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Mialland A, Atallah I, Bonvilain A. Toward a robust swallowing detection for an implantable active artificial larynx: a survey. Med Biol Eng Comput 2023; 61:1299-1327. [PMID: 36792845 DOI: 10.1007/s11517-023-02772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
Total laryngectomy consists in the removal of the larynx and is intended as a curative treatment for laryngeal cancer, but it leaves the patient with no possibility to breathe, talk, and swallow normally anymore. A tracheostomy is created to restore breathing through the throat, but the aero-digestive tracts are permanently separated and the air no longer passes through the nasal tracts, which allowed filtration, warming, humidification, olfaction, and acceleration of the air for better tissue oxygenation. As for phonation restoration, various techniques allow the patient to talk again. The main one consists of a tracheo-esophageal valve prosthesis that makes the air passes from the esophagus to the pharynx, and makes the air vibrate to allow speech through articulation. Finally, swallowing is possible through the original tract as it is now isolated from the trachea. Yet, many methods exist to detect and assess a swallowing, but none is intended as a definitive restoration technique of the natural airway, which would permanently close the tracheostomy and avoid its adverse effects. In addition, these methods are non-invasive and lack detection accuracy. The feasibility of an effective early detection of swallowing would allow to further develop an implantable active artificial larynx and therefore restore the aero-digestive tracts. A previous attempt has been made on an artificial larynx implanted in 2012, but no active detection was included and the system was completely mechanic. This led to residues in the airway because of the imperfect sealing of the mechanism. An active swallowing detection coupled with indwelling measurements would thus likely add a significant reliability on such a system as it would allow to actively close an artificial larynx. So, after a brief explanation of the swallowing mechanism, this survey intends to first provide a detailed consideration of the anatomical region involved in swallowing, with a detection perspective. Second, the swallowing mechanism following total laryngectomy surgery is detailed. Third, the current non-invasive swallowing detection technique and their limitations are discussed. Finally, the previous points are explored with regard to the inherent requirements for the feasibility of an effective swallowing detection for an artificial larynx. Graphical Abstract.
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Affiliation(s)
- Adrien Mialland
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France.
| | - Ihab Atallah
- Institute of Engineering and Management Univ. Grenoble Alpes, Otorhinolaryngology, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Agnès Bonvilain
- Institute of Engineering and Management Univ. Grenoble Alpes, Univ. Grenoble Alpes, CNRS, Grenoble INP, Gipsa-lab, 38000, Grenoble, France
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Rayneau P, Bouteloup R, Rouf C, Makris P, Moriniere S. Automatic Detection and Analysis of Swallowing Sounds in Healthy Subjects and in Patients with Pharyngolaryngeal Cancer. Dysphagia 2021; 36:984-992. [PMID: 33389178 DOI: 10.1007/s00455-020-10225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Assessment of swallowing function is often invasive or involves irradiation. Analysis of swallowing sounds is a noninvasive method for assessment of swallowing but is not used in daily medical practice. Dysphagia could be the first symptom that occurs in head and neck cancer. This study evaluated a method for the automatic detection and analysis of swallowing sounds in healthy subjects and in patients with pharyngolaryngeal cancer. A smartphone application, developed for automatic detection and analysis of swallowing sounds was developed and tested in 12 healthy volunteers and in 26 patients with pharyngolaryngeal cancer. Swallowing sounds were recorded with a laryngophone during a standardized meal (100 mL mashed potatoes, 100 mL water, and 100 mL yogurt). Swallowing number and duration were noted; the results were compared to a standard swallowing sound analysis using the software AUDACITY®. There were no statistically significant differences in swallowing number or duration between the two analysis methods for the three types of foods in healthy volunteers and only for water in patients. In healthy volunteers, the results of our automatic analysis were comparable with those obtained with the standard analysis. However, a better discrimination of swallowing sounds is necessary for the algorithm to obtain reliable results with thicker food in patients with head and neck cancer.
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Affiliation(s)
- P Rayneau
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France. .,Service ORL Et Chirurgie Cervico-Faciale, CHU de Tours, 2 Boulevard Tonnelé, 37044, Tours, France.
| | - R Bouteloup
- Polytech School, University of Tours, 64 Avenue Jean Portalis, 37200, Tours, France
| | - C Rouf
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France
| | - P Makris
- Tours Fundamental and Applied Computer Laboratory, University of Tours, CNRS 7002, 64 Avenue Jean Portalis, 37200, Tours, France
| | - S Moriniere
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France.,Francois-Rabelais University of Tours, University Hospital of Tours, 10 Boulevard Tonnelé, 37032, Tours, France
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Santoso LF, Baqai F, Gwozdz M, Lange J, Rosenberger MG, Sulzer J, Paydarfar D. Applying Machine Learning Algorithms for Automatic Detection of Swallowing from Sound. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2584-2588. [PMID: 31946425 DOI: 10.1109/embc.2019.8857937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the severe consequences of dysfunctional swallowing, there is no simple method of monitoring swallowing outside of clinical settings. People who cannot swallow cannot eat safely, resulting in profound changes in quality of life and risk of death from aspiration pneumonia. A non-invasive swallowing detector may have widespread impact in both clinical care and research. Detection of swallowing from laryngeal sounds could become an ideal assessment tool because sounds are simple to record, quantifiable, and amenable to software analysis. The focus of this paper is to achieve high accuracy binary swallowing detection from sound recordings. A dataset with 2500 swallow sound samples and 1700 mixed laryngeal noise samples from 15 healthy adults was used to train and test three supervised machine learning algorithms. A decision tree, support vector machine (SVM), and neural network trained with the scaled conjugate gradient (SCG) method had areas under the receiver operating characteristic (ROC) curve of 0.970, 0.961, and 0.971 and average accuracies of 93.2 percent, 86.2 percent, and 93.7 percent respectively. While further work needs to be done to further optimize these algorithms and validate their efficacy, these initial results suggest machine learning strategies may be helpful to improve accuracy of swallowing detection.
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Taveira KVM, Santos RS, Leão BLCD, Stechman Neto J, Pernambuco L, Silva LKD, De Luca Canto G, Porporatti AL. Diagnostic validity of methods for assessment of swallowing sounds: a systematic review. Braz J Otorhinolaryngol 2018; 84:638-652. [PMID: 29456200 PMCID: PMC9452251 DOI: 10.1016/j.bjorl.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/07/2017] [Accepted: 12/27/2017] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may lead to outcomes of aspiration pneumonia, ranging from hospitalization to death. This assessment proposes a non-invasive, acoustic-based method to differentiate between individuals with and without signals of penetration and aspiration. OBJECTIVE This systematic review evaluated the diagnostic validity of different methods for assessment of swallowing sounds, when compared to videofluroscopy swallowing study to detect oropharyngeal dysphagia. METHODS Articles in which the primary objective was to evaluate the accuracy of swallowing sounds were searched in five electronic databases with no language or time limitations. Accuracy measurements described in the studies were transformed to construct receiver operating characteristic curves and forest plots with the aid of Review Manager v. 5.2 (The Nordic Cochrane Centre, Copenhagen, Denmark). The methodology of the selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS The final electronic search revealed 554 records, however only 3 studies met the inclusion criteria. The accuracy values (area under the curve) were 0.94 for microphone, 0.80 for doppler, and 0.60 for stethoscope. CONCLUSION Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.
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Affiliation(s)
| | - Rosane Sampaio Santos
- Universidade Tuiuti do Paraná (UTP), Programa de Pós-graduação em Distúrbios da Comunicação, Curitiba, PR, Brazil
| | | | - José Stechman Neto
- Universidade Tuiuti do Paraná (UTP), Programa de Pós-graduação em Distúrbios da Comunicação, Curitiba, PR, Brazil
| | - Leandro Pernambuco
- Universidade Federal da Paraíba (UFPB), Departamento de Fonoaudiologia, João Pessoa, PB, Brazil
| | - Letícia Korb da Silva
- Instituto de Educação Luterana de Santa Catarina, Departamento de Fonoaudiologia, Joinville, SC, Brazil
| | - Graziela De Luca Canto
- Universidade Federal de Santa Catarina (UFSC), Departamento de Odontologia, Brazilian Centre for Evidence-based Research, Florianópolis, SC, Brazil; University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Alberta, Canada
| | - André Luís Porporatti
- Universidade Federal de Santa Catarina (UFSC), Departamento de Odontologia, Brazilian Centre for Evidence-based Research, Florianópolis, SC, Brazil
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Dudik JM, Coyle JL, Sejdić E. Dysphagia Screening: Contributions of Cervical Auscultation Signals and Modern Signal-Processing Techniques. IEEE TRANSACTIONS ON HUMAN-MACHINE SYSTEMS 2015; 45:465-477. [PMID: 26213659 PMCID: PMC4511276 DOI: 10.1109/thms.2015.2408615] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cervical auscultation is the recording of sounds and vibrations caused by the human body from the throat during swallowing. While traditionally done by a trained clinician with a stethoscope, much work has been put towards developing more sensitive and clinically useful methods to characterize the data obtained with this technique. The eventual goal of the field is to improve the effectiveness of screening algorithms designed to predict the risk that swallowing disorders pose to individual patients' health and safety. This paper provides an overview of these signal processing techniques and summarizes recent advances made with digital transducers in hopes of organizing the highly varied research on cervical auscultation. It investigates where on the body these transducers are placed in order to record a signal as well as the collection of analog and digital filtering techniques used to further improve the signal quality. It also presents the wide array of methods and features used to characterize these signals, ranging from simply counting the number of swallows that occur over a period of time to calculating various descriptive features in the time, frequency, and phase space domains. Finally, this paper presents the algorithms that have been used to classify this data into 'normal' and 'abnormal' categories. Both linear as well as non-linear techniques are presented in this regard.
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Affiliation(s)
- Joshua M. Dudik
- Department of Electrical and Computer Engineering, Swanson School
of Enginering, University of Pittsburgh, Pittsburgh, PA, USA
| | - James L. Coyle
- Department of Communication Science and Disorders, School of Health
and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School
of Enginering, University of Pittsburgh, Pittsburgh, PA, USA
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Steele CM. The Blind Scientists and the Elephant of Swallowing: A Review of Instrumental Perspectives on Swallowing Physiology. J Texture Stud 2014. [DOI: 10.1111/jtxs.12101] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory; Toronto Rehabilitation Institute; University Health Network; 550 University Avenue Toronto Ontario M5G 2A2
- Department of Speech-Language Pathology; University of Toronto; Toronto Canada
- Graduate Department of Rehabilitation Sciences; University of Toronto; Toronto Canada
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto Canada
- Bloorview Research Institute; Toronto Canada. International Dysphagia Diet Standardisation Initiative Foundation Committee; Brisbane Australia
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Espitalier F, Testelin S, Blanchard D, Binczak M, Bollet M, Calmels P, Couturaud C, Dreyer C, Navez M, Perrichon C, Morinière S, Albert S. Management of somatic pain induced by treatment of head and neck cancer: Postoperative pain. Guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:249-52. [PMID: 25106697 DOI: 10.1016/j.anorl.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present the guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL) concerning the management of somatic pain induced by the treatment of head and neck cancer, and in particular the management of early and late post-surgical pain. METHODS A multidisciplinary work group conducted a review of the scientific literature on the study topic. An editorial group subsequently read the resulting guidelines before validation. RESULTS It is recommended to prevent onset of pain caused by malpositioning on the operating table, as well as pain related to postoperative care. During surgery, it is recommended to spare nerve and muscle structures as far as possible to limit painful sequelae. Management of early postoperative pain upon tumor resection and flap harvesting sites requires patient-controlled analgesia by morphine pump. Physical therapy is recommended after flap harvesting to minimize painful sequelae. CONCLUSION Preventive and curative measures should be undertaken for appropriate management of post-surgical pain in the treatment of head and neck cancers.
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Affiliation(s)
- F Espitalier
- Service d'ORL et de chirurgie cervico-faciale, hôpital Hôtel-Dieu, CHU, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France.
| | - S Testelin
- Service de chirurgie maxillo-faciale, CHU, place Victor-Pauchet, 80054 Amiens cedex, France
| | - D Blanchard
- Service d'ORL et de chirurgie cervico-faciale, centre François-Baclesse - centre de lutte contre le cancer Basse-Normandie, 3, avenue Général-Harris, BP 5026, 14076 Caen cedex 05, France
| | - M Binczak
- Service d'anesthésie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - M Bollet
- Oncologie-radiothérapie, centre de radiothérapie Hartmann, 4, rue Kléber, 92300 Levallois-Perret, France
| | - P Calmels
- Service de médecine physique et de réadaptation, hôpital de Bellevue, CHU, 42055 Saint-Étienne cedex, France
| | - C Couturaud
- Service de chirurgie maxillo-faciale, CHU Nord, place Victor-Pauchet, 80054 Amiens cedex, France
| | - C Dreyer
- Service de cancérologie, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - M Navez
- Département d'anesthésie-réanimation, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
| | - C Perrichon
- Service d'ORL et de chirurgie cervico-faciale, CHU Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Morinière
- Service d'ORL et de chirurgie cervico-faciale, hôpital Bretonneau, CHU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - S Albert
- Service d'ORL et de chirurgie cervico-faciale, groupe hospitalier Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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Hammoudi K, Boiron M, Hernandez N, Bobillier C, Morinière S. Acoustic study of pharyngeal swallowing as a function of the volume and consistency of the bolus. Dysphagia 2014; 29:468-74. [PMID: 24695959 DOI: 10.1007/s00455-014-9529-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/15/2014] [Indexed: 11/29/2022]
Abstract
Cervical auscultation is a noninvasive technique for the exploration of swallowing and has been used since the 1960s. The aim of our study was to describe how the volume and consistency of the bolus affect swallowing acoustic sound characteristics in healthy subjects. Twenty-three subjects aged from 20 to 59 years were included (13 women and 10 men). A microphone mounted on a stethoscope chest piece, positioned on the skin on the right side in front of the posteroinferior border of the cricoid cartilage, was used; it was connected to a computer for acoustic recordings. Each subject swallowed 2-, 5-, and 10-ml aliquots of water, yogurt, and mashed potato. Each bolus was administered once, with a period of at least 30 s between each swallow. For each recorded sound, the total duration of the sound and the duration of each sound component (SC) (SC1, SC2, and SC3) and interval (IT1 and IT2) between the SCs were measured. For all records, the average duration of acoustic measures was calculated. Differences according to the volume and the consistency of the swallowed bolus were assessed using Student's t test for paired data. We calculated the percentage of recordings that included each SC. We also compared results between men and women using Student's t test. We successfully interpreted 540 of the 621 (87 %) records. The results indicated that the average total duration of the sound, and especially the average duration of SC2, increased with increasing volume and was greater for mashed potato than for the boluses of other consistencies. SC2 was present in all of the records.
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