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Gölaç H, Aydınlı FE, Dumbak AB, İncebay Ö, Enver N, Yapar D, Düzlü M, Bulut EG, Süslü NS, Yılmaz M. Swallowing Kinematics in Male Patients with Total Laryngectomy. Laryngoscope 2024. [PMID: 39371010 DOI: 10.1002/lary.31825] [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: 07/16/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVE The present study aimed to investigate the symptomatic swallowing complaints in individuals with total laryngectomy (TL) and reveal how swallowing kinematics differs between those with and without symptomatic dysphagia complaints. METHODS A total of 34 subjects with TL were included in the study. Swallowing kinematics of those with symptomatic swallowing complaints (Group 1) were compared to those without (Group 2). Kinematic parameters including pharyngeal transit duration (PTD), maximum pharyngeal constriction ratio (MPCR), upper esophageal sphincter opening ratio (UESOR), upper esophageal sphincter opening duration (UESOD), and bolus clearance ratio (BCR) were investigated from Videofluoroscopic Swallowing Study (VFSS) records via ImageJ software. RESULTS Symptomatic swallowing complaints were determined in 47.1% of the subjects (n = 16). Difficulty while swallowing solid foods and pills, diminished pleasure of eating, food getting stuck in the throat, and increased level of stress during swallowing were among the major swallowing complaints in the present cohort. PTD, MPCR, and BCR parameters were significantly higher in subjects with symptomatic swallowing complaints than those without. CONCLUSION These preliminary findings indicate that almost half of individuals with TL may have symptomatic swallowing complaints. The underlying pathophysiology of this phenomenon may be the devianced kinematic parameters including PTD, MPCR, and BCR in this population. Therefore, it is recommended to include the kinematic measurements in the dysphagia evaluation protocol in individuals with TL, most notably in those with symptomatic swallowing complaints. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Hakan Gölaç
- Department of Speech and Language Therapy, Faculty of Health Sciences, Gazi University, Ankara, Türkiye
| | - Fatma E Aydınlı
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Türkiye
| | - Aydan B Dumbak
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Türkiye
| | - Önal İncebay
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Türkiye
| | - Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Marmara University, Istanbul, Türkiye
| | - Dilek Yapar
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Mehmet Düzlü
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Elif G Bulut
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | | | - Metin Yılmaz
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
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Greenbaum T, Kalichman L, Kedem R, Emodi-Perlman A. The mouth-opening muscular performance in adults and elderlies with and without dysphagia: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 124:105448. [PMID: 38653018 DOI: 10.1016/j.archger.2024.105448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To characterize mouth-opening muscular performance (MOMP) in adults and elderly individuals with dysphagia and healthy controls. METHODS We searched the PubMed, EMBASE, CINAHL, Cochrane, Scopus, and Web of Science databases from inception to Jan. 26, 2023. Two independent researchers considered the titles, abstracts, and full texts of potentially eligible papers from 1451 search results. Twenty-five studies that evaluated mouth-opening maximal strength (MOMS) in healthy adults, elderly individuals, and patients with dysphagia met the inclusion criteria. RESULTS We found comparable, reliable values with significant sex differences in maximal mouth opening strength (MMOS) in the meta-analysis for healthy elderly patients (females 5.31 ± 0.47 kg vs. males 7.04 ± 0.70 kg; mean difference of 0.84 kg). Age has also emerged as an essential factor in reducing strength. There was a significant reduction in the MMOS score in the only study that compared dysphagic individuals to healthy elderly individuals. In another study, the MMOS score was comparable to the meta-analysis of healthy elderly individuals. CONCLUSIONS Both sex and age play significant roles in the MMOS. There is no reliable data on the normal mouth-opening strength and endurance of healthy adults, patients with dysphagia, or individuals with other relevant clinical problems.
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Affiliation(s)
- Tzvika Greenbaum
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Leonid Kalichman
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ron Kedem
- Academic Branch, Medical Corps, IDF, Tel Aviv, Israel
| | - Alona Emodi-Perlman
- The School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Curtis JA, Diaz C, Lee T, Rameau A. Validation of a Low-Cost Manometer to Assess of Tongue, Lip, Cheek, and Respiratory Strength: A Laboratory-Based Study. Laryngoscope 2024. [PMID: 39177166 DOI: 10.1002/lary.31727] [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: 04/10/2024] [Revised: 07/15/2024] [Accepted: 08/08/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE(S) The objective of this study was to characterize the level of agreement between three manometers: (1) Iowa Oral Performance Instrument (IOPI)-the reference standard for tongue, lip, and cheek strength assessments; (2) MicroRPM Respiratory Pressure Meter (MicroRPM)-the reference standard for respiratory strength assessments; and (3) Digital Pressure Manometer (DPM)-an alternative, low-cost pressure testing manometer. METHODS Manual pressures were simultaneously applied to the IOPI and DPM, and to the MicroRPM and DPM, within a controlled laboratory setting. Agreement in pressure readings were analyzed using descriptive statistics, Lin's concordance correlation, and Bland-Altman Plots. Agreement was interpreted as "poor" if ρc < 0.90, "moderate" if ρc = 0.90 - < 0.95, "substantial" if ρc = 0.95 - < 0.99, and "excellent" if ρc ≥ 0.99. RESULTS Differences in pressure readings between the DPM and clinical reference standards were consistently present yet highly predictable. There was a median absolute difference of 2.0-3.9 kPa between the IOPI and DPM, and 4.5-9.8 cm H2O between the MicroRPM and DPM. Lin's concordance revealed "substantial" agreement between the IOPI and DPM (ρc = 0.98) and the MicroRPM and DPM (ρc = 0.99). CONCLUSION The DPM revealed higher pressure readings when compared to the IOPI and MicroRPM. However, differences in pressure readings were relatively small, highly predictable, and yielded substantial overall agreement. These findings suggest the DPM may be a valid, lower-cost alternative for objective assessments of tongue, lip, cheek, and respiratory muscle strength. Future research should expand on the present findings in clinical patient populations. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- James A Curtis
- Aerodigestive Innovations Research lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College of Cornell University, New York, New York, U.S.A
| | - Crystal Diaz
- Aerodigestive Innovations Research lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College of Cornell University, New York, New York, U.S.A
- Communication Sciences and Disorders Program, Department of Biobehavioral Sciences, Teachers College of Columbia University, New York, New York, U.S.A
| | - Theresa Lee
- Aerodigestive Innovations Research lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College of Cornell University, New York, New York, U.S.A
- Communication Sciences and Disorders Program, Department of Biobehavioral Sciences, Teachers College of Columbia University, New York, New York, U.S.A
| | - Anaïs Rameau
- Laryngology Innovation Lab, Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College of Cornell University, New York, New York, U.S.A
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Vergara J, Andreollo NA, Starmer HM, Miles A, Baraçal-Prado ACC, Junqueira AA, Tincani AJ. Swallowing Safety after Remote sub-total Esophagectomy: How Important is Tongue Pressure? Dysphagia 2024:10.1007/s00455-024-10745-8. [PMID: 39153046 DOI: 10.1007/s00455-024-10745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/31/2024] [Indexed: 08/19/2024]
Abstract
The factors related to oropharyngeal dysphagia after remote esophagectomy (greater than five months) remain unclear. This study aimed to assess patient perception of dysphagia, maximum anterior isometric pressure (MAIP), maximum posterior isometric pressure (MPIP), lingual swallowing pressure (LSP) and radiographic physiological components of the oral and pharyngeal phases of swallowing in patients who are post remote sub-total esophagectomy (SE). Patient perception of dysphagia was assessed using the Eating Assessment Tool (EAT-10). MAIP, MPIP, and LSP were measured using the Iowa Oral Performance Instrument. Videofluoroscopy was used to assess the physiologic components of swallowing with the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Ten patients were included in the study (53.2% male; mean age 54.5 ± 18.0). The mean postoperative time was 30 months (range, 5.0-72 months). Seven patients had elevated EAT-10 scores (> 3). All patients demonstrated impaired oropharyngeal swallowing on at least three MBSImP components (range 3-12) and two patients aspirated (PAS 8). There was a significant difference in MAIP values when comparing patients with normal versus impaired laryngeal elevation and epiglottic movement (p < 0.001). MPIP values were significantly different in patients with normal versus impaired epiglottic movement as well as normal versus elevated PAS scores (p < 0.001). Decreased lingual pressure and physiological changes in swallowing coexist after SE. Our results indicate that the decrease in tongue strength may be one of the factors related to unsafe swallow. The assessment of lingual pressure provides diagnostic value and should be incorporated as part of a comprehensive assessment in this population.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, R. Tessália Vieira de Camargo, 126, Campinas, 13083-887, SP, Brazil.
| | - Nelson Adami Andreollo
- Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Heather M Starmer
- Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, CA, USA
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | | | | | - Alfio José Tincani
- Department of Surgery, Head and Neck Surgery, University of Campinas, R. Tessália Vieira de Camargo, 126, Campinas, 13083-887, SP, Brazil
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Curtis JA, Mocchetti V, Rameau A. Concurrent Validity of the IOPI and Tongueometer Orofacial Strength Measurement Devices. Laryngoscope 2023; 133:3123-3131. [PMID: 37249206 DOI: 10.1002/lary.30782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE(S) This study examined the concurrent validity of two orofacial strength manometers: (1) the Iowa Oral Performance Instrument (IOPI) - the current, gold standard orofacial manometer; and (2) the Tongueometer - a newly-available, lower cost, orofacial manometer. METHODS This study compared IOPI and Tongueometer pressure readings across three experimental conditions. Experiment 1 compared full setup (manometer + tongue bulb) pressure readings between the IOPI and Tongueometer. Experiment 2 compared IOPI tongue bulb and Tongueometer tongue bulb pressure readings, while controlling for manometer. Experiment 3 compared IOPI manometer and Tongueometer manometer pressure readings, while controlling for tongue bulb. Pressures were applied manually within a laboratory setting. Lin's concordance correlation (ρc ) was used to calculate level of agreement, with ρc interpreted as 'poor' if <0.90, 'moderate' if 0.90 to <0.95, 'substantial' if 0.95 to <0.99, and 'excellent' if ≥0.99. RESULTS 539 trials were analyzed. There was a median absolute difference of 2.4 kPa in pressure readings between the IOPI and Tongueometer full setups (manometer + tongue bulb). Correlations revealed substantial agreement between IOPI and Tongueometer full setups (experiment 1: n = 292; ρc = 0.986), tongue bulbs (experiment 2: n = 146; ρc = 0.987-0.992), and manometers (experiment 3: n = 101; ρc = 0.970). CONCLUSIONS Differences in pressures were consistently observed between the Tongueometer and IOPI. Despite these differences, substantial agreement was present. These data suggest the Tongueometer may be a valid, lower cost alternative to the IOPI for objectively assessing orofacial strength in clinical practice. LEVEL OF EVIDENCE Level 2 Laryngoscope, 133:3123-3131, 2023.
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Affiliation(s)
- James A Curtis
- Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, NY, USA
- Aerodigestive Innovations Research lab (AIR), Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Valentina Mocchetti
- Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, NY, USA
| | - Anaïs Rameau
- Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, NY, USA
- Laryngology Innovation Lab, Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, NY, USA
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The Relationship Between Lingual Strength and Functional Swallowing Outcomes in Parkinson’s Disease. Dysphagia 2022:10.1007/s00455-022-10543-0. [DOI: 10.1007/s00455-022-10543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
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