihyoid (OM-MIP) strength and displacement swallowing kinematics, and binomial logistic regressions were used to examine the relationships between clinical measures of lingual and perihyoid strength and swallowing safety (Penetration-Aspiration Scale [PAS]). Results Multivariate regressions revealed significant relationships of L-MIPA, L-MIPP, S-MSP, and OM-MIP with group-level changes to the displacement swallowing kinematics. Univariate analyses revealed significant relationships of L-MIPA and L-MIPP with pharyngeal constriction ratio, maximal extent of upper esophageal segment opening, and PAS. Conclusions Weak relationships were identified of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics. These findings suggest that clinical measures of lingual and perihyoid strength do not fully explain impairments in swallowing kinematics across a heterogenous group of dysphagic patients. Weak-to-moderate relationships were identified between clinical measures of lingual strength and PAS, suggesting that they may have value in predicting functional measures of swallowing safety. Further research is needed to examine how findings may differ between specific patient populations.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Joey Laus
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Sarah L Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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40
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Sabry A, Coyle JL, Abou-Elsaad T. Mansoura Fiberoptic Endoscopic Evaluation of Swallowing Residue Rating Scale (MFRRS): An Anatomically Based Tool - A Preliminary Study. Folia Phoniatr Logop 2020; 73:478-490. [PMID: 33333513 DOI: 10.1159/000512158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this work was to design an anatomically based scale for judging post-swallow residue in the pharyngeal cavities, for use during the fiberoptic endoscopic evaluation of swallowing (FEES) in patients with dysphagia, and to assess its feasibility. METHODS Two 7-point ordinal scales (one for vallecular residue and one for pyriform sinus residue), were developed using detailed anatomic landmarks to denote residue levels. Hard copy color images of a specified frame, from 210 videos of 30 adult FEES evaluations demonstrating the range of all possible residue patterns, were selected (n = 56 valleculae, 62 pyriform sinuses). Half of these images were used to train 4 raters. The remaining half of the images were randomly ordered and rated by the trained raters. Two weeks later the same images were randomized again, and each rater re-analyzed them. The inter- and intra-rater reliability and criterion validity were determined using the kappa statistics and their standard errors. The internal consistency of the items in MFRRS was examined. RESULTS MFRRS showed strong inter-rater reliability (valleculae, κ = 0.832 ± 0.038; pyriform sinus, κ = 0.855 ± 0.034), almost perfect intra-rater reliability (valleculae, κ = 0.964 ± 0.018; pyriform sinus, κ = 0.962 ± 0.02), almost perfect concurrent validity (valleculae, κ = 0.968 ± 0.020; pyriform sinus, κ = 0.0971 ± 0.017), and excellent internal consistency (valleculae, Cronbach's α = 0.990; pyriform sinus, Cronbach's α = 0.985). CONCLUSION MFRRS is a feasible and reliable, anatomically based tool that can provide more accurate pharyngeal residue judgments. The optimized description of residue accumulation patterns can contribute to a better overall description of the functional problem and future description of dysphagia phenotypes.
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Affiliation(s)
- Aliaa Sabry
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tamer Abou-Elsaad
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt,
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Dharmarathna I, Miles A, Fuller L, Allen J. Quantitative video-fluoroscopic analysis of swallowing in infants. Int J Pediatr Otorhinolaryngol 2020; 138:110315. [PMID: 32861978 DOI: 10.1016/j.ijporl.2020.110315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To utilize objective, quantitative videofluoroscopic swallow measures to profile swallowing in infants and to determine the likelihood of objective swallow measures to predict risk of swallow impairments such as airway violation, reflux and post swallow residue. STUDY DESIGN Our single center retrospective observational study used a cohort of 146 bottle-fed infants (0-9 months) referred for VFSS with any kind of feeding related concern. Frame-by-frame analysis of 20-s video loops of mid-feed sucking was completed to obtain quantitative timing, displacement and coordination measures as well as presence of other findings including aspiration, residue and naso-pharyngeal reflux (NPR) and esophago-pharyngeal reflux (EPR). Spearman correlation, Mann-Whitney U test and binomial logistic regression were conducted to determine statistical associations between swallow measures and binary reporting of swallow impairments. RESULTS Videofluoroscopic data of 146 infants were reviewed and analyzed. 49% of infants demonstrated at least one penetration or aspiration event. Total pharyngeal transit time (TPT) and suck-swallow ratio were associated with aspiration (p < .05). Infants with >3 sucks per swallow had significantly longer TPT and their risk of aspiration was greater than those with <3 sucks per swallow (RR 1.23, 95% CI 0.43-8.507, p = .03). Pharyngeal constriction ratio (PCR) and bolus clearance ratio (BCR) were associated with residue, NPR and EPR (p < .05). CONCLUSION Objective measures provide clinicians with reliable timing and displacement data even in the very young. These measures correlate with swallowing safety and may help to identify enhanced risk in some infants, which may influence management recommendations.
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Affiliation(s)
- Isuru Dharmarathna
- Speech Science, School of Psychology, The University of Auckland, New Zealand; Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Sri Lanka.
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, New Zealand
| | - Laura Fuller
- Speech Science, School of Psychology, The University of Auckland, New Zealand; Counties Manukau Health, Auckland, New Zealand
| | - Jacqui Allen
- Department of Surgery, The University of Auckland, New Zealand
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Namasivayam-MacDonald AM, Riquelme LF, Molfenter SM. Establishing a method for quantifying spinal curvature during videofluoroscopic swallow studies: Applying the modified Cobb angle to healthy young and older adults. OBM GERIATRICS 2020; 4:10.21926/obm.geriatr.2003129. [PMID: 35291579 PMCID: PMC8919804 DOI: 10.21926/obm.geriatr.2003129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Cobb angle is traditionally used for quantifying the degree of spinal curvature through evaluation of the full spinal cord. When conducting measurements on videofluoroscopy swallowing studies (VFSS), the Cobb angle can measure degree of cervical vertebrae curvature, which may have implications for swallowing. Given that this measure may have utility in dysphagia research, the reliability of this measure taken from C2-C4 and establishing the presence of changes with age were the focus of the current, proof-of-principle study. VFSS from 19 healthy young adults and 39 healthy older adults were retrospectively analyzed. The C2-C4 Cobb angle was measured between cervical vertebrae two and four on frames of laryngeal vestibule closure (LVC) and post-swallow rest. Results revealed excellent levels of inter- and intra-rater reliability for frame of post-swallow rest (ICCs = 0.788 and 0.793), and fair to good levels of agreement for frame of LVC (ICCs = 0.667 and 0.621). Significant differences in the C2-C4 Cobb angle were found between the healthy young and old data (p < 0.01). Healthy younger adults had a mean angle of 5.8±9.0 degrees at LVC and 7.7±4.5 degrees at swallow rest, whereas healthy older adults had a mean angle of 12.5±9.0 degrees at LVC and 12.4±9.7 degrees at rest. Consistent with the existing spine literature, the curvature of cervical vertebrae appears to increase with age. With established reliability, we propose that the C2-C4 Cobb angle may be used to determine the degree of spinal curvature in a variety of patient populations in order to determine impacts on swallowing function.
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Affiliation(s)
| | - Luis F. Riquelme
- Speech-Language Pathology, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY, United States
- Barrique Speech-Language Pathology, 320 7 Avenue, #308, Brooklyn, NY, United States
| | - Sonja M. Molfenter
- Communicative Sciences and Disorders, New York University, 665 Broadway #9, New York, United States
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Smaoui S, Langridge A, Steele CM. The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review. Dysphagia 2020; 35:745-761. [PMID: 31612288 PMCID: PMC7522100 DOI: 10.1007/s00455-019-10066-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions. Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.
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Affiliation(s)
- Sana Smaoui
- Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada.
| | - Amy Langridge
- Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada
| | - Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE - Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th Floor, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, M5G 1V7, Canada
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Kroon RHMJM, Horlings CGC, de Swart BJM, van Engelen BGM, Kalf JG. Swallowing, Chewing and Speaking: Frequently Impaired in Oculopharyngeal Muscular Dystrophy. J Neuromuscul Dis 2020. [PMID: 32804098 PMCID: PMC7592669 DOI: 10.3233/jnd-200511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Oculopharyngeal muscular dystrophy (OPMD) is a late onset progressive neuromuscular disorder. Although dysphagia is a pivotal sign in OPMD it is still not completely understood. Objective: The aim of this study was to systematically investigate oropharyngeal functioning in a large OPMD population. Methods: Forty-eight genetically confirmed OPMD patients completed questionnaires, performed clinical tests on swallowing, chewing, speaking, tongue strength and bite force, and underwent videofluoroscopy of swallowing. Descriptive statistics was used for all outcomes and logistic regression to investigate predictors of abnormal swallowing. Results: Eighty-two percent reported difficulties with swallowing, 27% with chewing and 67% with speaking. Patients performed significantly worse on all oropharyngeal tests compared to age-matched controls except for bite force. Also asymptomatic carriers performed worse than controls: on chewing time, swallowing speed and articulation rate. During videofluoroscopy, all patients (except one asymptomatic) had abnormal residue and 19% aspirated. Independent predictors of abnormal residue were reduced swallowing capacity for thin liquids (OR 10 mL = 0.93; 20 mL = 0.95) and reduced tongue strength for thick liquids (OR 10 mL = 0.95); 20 mL = 0.90). Aspiration of thin liquids was predicted by disease duration (OR = 1.11) and post-swallow residue with 20 mL (OR = 4.03). Conclusion: Next to pharyngeal dysphagia, chewing and speaking are also frequently affected in OPMD patients, even in asymptomatic carriers. Residue after swallowing is a very early sign, while aspiration is a later sign in OPMD. For clinical follow-up monitoring of subjective complaints, swallowing capacity and tongue strength seems relevant.
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Affiliation(s)
- Rosemarie H M J M Kroon
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, Netherlands
| | - Corinne G C Horlings
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, Netherlands
| | - Bert J M de Swart
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, Netherlands
| | - Baziel G M van Engelen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, Netherlands
| | - Johanna G Kalf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, Netherlands
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Kroon RHMJM, Horlings CGC, de Swart BJM, van Engelen BGM, Kalf JG. Swallowing, Chewing and Speaking: Frequently Impaired in Oculopharyngeal Muscular Dystrophy. J Neuromuscul Dis 2020; 7:483-494. [PMID: 32804098 DOI: 10.3233/jad-200511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oculopharyngeal muscular dystrophy (OPMD) is a late onset progressive neuromuscular disorder. Although dysphagia is a pivotal sign in OPMD it is still not completely understood. OBJECTIVE The aim of this study was to systematically investigate oropharyngeal functioning in a large OPMD population. METHODS Forty-eight genetically confirmed OPMD patients completed questionnaires, performed clinical tests on swallowing, chewing, speaking, tongue strength and bite force, and underwent videofluoroscopy of swallowing. Descriptive statistics was used for all outcomes and logistic regression to investigate predictors of abnormal swallowing. RESULTS Eighty-two percent reported difficulties with swallowing, 27% with chewing and 67% with speaking. Patients performed significantly worse on all oropharyngeal tests compared to age-matched controls except for bite force. Also asymptomatic carriers performed worse than controls: on chewing time, swallowing speed and articulation rate. During videofluoroscopy, all patients (except one asymptomatic) had abnormal residue and 19% aspirated. Independent predictors of abnormal residue were reduced swallowing capacity for thin liquids (OR 10 mL = 0.93; 20 mL = 0.95) and reduced tongue strength for thick liquids (OR 10 mL = 0.95); 20 mL = 0.90). Aspiration of thin liquids was predicted by disease duration (OR = 1.11) and post-swallow residue with 20 mL (OR = 4.03). CONCLUSION Next to pharyngeal dysphagia, chewing and speaking are also frequently affected in OPMD patients, even in asymptomatic carriers. Residue after swallowing is a very early sign, while aspiration is a later sign in OPMD. For clinical follow-up monitoring of subjective complaints, swallowing capacity and tongue strength seems relevant.
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Affiliation(s)
- Rosemarie H M J M Kroon
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, Netherlands
| | - Corinne G C Horlings
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, Netherlands
| | - Bert J M de Swart
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, Netherlands
| | - Baziel G M van Engelen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, Netherlands
| | - Johanna G Kalf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, Netherlands
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Bahia MM, Lowell SY. A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults With Normal and Disordered Swallowing. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1655-1673. [PMID: 32463714 DOI: 10.1044/2020_ajslp-19-00132] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This systematic review summarizes the biomechanical and functional effects of the effortful swallow in adults with and without dysphagia, highlighting clinical implications and future research needs. Specifically, the effects of the effortful swallow on swallowing physiology, safety, and efficiency were identified, as well as the strengths and limitations of current research. Method Recommendations specified by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. A literature search of three databases and relevant articles cited in the searched studies was performed. Two evaluators independently analyzed the studies for eligibility criteria, and final inclusion of studies was decided by consensus. Evaluators also assessed each study for quality of evidence. Results Twenty-three studies were included in this systematic review. Main findings indicated that the effortful swallow generated greater pressures in the tongue-to-palate, pharynx, upper esophageal sphincter, and esophageal regions. Inconsistent results for hyolaryngeal excursion were reported, as well as for swallowing function. Instructions of the effortful swallow varied greatly across studies. Two of the 23 studies were judged to be of high quality, and the remaining studies were of medium quality based on the quality indicators of this review. Conclusions Biomechanical effects of the effortful swallow included increased pressures in the oral, pharyngeal, and esophageal regions. Future investigations should address the effects of the effortful swallow in individuals with dysphagia and its potential role as a rehabilitative maneuver. Moreover, standardization of the effortful swallow instructions based on its physiological and functional effects is essential.
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Affiliation(s)
- Mariana M Bahia
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, NY
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Steele CM, Peladeau-Pigeon M, Barrett E, Wolkin TS. The Risk of Penetration-Aspiration Related to Residue in the Pharynx. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1608-1617. [PMID: 32598168 PMCID: PMC7893525 DOI: 10.1044/2020_ajslp-20-00042] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 05/04/2023]
Abstract
Purpose Reference data from healthy adults under the age of 60 years suggest that the 75th and 95th percentiles for pharyngeal residue on swallows of thin liquids are 1% and 3%(C2-4)2, respectively. We explored how pharyngeal residue below versus above these values prior to a swallow predicts penetration-aspiration. Method The study involved retrospective analysis of a previous research data set from 305 adults at risk for dysphagia. Participants swallowed six thin boluses and three each of mildly, moderately, and extremely thick barium in videofluoroscopy. Raters measured preswallow residue in %(C2-4)2 units and Penetration-Aspiration Scale (PAS) scores for each swallow. Swallows were classified as (a) "clean baseline" (with no preswallow residue), (b) "clearing" swallows of residue with no new material added, or (c) swallows of "additional material" plus preswallow residue. Frequencies of PAS scores of ≥ 3 were compared across swallow type by consistency according to residue severity (i.e., ≤ vs. > 1%(C2-4)2 and ≤ vs. > 3%(C2-4)2. Results The data set comprised 2,541 clean baseline, 209 clearing, and 1,722 swallows of additional material. On clean baseline swallows, frequencies of PAS scores of ≥ 3 were 5% for thin and mildly thick liquids and 1% for moderately/extremely thick liquids. Compared to clean baseline swallows, the odds of penetration-aspiration on thin liquids increased 4.60-fold above the 1% threshold and 4.20-fold above the 3% threshold (mildly thick: 2.11-fold > 1%(C2-4)2, 2.26-fold > 3%(C2-4)2). PAS scores of ≥ 3 did not occur with clearing swallows of moderately/extremely thick liquids. Lower frequencies of above-threshold preswallow residue were seen for swallows of additional material than for clearing swallows. Compared to clean baseline swallows, the odds of PAS scores of ≥ 3 on swallows of additional material increased ≥ 1.86-fold above the 1% threshold and ≥ 2.15-fold above the 3% threshold, depending on consistency. Conclusion The data suggest that a pharyngeal residue threshold of 1%(C2-4)2 is a meaningful cut-point for delineating increased risk of penetration-aspiration on a subsequent swallow.
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Affiliation(s)
- Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
| | - Emily Barrett
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
| | - Talia S Wolkin
- Swallowing Rehabilitation Research Laboratory, KITE, Toronto Rehabilitation Institute, University Health Network, Canada
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Nakao Y, Yamashita T, Honda K, Katsuura T, Hama Y, Nakamura Y, Ando K, Ishikura R, Kodama N, Uchiyama Y, Domen K. Association Among Age-Related Tongue Muscle Abnormality, Tongue Pressure, and Presbyphagia: A 3D MRI Study. Dysphagia 2020; 36:483-491. [PMID: 32743742 DOI: 10.1007/s00455-020-10165-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/25/2020] [Indexed: 01/10/2023]
Abstract
Muscle aging such as sarcopenia adversely affects motor activities. However, few studies have elucidated the aging physiological mechanism of tongue concerted with the changes muscle composition. The present study aimed to examine the tongue composition changes to detect the effect of tongue fat mass on tongue pressure and swallowing function with aging. Twenty community-dwelling elderly without head and neck cancer, stroke, or neuromuscular disease and 20 healthy young were included. Tongue volume, tongue fat mass, tongue lean muscle mass, and tongue fat percentage were evaluated with 3D magnetic resonance imaging (MRI) and Dixon MRI. Tongue pressure was also measured. Swallowing function among elderly individuals was assessed via videofluorography, which was evaluated using the penetration-aspiration scale (PAS) and normalized residue ratio scale (NRRS). Tongue fat mass and tongue fat percentage significantly increased with aging. The tongue fat percentage of elderly participants was 20%, which was two times greater than that of young participants. No significant difference was observed in tongue volume and tongue lean muscle mass. A significantly negative correlation was observed between tongue fat mass and tongue fat percentage as well as tongue pressure. Conversely, tongue volume was not significantly correlated with tongue pressure. Tongue muscle composition exhibited no effect in the PAS and NRRS. Increase of fat mass is a major change in tongue composition with aging, which is associated with low tongue pressure. Thus, attention must be paid not only to tongue quantity but also to the quality of tongue muscles.
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Affiliation(s)
- Yuta Nakao
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Nishinomiya, Hyogo, Japan.
| | - Taiji Yamashita
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Department of Rehabilitation, Matsuyama Rehabilitation Hospital, Matsuyama, Ehime, Japan
| | - Kosuke Honda
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takayuki Katsuura
- Department of Radiology, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan
| | - Yasuhiko Hama
- Department of Radiological Technology, Hyogo College of Medicine College Hospital, Nishinomiya, Japan
| | - Yuki Nakamura
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kumiko Ando
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Reiichi Ishikura
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Coyle JL, Sejdić E. High-Resolution Cervical Auscultation and Data Science: New Tools to Address an Old Problem. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:992-1000. [PMID: 32650655 PMCID: PMC7844341 DOI: 10.1044/2020_ajslp-19-00155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/15/2020] [Accepted: 02/16/2020] [Indexed: 06/11/2023]
Abstract
High-resolution cervical auscultation (HRCA) is an evolving clinical method for noninvasive screening of dysphagia that relies on data science, machine learning, and wearable sensors to investigate the characteristics of disordered swallowing function in people with dysphagia. HRCA has shown promising results in categorizing normal and disordered swallowing (i.e., screening) independent of human input, identifying a variety of swallowing physiological events as accurately as trained human judges. The system has been developed through a collaboration of data scientists, computer-electrical engineers, and speech-language pathologists. Its potential to automate dysphagia screening and contribute to evaluation lies in its noninvasive nature (wearable electronic sensors) and its growing ability to accurately replicate human judgments of swallowing data typically formed on the basis of videofluoroscopic imaging data. Potential contributions of HRCA when videofluoroscopic swallowing study may be unavailable, undesired, or not feasible for many patients in various settings are discussed, along with the development and capabilities of HRCA. The use of technological advances and wearable devices can extend the dysphagia clinician's reach and reinforce top-of-license practice for patients with swallowing disorders.
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Affiliation(s)
- James L. Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, PA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, PA
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