Initiation Of Pharyngeal Swallow Research Articles

Risk Factors of Aspiration in Pediatric Dysphagia: A Videofluoroscopic Swallowing Study Analysis

Objectives: This study examined to identify effective temporal measures to distinguish between aspirators and non-aspirators in young children with dysphagia.Methods: Fortytwo children aged from 1 year to 3 years 11 months were included in this study. All children were referred to Videofluoroscopic Swallowing Study (VFSS) at a tertiary hospital in South Korea. The children were divided into two groups depending on the presence of aspiration: aspirators (N=16) and non-aspirators (N=26). Seven temporal measures were measured to identify swallowing physiologies by using frame-by-frame analysis. A multilevel model with binomial distribution was used to examine which temporal measures better predict group membership.Results: Delayed pharyngeal swallow (DPS), pharyngeal transit time (PTT), and initiation of laryngeal closure (ILC) were significant factors in distinguishing the aspirators from the non-aspirators. DPS was the most useful temporal measure to distinguish between the groups. ILC placed second, followed by PTT. A model including DPS and PTT was the best model to predict the group membership. A model with PTT and ILC ranked second.Conclusion: The findings indicated that an aspiration risk appeared to increase when the bolus stayed longer in the pharynx and initiation of pharyngeal swallow was delayed. Also, the bolus remained in the pharynx for an abnormally longer time while the airway was open in the aspirators. This study suggests that clinicians should not only recognize pathophysiological factors that may increase the aspiration risk but also determine which abnormal physiology is a main factor of aspiration during VFSS.

Factors Influencing Initiation of Pharyngeal Swallow in Healthy Adults.

Purpose The purpose of this study was to investigate factors influencing the initiation of pharyngeal swallow (IPS) in healthy, nondysphagic adults. Method A total of 195 healthy participants ranging in age from 21 to 89 years participated in a modified barium swallow study. IPS was quantified using the Modified Barium Swallow Impairment Profile standardized scoring system across nine swallowing tasks observed in the lateral viewing plane for each participant. Results Large variability for bolus head location at time of hyoid burst (IPS) was observed within this healthy cohort, ranging from the ramus of the mandible to the pyriform sinuses. Significant effects of bolus volume, viscosity, sex, and race were also observed. Conclusion Study findings indicate that IPS is variable in healthy adults and influenced by volume, viscosity, sex, and race. Thus, variability in IPS may be considered typical in otherwise nondysphagic adults. The clinical significance of high Modified Barium Swallow Impairment Profile IPS scores in dysphagic patients, therefore, must be considered within the context of other swallowing impairments. Supplemental Material https://doi.org/10.23641/asha.12735935.

Do Ratings of Swallowing Function Differ by Videofluoroscopic Rate? An Exploratory Analysis in Patients After Acute Stroke

ObjectiveTo determine differences between continuous videofluoroscopic swallow studies (VFSS) with a pulse rate and frame rate of 30 and the same swallows reduced to 15 frames per second (fps) on measures of swallowing function in patients after acute ischemic stroke. DesignBlinded comparison. SettingAcute hospital. ParticipantsPatients after ischemic stroke (N=20). InterventionsNot applicable. Main Outcome MeasuresSingle and sequential sips of thin liquids, single sips of nectar liquids, pudding, and cookie boluses were rated on measures of timing of swallowing events, Modified Barium Swallowing Impairment Profile component scores, and Penetration-Aspiration Scale scores. The ratings for videos at 15 fps and 30 fps were compared by Wilcoxon signed rank tests. ResultsPharyngeal transit time was longer and bolus entry into the hypopharynx was later for 30 fps than for 15 fps. Components of Oral Residue and Pharyngoesophageal Segment Opening ratings were more severe for 15 fps than 30 fps, whereas Bolus Transport and Initiation of Pharyngeal Swallow were rated as more severe for 30 fps than for 15 fps. There was no difference between 30 fps and 15 fps on the remaining measures, including Penetration-Aspiration Scale scores. ConclusionContinuous VFSS recorded at 30 fps and their down-sampled 15 fps duplicates yielded contrasting results on certain durational and functional measures of swallowing, though not on others. VFSS should be administered continuously or at 30 pulses per second for valid assessment of swallowing while using other methods to reduce radiation exposure.

Longitudinal Evaluation of Swallowing with Videofluoroscopy in Patients with Locally Advanced Head and Neck Cancer After Chemoradiation.

The aim of this study was to investigate the prevalence, severity, and pattern of evolution of swallowing impairments encountered in head and neck cancer (HNC) patients before and after chemoradiation (CRT) with videofluoroscopy of swallowing study (VFSS), using the modified barium swallow impairment profile (MBSImP) protocol and scoring system, and to determine the appropriate time points in which these patients should undergo VFSS post-CRT. A prospective cohort of 69 patients with locally advanced HNC underwent VFSS with the MBSImP protocol at 5 evaluation points: pre-CRT, and 1, 3, 6, and 12months post-CRT. VFSS was scored with MBSImP, penetration-aspiration scale (PAS), and swallowing performance status (SPS) scale. Statistical analysis was performed only for the 12-month disease-free subset of patients. MBSImP, PAS, and SPS scale scores reached their peak at 3months post-CRT and improved at 6-12months, but without returning at pre-treatment levels. Base of tongue retraction, initiation of pharyngeal swallow, epiglottic movement, laryngeal vestibule closure, and laryngeal elevation were the most frequently observed impaired MBSImP components. Epiglottic movement significantly improved (p = 0.009) and laryngeal vestibule closure significantly deteriorated (p = 0.042) over time (Friedman test). Severe swallowing deficits and high aspiration rates are observed in HNC patients pre-CRT, which further deteriorate post-CRT, peak at 3months, and despite slight improvement, persist over time. We suggest that these patients, regardless of the presence of subjective dysphagia, should undergo VFSS both before and 3months post-CRT, and also if possible, 1month post-CRT, in order to facilitate implementation of early swallowing rehabilitation.

Dysphagia in infants with single ventricle anatomy following stage 1 palliation: Physiologic correlates and response to treatment.

Deficits in swallowing physiology are a leading morbidity for infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliation. Despite the high prevalence of this condition, the underlying deficits that cause this post-operative impairment remain poorly understood. Identify the physiologic correlates of dysphagia in infants with functional single ventricles and systemic outflow tract obstruction following stage 1 palliative surgery. Postoperative fiberoptic laryngoscopies and videofluoroscopic swallow studies (VFSS) were conducted sequentially on infants with functional single ventricles following stage 1 palliative surgery. Infants were dichotomized as having normal or impaired laryngeal function based on laryngoscopy findings. VFSS were evaluated frame-by-frame using a scale that quantifies performance within 11 components of swallowing physiology. Physiologic attributes within each component were categorized as high functioning or low functioning based on their ability to support milk ingestion without bolus airway entry. Thirty-six infants (25 male) were included in the investigation. Twenty-four underwent the Norwood procedure and twelve underwent the Hybrid procedure. Low function physiologic patterns were observed within multiple swallowing components during the ingestion of thin barium as characterized by ≥4 sucks per swallow (36%), initiation of pharyngeal swallow below the level of the valleculae (83%), and incomplete late laryngeal vestibular closure (56%) at the height of the swallow. Swallowing deficits contributed to aspiration in 50% of infants. Although nectar thick liquids reduced the rate of aspiration (P = .006), aspiration rates remained high (27%). No differences in rates of penetration or aspiration were observed between infants with normal and impaired laryngeal function. Deficits in swallowing physiology contribute to penetration and aspiration following stage 1 palliation among infants with normal and impaired laryngeal function. Although thickened liquids may improve airway protection for select infants, they may inhibit their ability to extract the bolus and meet nutritional needs.

Evaluation of dysphagia at the initial diagnosis of amyotrophic lateral sclerosis.

Dysphagia eventually occurs in amyotrophic lateral sclerosis (ALS). Swallowing in patients with ALS at their initial diagnosis was evaluated using videofluoroscopy (VF). Nineteen consecutive patients with ALS, 14 with bulbar symptoms, and 5 without them, underwent VF. Fourteen physiologic components, 6 oral and 8 pharyngeal components, were assessed during the examination. Significantly poorer scores were observed in three of the 6 oral components and 3 of the 8 pharyngeal components in patients with bulbar symptoms. Furthermore, bolus transport from the oral cavity to pharynx, pharyngeal constriction, oral residue and pharyngeal residue were impaired in patients even without bulbar symptoms. On the other hand, pharyngoesophageal segment opening was preserved in patients even with bulbar symptoms. Bolus transport and initiation of pharyngeal swallow were correlated with the swallowing category of the ALS severity scale. Defining types of impairment in patients with or without bulbar symptoms is useful for evaluating dysphagia in this disease. Although VF showed impairment of oral and pharyngeal phases of swallowing, the oral phase affected the eating habit in ALS at the initial diagnosis.

Preliminary investigation of the effect of pulse rate on judgments of swallowing impairment and treatment recommendations.

Reducing fluoroscopic pulse rate, a method used to reduce radiation exposure from modified barium swallow studies (MBSSs), decreases the number of images available from which to judge swallowing impairment. It is necessary to understand the impact of pulse rate reduction on judgments of swallowing impairment and, consequentially, treatment recommendations. This preliminary study explored differences in standardized MBSS measurements [Modified Barium Swallow Impairment Profile (MBSImP™©) and Penetration Aspiration Scale (PAS) Scores] between two pulse rates: 30 and simulated 15 pulses per second (pps). Two reliable speech-language pathologists (SLPs) scored all five MBSSs. Five SLPs reported treatment recommendations based on those scores. Differences in judgments of swallowing impairment were found between 30 and simulated 15pps in all five MBSSs. These differences were in six physiological swallowing components: initiation of pharyngeal swallow, anterior hyoid excursion, epiglottic movement, pharyngeal contraction, pharyngeal-esophageal segment opening, and tongue base retraction. Differences in treatment recommendations were found between 30 and simulated 15pps in all five MBSSs. These findings suggest that there are differences in both judgment of swallowing impairment and treatment recommendations when pulse rates are reduced from 30 to 15pps to minimize radiation exposure.

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.

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