-
Otolaryngologic Clinics of North America Dec 2020Oropharyngeal cancers and their treatment can exquisitely affect a patient's quality of life and functional outcome. Transoral robotic surgery offers a minimally... (Review)
Review
Oropharyngeal cancers and their treatment can exquisitely affect a patient's quality of life and functional outcome. Transoral robotic surgery offers a minimally invasive surgical approach that mitigates injury from traditional open surgical approaches and offers a treatment more likely to have short-term side effects compared with nonsurgical treatment. Feeding tube dependence, oral intake, and swallowing questionnaires, in addition to swallowing evaluations provide a snapshot of a patient's current swallowing function. Investigation of patient-reported quality-of-life outcomes allows for understanding of their symptomatology and the comparison of different treatment strategies.
Topics: Deglutition; Humans; Oropharyngeal Neoplasms; Patient Reported Outcome Measures; Quality of Life; Robotic Surgical Procedures
PubMed: 32917421
DOI: 10.1016/j.otc.2020.07.018 -
Journal of Oral Rehabilitation Oct 2023With the ageing process changes in the musculature of oro-facial structures take place, consequently there is a reduction in the strength and mobility of the lips,... (Observational Study)
Observational Study
BACKGROUND
With the ageing process changes in the musculature of oro-facial structures take place, consequently there is a reduction in the strength and mobility of the lips, tongue and cheeks.
OBJECTIVE
The aim of this study was to correlate oro-facial structures and chewing and swallowing functions among a group of senior citizens and young adults and check the influence of lip and tongue pressure of these functions.
METHODS
This is an observational, cross-sectional and analytical study. Thirty seniors with an average age of 67.13 years and 30 young adults with an average age of 22.03 years participated in the study. The Oro-facial Myofunctional Assessment Protocol with Scores for the Elderly and the Oro-facial Myofunctional Assessment Protocol with Expanded Scores were also used. The evaluation of the force of pressure of the lips and tip and dorsum of the tongue was carried out using the Biofeedback device Pró-Fono: Lip and Tongue Pressure.
RESULTS
Young adults had a higher evaluation score for the aspect/posture of the face, cheeks, lips, mentalis muscle, tongue, mobility of lips, tongue, jaw and cheeks, chewing and swallowing functions, total time and chewing strokes, and tip pressure and dorsum of tongue. According to the Structural Equation Modelling, a direct relationship was found between the tongue dorsum pressure force and the swallowing function.
CONCLUSION
With healthy ageing changes occurring in the appearance, posture and mobility of the lips, tongue, jaw and cheeks, with the seniors and reduced performance of chewing and swallowing functions.
Topics: Young Adult; Humans; Aged; Adult; Tongue; Lip; Cross-Sectional Studies; Pressure; Deglutition; Mastication
PubMed: 37282365
DOI: 10.1111/joor.13531 -
Brazilian Journal of Otorhinolaryngology 2015Aspects of the neuroanatomical representation of swallowing have been investigated in humans through brain mapping techniques, such as functional magnetic resonance... (Review)
Review
INTRODUCTION
Aspects of the neuroanatomical representation of swallowing have been investigated in humans through brain mapping techniques, such as functional magnetic resonance imaging (fMRI).
OBJECTIVE
This critical qualitative review of the literature analyzed international scientific publications in the PubMed database that investigated the activation of the central nervous system in humans during the act of swallowing.
METHODS
This investigation was limited to articles that investigated adults older than 18 years, published in English or Portuguese, between January 2002 and December 2013. Publications that did not have access to the full text, that were repeated by overlapping keywords, case studies, literature reviews, letters to the editor, and those not directly related to the topic of the investigation were excluded.
RESULTS
A total of 649 articles were identified, of which 21 matched the inclusion criteria.
CONCLUSION
The main purpose of the manuscripts that investigate the swallowing process through fMRI were: to characterize swallowing in different pathologies; to compare swallowing in different age groups; to describe brain activation in different stimulation conditions. These studies indicate multiple cortical regions involved in swallowing control. Overall, the studies indicate that fMRI is a non-invasive and quantitative method that allows the investigation of characteristics that are quite often not clinically visible.
Topics: Deglutition; Deglutition Disorders; Humans; Magnetic Resonance Imaging
PubMed: 26394917
DOI: 10.1016/j.bjorl.2015.08.006 -
Trends in Research Literature Describing Dysphagia in Motor Neuron Diseases (MND): A Scoping Review.Dysphagia Dec 2017Dysphagia in motor neuron diseases (MNDs) is highly complex, affecting all stages of swallowing and leading to impaired swallowing safety and efficiency. In order to... (Review)
Review
Dysphagia in motor neuron diseases (MNDs) is highly complex, affecting all stages of swallowing and leading to impaired swallowing safety and efficiency. In order to explore the degree to which research is capturing the symptom of dysphagia in MND, we conducted a scoping review of the existing literature. The primary aims of this review were to identify common themes within the literature on dysphagia in MND, explore patterns and trends in research focus, and identify if any imbalances exist between the research themes related to dysphagia description and management. A comprehensive search strategy yielded 1690 unique articles for review. Following relevance screening, a total of 157 articles were included in the synthesis. Relevant data and keywords were extracted from each article and grouped into themes. Frequency estimates were calculated for each theme to identify trends across research literature. Swallowing impairment in MNDs is described in a variety of ways across current research. The most commonly reported theme was Aspiration/Penetration, mentioned in 73.2% of all included articles; a significant imbalance was identified between reports of swallowing safety and efficiency (p = 0.008). The most frequently reported theme related to dysphagia management was Enteral Nutrition, and very few studies have reported on the efficacy of Rehabilitation/Compensatory recommendations. It is suggested that researchers and clinicians remain mindful of imbalances and gaps in research, and aim to characterize dysphagia in MNDs in a comprehensive manner. Further research investigating discrete, measureable changes in swallowing pathophysiology would be beneficial to delineate the key factors contributing to impaired swallowing safety and efficiency.
Topics: Deglutition; Deglutition Disorders; Enteral Nutrition; Humans; Motor Neuron Disease
PubMed: 28664472
DOI: 10.1007/s00455-017-9819-x -
Neurological Sciences : Official... Jul 2022The aim of this study was to examine the relationship between dysphagia severity and head and neck proprioception in patients with neurological diseases.
PURPOSE
The aim of this study was to examine the relationship between dysphagia severity and head and neck proprioception in patients with neurological diseases.
METHODS
Twenty-six patients with neurological diseases who received the modified barium swallowing study (MBSS) were included. Dysphagia severity was assessed with the penetration aspiration scale (PAS). Patients were divided into two groups according to their PAS scores as "with dysphagia" (n = 15) and "without dysphagia" (n = 11). Active range of motion (AROM) and muscle strength were measured. Proprioception measurement of the cervical region was performed with a laser marker placed on the head of the patients, and the deviation from the middle target was noted in centimeters.
RESULTS
There was no difference between groups in terms of gender, age, height, weight, diagnosis, AROM, and the muscle strength of the cervical region (p > 0.05). A moderate, positive correlation was found between dysphagia severity and the results of proprioception in terms of neck flexion, extension, and left rotation (r = 0.48, p = 0.01; r = 0.58, p = 0.002; r = 0.42, p = 0.02, respectively). There was a statistically significant difference in proprioception measurements of neck flexion, extension, and left rotation between groups (p < 0.05).
CONCLUSION
In conclusion, patients' decreased head and neck proprioception is related to severe dysphagia. Therefore, a holistic approach should be followed for swallowing function, and head and neck proprioception should be considered in dysphagia management.
Topics: Deglutition; Deglutition Disorders; Humans; Neck; Nervous System Diseases; Proprioception
PubMed: 35262830
DOI: 10.1007/s10072-022-05998-w -
Neuromodulation : Journal of the... Dec 2022Transcutaneous stimulation above and below the hyoid is used to assist patients with swallowing disorders (dysphagia) but has shown different effects. Previously,... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Transcutaneous stimulation above and below the hyoid is used to assist patients with swallowing disorders (dysphagia) but has shown different effects. Previously, infrahyoid transcutaneous stimulation lowered the hyoid and larynx resisting swallowing movement while suprahyoid stimulation had no effects on hyolaryngeal movement either at rest or during swallowing. More recently, large submental electrodes, covering the submental region, are used for swallowing therapy in combination with resistance therapy. To gain insight into the effects of these electrodes on movement during swallowing, we studied healthy volunteers using videofluoroscopy (VF). We hypothesized that submental electrical stimulation might elevate the hyoid but not the larynx increasing vestibular opening potentially reducing swallowing safety.
MATERIALS AND METHODS
While undergoing VF, seven healthy volunteers (mean age 51, 5 males) swallowed 5 mL of liquid barium on at least ten trials randomly ordered across three conditions: stimulation at rest, swallowing without stimulation, and swallowing with stimulation.
RESULTS
During stimulation at rest, significant (one tailed p < 0.05) anterior movement occurred in the hyoid and larynx, no superior hyoid and laryngeal movement and an increase in the distance between the hyoid and larynx. When comparing swallowing with and without submental stimulation, during stimulation volunteers significantly reduced anterior hyoid motion (p = 0.028) and increased hyoid elevation (p = 0.043) without changing anterior or superior laryngeal movement or the distance between the hyoid and larynx.
CONCLUSIONS
The healthy volunteers immediately corrected for the effects of submental stimulation by reducing hyoid anterior motion and increasing superior hyoid motion without changing laryngeal motion to prevent increased vestibule opening with stimulation. This suggests that healthy volunteers had an internal schema for swallowing movement patterning with feedforward correction for the effects of stimulation.
Topics: Humans; Male; Deglutition; Deglutition Disorders; Healthy Volunteers; Hyoid Bone; Larynx; Movement
PubMed: 34590756
DOI: 10.1111/ner.13537 -
The Laryngoscope Jun 2020Static Endoscopic Evaluation of Swallowing (SEES) has been demonstrated to have a strong correlation with the Videofluoroscopic Swallow Study (VFSS) in adults. In... (Comparative Study)
Comparative Study
OBJECTIVES
Static Endoscopic Evaluation of Swallowing (SEES) has been demonstrated to have a strong correlation with the Videofluoroscopic Swallow Study (VFSS) in adults. In children, Fiberoptic Endoscopic Evaluations of Swallow (FEES) are frequently performed to avoid repeated VFSS; however, a subset of the population does not tolerate FEES. The purpose of this study was to evaluate the utility of a modified SEES in children.
METHODS
Charts of 50 consecutive patients who underwent FEES evaluations were reviewed. Patients age 3 months to 12 years undergoing SEES, FEES, and VFSS were extracted. We compared a binary assessment of outcome on SEES versus VFSS as the diagnostic standard to report characteristics, including sensitivity, specificity, and positive and negative predicted value.
RESULTS
A total of 36 patients met all inclusion criteria (mean age 2.8 years). Using the VFSS as the diagnostic standard, residue seen on SEES had a sensitivity of 80.0%, specificity of 85.7%, a positive predictive value of 88.9%, and a negative predictive value of 75.0% for predicting deep penetration or aspiration.
CONCLUSION
SEES may be helpful for developing an initial diagnostic impression and may serve as a platform for patient and caregiver counseling. In children who are unable to cooperate with FEES, SEES may provide clinical insight in predicting an abnormal swallow study; however, a normal SEES was less reliable in predicting a safe swallow on subsequent VFSS in this patient population.
LEVEL OF EVIDENCE
4 Laryngoscope, 130:1590-1594, 2020.
Topics: Child; Child, Preschool; Cohort Studies; Deglutition; Deglutition Disorders; Endoscopy, Gastrointestinal; Fiber Optic Technology; Fluoroscopy; Humans; Infant; Video Recording
PubMed: 31448817
DOI: 10.1002/lary.28263 -
The Laryngoscope Nov 2023Our study aimed to investigate the feasibility of using high-density surface electromyography (HD-sEMG) for swallowing assessment by comparing the quantitative...
OBJECTIVES
Our study aimed to investigate the feasibility of using high-density surface electromyography (HD-sEMG) for swallowing assessment by comparing the quantitative parameters and topographic patterns of HD-sEMG between post-irradiated patients and healthy individuals.
METHODS
Ten healthy volunteers and ten post-irradiated nasopharyngeal carcinoma patients were recruited. 96-channel HD-sEMG was recorded although each participant consumed different consistencies of food (thin and thick liquid, puree, congee, and soft rice). Dynamic topography was generated from the root mean square (RMS) of the HD-sEMG signals to illustrate the anterior neck muscle function in the swallowing process. The averaged power of muscles and the symmetry of swallowing patterns were assessed by objective parameters including average RMS, Left/Right Energy Ratio, and Left/Right Energy Difference.
RESULTS
The study showed different swallowing patterns between patients with dysphagia and healthy individuals. The mean RMS values were higher in the patient group compared to the healthy group, but the difference was not statistically significant. Asymmetrical patterns were shown in patients with dysphagia.
CONCLUSION
HD-sEMG is a promising technique that could be used to quantitatively evaluate the average power of neck muscles and the symmetry of swallowing activities in patients with swallowing difficulties.
LEVEL OF EVIDENCE
Level 3 Laryngoscope, 133:2920-2928, 2023.
Topics: Humans; Electromyography; Deglutition Disorders; Deglutition; Neck Muscles; Muscle Contraction
PubMed: 37010343
DOI: 10.1002/lary.30679 -
Journal of Oral Rehabilitation Dec 2023Dysphagia 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...
BACKGROUND
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.
OBJECTIVE
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Topics: Humans; Deglutition Disorders; Tongue; Parkinson Disease; Pressure; Deglutition
PubMed: 37605286
DOI: 10.1111/joor.13568 -
Annual International Conference of the... Jul 2022Swallowing is a vital function that serves to safely transport food and fluid to the stomach, while simultaneously protecting our airways. Evaluation of swallowing is...
Swallowing is a vital function that serves to safely transport food and fluid to the stomach, while simultaneously protecting our airways. Evaluation of swallowing is important for the diagnosis and rehabilitation of individuals with dysphagia, a disorder of swallowing. Flexible high-density surface electromyography (HD sEMG) arrays were designed and fabricated to span the floor of mouth and neck muscles. These arrays were applied on 6 healthy participants over duplicate recording sessions. During each recording session, participants performed three different swallowing motor tasks. The HD sEMG signals were filtered and tasks extracted. For each task, the RMS amplitude was computed, visualized, and compared. Dynamic motor coordination was evident in the filtered signals traces, with different electrode locations showing unique temporal activations. The 2D topographical maps allowed the location of different RMS intensities to be visualized, revealing qualitatively similar patterns across participants and tasks. These motor task trends were also seen within RMS quantifications. The RMS metric across all participants identified significant differences between non-effortful 3 ml and effortful 3 ml swallow tasks ( p=0.006) and there was a minimal variation of 3.1±1.9 μV RMS for repeated recording sessions by each participant. The HD-sEMG array successfully recorded differences in muscle activations during swallowing and was able to discern between two different motor tasks. The arrays offers a spatially detailed non-invasive assessment of the neuromuscular performance of swallowing. Clinical Relevance- The utility of HD-sEMG arrays for evaluation of the muscles involved in swallowing could enable diagnosis and rehabilitation of individuals with dysphagia.
Topics: Deglutition; Deglutition Disorders; Electromyography; Healthy Volunteers; Humans; Neck Muscles
PubMed: 36083930
DOI: 10.1109/EMBC48229.2022.9871168