Laryngeal Elevation Research Articles

Evaluation of the location of capsules swallowed with food during the pharyngeal phase triggering in asymptomatic adults.

To assess the location of hard gelatin capsules in the pharyngeal phase triggering among asymptomatic adults. The location of the bolus during the pharyngeal phase triggering provides information about the sensorimotor model of the beginning of deglutition onset. To evaluate the location of hard gelatin capsules in the pharyngeal phase triggering among asymptomatic adults. A videofluoroscopy swallowing study was carried out in 60 subjects (14 male and 46 female participants) aged between 27 and 55 years, who were evaluated with hard gelatin capsules #00 and #3 containing barium sulfate, swallowed with liquid food and pudding, in free volume. The first laryngeal elevation movement was the criterion to locate the pharyngeal phase triggering. Statistical analysis was based on the McNemar test. Capsule #3 presented higher percentage of location in the tongue dorsum compared to capsule #00, and capsule #00 presented higher percentage of location in the tongue base and vallecula compared to capsule #3. There was a difference between different capsules swallowed with liquid (p=0.016) and pudding (p=0.037). The capsule size influenced the location of the pharyngeal phase triggering. Smaller capsules started pharyngeal phase in the most anterior region (tongue dorsum) compared to larger capsules.

한국 정상 노인층의 삼킴장애지수와 후두 기능에 따른 삼킴 특성

Larynx plays an important role in phonation and protection of the respiratory tract during swallowing. The reduced anatomical and physiological function in elevation of larynx and glottis closure can cause problems in voice and swallowing. The present study investigated the Korean version of handicap index of dysphagia in elderly Koreans. Therefore, 60 normal elderly Koreans ranged from 65 to 95 and 20 normal Korean young adults aged from 20 to 25 were participated in this study to compare total (T), physical (P), functional (F), and emotional (E) index scores between two groups as well as among sub groups (60s, 70s, 80s) in elderly. For swallowing, total and sub dysphagia handicap index (DHI) scores, voice quality during /a/phonation following swallowing (saliva and water), intensity of coughing, and L-DDK were measured. The results showed that functional (P), physical (P), emotional (E) scores as well as total (T) score were significantly different between young adults and old adults in DHI(p<.05). Additionally, there was a negative correlation between total DHI score and intensity of coughing (r=-.51) as well as L-DDK (r=-.70). These findings suggest that a slow rate in vocal fold adduction and reduced intensity of coughing in the elderly affect swallowing function. Thus, recently translated Korean version of DHI may be useful as supplement in evaluating the swallowing problems in elderly people.

Quantitative evaluation of age-related alteration of swallowing function: Videofluoroscopic and manometric studies.

Swallowing function progressively deteriorates with advancing age, leading to high morbidity and mortality in the elderly population. To establish strategies for treatment of age-related swallowing disorders, the mechanisms of such disorders must be quantitatively clarified. The purpose of this paper was to elucidate the swallowing function of healthy elderly individuals by comparison with that of young adults by videofluorographic and manometric examinations. The subjects were 70 healthy volunteers with no history of diseases affecting swallowing function. They were classified into three groups according to age: the young adult group (21-32 years of age, n=8), early elderly group (60-69 years of age, n=39), and late elderly group (70-83 years of age, n=23). Their swallowing functions were quantitatively evaluated by videofluorographic and manometric studies. Videofluorographic examination showed no significant differences in the moving distances of the hyoid bone and larynx in the pharyngeal swallowing phase between the young and elderly groups. The pharyngeal transit time (PTT) of the bolus in the elderly group was longer and the percentage of laryngeal elevation (%LE) was lower than those in the young group. Manometric examination revealed higher hypopharyngeal swallowing pressure in the elderly groups. The traveling velocity of the swallowing pressure in the upper esophageal sphincter (UES) region and the UES relaxation time decreased with aging. Reduction of the UES pressure during the pharyngeal swallowing phase was insufficient in 15.4% of the early elderly group and 30.4% of the late elderly group. Additionally, the UES zone was broadened in 20.5% of the early elderly group and 26.1% of the late elderly group. Videofluorographic and manometric examinations quantitatively demonstrated that the swallowing reflex was delayed and UES opening was impaired by aging. UES dysfunction may develop secondary by increased tonicity and decreased elasticity of the cricopharyngeal muscle. Stimulation of oropharyngeal sensory function and exercising the laryngeal levator muscles may be effective for age-related swallowing disorders.

Clinical Feasibility Trial for Transtracheal Stimulation of Vocal Fold Closure in Sensate Human Subjects

Objectives: (1) Apply transtracheal stimulation (TTS) of the recurrent laryngeal nerve (RLN) for vocal fold closure (VFC) in sensate humans. (2) Characterize tracheal sensory response to electrical stimuli. Methods: Patients with chronic tracheostomies were selected for a “first-in-man” clinical device trial to stimulate the RLN through tracheal tissue for VFC. Etiologies of trach dependence varied, but all subjects had normal laryngeal sensation, vocal cord mobility, and RLN function. Devices were introduced through subjects’ ostomies, and electrodes were subsequently deployed for tracheal contact. Videoendoscopy recorded responses to square wave pulse trains of varying pulse amplitude (PA) and pulse width (PW; 0.5 mA-5 mA and 60 us-500 us, respectively). Subjects were surveyed for sensory changes, discomfort, and pain. Results: TTS of the RLN successfully elicited VFC in all subjects. The PA threshold for closure (ThPA; at PW = 200 us) ranged from 1.5 mA to 3.5 mA unilaterally, and 1.0 mA to 2.5 mA bilaterally for all subjects except 1 outlier with thresholds of 0.9 mA and 1.2 mA unilaterally, and 0.7 mA bilaterally. PW thresholds (ThPW) ranged from 100 us to 300 us for all subjects (PA = 0.75 × ThPA). All subjects denied pain, but 3 described mild incremental “tingling” that initiated cough or swallow responses only at suprathreshold levels. Conclusions: TTS initiated arytenoid medialization for VFC in all subjects without pain or significant discomfort. This study presents a novel technique for noninvasive restoration of VFC in humans. Further trials will determine full clinical utility of this device component, individually and in conjunction with components targeting swallow detection and laryngeal elevation for coordinated airway protection.

Effortful Pitch Glide: A Potential New Exercise Evaluated by Dynamic MRI

The purpose of this study was to compare the biomechanics of the effortful pitch glide (EPG) with swallowing using dynamic MRI. The EPG is a combination of a pitch glide and a pharyngeal squeeze maneuver for targeting laryngeal and pharyngeal muscles. The authors hypothesized that the EPG would elicit significantly greater structural excursions of anterior hyoid, superior hyoid, hyolaryngeal approximation, laryngeal elevation, and lateral pharyngeal wall medialization compared with swallowing. Eleven healthy, young subjects with a mean age of 25 were recruited. The EPG was first taught and verified via laryngoscopy. Then 2-planar (coronal and sagittal) dynamic MRI acquisitions captured 10 repeated swallows and 3 EPGs. Kinematic analyses of minimum and maximum excursion of anatomical landmarks were calculated. Results showed a nonsignificant difference between the 2 tasks for range of excursion with all measured biomechanics except for superior hyoid, where the swallow showed significantly greater excursion. This indicated that swallowing and EPG biomechanics were comparable, lending support for the potential use of the EPG as another nonswallowing exercise. Findings suggest EPG may be an effective exercise to target several important swallowing muscles, especially the long pharyngeal muscles that elevate the larynx and shorten the pharynx in swallowing.

Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy.

BackgorundThe aim of this study was to evaluate dysphagia in patients with head and neck cancer (HNC) undergoing three-dimensional conformal radiation therapy using objective and subjective tools simultaneously and to associate the clinical correlates of dysphagia with dosimetric parameters.MethodsTwenty patients were included in the study. The primary tumor and the involved lymph nodes (LN) were treated with 66-70 Gy, the uninvolved LN were treated with 46-50 Gy. Six swallowing structures were identified: the superior pharyngeal constrictor muscle (SPCM), the middle pharyngeal constrictor muscle (MPCM), the inferior pharyngeal constrictor muscle (IPCM), the base of tongue (BOT), the larynx and the proximal esophageal sphincter (PES). Dysphagia was evaluated using videofluoroscopy and European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ-C30) and supplemental EORTC QoL module for HNC (QLQ-H&N35). The evaluations were performed before treatment, at 3 months and at 6 months following treatment.ResultsOn objective evaluation, the Dmax for the larynx and the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness and proximal esophageal stricture at 3 months, whereas the V65, the V70and the Dmax for the larynx was correlated with BOT weakness and the V65, the V70, the Dmax or the Dmean for the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness, reduced laryngeal elevation, reduced epiglottic inversion and aspiration at 6 months following treatment. On subjective evaluation, the V60, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 3 months, whereas the V70 for SPCM were correlated with QoL scores for HNPA and the V60, the V65, the V70, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 6 months following treatment.ConclusionsThe use of multiple dysphagia-related endpoints to complement eachother rather than to overlap with one another, as well as the use of multiple evaluations over time to represent a scale of early to late findings might provide a better insight in terms of the association of the clinical correlates of dysphagia with the dose-volume data for the dysphagia-related anatomical structures.

Effect of Gabapentin on Swallowing During and After Chemoradiation for Oropharyngeal Squamous Cell Cancer

The aim of this study was to examine the impact of gabapentin (neurontin) on swallowing and feeding tube use during chemoradiation (CRT) for oropharyngeal squamous cell carcinoma (OPSCC), and physiologic swallowing outcomes following completion of treatment. A total of 23 patients treated for OPSCC with concurrent CRT and prophylactically treated for pain using gabapentin were assessed. Historical controls were matched for T stage and primary site of disease. Timing of PEG use and removal were recorded. Video fluoroscopic swallowing studies were completed post-treatment to assess physiologic outcomes as well as penetration-aspiration scores (PAS). Functional oral intake scale (FOIS) scores were determined at the time of swallowing evaluation to assess diet level. Patients treated with gabapentin began using their PEG tubes later (3.7 vs. 2.29 weeks; P = 0.013) and had their PEG tubes removed earlier (7.29 vs. 32.56 weeks; P = 0.039) than the historical controls. A number of physiologic parameters were found to be less impacted in the gabapentin group, including oral bolus control (P = 0.01), epiglottic tilt (P = 0.0007), laryngeal elevation (P = 0.0017), and pharyngeal constriction (P = 0.002). PAS scores were significantly lower in the group treated with gabapentin (1.89 vs. 4; P = 0.0052). Patients receiving gabapentin had more advanced diet levels at the time of the initial swallowing study as evidenced by their FOIS scores (5.4 vs. 3.21; P = 0.0003). We conclude that patients using gabapentin for pain management during CRT appears to do well maintaining swallow function during treatment and have favorable post-treatment physiologic swallowing outcomes. Prospective evaluation is warranted.

Targeted Transtracheal Stimulation for Vocal Fold Closure

Paralysis of the structures in the head and neck due to stroke or other neurological disorder often causes dysphagia (difficulty in swallowing). Patients with dysphagia have a significantly higher incidence of aspiration pneumonia and death. The recurrent laryngeal nerve (RLN), which innervates the intrinsic laryngeal muscles that control the vocal folds, travels superiorly in parallel to the trachea in the tracheoesophageal groove. This study tests the hypothesis that functional electrical stimulation (FES) applied via transtracheal electrodes can produce controlled vocal fold adduction. Bipolar electrodes were placed at 15° intervals around the interior mucosal surface of the canine trachea, and current was applied to the tissue while electromyography (EMG) from the intrinsic laryngeal muscles and vocal fold movement visualization via laryngoscopy were recorded. The lowest EMG thresholds were found at an average location of 100° to the left of the ventral midsagittal line and 128° to the right. A rotatable pair of bipolar electrodes spaced 230° apart were able to stimulate bilaterally both RLNs in every subject. Laryngoscopy showed complete glottal closure with transtracheal stimulation in six of the eight subjects, and this closure was maintained under simultaneous FES-induced laryngeal elevation. Transtracheal stimulation is an effective tool for minimally invasive application of FES to induce vocal fold adduction, providing an alternative mechanism to study airway protection.

Safety of Microstimulator During Radiation Therapy - A Preliminary Study on Head and Neck Cancer Patients

Objectives: To determine the safety and performance of miniature neuromuscular stimulator called MicroStimulator (MS) during radiation therapy (RT) of head and neck cancer (HNC). Study Design: Pilot study Methods: Four patients who underwent modified radical neck dissection for HNC received MS implants. The implant was placed 2-3 mm above and parallel to the hypoglossal nerve. All patients had tracheotomy and gastric tubes placed during surgery. Stimulation thresholds were obtained in three patients and electrical exercise programs were initiated in two patients. One patient completed the study, started RT and stimulation of the MS 3-4 weeks after surgery. The implant was energized and controlled by a radio frequency magnetic field from an external coil placed near the implant. Patients underwent stimulation of the MS one hour per day using intermittent trains of stimuli generating fused, maximal contractions. Results: No postoperative or implant specific complication was noted. All patients required and tolerated stimulation without pain or discomfort. Visible contraction of muscles of swallowing was noted in both patients during stimulation indicating that MS remained functional during RT. All patients used the device at home and maintained their oral feeding and weight. None had aspiration pneumonia. Conclusions: MS appears to be a safe device for stimulation of swallowing muscles during MS for HNC. Implant performance is not affected by RT. It effectively stimulates the nerves to induce robust contraction of muscles of swallowing and laryngeal elevation. High patient compliance was achieved with this implant.

Chapter 13 - The generation of pharyngeal phase of swallow and its coordination with breathing: Interaction between the swallow and respiratory central pattern generators

Swallowing and breathing utilize common muscles and an anatomical passage: the pharynx. The risk of aspiration of ingested material is minimized not only by the laryngeal adduction of the vocal folds and laryngeal elevation but also by the precise coordination of swallows with breathing. Namely, swallows: (1) are preferentially initiated in the postinspiratory/expiratory phase, (2) are accompanied by a brief apnea, and (3) are often followed by an expiration and delay of the next breath. This review summarizes the expiratory evidence on the brainstem regions comprising the central pattern generator (CPG) that produces the pharyngeal stage of swallow, how the motor acts of swallowing and breathing are coordinated, and lastly, brainstem regions where the swallowing and respiratory CPGs may interact in order to ensure "safe" swallows.

Effects of Larynx Elevation Training for the Elderly Using Visual Biofeedback of the Laryngeal Movement

Effects of Larynx Elevation Training for the Elderly Using Visual Biofeedback of the Laryngeal Movement

Association between Location of Brain Lesion and Clinical Factors and Findings of Videofluoroscopic Swallowing Study in Subacute Stroke Patients

Objective: To investigate whether patterns of dysphagia were associated with the location of the brain lesion and clinical factors in subacute stroke patients. Method: One hundred and seventy-eight first-ever subacute stroke patients who underwent videofluoroscopic swallowing study (VFSS) from January 2006 to April 2012 were enrolled in the present study. Swallowing-related parameters were assessed by VFSS. The location of brain lesions were classified into the cortical, subcortical, and brain stem. The degree of cognitive impairment and the independency of activities of daily living were assessed by the Korean version of mini-mental status examination and Korean version of modified Barthel index (K-MBI). Aphasia and hemineglect were assessed by Korean version of Western aphasia battery and line bisection test. These data were collected via retrospective chart review. Results: A reduced laryngeal elevation and prolonged pharyngeal delay time were associated with brain stem lesion. Other swallowing parameters were not associated with lesion topology. Pyriform sinus residue was associated with the presence of aphasia and low K-MBI scores. Prolonged pharyngeal delay time was associated with the patient's age, type of stroke and brain stem lesion. Conclusion: Pyriform sinus residue was associated with clinical factors such as aphasia and K-MBI scores rather than with the location of brain lesion. However, reduced laryngeal elevation and prolonged pharyngeal delay time were predominant in brain stem lesions. (Brain & NeuroRehabilitation 2014; 7: 54-60)

The effect of the different swallowing training techniques on the pre-swallow peak pressure of upper esophageal sphinctor

Objective To explore the change of the pre-swallow peak pressure of upper esophageal sphincter (UES) in patients with post-stroke cricopharyngeal achalasia,and investigate the effect of pre-swallowing peak UES pressure on swallowing function by quantitative analysis.Methods Fifty-seven stroke patients with cricopharyngeal achalasia were recruited and divided into balloon dilation group,combined training group and routine swallowing training group with 19 patients in eachp.All the three groups accepted routine swallowing training.In addtion,the routine swallowing training group and balloon dilation group accepted larynx elevation training and balloon dilation training,respectively,while the combined training group accepted larynx elevation training and balloon dilation training simultaneously.The pre-swallow peak UES pressure was measured by using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR,CTD-synectics,Sweden) before and after 8 weeks of treatment.The swallowing function was assessed using swallowing function classification and water swallowing test.Results Before treatment,there was no significant difference among the 3 groups in terms of the pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS (P ＞ 0.05).After treatment,pre-swallow peak UES pressure,swallowing function classification,water swallowing test and VFSS of the balloon dilation group and combined training group improved significantly compared with those before treatment (P ＜ 0.05),and the improvement in the combined training group was to a significantly better extent than in the balloon dilation group(P ＜O.05).Conclusion Balloon dilation and larynx elevation training plus routine swallowing training can increase pre-swallow peak UES pressure,decrease the UES resting pressure of stroke patients with cricopharyngeal achalasia,which is of great importance for their recovery. Key words: Cricopharyngeal achalasia ; Rehabilitation ; Dysphagia ; Biomechanics

Radiation dose to the floor of mouth muscles predicts swallowing complications following chemoradiation in oropharyngeal squamous cell carcinoma

While radiation dose to the larynx and pharyngeal constrictors has been the focus of swallowing complications, the suprahyoid muscles, or floor of mouth (FoM) muscles, are critical for hyoid and laryngeal elevation and effective bolus diversion, preventing penetration and aspiration. We hypothesize that radiation dose to these muscles may be important in the development of dysphagia. We studied 46 patients with OPSCC treated with CRT and who underwent baseline swallowing evaluations and post-treatment videofluoroscopic swallowing studies (VFSS) from 2007 to 2010. Patients with abnormal penetration aspiration scores (PAS>2) served as the study population and patients with normal PAS scores (≤ 2) served as the control cohort. Three suprahyoid muscles and two extrinsic tongue muscles were individually delineated and collectively referred to as the FoM muscles. Radiation dose-volume relationships for these muscles were calculated. Univariate logistic regression analysis was used to determine parameters of significance between patients with normal or abnormal PAS scores. A multivariate regression analysis was subsequently performed to isolate the most statistically critical structures associated with abnormal PAS. Univariate analysis resulted in significance/borderline significance of multiple structures associated with abnormal PAS following irradiation. However, when a multivariate model was applied, only the mean dose to the floor of mouth and minimum dose to the geniohyoid were associated with post-radiation abnormal PAS. The dose and volume delivered to the collective FoM muscles may be associated with an increased risk of laryngeal penetration/aspiration to a greater degree than previously recognized organs at risk.

Effect of Carbonated Beverages on Pharyngeal Swallowing in Young Individuals and Elderly Inpatients

Gustatory and chemical stimulations of the oral cavity and pharyngeal mucosa by carbonated water improve pharyngeal swallowing. We compared changes in pharyngeal swallowing and sensory aspects induced by a carbonated beverage preferred by Japanese with those induced by carbonated water, a sports drink, and tap water in healthy young subjects and elderly inpatients with no swallowing problems. The duration of laryngeal elevation (DOLE) for swallowing the carbonated beverage and water in the second session was shorter compared to that for water in the first session in the elderly subjects. The DOLE and the duration of suprahyoid muscle activity for swallowing were longer in the elderly subjects than in the young subjects for all beverages. Beverages that the subjects subjectively felt were easy to swallow were the sports drink and carbonated beverage, whereas they stated that carbonated water was less easy to swallow. In the elderly subjects, swallowing ability latently decreased, even though they had no problem swallowing in their daily lives, and it was assumed that the carbonated beverage improved pharyngeal swallowing. In addition, the carbonated beverage also influenced the subsequent swallowing of water, showing a persistent effect. It was suggested that carbonated beverages are easy to swallow and effective for improving pharyngeal swallowing.

Comparison of timing abnormalities leading to penetration versus aspiration during the oropharyngeal swallow

Objectives/HypothesisPenetration and aspiration during the oropharyngeal swallow have different clinical implications. This study examined temporal measures made from modified barium swallow examinations that might differentiate the two events.Study DesignRetrospective cohort study.MethodsTemporal measures of swallows of male patients with penetration only on the modified barium swallow study, those who showed aspiration (during the swallow), and normal control subjects were compared.ResultsSignificantly longer durations of temporal measures (glossopalatal junction opening until laryngeal vestibule closure and laryngeal lifting onset until laryngeal vestibule closure) were found for the penetration and aspiration groups compared to the normal group. No significant differences were found between the penetration and aspiration groups for any temporal measure.ConclusionsBoth aspiration and penetration cases showed abnormal timing measures compared to normal. However, aspiration during the swallow was not associated with a more extreme abnormality of temporal measures than penetration. Therefore, in the aspiration cases, there may be an additional neuromuscular disorder at the vocal fold level, allowing for deeper invasion of material into the airway. In addition, findings point to slow laryngeal elevation, and not a delayed onset of laryngeal elevation, as the dominant cause for the prolonged intervals seen with aspiration during the swallow.Level of Evidence3b. Laryngoscope, 124:935–941, 2014

Characteristics of Dysphagia in Children with Cerebral Palsy, Related to Gross Motor Function

The aim of this study was to report the characteristics of dysphagia in children with cerebral palsy (CP), related to gross motor function. Videofluoroscopic swallow study was performed in 29 children with CP, according to the manual of Logemann. Five questions about oromotor dysfunction were answered. Gross motor function level was classified by the Gross Motor Function Classification System Expanded and Revised. The results of the videofluoroscopic swallowing studies showed that reduced lip closure, inadequate bolus formation, residue in the oral cavity, delayed triggering of pharyngeal swallow, reduced larynx elevation, coating on the pharyngeal wall, delayed pharyngeal transit time, multiple swallow, and aspiration were significantly more common in the severe group (Gross Motor Function Classification System Expanded and Revised IV or V). As for aspiration, 50% of the children with severe CP had problems, but only 14.3% of them with moderate (Gross Motor Function Classification System Expanded and Revised III) CP and none of them with mild CP had abnormalities. In addition, five of the seven aspiration cases occurred silently. This study shows that dysphagia is closely related to gross motor function in children with CP. Silent aspiration was observed in the moderate to severe CP groups. Aspiration is an important cause of medical problems such as acute and chronic lung disease, and associated respiratory complications contribute significantly in increasing morbidity and mortality in these patient groups. Therefore, the authors suggest that early dysphagia evaluation including videofluoroscopic swallow study is necessary in managing feeding problems and may prevent chronic aspiration, malnutrition, and infections.

Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

Emerging research suggests that preventative swallowing rehabilitation, undertaken before or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters that are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation. Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. A total of 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, 19 publications met the study’s inclusion criteria. Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base-of-tongue (BOT) dysfunction, reduced pharyngeal contraction, and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75 % in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50 %. Subanalysis suggested a trend that the prevalence of these key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC.

Functional Electrical Stimulation for Patients with Reduced Laryngeal Elevation

Functional Electrical Stimulation for Patients with Reduced Laryngeal Elevation

High-resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms

The utility of high-resolution impedance manometry (HRIM) for evaluating oropharyngeal dysphagia (OPD) has been investigated. These approaches are limited because of the sophisticated methodology. A method of transforming HRIM into a simple and useful diagnostic tool for evaluating OPD is needed. A videofluoroscopic swallowing study (VFSS) and HRIM were performed by independent blinded examiners in 26 consecutive healthy volunteers (12 men; median age, 56.5 years) and 10 OPD patients (five men; median age, 59.5 years). Upper esophageal sphincter (UES) relaxation parameters were measured using a standard HRIM protocol. Peristalsis and bolus transit of the pharyngoesophageal (PE) segment were assessed using an HRIM-modified protocol in which the catheter was pulled back 10 cm. PE bolus transits were evaluated with an impedance contour pattern (linear vs. stasis) method. A significant difference was observed between the manometric measures of healthy volunteers and OPD patients for only the duration of pharyngeal contraction (0.49 ± 0.19 vs. 0.76 ± 0.33 s, P = 0.04). The percentage agreement and kappa value for detecting pharyngeal residue between the VFSS and the impedance analysis were 100% and 1.00, respectively. HRIM allowed for comprehensive assessment of abnormal pharyngeal components that caused pharyngeal residue on VFSS in two patients; reduced base of the tongue versus weak pharyngeal contraction in one, and reduced relaxation of the UES versus reduced laryngeal elevation in the remaining patient. Our findings demonstrated that HRIM using a simple methodology (i.e., pull-back of the catheter) detected pharyngeal residue through a simple analysis of the impedance contour pattern (linear vs. stasis). Furthermore, HRIM facilitated a comprehensive assessment of OPD mechanisms and recognition of subtle abnormalities not yet visible to the naked eye on VFSS.