Abnormal Swallowing Research Articles

Progressieve botdestructie bij een hond die operatief werd behandeld voor otitis media: follow-up via klinisch onderzoek en computertomografie

Een beagle van 5,5 jaar oud werd aangeboden omwille van klachten van abnormaal slikken en een scheve kopstand die reeds twee weken aanwezig was. Inspectie van de keel werd uitgevoerd. Op otoscopisch onderzoek werd een intact maar bolstaand trommelvlies aangetroffen. Op de beelden van het computertomografisch (CT) onderzoek bleek de rechter bulla tympanica gevuld met materiaal met een weke-delendensiteit, terwijl de ventrale bullawand deels lytisch was, evenals het pars petrosa van het os temporale. De bulla werd benaderd via ventrale bulla osteotomie, waarbij een steriel cholesterol granuloom en een cholesteatoma werden gediagnosticeerd. De hond herstelde, maar acht maanden na de chirurgie trad opnieuw een scheve kopstand op. Een nieuwe CT-scan toonde uitbreiding van de lyse van de bullawand en toegenomen lyse van het pars petrosum van het os temporale aan. De eigenaar wenste geen nieuwe chirurgische interventie. Nog eens twee jaar later, werd de CT-scan herhaald. Ditmaal was er een duidelijke intracraniale uitbreiding van het letsel zichtbaar. Niettegenstaande de uitgebreidheid en de progressie van de letsels was de hond klinisch stabiel.

Serum sodium shift in hyponatremic patients undergoing liver transplantation: a retrospective cohort study

Introduction: We aimed to describe the pre-operative incidence of hyponatremia in patients undergoing liver transplantation (LTx), as well as the rate and consequences of rapid peri-operative sodium rises in these patients. Methods: This was a retrospective before and after observational study performed at a University-affiliated LTx center between January 2007 and June 2013. The primary exposure was pre-operative hyponatremia, defined as a serum sodium (SNa) <133 mmol/L. The primary outcome was occurrence of a rapid SNa shift, defined as ≥10 mmol/L in the first 24 h following LTx. The rates of rapid peri-operative SNa shift were compared before and after a focused quality assurance (QA) initiative performed in July 2009. Results: Of 366 LTx, 69 (18.9%) had pre-operative hyponatremia, 6 (8.7%) of whom had a rapid rise in serum sodium (SNa). Rapid rise was associated with a greater intra-operative positive fluid balance (p < 0.001) and use of intra-operative continuous renal replacement therapy (CRRT) (p = 0.017). A rapid rise in SNa was associated with more neurological investigations in the post-transplant period (brain computed tomography, electroencephalogram, swallow studies), increased neurological deficits (p = 0.006), more abnormal swallowing assessments (p = 0.003), a tendency for more neurology consultations (p = 0.058), increased discharge to a rehabilitation or long-term care facility (p < 0.001), and increased 6-month mortality (p < 0.001). Following a QA initiative, rapid peri-operative rises in SNa among hyponatremic patients was significantly reduced (20% vs. 0%, p < 0.003). Conclusion: Pre-operative hyponatremia and rapid peri-operative SNa shifts are associated with a more complicated post-operative course and worse outcomes following LTx. Increased education and awareness, along with process changes, such as standardizing CRRT prescription, can reduce iatrogenic rapid peri-operative shifts in SNa.

Early Numerical Studies on the Peristaltic Flow through the Pharynx

AbstractThe flow through the pharynx from the GPJ to the UES has been numerically investigated with a non‐Newtonian fluid obeying the power law with similar rheological indices to a contrast medium used in videofluroscopy. Flow fields revealed the occurrence of reflux regions in the beginning, being this effect stronger at low entrance pressure, which could be related to abnormal swallowing. As a consequence, the bolus travels preferably along the walls. It has been also observed that the bolus head travels faster than the bolus tail, which indicates that the bolus is elongated. Results from this work can be further used for a rheological characterization of oral nutritional supplements for patients suffering from swallowing disorders.Practical ApplicationsThe flow through the pharynx has been numerically investigated with a non‐Newtonian fluid to get insight about causes leading to abnormal swallowing. Reflux has been observed in the beginning as result of a central stream and two symmetric loops generated along the walls, being this effect at low peristaltic pressure. Velocity fields revealed that the bolus head travels faster than the bolus tail, which is a result of the geometry and conservation of mass. Under these conditions, extensional stresses are generated by the flexion of the pharynx walls. Shear rate fields allowed establishing the shear rate range at which the bolus is subjected along the pharynx, which is useful for the rheological characterization of supplements for patients suffering from swallowing disorders.

Relationship between Malocclusion and Oral Habits

In addition to heredity, oral habits are considered important factors in the etiology of malocclusion. This study was taken to assess the relationship between Malocclusion and Oral Habits. The sample comprised of 674 orthodontically untreated subjects, 324 males (48%) and 350 females (52%) 12 to 15-year-old schoolchildren from the southern part of Italy. Orthodontic variables and oral habits including mouth breathing and swallowing pattern; thumb, finger and lip sucking; and nail biting of the patients were evaluate. Two examiners, who had been previously trained in the use of occlusal indices, screened all the schoolchildren. The chi-square and binomial test was used to evaluate the data. A total of 589 of the subjects were found to have deleterious oral habits. Nail biting was found to be the most common habit (65.5%) followed by lip sucking (42.7%), mouth breathing (28.6%), abnormal swallowing pattern (22.7%) and thumb sucking (13.2%). Positive association exist between deleterious oral habits and malocclusions; however, there is no significant relationship between the type of oral habit and malocclusions.

Congenital esophageal stenosis associated with esophageal atresia

Congenital esophageal stenosis (CES) is a rare clinical condition but is frequently associated with esophageal atresia (EA). The aim of this study is to report the diagnosis, management, and outcome of CES associated with EA. Medical charts of CES-EA patients from Lille University Hospital, Sainte-Justine Hospital, and Montreal Children's Hospital were retrospectively reviewed. Seventeen patients (13 boys) were included. The incidence of CES in patients with EA was 3.6%. Fifteen patients had a type C EA, one had a type A EA, and one had an isolated tracheoesophageal fistula. Seven patients had associated additional malformations. The mean age at diagnosis was 11.6 months. All but two patients had non-specific symptoms such as regurgitations or dysphagia. One CES was diagnosed at the time of surgical repair of EA. In 12 patients, CES was suspected based on abnormal barium swallow. In the remaining four, the diagnostic was confirmed by esophagoscopy. Eleven patients were treated by dilation only (1-3 dilations/patient). Six patients underwent surgery (resection and anastomosis) because of failure of attempted dilations (1-7 dilations/patient). Esophageal perforation was encountered in three patients (18%). Three patients had histologically proven tracheobronchial remnants. CES associated with EA is frequent. A high index of suspicion for CES must remain in the presence of EA. Dilatation may be effective to treat some of them, but perforation is frequent. Surgery may be required, especially in CES secondary to ectopic tracheobronchial remnants.

Relationship between abnormal swallowing and mouth breathing

To investigate the relationship between abnormal swallowing and mouth breathing. Thirty-eight patients with abnormal swallowing and 38 patients with normal swallowing were selected. All patients presented with no airway constriction. The age range of the patients was 11-14 years old. The number of patients with mouth breathing was calculated. Statistical analysis (χ(2) test) was performed. The number of patients with mouth breathing in the abnormal swallowing group (17, 45%) was significantly higher than that in the normal swallowing group (5, 13%) (χ(2) = 9.212, P = 0.002). Abnormal swallowing was related to mouth breathing.

Lung Herniation: An Unusual Cause of Dysphagia

Lung herniation is a rare condition that can be classified on the basis of location and etiology. We report an unusual case of right apical lung herniation presenting with dysphagia. Computed tomography of the neck demonstrated an air-containing structure in the root of the right side of the neck, related to but separate from the anteromedial aspect of the right lung apex. The diagnosis of an apical lung hernia was confirmed using high-resolution CT reconstructions. This case highlights that, although uncommon, apical lung hernias should always be considered when investigating abnormalities of swallowing. Identification of an apical lung hernia on plain chest radiographs avoids further unnecessary investigations and surgical intervention. Knowledge of their presentation may avoid complications that could arise from neck interventions such as subclavian central catheter insertion.

Catecholamine Disorders and Hereditary Sensory and Autonomic Neuropathy

Hereditary disorders affecting catecholamine metabolism or development of sensory and autonomic neurons manifest with a wide range of autonomic disturbance. Genetic catecholamine disorders include deficiencies of tyrosine hydroxylase (TH), tetrahydrobiopterin (BH4), L-amino acid decarboxylase (L-ADCC), dopamine-beta-hydroxylase (DBH), vesicula monoamine transporter (VMAT) 2, and norepinephrine transporter (NET). BH4, L-ADCC and VMAT2 deficiency have similar manifestations; autonomic symptoms include hypersalivation, temperature instability, and pupil abnormalities, associated with various motor (eg, dystonia) and behavioral abnormalities. DBH deficiency manifests neonatally with hypotension, hypothermia, hypoglycemia, vomiting and dehydration; orthostatic hypotension is the major manifestation in childhood and later. NET deficiency produces orthostatic intolerance with postural tachycardia. Hereditary sensory and autonomic neuropathies (HSANs) are a heterogenous group of disorders that present with sensory loss and variable degrees of motor and autonomic involvement. Autosomal dominant HSANs include HSAN-1 (due SPTLC1 mutations), Charcot-Marie-Tooth (CMT) disease 2B (due to Rab7 mutations), and HSAN-1 with dementia and hearing loss (linked to DNTM1 mutations). HSAN-1 has a juvenile-to-adult onset sensory neuropathy with minor autonomic involvement; CMT2B has prominent motor manifestations. Autosomal recesssive forms include HSAN-II (linked to mutations in the WNK1, FAM134B, or KIF1A genes), HSAN-III (linked to IKBKAP mutation), HSAN-IV (linked to NTRK1 mutations), HSAN-V (linked to NGFB mutations), and HSAN with spastic paraplegia (linked to CCT5 mutations). Autosomal recessive HSANs have onset at birth or in early childhood and have prominent autonomic symptoms. In particular, HSAN-III (familial dysautonomia or Riley-Day syndrome) is characterized by severe small fiber sensory loss and life-threatening autonomic dysfunction. Prominent manifestations include absence of cold and pain sensation, temperature instability (hypothermia and excessive perspiration), blood pressure lability (due to impaired baroreflex afferent function), abnormal swallowing, vomiting crises, and recurrent bouts of aspiration pneumonia. HSAN-IV and HSN-V are characterized by congenital insensitivity to pain and reduced or absent sweating.

SAT0186 Abnormal Videofluoroscopy Swallow study Finding in Inflammatory Myopathy Patient with Dysphagia as Predictor of Prognosis

BackgroundPrevious reports of dysphagia in patients with inflammatory myopathy (IM) have been focused on detection, intervention and rehabilitation. However, whether dysphagia with abnormal videofluoroscopy swallow study (VFSS) findings is in...

Tu1200 Swallow Function and Post-Swallow Residue in Dysphagic Patients With and Without a History of Pneumonia

BACKGROUND: Automated Impedance Manometry (AIM) analysis defines swallow metrics indicative of bolus timing and presence, contractile vigour and luminal diameter. The Swallow Risk Index (SRI) and integrated nadir impedance to impedance ratio (iZn/Z) are global indices correlating with aspiration risk and post-swallow residue respectively (Omari et al., Gastroenterology 2011; Omari et al., Neurogastro. Mot. 2012). This study compared the SRI and iZn/Z ratio for controls and dysphagic patients with and without a history of pneumonia. METHODS: 87 asymptomatic controls 20-91y (39M, mean 59y) and 201 dysphagic patients 17-91y (117 male, mean 67y) were investigated. 33 patients had history of pneumonia. Swallowing of 5-10ml liquid boluses was recorded by solid state manometryimpedance catheter (OD 3.2mm, 36 pressure at 1cm, 12 impedance at 2cm). AIMplot software was used to derive SRI and iZn/Z indices. RESULTS: 140 patients had abnormal swallow function (SRI>15). 123 patients had significant post-swallow residue (iZn/Z.500). The SRI and iZn/Z ratio were higher in relation to dysphagia. Furthermore, the iZn/Z ratio was higher in dysphagic patients with a history of pneumonia compared to those with no history (See Figure). The latency from bolus flow to pharyngeal contraction was shorter and pharyngeal bolus dwell time was longer in relation to pneumonia (ANOVA p,0.001, p,0.05 for all pairwise comparisons). Pharyngeal pressures and UES relaxation pressures were not significantly different in relation to pneumonia. CONCLUSIONS: Pharyngeal HRIM with AIM analysis can detect increased swallow dysfunction and post-swallow residue in dysphagic patients. Patients with a history of pneumonia have higher post swallow residues.

Assessment of laryngopharyngeal sensation in children with dysphagia

To assess laryngopharyngeal sensation, prevalence of laryngopharyngeal sensory deficit and abnormal swallowing function parameters in children with dysphagia. Retrospective chart review. The medical records of children who underwent flexible endoscopic evaluation of swallowing with sensory testing (FEESST) were reviewed. Laryngopharyngeal sensory threshold (LPST) was assessed based on the threshold intensity of air pulse stimulation eliciting laryngeal adductor reflex. Swallowing function parameters including pharyngeal residue, hypopharyngeal pooling of secretions, premature spillage, laryngeal penetration, and aspiration were evaluated. Prevalence of abnormal swallowing function parameters in children with normal and impaired LPST was compared. Forty children with dysphagia (28 male, 12 female; age range, 3 months to 17 years) underwent FEESST. LPST was normal in six patients, moderately impaired in 20 patients, and severely impaired in 10 patients. LPST could not be measured in four patients. Children showed one or more abnormal swallowing function parameters. The prevalence of abnormal swallowing parameters in patients with normal LPST was lower than that of patients with moderately or severely impaired LPST (P < .05). The prevalence of pharyngeal residue, hypopharyngeal pooling of secretions, and spillage in patients with severely impaired LPST was higher than that of patients with moderately impaired LPST (P < .05). The majority of children with dysphagia have impaired LPST. The prevalence of abnormal swallowing function parameters in children with normal LPST is lower than that in children with moderately or severely impaired LPST. Prevalence of aspiration tends to increase when the abnormal swallowing function parameters are associated with severely impaired LPST.

Continuing Education

Article| Online March 01 2013 Continuing Education Author & Article Information Online Issn: 1943-7676 Print Issn: 0272-9490 Copyright © 2013 by the American Occupational Therapy Association, Inc.2013 The American Journal of Occupational Therapy, 2013, Vol. 67(2), 256. https://doi.org/10.5014/ajot.67.2.256 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Continuing Education. Am J Occup Ther March/April 2013, Vol. 67(2), 256. doi: https://doi.org/10.5014/ajot.67.2.256 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentThe American Journal of Occupational Therapy Search Advanced Search AOTA Taxonomy: Education Keywords: adult, child, clients, evidence-based practice, mental health, occupational therapists, older adult, older drivers, practice guidelines, fall prevention Early Childhood: Occupational Therapy Services for Children Birth to Five. Edited by Barbara E. Chandler, PhD, OTR/L, FAOTA. Provides a journey of occupational therapy in early childhood to develop readers’ perspectives, knowledge, and skills and improve the ability of practitioners to have a positive impact on the lives of children and families, teachers, and child care providers. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3026, AOTA Members: $259, Nonmembers: $359. Dysphagia Care and Related Feeding Concerns for Adults, 2nd Edition. Edited by Wendy Avery, MS, OTR/L. Dysphagia second edition is an up-to-date resource and educational tool for practitioners to provide skilled care and broaden their knowledge of interventions and approaches with dysphagia clients. Includes “The Dynamic Swallow” CD with diagrams, animations, and videofluoroscopic images of the normal and abnormal swallow. Earn 1.5 AOTA CEUs (18.75 NBCOT PDUs/15 contact hours). Order #3028, AOTA Members: $199, Nonmembers: $299. Mental... You do not currently have access to this content.

Theoretical Estimation of Shear Rate during the Oral Phase of Swallowing: Effect of Partial Slip

AbstractThe goal of this study was to quantify the shear rate in a simplified model of the oral cavity during bolus ejection. Parallel plate squeezing flow was used to approximate the action of the tongue against the palate as a bolus is ejected from the mouth and into the pharynx during a swallow. The current work quantified variations in shear rate with respect to two main effects – the relative degree of boundary slip for Newtonian boluses of varying viscosity. The results suggest that a single shear rate that describes oropharyngeal swallowing is a too simplistic concept. Rather variation in bolus viscosity, level of lubrication as well as others may have a strong effect on shear rate.Practical ApplicationsMathematical modeling of oropharyngeal swallowing has the potential to play an important role in understanding the underlying mechanics of normal and abnormal swallowing, as well as in guiding the development and optimization of therapeutic strategies for swallowing disorders. The long‐term objective of this research is to develop a robust methodology for prediction of bolus flow characteristics in response to motions of the oropharyngeal structures, such as the tongue and pharyngeal walls. In addition to furthering our understanding of the normal swallow, such models could probe the physical basis of biomechanical treatment strategies, such as postural changes (e.g., chin‐tuck) or dietary medications (commonly referred to as “thickened liquids”), as well as optimizing such strategies or suggesting new strategies altogether.

Oropharyngeal and Esophageal Swallowing Impairments: Their Association and the Predictive Value of the Modified Barium Swallow Impairment Profile and Combined Multichannel Intraluminal Impedance—Esophageal Manometry

Deglutition is a highly integrated process of neural signaling and coordinated muscular contraction that begins with bolus preparation in the oral cavity and ends with closure of the lower esophageal sphincter after bolus passage. The goal of this study was to examine the relationship between measures of oropharyngeal and esophageal swallow function. A retrospective review was performed of patients who underwent modified barium swallow study (MBSS) and multichannel intraluminal impedance-esophageal manometry (MII-EM) over 7 years at an academic institution. The MBSS was scored with the Modified Barium Swallow Impairment Profile (MBSImP). Associations between impairments as measured by the MBSImP and MII-EM were assessed with a 2-sided Fisher's exact test. One hundred sixty-four patients met the inclusion criteria for the study. Comparison of MBSImP component and oral and pharyngeal total regional scores to MII-EM scores revealed a significant association between abnormal esophageal clearance on MBSS (MBSImP component 17) and abnormal findings on MII-EM (p < 0.001). Delay in initiation of pharyngeal swallow (MBSImP component 6) was significantly associated with abnormal esophageal clearance on MBSS (p = 0.023). Abnormal esophageal clearance on MBSS (MBSImP component 17) indicates a need for further esophageal testing. A functional interrelationship between abnormalities of oropharyngeal and esophageal swallowing does exist, illuminating the importance of thorough pharyngoesophageal examination for dysphagia symptoms.

Changes in Swallowing-Related Quality of Life after Parathyroidectomy for Hyperparathyroidism: A Prospective Cohort Study

To prospectively evaluate the impact of parathyroidectomy on swallowing-related quality of life using the Swallowing Quality Of Life (SWAL-QOL) validated outcomes assessment tool. Many patients with primary hyperparathyroidism report nonspecific symptoms, such as fatigue, irritability, cognitive impairment, sleep disturbances, and dysphagia. To date, there have been no prospective studies evaluating swallowing function before and after parathyroid surgery. Patients undergoing parathyroidectomy from September 2007 to January 2009 completed the SWAL-QOL questionnaire before and one year after surgery. Data were collected on demographic and clinicopathologic variables. Comparisons were made to determine the effect of surgery on patients' perceptions of swallowing function. Of 151 eligible patients, 102 (68%) completed the study. The mean patient age was 60 years, and 79% were female. A total of 73 patients (67%) had minimally invasive parathyroidectomies, whereas the remainder had bilateral explorations. In all, 83 patients (81%) had a parathyroid adenoma, 16 patients (16%) had hyperplasia, and 3 patients (3%) had a double adenoma on final pathologic interpretation. Mean preoperative SWAL-QOL scores were <90 for 4 of the 11 domains, indicating the perception of oropharyngeal dysphagia and diminished quality of life. Following parathyroidectomy, significant improvements were demonstrated in eight SWAL-QOL domains. Many patients with parathyroid disease have the perception of abnormal swallowing function. In these patients with symptoms of dysphagia, parathyroid surgery leads to significant improvements in many aspects of swallowing-related quality of life measured by the SWAL-QOL instrument. This study represents the first use of a condition-specific instrument to assess swallowing-related quality of life for patients with parathyroid disease before and after parathyroid surgery.

Swallowing abnormalities in HIV infected children: an important cause of morbidity

BackgroundSwallowing disorders, well recognised in adults, contribute to HIV-infection morbidity. Little data however is available for HIV-infected children. The purpose of this study is to describe swallowing disorders in a group of HIV-infected children in Africa after the introduction of combined anti-retroviral therapy.MethodsWe describe 25 HIV-infected children referred for possible swallowing disorders. Clinical and videofluoroscopic assessment of swallowing (VFSS), HIV stage, and respiratory and neurological examination were recorded.ResultsMedian age was 8 months (range 2.8-92) and 15 (60%) were male. Fifteen (60%) were referred for recurrent respiratory complaints, 4 (16%) for poor growth, 4 (16%) for poor feeding and 2 (8%) patients for respiratory complaints and either poor growth or feeding. Twenty patients (80%) had clinical evidence of swallowing abnormalities: 11 (44%) in the oral phase, 4 (16%) in the pharyngeal phase, and 5 (25%) in both the oral and pharyngeal phases. Thirteen patients had a videofluoroscopic assessment of which 6 (46%) where abnormal. Abnormalities were detected in the oral phase in 2, in the pharyngeal phase in 3, and in the oral and pharyngeal phase in 1; all of these patients also had evidence of respiratory involvement. Abnormal swallowing occurred in 85% of children with central nervous system disease. CNS disease was due to HIV encephalopathy (8) and miscellaneous central nervous system diseases (5). Three of 4 (75%) patients with thrush had an abnormal oral phase on assessment. No abnormalities of the oesophagus were found.ConclusionsThis report highlights the importance of swallowing disorders in HIV infected children. Most patients have functional rather than structural or mucosal abnormalities. VFSS makes an important contribution to the diagnosis and management of these patients.

The Role of Barium Swallow Pharyngoesophagography in the Management of the Globus Pharyngeus: Our Ten Years Local Experience of Asian Population

Patients with globus pharyngeus referred for barium swallow pharyngoesophagography in a local hospital from 1/7/1999 to 30/6/2009 were identified. Their fluoroscopic images were reviewed, and their outcomes were used as gold standard. A total of 908 patients with globus pharyngeus were referred for barium swallow in the period. There were 783 patients with normal barium swallow and 125 patients with abnormal barium swallow findings. All patients aged below 30years had normal barium swallow result and unremarkable follow up. The sensitivity and specificity of barium swallow were 25.6 and 97.5% respectively; and the positive predictive value and negative predictive value were 61.5 and 89.1% respectively. The overall accuracy was 87.6%. Barium swallow is of limited diagnostic value in patients with typical globus pharyngeus, and it is not recommended in these patients, especially with young age.

Classification of healthy and abnormal swallows based on accelerometry and nasal airflow signals

Dysphagia assessment involves diagnosis of individual swallows in terms of the depth of airway invasion and degree of bolus clearance. The videofluoroscopic swallowing study is the current gold standard for dysphagia assessment but is time-consuming and costly. An ideal alternative would be an automated abnormal swallow detection methodology based on non-invasive signals. Building upon promising results from single-axis cervical accelerometry, the objective of this study was to investigate the combination of dual-axis accelerometry and nasal airflow for classification of healthy and abnormal swallows in a patient population with dysphagia. Signals were acquired from 24 adult patients with dysphagia (17.8±8.8 swallows per patient). The abnormality of each swallow was quantified using 4-point videofluoroscopic rating scales for its depth of airway invasion, bolus clearance from the valleculae, and bolus clearance from the pyriform sinuses. For each scale, we endeavored to automatically discriminate between the 2 extreme ratings, yielding 3 separate binary classification problems. Various time, frequency, and time-frequency domain features were extracted. A genetic algorithm was deployed for feature selection. Smoothed bootstrapping was utilized to balance the two classes and provide sufficient training data for a multidimensional feature space. A Euclidean linear discriminant classifier resulted in a mean adjusted accuracy of 74.7% for the depth of airway invasion rating, whereas Mahalanobis linear discriminant classifiers yielded mean adjusted accuracies of 83.7% and 84.2% for bolus clearance from the valleculae and pyriform sinuses, respectively. The bolus clearance from the valleculae problem required the lowest feature space dimensionality. Wavelet features were found to be most discriminatory. This exploratory study confirms that dual-axis accelerometry and nasal airflow signals can be used to discriminate healthy and abnormal swallows from patients with dysphagia. The fact that features from all signal channels contributed discriminatory information suggests that multi-sensor fusion is promising in abnormal swallow detection.

NUMERICAL SIMULATION OF THE SWALLOWING OF LIQUID BOLUS

ABSTRACTThickened liquid foods are given to alleviate swallowing disorder, and their usefulness depends on the flow behavior of the liquid bolus when it is swallowed. In order to optimize the use of the bolus, its swallowing flow was simulated numerically for a pharynx. The rheological model of the bolus liquid was assumed to be a viscous power law model. The movements of the tongue and pharynx were modeled to simulate the swallowing flow. The interaction of the flow of the bolus and the movements of the pharynx were analyzed using a finite element method. In normal swallowing, the viscous liquid reduced the bolus velocity compared with the velocity of the water bolus, but the difference in the velocity because of viscosity was slight between the thickened boluses. With respect to abnormal swallowing, simulations were conducted for two kinds of disorder. (1) When the disorder was caused by dysfunction in the lift up of the throat and retroflexion of the epiglottis, the water bolus was scattered over the epiglottis and was partly aspirated. A thickened bolus of 10 cc was also aspirated from the pyriform sinuses to the larynx. A small bolus of 2 cc remained at the valleculae and then dropped down into the larynx. In contrast, a bolus of 5 cc flowed along the pyriform sinuses and was not aspirated differently from the other cases. (2) When the disorder was caused by early termination of swallowing movements, a part of the bolus remained around the epiglottis, and the return of the epiglottis induced part of the bolus to drop into the larynx. These results suggested that the pattern of the aspiration depended on the swallowing movements, and the viscosity and volume of the bolus.PRACTICAL APPLICATIONSLiquid care foods have been developed for use with swallowing disorders, and the particular viscous properties that are optimal for these foods have been studied. However, there are different types of swallowing disorder; hence, providing general guidelines for the properties of liquid care foods is difficult. The object of the study reported herein was to develop a numerical model for the simulation of the swallowing of a liquid bolus, which can be used to aid the effort to produce safe liquid care foods.

Objective Assessment of Swallowing Function After Definitive Concurrent (Chemo)radiotherapy in Patients with Head and Neck Cancer

The aim of this study was to objectively assess swallowing function and factors impacting it after curative intent definitive (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a cohort of 47 patients with locoregionally advanced (T1-4, N0-3) HNSCC treated with definitive CRT. Objective assessment of swallowing function was done using modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups. Scoring of MBS was done using penetration-aspiration scale (PAS). Abnormal swallowing was defined in terms of incidence and severity of penetration-aspiration, pharyngeal residue, postural change, and regurgitation. Aspiration, residual, postural change, and regurgitation were present on baseline pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that increased to 11 (29%), 11 (29%), 12 (32%), and 10 (26%) patients, respectively, at 6-month post-CRT evaluation. The proportion of patients with high PAS scores (3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among patients (n=34) with low PAS scores (≤2) at baseline, additional impairment of swallowing function was seen in 53 and 46% at 2- and 6-month assessment, respectively. Residue (44%) and aspiration (18%) domains were impaired in a higher proportion of patients after CRT. Thin and thick barium had higher aspiration and residue function impairment, respectively. Patients with pre-CRT poor subjective swallowing function (P=0.004), hypopharyngeal primary (P=0.05), and large tumor volume (P=0.05) had significantly worse objective swallowing function at baseline as demonstrated by pretreatment PAS scores. This study provides useful information regarding patterns of objective swallowing dysfunction in patients treated with definitive (chemo)radiotherapy. There is significant impairment of objective swallowing function in all domains following CRT, with residue and aspiration domains being affected most significantly.