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The Laryngoscope Jun 2023Quantitative swallowing displacement kinematics evolve in patients treated for oropharyngeal squamous cell carcinoma (OPSCC). We aimed to longitudinally assess these...
BACKGROUND/OBJECTIVE
Quantitative swallowing displacement kinematics evolve in patients treated for oropharyngeal squamous cell carcinoma (OPSCC). We aimed to longitudinally assess these measurements and correlate them with functional swallowing outcomes.
METHOD
A retrospective review was conducted on patients with OPSCC treated with definitive (chemo)radiation ([C]RT) or surgery with adjuvant (chemo)radiation (S-[C]RT) who completed at least two videofluoroscopic swallow studies (VFSS). Longitudinal analysis was accomplished via mixed-effects logistic regression for the Functional Oral Intake Scale (FOIS), and Penetration Aspiration Scale (PAS), and mixed-effects linear regression for kinematic measures. Spearman's correlation was conducted between changes in FOIS/PAS and kinematic measures.
RESULTS
Ninety-seven patients (76 males; mean age 61) completed 245 VFSS studies. A total of 94% had human papillomavirus (HPV)/p16 positive OPSCC and 74% were T0-T2. Sixty-four patients underwent [C]RT while 33 patients underwent S-[C]RT. After treatment, posterior pharyngeal wall at hold (PPWhold) increased 3.2 standard deviation (SD) between 0 and 6 months (p < 0.001), then decreased 2.2 SD between 6 and 12 months (p < 0.001) and did not return to baseline. Hyoid-to-larynx (HL) (p = 0.046) and maximal hyoid displacement (Hmax) + HL (p = 0.042) increased between 6 and 12 months. Hmax (p = 0.020) and Hmax + HL (p < 0.001) decreased between 12-24 months beyond baseline values. The decrease in HL and increase in PPWhold (p < 0.05) correlated with an increase in PAS. From baseline, increased pharyngeal constriction ratio correlated with decreased FOIS and PPWhold (p < 0.05).
CONCLUSIONS
Quantitative swallowing kinematic measures can effectively track changes in swallowing physiology. Increased PPWhold and restricted hyolaryngeal movement were seen in patients with OPSCC after treatment and correlated with a change in swallowing outcome, emphasizing the need for serial VFSS monitoring and targeted intervention.
LEVEL OF EVIDENCE
3 Laryngoscope, 133:1339-1348, 2023.
Topics: Male; Humans; Middle Aged; Deglutition; Deglutition Disorders; Biomechanical Phenomena; Oropharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms
PubMed: 36054296
DOI: 10.1002/lary.30355 -
Biomedical Engineering Online May 2024Monitoring of ingestive activities is critically important for managing the health and wellness of individuals with various health conditions, including the elderly,...
Monitoring of ingestive activities is critically important for managing the health and wellness of individuals with various health conditions, including the elderly, diabetics, and individuals seeking better weight control. Monitoring swallowing events can be an ideal surrogate for developing streamlined methods for effective monitoring and quantification of eating or drinking events. Swallowing is an essential process for maintaining life. This seemingly simple process is the result of coordinated actions of several muscles and nerves in a complex fashion. In this study, we introduce automated methods for the detection and quantification of various eating and drinking activities. Wireless surface electromyography (sEMG) was used to detect chewing and swallowing from sEMG signals obtained from the sternocleidomastoid muscle, in addition to signals obtained from a wrist-mounted IMU sensor. A total of 4675 swallows were collected from 55 participants in the study. Multiple methods were employed to estimate bolus volumes in the case of fluid intake, including regression and classification models. Among the tested models, neural networks-based regression achieved an R of 0.88 and a root mean squared error of 0.2 (minimum bolus volume was 10 ml). Convolutional neural networks-based classification (when considering each bolus volume as a separate class) achieved an accuracy of over 99% using random cross-validation and around 66% using cross-subject validation. Multiple classification methods were also used for solid bolus type detection, including SVM and decision trees (DT), which achieved an accuracy above 99% with random validation and above 94% in cross-subject validation. Finally, regression models with both random and cross-subject validation were used for estimating the solid bolus volume with an R value that approached 1 and root mean squared error values as low as 0.00037 (minimum solid bolus weight was 3 gm). These reported results lay the foundation for a cost-effective and non-invasive method for monitoring swallowing activities which can be extremely beneficial in managing various chronic health conditions, such as diabetes and obesity.
Topics: Humans; Electromyography; Deglutition; Male; Female; Automation; Signal Processing, Computer-Assisted; Adult; Neural Networks, Computer; Wireless Technology
PubMed: 38760808
DOI: 10.1186/s12938-024-01241-z -
Dysphagia Feb 2023The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations,... (Review)
Review
The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations, the MBSS uses ionizing radiation with related radiation risks. Thus, the procedures and protocols related to MBSSs must balance the benefit of the diagnostic information gained with the risk of radiation exposure. This requires complex decision-making for any given clinician but becomes complicated due to the interprofessional nature of conducting MBSSs, namely the direct involvement of both the speech-language pathologist and radiologist with indirect involvement of the medical physicist and the referring physician. This editorial provides the perspectives of the various stakeholder groups related to radiation use in adult MBSSs, identifies barriers to conducting MBSSs in an evidence-based manner, and suggests areas for improvement.
Topics: Humans; Adult; Barium; Deglutition Disorders; Barium Sulfate; Deglutition; Fluoroscopy
PubMed: 35461361
DOI: 10.1007/s00455-022-10447-z -
Journal of the History of Biology Dec 2023
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Current Gastroenterology Reports Aug 2020In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the... (Review)
Review
PURPOSE OF REVIEW
In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the cause of symptoms, identify pathology and guide effective management. One of the most notable recent advances in the field of oesophageal function has been high-resolution manometry (HRM). This review explores how innovation in HRM has progressed and has far from reached a plateau.
RECENT FINDINGS
HRM technology, methodology and utility continue to evolve; simple additions to the swallow protocol (e.g. eating and drinking), shifting position, targeting symptoms and adding impedance sensors to the HRM catheter have led to improved diagnoses, therapeutic decision-making and outcomes. Progress in HRM persists and shows little sign of abating. The next iteration of the Chicago Classification of motor disorders will highlight these advances and will also identify opportunities for further research and innovation.
Topics: Deglutition; Electric Impedance; Esophageal Motility Disorders; Humans; Manometry; Patient Positioning
PubMed: 32767186
DOI: 10.1007/s11894-020-00787-x -
Journal of Texture Studies Feb 2021Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia).... (Review)
Review
Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of thickened fluids and texture-modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for thickened fluids and for texture-modified foods. Important parameters of thickened fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture-modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of thickened fluids and texture-modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of thickened fluids and texture-modified foods for dysphagia management.
Topics: Deglutition; Deglutition Disorders; Diet; Food; Humans; Rheology; Viscosity
PubMed: 33155674
DOI: 10.1111/jtxs.12567 -
Dysphagia Aug 2022The upper esophageal sphincter (UES) plays a central role in safe swallowing. Impaired UES opening is commonly observed in individuals presenting with impaired... (Review)
Review
The upper esophageal sphincter (UES) plays a central role in safe swallowing. Impaired UES opening is commonly observed in individuals presenting with impaired swallowing and various interventions are available aiming to improve bolus passage across the UES during swallowing. This scoping review addressed the following question: Which behavioral interventions are available to improve UES opening for deglutition? We searched MEDLINE, CINAHL, Ovid Emcare, Web of Science, SCOPUS and ProQuest for studies that met the following criteria: i. behavioral interventions targeting UES opening ii. performed over a period of time, which iii. were assessed using UES specific outcome measures. Study quality was assessed using the Joanna Briggs Institute and GRADE frameworks. Data were extracted and synthesized into dominant themes. Of the 357 studies originally identified, 15 met inclusion criteria and reported interventions that were grouped into four intervention types: (1) floor of mouth exercises that were sub-categorized into the Shaker exercise and other strengthening exercises, (2) Mendelsohn maneuver, (3) lingual exercises and (4) mixed exercise paradigms. Across the included studies, varying levels of success in improving various aspects of UES opening metrics were reported. Nine of 15 studies evaluated patients with demonstrated swallowing impairment, whereas six studies evaluated healthy adults. Quality assessment revealed significant variability in study quality, unclear reporting of participant training and treatment fidelity, as well as training dosage. The evidence base for the four behavioral intervention approaches targeting deglutitive UES opening is limited. The translation of existing evidence to clinical practice is hindered by small sample sizes and methodological limitations. Further research in this space is warranted.
Topics: Adult; Deglutition; Deglutition Disorders; Esophageal Sphincter, Upper; Exercise Therapy; Humans; Manometry; Tongue
PubMed: 34448028
DOI: 10.1007/s00455-021-10349-6 -
Dysphagia Feb 2017Feeding, swallowing, and airway protection are three distinct entities. Feeding involves a process of sequential, neurosensory, and neuromotor interactions of reflexes... (Review)
Review
Feeding, swallowing, and airway protection are three distinct entities. Feeding involves a process of sequential, neurosensory, and neuromotor interactions of reflexes and behaviors facilitating ingestion. Swallowing involves anterograde bolus movement during oral-, pharyngeal-, and esophageal phases of peristalsis into stomach. During these events, coordination with airway protection is vital for homeostasis in clearing any material away from airway vicinity. Neurological-airway-digestive inter-relationships are critical to the continuum of successful feeding patterns during infancy, either in health or disease. Neonatal feeding difficulties encompass a heterogeneous group of neurological, pulmonary, and aerodigestive disorders that present with multiple signs posing as clinical conundrums. Significant research breakthroughs permitted understanding of vagal neural pathways and functional aerodigestive connectivity involved in regulating swallowing and aerodigestive functions either directly or indirectly by influencing the supra-nuclear regulatory centers and peripheral effector organs. These neurosensory and neuromotor pathways are influenced by pathologies during perinatal events, prematurity, inflammatory states, and coexisting medical and surgical conditions. Approaches to clarify pathophysiologic mapping of aerodigestive interactions, as well as translating these discoveries into the development of personalized and simplified feeding strategies to advance child health are discussed in this review article.
Topics: Airway Management; Deglutition; Digestive System Diseases; Gastroenterology; Humans; Infant; Infant, Newborn; Neonatology; Pulmonary Medicine; Respiration
PubMed: 28044203
DOI: 10.1007/s00455-016-9773-z -
Acta Oto-laryngologica Oct 2020Respiratory phase patterns associated with deglutition and clearance of pharynx by deglutition are important in protecting airways and lungs against aspiration....
Respiratory phase patterns associated with deglutition and clearance of pharynx by deglutition are important in protecting airways and lungs against aspiration. Sleep-related deglutition and respiratory phase patterns in the aged with obstructive sleep apnea (OSA) before and under CPAP therapy were investigated. Ten aged adults with severe OSA under CPAP therapy were examined by polysomnography and surface electromyography of the muscles related to swallowing and compared with the same patients before CPAP therapy. Under CPAP therapy, swallowing was also infrequent and absent for long periods. The deeper the sleep stage, the lower the deglutition frequency. The median number of swallows per hour during total sleep time was 1.5 and the median longest deglutition-free period was 74.5 min. Swallows following and/or followed by inspiration, which were observed a great deal before CPAP therapy, were markedly reduced. On the other hand, swallows following and/or followed by expiration markedly increased. Approximately, 73.5% of swallows occurred after expiration and approximately 66.8% were followed by expiration. Respiratory phase patterns associated with sleep-related deglutition improved under CPAP. CPAP therapy improved sleep-related deglutition and respiratory phase patterns in the aged with OSA.
Topics: Aged; Aged, 80 and over; Continuous Positive Airway Pressure; Deglutition; Electromyography; Humans; Male; Polysomnography; Respiratory Physiological Phenomena; Sleep; Sleep Apnea, Obstructive
PubMed: 32536229
DOI: 10.1080/00016489.2020.1772504 -
Dysphagia Dec 2022Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes.... (Review)
Review
Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes. Given that power analyses are infrequently reported in dysphagia research, it remains unclear whether studies are adequately powered to detect a range of treatment effects. Therefore, this review sought to examine the current landscape of statistical power in swallowing rehabilitation research. Databases were searched for swallowing treatments using instrumental evaluations of swallowing and the penetration-aspiration scale as an outcome. Sensitivity power analyses based on each study's statistical test and sample size were performed to determine the minimum effect size detectable with 80% power. Eighty-nine studies with 94 treatment comparisons were included. Sixty-seven percent of treatment comparisons were unable to detect effects smaller than d = 0.80. The smallest detectable effect size was d = 0.29 for electrical stimulation, d = 0.49 for postural maneuvers, d = 0.52 for non-invasive brain stimulation, d = 0.61 for combined treatments, d = 0.63 for respiratory-based interventions, d = 0.70 for lingual strengthening, and d = 0.79 for oral sensory stimulation. Dysphagia treatments examining changes in penetration-aspiration scale scores were generally powered to reliably detect larger effect sizes and not smaller (but potentially clinically meaningful) effects. These findings suggest that non-significant results may be related to low statistical power, highlighting the need for collaborative, well-powered intervention studies that can detect smaller, clinically meaningful changes in swallowing function. To facilitate implementation, a tutorial on simulation-based power analyses for ordinal outcomes is provided ( https://osf.io/e6usd/ ).
Topics: Humans; Deglutition; Deglutition Disorders; Rehabilitation Research; Combined Modality Therapy
PubMed: 35226185
DOI: 10.1007/s00455-022-10428-2