Tongue Pressure Measurement Research Articles

Association Between Tongue Pressure and Prevalence of Mild Cognitive Impairment in Japan.

Although it has been suggested that a decline in oral function is one of the potential risk factors affecting mild cognitive impairment (MCI), evidence is insufficient to draw clear conclusions. This Japanese cross-sectional study examined the association between tongue pressure (TP) and MCI in middle-aged and older adults aged 36-84years. Study participants were 1019 (368 men and 651 women). TP was evaluated using a TP measurement device. The maximum value of three measurements was used for analysis. MCI was defined as being present if a participant had a Japanese version of the Montreal Cognitive Assessment score of <26. Adjustment was made for age, smoking status, alcohol consumption, leisure-time physical activity, body mass index, hypertension, dyslipidemia, diabetes mellitus, history of depression, number of teeth, employment, education, and household income. The prevalence of MCI was 45.3%. Among women, compared with the lowest tertile of TP, the second and highest tertiles were significantly associated with a lower prevalence of MCI with a clear dose-response relationship; the adjusted odds ratio (95% confidence intervals) in the second and highest tertiles of TP were 0.54 (0.36-0.83) and 0.55 (0.36-0.84), respectively (p for trend=0.005). In contrast, no statistically significant association was observed between TP and the prevalence of MCI among men. Our findings suggest that higher TP might be inversely associated with the prevalence of MCI in middle-aged and older Japanese women.

Restricted tongue mobility and ankyloglossia in 6-8-year-old Vietnamese school children: prevalence and association with tongue strength and endurance.

Generating adequate tongue pressure against the hard palate requires full-range mobility of the tongue. The study aimed to (1) determine the prevalence of restricted tongue mobility and ankyloglossia and (2) determine whether, in children with restricted tongue mobility, their condition also affects tongue pressure. A cross-sectional study of healthy 6-8-year-old children from primary schools in central Vietnam was conducted in 2019. Restricted tongue mobility and ankyloglossia were graded using the tongue range of motion ratio (TRMR), with the tongue-tip-to-incisive papillae (TIP) for the anterior tongue tip and lingual-palatal suction (LPS) for the posterior two-thirds of the tongue. Tongue strength and tongue endurance were measured by the Iowa Oral Pressure Instrument. Statistical analysis investigated the associations between tongue mobility and tongue pressure measurement. Five hundred twelve children (46.5% female, mean age 7.2 ± 0.2years) were assessed. The prevalence of anterior ankyloglossia and restricted mobility was 17.5%, with 16.2% cases of less than 50% mobility and 1.3% cases of less than 25% mobility. The prevalence of posterior ankyloglossia and restricted mobility with less than 30% mobility was 28.9%. Anterior restricted mobility was not a predictor of reduced tongue pressure. Posterior restricted mobility in LPS was independently associated with tongue strength but not tongue endurance. Restrictions of posterior tongue mobility in ankyloglossia are more frequent than restrictions in anterior tongue mobility. Reduced tongue strength is related to mobility and the severity of restrictions in the posterior tongue. These findings suggest that restricted posterior tongue mobility may affect tongue muscle weakness.

Mastication and oral myofunctional status in excess weight children and adolescents: A cross-sectional observational study.

Masticatory function seems to play a role in the aetiology of obesity. However, literature on the association between oral myofunctional status and overweight and obesity in children and adolescents is scarce and contrasting. To compare masticatory performance, orofacial myofunctional status and tongue strength and endurance between children and adolescents with overweight and obesity and those with normal weight. Thirty children and adolescents with overweight and obesity and 30 subjects with normal weight matched for age and sex were recruited. All subjects were evaluated with the Test of Masticating and Swallowing Solids in Children (TOMASS-C) for masticatory performance and with the Italian Orofacial Myofunctional Evaluation with Scores (I-OMES) for the orofacial myofunctional status. Anterior and posterior maximum tongue pressures and tongue endurance were measured. Parents-reported (PRO) duration of meals was recorded. Data were compared between the groups through the paired samples t-test or the Wilcoxon signed-rank test. Children and adolescents with overweight showed significantly lower number of bites (p = .033), lower I-OMES scores (p < .05), and shorter meal duration (p = .005) compared to their peers with normal weight. No significant differences were found between the two groups for the number of swallows, the number of masticatory cycles and the total time of the TOMASS-C, and none of the tongue pressure measurements. Eating in children and adolescents with overweight and obesity is characterised by a larger bolus sizes and shorter PRO meal duration. Additionally, overweight and obesity seem to be associated with poorer orofacial skills and structures in the paediatric population.

Oropharyngeal Dysphagia Phenotypes Across Huntington's Disease Stages: Endoscopic Findings and Tongue Pressure Analysis.

Oropharyngeal dysphagia (OD) is a common symptom in Huntington's disease (HD) and is associated with severe health and psychosocial consequences. Different OD phenotypes are defined on the basis of characteristic patterns at fiberoptic endoscopic evaluation of swallowing (FEES), and they may vary during disease progression. To describe OD phenotypes in different HD stages and to analyze their association with neurological data and tongue pressure measurements. Twenty-four patients with HD at different stages of disease progression underwent a FEES. Data on penetration/aspiration, pharyngeal residue, and OD phenotypes were gained. Neurological examination was performed with the Unified Huntington's Disease Rating Scale (UHDRS). Patient Maximum tongue pressure (MTP) and tongue endurance were measured. We confirmed that the occurrence of penetration/aspiration increased with disease duration and pharyngeal residue increased from 16.7% to 100%, respectively. The most common OD phenotypes were oropharyngeal dyspraxia (91.7%), posterior oral incontinence (87.5%), and delayed pharyngeal phase (87.5%). These types of dysfunctions are already detectable in >80% of patients in the early disease stages. In more advanced stages, we also observed propulsion deficit (66.7%), resistive issue (54.2%), and protective deficit (37.5%). Propulsion deficit was associated with higher disease stage, greater motor dysfunction (UHDRS-I), and lower MTP and tongue endurance (p < 0.05). OD in HD results from a combination of different swallowing phenotypes. Early assessment of swallowing and periodical follow-ups are necessary to monitor OD severity and phenotypes and to revise diet recommendations.

Criterion (Concurrent) Validity and Clinical Utility of the Tongueometer Device.

Tongue manometry (i.e., tongue pressure measurement) is a commonly used assessment for patients with suspected oral-motor involvement in swallowing disorders. Availability of lingual manometry has changed in recent years, with the introduction of the Tongueometer device being a more affordable tongue manometry system. The purpose of this study was to test concurrent (criterion) validity of the Tongueometer compared to the current standard reference device, the Iowa Oral Performance Instrument (IOPI). Adults without dysphagia were recruited for participation in this study. Standard lingual measurements (swallowing-related pressures, maximum isometric pressure [MIP], and maximum isometric endurance) were recorded, with the bulb anteriorly placed, with both devices, in a randomized order. The Bland-Altman method was used to determine concurrent (criterion) validity of these measurements compared to the clinical standard IOPI device. A recently available suggested corrective value by Curtis et al. (2023) was also applied, with comparisons made between devices both with and without the Curtis correction. The final sample included 70 adult participants aged 20-89 years (Mage = 52.3 years). Measures with the Tongueometer device were significantly lower when compared with the same measures taken using the IOPI (p < .01) for all measures including MIP, endurance, and swallow pressures. The correction suggested by Curtis and colleagues did not ameliorate these differences. The Tongueometer lingual measurements were consistently lower compared to the IOPI. Clinical use of values taken with the Tongueometer device should be compared to normative data published for each specific device. Available features of each device (e.g., display, bulb texture, technology/application) should be considered when selecting which device to use with an individual patient.

Changes in the Activation Level of the Floor of the Mouth Muscles during Pressing and Swallowing Tasks According to the Degree of Tongue Pressure.

The suprahyoid muscles play an important role in protecting the airway by elevating both the hyoid bone and larynx superior-anteriorly during swallowing. However, providing systematic external resistance when performing exercises to improve suprahyoid muscle strength is practically difficult. This study attempted to confirm whether systematic resistance can be provided to the suprahyoid muscles using the Iowa Oral Performance Instrument (IOPI)-a representative tongue pressure measurement device. Thirty-one healthy adults participated in this study (20.6 ± 0.96 y, 19 females). The participants performed 16 exercise tasks using the IOPI three times each in random order (Anterior/posterior tongue × pressing/swallowing task × 40/60/80/100% maximum tongue pressure). Furthermore, the floor of the mouth (FOM) muscle activity during exercise was simultaneously measured using surface electromyography. During the pressing task, there were significant differences in FOM maximal muscle activity among the four exercise intensities for both the anterior and posterior oral tongue. For the swallowing task, a significant difference was found in FOM muscle activity among the four exercise intensities for the anterior tongue. For the posterior tongue, significant differences were identified among all conditions except for the comparison between 80% and 100% maximum tongue pressure. Significant correlations between the degree of tongue pressure and maximal FOM muscle activity were found in both the pressing and swallowing tasks at the anterior and posterior oral tongue. Overall, these results indicate that objective and systematic external resistance can be applied using the IOPI-a standard tongue pressure measurement device-during the program to improve suprahyoid muscle function.

Quantitative evaluation of swallowing function in Parkinson's disease using tongue pressure measurement: a mini-review.

Dysphagia is a common symptom of Parkinson's disease (PD) associated with aspiration pneumonia, choking, malnutrition, and a decreased quality of life, and is a leading cause of death among patients with PD. Tongue dysfunction in patients with PD affects the oral phase of swallowing, including the formation and propulsion of a bolus into the pharynx. Assessing tongue pressure, generated between the tongue and palate, is a method that quantitatively measures tongue function and is related to dysphagia in PD. Two assessment methods are used to measure tongue pressure: tongue strength and tongue pressure during swallowing. Previous studies measuring tongue pressure in PD have reported decreased tongue strength and pressure during swallowing, as well as a prolonged tongue pressure rise time, which are symptoms associated with PD severity and dysphagia. In this mini-review, we present a method for measuring tongue pressure and discuss its relationship with dysphagia in PD. We also describe limitations and future perspectives in tongue pressure measurement research.

Clinical Assessment of the Correlation Between Tongue Pressure, Modified Mallampati Score, BMI, and Obstructive Sleep Apnea

Objective This study aimed to assess the connection between tongue pressure, Modified Mallampati Score (MMS), BMI, and their role in evaluating obstructive sleep apnea (OSA). Materials and Methods A total of 180 participants were categorized into four groups ( n = 45) based on the MMS. After securing informed consent, demographic data, including age, gender, body height, and weight (used to calculate BMI) were collected. A tongue pressure measurement system, patented as Innovative Australian Patent no. 2021106623 on 24 November 2021, was utilized. Results The one-way analysis of variance test was employed to compare variations in average BMI and tongue pressure across the groups. The post hoc Tukey test revealed significant differences at p ≤ .05. Tongue pressure significantly varied among the distinct MMS categories ( p = .001), notably with group 4 displaying significantly lower tongue pressure compared to the other three groups. Conclusion The findings suggest that both tongue pressure and MMS are interconnected factors contributing to OSA, while BMI and tongue pressure operate independently in determining OSA.

Decreased serum creatinine to cystatin C ratio is associated with low tongue pressure.

Tongue strength plays an important role in the process of food intake, and low tongue pressure has been associated with aspiration pneumonia, cognitive decline, and mortality. However, special equipment for tongue pressure measurement is uncommon in general practice. Recently, the serum creatinine-to-cystatin C (Cr/CysC) ratio has been validated as a marker of muscle volume mass. Thus, we aimed to investigate the association of the serum Cr/CysC ratio with tongue pressure in a cross-sectional study. This single-center, cross-sectional study enrolled 73 participants (mean age, 71.7 years; men, 49.3%) who regularly attended the hospital for treatment of chronic disease. A tongue pressure of <30 kPa was defined as low tongue pressure. We evaluated the relationships between the serum Cr/CysC ratio and tongue pressure using multiple regression analysis. The serum Cr/CysC ratio was correlated with tongue pressure (R2 = 0.25, P < 0.0001). In multiple regression analyses adjusted for confounders including age, sex, body mass index, and serum albumin, the association remained significant (P = 0.0001). In logistic analyses, the multivariable-adjusted odds ratios of the Cr/CysC ratio for tertiles 1 and 2 compared with tertile 3 for low tongue pressure were 7.81 (95% confidence interval, 1.45-51.73) and 2.71 (95% confidence interval, 0.60-13.19), respectively. We demonstrated that a decreased serum Cr/CysC ratio was associated with a higher risk of low tongue pressure. Our findings suggest that this simple serum surrogate marker may be a first step toward an intervention for oral function by general practitioners. Geriatr Gerontol Int 2024; 24: 102-108.

Association between tongue pressure and oral status and activities of daily living in stroke patients admitted to a convalescent rehabilitation unit.

Clarifying how tongue pressure in convalescent stroke patients affects oral condition andactivities of daily living (ADL) is important for developing oral rehabilitation programs and for rehabilitation care to reacquire ADL. To clarify how tongue pressure is associated with oral status, ADL, and nutritional status in stroke patients. Sixty-eight patients aged 77.9 ± 10.0 years participated. The Japanese version of the Oral Health Assessment Tool was used to evaluate oral status. Data such as the ADL index functional independence measure (FIM), nutritional intake method, serum albumin, and body mass index were extracted from medical records. To examine factors associated with tongue pressure, multiple regression analysis was performed adjusting for confounding factors. The level of statistical significance was set at p < .05. In recovery phase stroke patients, tongue pressure was significantly lower in the total assistance group than in the partial assistance/independent group. In addition, tongue pressure was significantly lower in tube feeding patients than in oral feeding patients. FIM cognition score was an independent factor that had a significant effect on tongue pressure. These findings suggest that ADL status also affects tongue pressure, thus patients' ADL including the FIM cognition subscale should also be evaluated while measuring tongue pressure.

Impact of neck percutaneous interferential current sensory stimulation on swallowing function in patients with Parkinson's disease

Dysphagia is the clinical name for difficulty with swallowing. It can occur with some neurological diseases such as Parkinsonâ–™s disease and, given the rapidly ageing population, the numbers of patients with Parkinsonâ–™s disease and dysphagia is on the rise. Despite being quite commonplace, the complex mechanisms of dysphagia mean that the condition is not well understood. Assistant Professor Masahiro Nakamori is a clinical neurologist investigating the mechanisms of neurological disease, with a focus on neurodegenerative diseases and dysphagia. A current focus is on dysphagia and silent aspiration in people with Parkinsonâ–™s disease. He is based in the Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan. So far, Nakamori has explored several different techniques, including tongue pressure measurement and tongue ultrasonography, which are both used in swallowing evaluation. He is interested in non-invasive techniques that are simple to implement and wants to develop new creative instruments and techniques. In his current research, Nakamori and his collaborators are experimenting with multichannel surface electromyogram to gain a comprehensive understanding of neuromuscular activity. The goal is to develop new techniques and instruments that will help advance clinical neurology and dysphagia research and, of course, benefit patients; improving outcomes and quality of life.

Isometric tongue endurance and incomplete laryngeal vestibule closure in Parkinson's disease.

Dysphagia is a common symptom of Parkinson's disease (PD). A delay in laryngeal vestibule closure (LVC) and a reduction in tongue pressure, may affect swallowing safety and increase the risk of pulmonary aspiration. To verify the relationship between tongue pressure and airway protection in PD patients: (1) comparing tongue pressure measures and physiological events in the pharyngeal phase of swallowing between PD and controls and (2) analysing the association between tongue pressure and LVC in the PD group. Twenty-three patients with idiopathic PD (64.9 years) and 24 healthy controls (64.1 years) participated in this study. All participants underwent the following procedures to verify tongue pressure measurements using the Iowa Oral Performance Instrument: maximum anterior and posterior pressure, isotonic and isometric tongue endurance and anterior and posterior tongue pressure during saliva swallowing. To verify swallowing safety, videofluoroscopic swallowing studies focusing on the pharyngeal phase were performed based on the MBSImP protocol. Compared to healthy controls, PD exhibited a statistically significant decline in tongue pressure tasks: posterior maximum pressure, isotonic endurance, anterior and posterior isometric endurance and tongue pressure during posterior swallowing. Patients with PD had worse pharyngeal scores, including LVC scores, than controls. PD and incomplete LVC had lower anterior isometric endurance scores when compared to those with complete LVC. PD with incomplete LVC scored lower in the anterior isometric endurance task. We observed a potential clinical use of this task for the assessment and management of dysphagia in patients with PD.

Characteristics of Tongue Pressure and Oro-Motor Functions in Patients with Idiopathic Parkinson’s Disease

Objectives: Parkinson’s disease (PD) is a neurodegenerative disorder affecting motor control. This study aims to examine the characteristics of oromotor function and tongue pressure during 5ml water swallowing between patients with PD and normal adults. Methods: 16 patients with PD and 16 normal adults participated in this study. To evaluate oral motor function, the Korean-version of Speech Mechanism Screening Test (SMST) was used. Additionally, the tongue pressure device of Digital Swallowing Workstation&lt;sup&gt;TM&lt;/sup&gt; (Model 7120, KayPentex, USA) was used to measure three different positions (anterior, middle, posterior) of the tongue pressure during the 5 mL water swallow. Results: PD patients demonstrated significantly reduced oro-motor function, especially in the tongue and lips compared to the normal group. Moreover, significantly lower tongue pressure was detected in patients with Parkinson’s disease. Anterior tongue strength, in particular, showed greater decline in the PD group, but there were no significant differences across the different tongue positions. Conclusion: Declined tongue pressure and oromotor dysfunction can increase the risk of dysphagia in PD. Therefore, tongue pressure measurement can help detect the tongue motor disability related to swallowing and manage for oro-pharyngeal dysaphagia in patients with PD.

Real-Time Continuous Monitoring of Oral Soft Tissue Pressure with a Wireless Mouthguard Device for Assessing Tongue Thrusting Habits.

In orthodontics, understanding the pressure of oral soft tissues on teeth is important to elucidate the cause and establish treatment methods. We developed a small wireless mouthguard (MG)-type device that continuously and unrestrainedly measures pressure, which had previously been unachieved, and evaluated its feasibility in human subjects. First, the optimal device components were considered. Next, the devices were compared with wired-type systems. Subsequently, the devices were fabricated for human testing to measure tongue pressure during swallowing. The highest sensitivity (51-510 g/cm2) with minimum error (CV < 5%) was obtained using an MG device with polyethylene terephthalate glycol and ethylene vinyl acetate for the lower and upper layers, respectively, and with a 4 mm PMMA plate. A high correlation coefficient (0.969) was observed between the wired and wireless devices. In the measurements of tongue pressure on teeth during swallowing, 132.14 ± 21.37 g/cm2 for normal and 201.17 ± 38.12 g/cm2 for simulated tongue thrust were found to be significantly different using a t-test (n = 50, p = 6.2 × 10-19), which is consistent with the results of a previous study. This device can contribute to assessing tongue thrusting habits. In the future, this device is expected to measure changes in the pressure exerted on teeth during daily life.

Investigation of the mechanism of chewing movement in children with developmental insufficiency of oral function

We have previously reported that questionnaires and tongue pressure measurements are useful in the study of developmental insufficiency of oral function (DIOF). This study aimed to characterize the masticatory muscle activity of DIOF in children using electromyography to contribute to the future diagnosis and treatment of the disease. This study included 41 children (16 boys and 25 girls) aged 5–6 years. A cordless electromyograph was attached to the shallow masseter muscle, and the participants freely chewed the chewing check gum 60 times in the chair-sitting position. The activity of the masseter muscle was recorded for 60 bites. The chewing cycle, maximal peak interval, and right-sided masseter muscle were found to be predominantly lower in the DIOF group than in the non-DIOF group. No significant differences were observed in the duration of chewing time and chewing interval between the two groups. The electromyography measurements, as well as the comparison of muscle activity between the working and non-working sides, were found to be useful for the evaluation and treatment of DIOF.

Visual evaluation for the elasticity of suprahyoid muscles using sonographic elastography during tongue pressure measurement: A pilot study.

Suprahyoid muscles behavior during the tongue lifting movement has not yet been elucidated. The purpose of this study was to investigate the potential of elastography imaging to examine developmental oral dysfunction in children and oral hypofunction in older adults using sonography. Tongue pressure was measured using a manometer with a probe. The tongue pressure was measured with simultaneously scanning the geniohyoid muscle (GHM) and the anterior belly of the digastric muscle (DGM) using sonographic elastography. Sagittal images of the GHM and coronal images of the DGM were used for the strain ratio measurement. The strain ratio of the muscles was measured three times for each subject with the tongue pressure values of 0-30kPa. The strain ratio of the GHM were higher than those of the DGM at tongue pressure of 10, 20 and 30kPa. The strain ratio of the GHM increased as the tongue pressure increased in all participants. In contrast, the strain ratio of the DGM tended to slowly decrease as tongue pressure increased in female participants. Sonographic elastography is useful for visual and quantitative evaluation of elastic properties in suprahyoid muscles during tongue lifting movements.

Expression of Concern: Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements.

Expression of Concern: Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements.

Effects of Brief and Intensive Therapy for Dysphagia in Patients with Head and Neck Cancer during Radio-Chemotherapy: A Pilot Study

Objective: To verify the effectiveness of a Brief and Intensive Dysphagia Therapy programme, in patients with head and neck cancer, during radio-chemotherapy. Study Design: This is a randomized clinical trial - pilot project with a random sample consisting of 11 patients divided into two groups: 7 in the intervention group, who received brief and intensive therapy and 4 in the control group, with weekly therapy. The assessment instruments used were tongue pressure measurement, mouth-opening measures, oral intake scale and quality of life questionnaire. Patients were evaluated before radio-chemotherapy, after 15 days of speech therapy and after radio-chemotherapy. Results: The intervention group presented higher values of lingual apex pressure (p = 0.00), mouth opening maintenance from the second evaluation (35.14 ± 16.82 mm) until the end of the radio-chemotherapy (35.29 p± 5.93 mm), greater oral intake functionality (p = 0.00) and improvement in overall aspects of quality of life questionnaire (p = 0.05) after completion of brief and intensive therapy and radio-chemotherapy. Conclusion: Brief and intensive therapy presented superior results in the maintenance and/or rehabilitation of the swallowing mechanism in patients with head and neck cancer undergoing radio-chemotherapy.

Relationship between Tongue Pressure and Salivary Bacteria in the Older Adults Requiring Long-Term Care

Introduction: Aspiration pneumonia, an important issue for the older adults, is caused by an increase in pathogenic microorganisms in the saliva, aspiration, and weakened host immunity. Recently, decreased tongue pressure has been reported to be associated with dysphagia. This study aimed to investigate the relationship between decreased tongue pressure and the number of bacteria in the saliva of the older adults requiring long-term care. Methods: This cross-sectional study involved 95 older adults requiring long-term care in a facility or at home, eating orally, and who could understand the instructions for measuring tongue pressure. Sex, age, slowness, weakness, shrinking, exhaustion, low activity, number of teeth, functional teeth unit, denture use, oral hygiene, tongue coating index, dry mouth, tongue pressure, and number of bacteria in the saliva were examined. Bacterial counts were analyzed by real-time PCR for total bacteria, total streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans. Results: Multiple regression analysis showed that poor oral hygiene and decreased tongue pressure were independent risk factors for increased bacteria in the saliva. Decreased tongue pressure is significantly correlated with an increased number of total bacteria and the presence of P. gingivalis. Discussion/Conclusion: Our results suggest that tongue pressure not only maintains the swallowing function but also prevents the increase of bacteria in the saliva of older adults requiring long-term care.

Prevalence, nature and trajectory of dysphagia postoesophageal cancer surgery: a prospective longitudinal study protocol

IntroductionDysphagia is a common problem following oesophagectomy, and is associated with aspiration pneumonia, malnutrition, weight loss, prolonged enteral feeding tube dependence, in addition to an extended in-hospital stay and compromised...