Low Tongue Strength Research Articles

Tongue strength and swallowing-related masseter activity and oropharyngeal timing across the lifespan

Purpose: This study examined lifespan changes in maximum tongue strength, swallowing time, and masseter activity during swallowing. It provides normative data with which to compare clinical assessments of orofacial myofunctional disorders (OMD) and oropharyngeal dysphagia (OPD). Method: 409 healthy participants without identified OMD or OPD (ages 5 – 79 years) provided instrumental measures of tongue strength and electromyographic measurements for oropharyngeal transit time and masseter activity during swallows of four boluses. Participants were placed in three broad age groups (5 – 15, 16 – 59, 60 – 79) for crosssectional analysis. Results: Differences were found between age groups for tongue strength, such that the youngest group had significantly lower anterior tongue strength than the other groups, and lower posterior tongue strength than the 16 – 59 age group. Anterior tongue strength was significantly greater for males than females; posterior tongue strength did not differ significantly between the sexes. The youngest group had longer oropharyngeal transit times than either of the two older groups for most boluses. Swallowing transit time decreased in duration across the age groups, from youngest to oldest, for the 2.5 cc pudding bolus. Both right and left masseters differed in activation among tasks and age groups. The oldest age group had consistently greater levels of activation of the right masseter, and all groups had greater activation for the cracker bolus. Spearman rank-order correlations largely confirmed the inferential statistics and provided evidence of a relationship between tongue weakness and increased oropharyngeal transit time. Conclusion: Maximum tongue pressure generation and oropharyngeal timing measures support a developmental hypothesis, with lower tongue strength and longer swallowing transit times for children ages 5 through 15. The smaller pudding bolus provided the greatest differentiation among the age groups, which may prove to be a functional indicator for clinical evaluation. These results are largely consistent with existing data for tongue strength and oropharyngeal swallowing transit times.

A simplified method for evaluating swallowing ability and estimating malnutrition risk: A pilot study in older adults.

The aim of this pilot study was to develop a Thai-version of a simple swallowing questionnaire, called the T-SSQ, and to evaluate the association between malnutrition risk and swallowing ability, determined objectively by tongue strength and subjectively by the T-SSQ. Sensitivity analysis was also performed to determine which swallowing indices better estimate malnutrition in older adults. This cross-sectional study comprised two phases: Phase I, development and cross-cultural translation of the T-SSQ; and Phase II, application of the T-SSQ in 60 older adults. In Phase I, content and face validity of the T-SSQ was evaluated by 10 experts and 15 older adults. In Phase II, the convergent validity of the T-SSQ was evaluated by determining its association with objective tongue strength. Nutritional status was evaluated using the Thai-version of the Mini-Nutritional Assessment. Covariates included sociodemographic characteristics, and oral and health-related status. Adjusting for covariates, the associations between the two swallowing indices and malnutrition risk were determined using multivariable regression analyses. A cut-off value for low tongue strength was determined using a receiver operating characteristic (ROC) curve, and sensitivity analysis between the swallowing indices and malnutrition risk was performed. The T-SSQ comprised 4-items of common signs and symptoms of a swallowing problem. Its content and face validity were verified. Older adults were considered as having a swallowing problem when at least one item was reported. Convergent validity of the subjective index was shown by significantly different tongue strength values between the participants with and without a swallowing problem (p for independent t-test = 0.014). Based on the highest area under the ROC curve, an 18-kPa cut-off value was chosen to classify low tongue strength. Having a swallowing problem and low tongue strength was significantly associated with malnutrition risk. The positive predictive value of the subjective swallowing index was 1.8-fold higher than objective tongue strength. Self-reported swallowing problems determined by the T-SSQ can be used as a subjective index for evaluating swallowing ability in older adults. Subjective swallowing problems and objective tongue strength were associated with malnutrition risk. However, the T-SSQ estimated malnutrition risk better than the objective index.

Low tongue strength is associated with oral and cough-related abnormalities in older inpatients.

Sarcopenic dysphagia is partly characterized by a decline in the strength of the swallowing muscles. However, its associated characteristics and symptoms are unclear. The aim of this study was to clarify the characteristics and symptoms of swallowing ability associated with low tongue muscle strength, which is one of the swallowing muscles in older adults. This was a cross-sectional study of 197 older patients admitted to the hospital for orthopedic conditions. We measured the maximum tongue pressure (MTP) against the palate. Swallowing-related characteristics were assessed with the Mann assessment of swallowing ability. Sarcopenia was diagnosed using the 2019 Asian Working Group for Sarcopenia. The mean age of patients was 81.3 ± 7.6 y, and 80.2% of patients were women. Forty-two patients (21.3%) showed low MTP, defined as <20 kPa. Approximately 50% of participants had sarcopenia. Patients in the low MTP group had a significantly higher incidence of sarcopenia compared with the normal MTP group (71.4% vs. 48.4%; P=.008). After adjusting for potential confounders in the multivariate analyses, low MTP was found to be independently associated with abnormalities in tongue coordination (odds ratio [OR]: 5.251; 95% confidence interval [CI], 2.336-11.807; P < .001), oral transit (OR: 5.248; 95% CI, 1.424-19.345; P=.013), cough reflex (OR: 2.709; 95% CI, 1.280-5.733; P=.009), and voluntary cough (OR: 7.786; 95% CI, 3.329-18.208; P < .001). Patients with low tongue strength are characterized by abnormal oral and cough-related characteristics.

Low Tongue Strength and the Number of Teeth Present Are Associated with Cognitive Decline in Older Japanese Dental Outpatients: A Cross-Sectional Study.

To mitigate the impact of dementia, initiating early intervention is important. This study aims to investigate the associations between deterioration in oral function and cognitive decline in older outpatients whose oral health was maintained in the dental clinic. This study included 50 outpatients aged ≥65 years. We used the Japanese version of the Montreal Cognitive Assessment (MoCA-J) to assess cognitive decline. Oral function was evaluated by tongue pressure, masticatory performance, and swallowing ability. A full-mouth periodontal examination was conducted, and the occlusal support and number of teeth were recorded. Odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline (MoCA-J score ≤25 points) were calculated using logistic regression models. The age, number of teeth, tongue pressure, and masticatory performance were significantly correlated with cognitive decline (p < 0.05). Logistic regression analyses revealed that cognitive decline was independently associated with age (OR: 1.25; 95% CI: 1.03–1.52; p = 0.024), number of teeth (OR = 0.83; 95% CI: 0.76–1.00; p = 0.047), and lower tongue pressure (OR: 0.87; 95% CI: 0.77–0.98; p = 0.022). Lower tongue pressure and a small number of remaining teeth may be associated with cognitive decline in Japanese outpatients.

Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: A cross-sectional observational study

Dysphagia can be caused by sarcopenia in older adults. Although sarcopenic dysphagia has been reported to be associated with low tongue strength, whether tongue strength can be useful as a diagnostic index for sarcopenic dysphagia remains unclear. In addition, the association between sarcopenic dysphagia and lip force is unknown. The aim of the present study was to clarify the association of lip force and tongue strength with sarcopenic dysphagia, and their diagnostic accuracy for sarcopenic dysphagia. A cross-sectional study was conducted in consecutive 245 (166 women) inpatients aged ≥65 years in the post-acute phase of illness. The presence of sarcopenic dysphagia, lip force, and tongue strength were assessed. Additional factors were also assessed: cognitive function, nutritional status, comorbidity, oral intake level, occlusion status, physical function, and inflammatory status. Multivariable logistic regression analysis was conducted with the presence of sarcopenic dysphagia as a dependent variable. Lip force and tongue strength were assessed with the area under the receiver operating characteristic curve (AUC) to clarify diagnostic accuracy for sarcopenic dysphagia. In addition, the cut-off values of lip force and tongue strength for identifying sarcopenic dysphagia were determined according to sex. In total, 86 patients (35.1%) had sarcopenic dysphagia. Both men and women with sarcopenic dysphagia had lower lip force and tongue strength than men and women without dysphagia or sarcopenic dysphagia (p<0.001 for all). In multivariable logistic regression analysis, sarcopenic dysphagia was significantly associated with lip force (OR=0.63, 95% CI 0.53-0.74, p<0.001) and tongue strength (OR=0.92, 95% CI 0.87-0.98, p=0.011). The AUCs for lip force in patients with sarcopenic dysphagia were 0.88 (CI 0.81-0.95, p<0.001) for men and 0.84 (CI 0.77-0.90, p<0.001) for women. The AUCs for tongue strength were 0.79 (CI 0.69-0.89, p<0.001) for men and 0.74 (CI 0.65-0.82, p<0.001) for women. The cut-off values for sarcopenic dysphagia in men were 10.4N for lip force and 24.3kPa for tongue strength; the cut-off values in women were 8.5N for lip force and 23.9kPa for tongue strength. In older inpatients who are suspected as having dysfunction due to sarcopenia, lip force and tongue strength can be independently useful indices for diagnosing sarcopenic dysphagia, and may be factors that prevent and improve sarcopenic dysphagia.

Decreased Tongue Pressure Reflects Symptom of Dysphagia

The tongue plays a key role in oropharyngeal swallowing. It has been reported that maximum isometric tongue pressure decreases with age. The risk for dysphagia resulting from low tongue strength remains unclear. This study was designed to reveal the relationship between tongue pressure and clinical signs of dysphagic tongue movement and cough and to demonstrate the clinical value of tongue pressure measurement in the evaluation of swallowing function. One hundred forty-five institutionalized elderly in five nursing homes participated. Evaluation of physical activity with self-standing up capability and mental condition with Mini Mental Status Examination (MMSE) were recorded. Maximum tongue pressure was determined using a newly developed tongue pressure measurement device. Voluntary tongue movement and signs of dysphagic cough at mealtime were inspected and evaluated by one clinically experienced dentist and speech therapist. The relationship between level of tongue pressure and incidence of cough was evaluated using logistic regression analysis with physical and mental conditions as covariates. Tongue pressure as measured by the newly developed device was significantly related to the voluntary tongue movement and incidence of cough (p < 0.05). The results of this study suggest that tongue pressure measurement reflects clinical signs of dysphagic tongue movement and cough and that measurement of tongue pressure is useful for the bedside evaluation of swallowing.