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Tsuchiya M, Kubo Y, Maruyama N, Omori C, Fukami H. Observational study of effects of pharyngeal stimulation by carbonated solution on repetitive voluntary swallowing in humans. Medicine (Baltimore) 2023; 102:e34889. [PMID: 37653745 PMCID: PMC10470714 DOI: 10.1097/md.0000000000034889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
In this study, we conducted observational study to examine the effects of pharyngeal stimulation by a bolus of carbonated solution on repetitive voluntary swallowing in humans. Twelve healthy participants had a fine silicone tube inserted into their pharyngeal region, through which various solutions were slowly infused (0.2 mL/minute) to stimulate the pharyngeal mucosa without activating mechanoreceptors. The solutions included 0.3M NaCl (NaCl), carbonated 0.3M NaCl (NaCl + CA), 0.3M NaCl with acetic acid, distilled water, and carbonated distilled water. We used NaCl to inhibit water-sensitive neurons in the pharyngeal mucosa and enable the evaluation of the effects of carbonic acid stimulation on swallowing. Participants were instructed to repeat swallows as rapidly as possible during the infusion, and the swallowing interval (SI) was measured via submental surface electromyographic activity. SI was significantly shorter during the infusion of NaCl + CA, distilled water, and carbonated distilled water than during the infusion of NaCl. There was a significant positive correlation between SI with NaCl stimulation and the facilitative effects of the other solutions. Longer SIs with NaCl stimulation indicated potent facilitative effects. Thus, stimulation with NaCl + CA facilitated swallowing by reducing SI. Furthermore, the facilitative effects of SI were more pronounced in participants who had difficulty with repetitive voluntary swallowing. The sensation induced by carbonated solution may enhance the ability for repetitive voluntary swallowing, making it a potentially useful approach for rehabilitating patients with dysphagia.
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Affiliation(s)
- Mika Tsuchiya
- Department of Oral Health Sciences, Faculty of Nursing and Health Care, Baika Women's University, Ibaraki, Osaka, Japan
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Benli ET, Avci Ş, Öğün MN. Feel it or deal with it: Oral perception and aspiration risk in early stroke. J Oral Rehabil 2023; 50:217-222. [PMID: 36533879 DOI: 10.1111/joor.13402] [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: 03/21/2022] [Revised: 08/26/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sensation and perception impairments are significant problems faced by individuals with early-stage stroke. Sensory inputs needed in swallowing guide the perceptual process with the involvement of cognitive functions. In the absence of sensory input, bolus perception may be altered, and swallowing safety may be compromised. OBJECTIVES This study aims to evaluate the oral perception of volume change and the aspiration risk of individuals with stroke and determine the relationship between oral perception and aspiration risk. METHODS Total participants were 35. The Gugging Swallowing Screening Test (GUSS) was used to determine individuals' risk of aspiration and divide them into groups 'aspiration risk' and 'non-aspiration risk'. The Oral Perception of Liquid Volume Changes Test (OPLVCT) was used to determine the level of oral perception. RESULTS The groups were statistically similar in terms of age and other descriptives. When the OPLVC test was examined, the scores of the aspiration risk group were significantly lower (p < .001). In addition, a moderate negative correlation was found between aspiration risk and the OPLVC scores (r: -0.502; p < .001). CONCLUSION In this study, a relationship was found between aspiration risk and oral perception. It also revealed that individuals with stroke who are at risk of aspiration have low oral perception abilities. Based on these results, it was concluded that these individuals cannot reliably determine the maximum volume of liquid to be consumed without assistance. We suggest that evaluations and training of oral perception should be added to the rehabilitation of individuals with stroke.
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Affiliation(s)
- Enes Tayyip Benli
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Şebnem Avci
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Muhammed Nur Öğün
- Faculty of Medicine, Department of Neurology, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Electromyographic activation patterns during swallowing in older adults. Sci Rep 2021; 11:5795. [PMID: 33707528 PMCID: PMC7952701 DOI: 10.1038/s41598-021-84972-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
Age-related weakness due to atrophy and fatty infiltration in oropharyngeal muscles may be related to dysphagia in older adults. However, little is known about changes in the oropharyngeal muscle activation pattern in older adults. This was a prospective and experimental study. Forty healthy participants (20 older [> 60 years] and 20 young [< 60 years] adults) were enrolled. Six channel surface electrodes were placed over the bilateral suprahyoid (SH), bilateral retrohyoid (RH), thyrohyoid (TH), and sternothyroid (StH) muscles. Electromyography signals were then recorded twice for each patient during swallowing of 2 cc of water, 5 cc of water, and 5 cc of a highly viscous fluid. Latency, duration, and peak amplitude were measured. The activation patterns were the same, in the order of SH, TH, and StH, in both groups. The muscle activation patterns were classified as type I and II; the type I pattern was characterized by a monophasic shape, and the type II comprised a pre-reflex phase and a main phase. The oropharyngeal muscles and SH muscles were found to develop a pre-reflex phase specifically with increasing volume and viscosity of the swallowed fluid. Type I showed a different response to the highly viscous fluid in the older group compared to that in the younger group. However, type II showed concordant changes in the groups. Therefore, healthy older people were found to compensate for swallowing with a pre-reflex phase of muscle activation in response to increased liquid volume and viscosity, to adjust for age-related muscle weakness.
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Mehraban-Far S, Alrassi J, Patel R, Ahmad V, Browne N, Lam W, Jiang Y, Barber N, Mortensen M. Dysphagia in the elderly population: A Videofluoroscopic study. Am J Otolaryngol 2021; 42:102854. [PMID: 33482586 DOI: 10.1016/j.amjoto.2020.102854] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/22/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the impact of age and underlying comorbid conditions on swallowing in elderly patients with dysphagia. METHODS Charts of consecutive patients aged >64 studied by Videofluoroscopic swallowing study (VFSS) between 2010 and 2018 at our institution were reviewed (n = 731). Patients were categorized based on age into young old (aged 65-74), older old (aged 75-84) and oldest old (aged 85+). The underlying comorbidities and VFSS results were compared between different age groups. RESULTS Dysphagia was more likely to be caused by presbyphagia (p < 0.01) and dementia (p < 0.0001) in the oldest old, whereas, head and neck cancers (p < 0.0001) were more common in the young old cohort. In the absence of organic disease (e.g. cancer, stroke, dementia), aging was associated with prolonged oral transit time (OTT) (p < 0.05) and aspiration after swallow (p < 0.05). Compared to those with presbyphagia, patients with organic disease were more likely to have delayed pharyngeal swallow response (p < 0.05) and aspiration during swallow (p < 0.005). CONCLUSION There are significant differences in the etiology of dysphagia between different age cohorts amongst the dysphagic elderly population. In addition, organic diseases affect swallowing differently than does mere aging. The rate of prolonged OTT and post-swallow aspiration increase with aging in patients with presbyphagia, likely due to age-related sarcopenia of the swallowing muscles. Whereas, those with organic diseases have a higher rate of delayed pharyngeal swallow response and aspiration during swallow, likely due to sensorineural impairment. Thus, it is important to view the elderly as a heterogeneous group when evaluating patients with dysphagia.
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Affiliation(s)
- Sina Mehraban-Far
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA.
| | - James Alrassi
- SUNY Downstate Health Sciences University, Department of Otolaryngology, Brooklyn, NY, USA
| | - Rushil Patel
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Verdah Ahmad
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Nicholas Browne
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Wai Lam
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Yujie Jiang
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Nathaniel Barber
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Melissa Mortensen
- Albany Medical College, Department of Otolaryngology, Albany, NY, USA
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Watanabe S, Izuhara E, Oh-Shige H, Miyachi H, Goto M, Hasegawa S, Miyabe S, Nagasaka Y, Shimozato K, Nagao T. Relationship between age and sex and the numbers of ingestions and swallows for foods of different textures among healthy adults. Physiol Behav 2021; 229:113225. [PMID: 33122093 DOI: 10.1016/j.physbeh.2020.113225] [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: 07/29/2020] [Revised: 09/23/2020] [Accepted: 10/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of swallows needed per single ingestion of food is an important index when assisting a patient with dysphagia in eating. While providing meal assistance, the caregiver may assume that one ingestion is completed with one swallow and then may administer the next ingestion even if the individual's mouth still has remaining food from the previous ingestions, increasing the risk for aspiration and choking. OBJECTIVE The objective of this pilot study was to clarify the differences in foods ingested and swallowed because of influencing factors such as age and gender among healthy adults. METHODS The study enrolled 110 healthy adults (47.4 ± 15.8 years; 57 males, 53 females). The numbers of ingestions and swallows were counted and evaluated by food type (pilaf, 100 g; yogurt 80 g; and sponge cake, 35 g) and participant age and sex and analyzed by least-squares multiple regression analysis. RESULTS The mean numbers of ingestion/swallows were pilaf, 12.5 ± 3.2/13.4 ± 4.2; yogurt, 8.8 ± 2.1/10.8 ± 2.1; and sponge cake, 5.8 ± 2.1/7.0 ± 2.1. The mean number of ingestions and swallows for all foods were higher for female participants compared with male participants. Statistical analysis identified sex as a significant influencing factor for the number of ingestion for all foods. For the number of swallows, the significant influencing factors were sex for sponge cake and age for pilaf and yogurt. CONCLUSION For the test foods of different textures, sex and age were significant influencing factors for the numbers of ingestions and swallows. Further research is needed to elucidate the problem areas in this pilot study.
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Affiliation(s)
- Satoshi Watanabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan.
| | - Eri Izuhara
- Department of Oral and Maxillofacial Surgery, Handa City Hospital, Aichi, Japan
| | - Hideo Oh-Shige
- Department of Oral and Maxillofacial Surgery, Kuwana City Medical Center, Mie, Japan
| | - Hitoshi Miyachi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Mitsuo Goto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Shogo Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Satoru Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Yoshiki Nagasaka
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Kazuo Shimozato
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Toru Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
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Kaneoka A, Pisegna JM, Krisciunas GP, Nito T, LaValley MP, Stepp CE, Langmore SE. Variability of the Pressure Measurements Exerted by the Tip of Laryngoscope During Laryngeal Sensory Testing: A Clinical Demonstration. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:729-736. [PMID: 28732098 DOI: 10.1044/2017_ajslp-16-0006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Clinicians often test laryngeal sensation by touching the laryngeal mucosa with the tip of a flexible laryngoscope. However, the pressure applied to the larynx by using this touch method is unknown, and the expected responses elicited by this method are uncertain. The variability in pressure delivered by clinicians using the touch method was investigated, and the subject responses to the touches were also reported. METHODS A fiberoptic pressure sensor passed through the working channel of a laryngoscope, with its tip positioned at the distal port of the channel. Two examiners each tested 8 healthy adults. Each examiner touched the mucosa covering the left arytenoid 3 times. The sensor recorded the pressure exerted by each touch. An investigator noted subject responses to the touches. From the recorded videos, the absence or presence of the laryngeal adductor reflex in response to touch was judged. RESULTS Pressure values obtained for 46 of the 48 possible samples ranged from 17.9 mmHg to the measurement ceiling of 350.0 mmHg. The most frequently observed response was positive subject report followed by the laryngeal adductor reflex. CONCLUSION Pressure applied to the larynx by using the touch method was highly variable, indicating potential diagnostic inaccuracy in determining laryngeal sensory function.
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Affiliation(s)
- Asako Kaneoka
- Department of Speech, Language & Hearing Sciences, Boston University, Sargent College, MA
- The University of Tokyo Hospital Rehabilitation Center, Japan
| | - Jessica M Pisegna
- Department of Speech, Language & Hearing Sciences, Boston University, Sargent College, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, MA
| | - Gintas P Krisciunas
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, MA
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo School of Medicine, Japan
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, MA
| | - Cara E Stepp
- Department of Speech, Language & Hearing Sciences, Boston University, Sargent College, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, MA
| | - Susan E Langmore
- Department of Speech, Language & Hearing Sciences, Boston University, Sargent College, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, MA
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Di Monaco R, Galiñanes Plaza A, Miele NA, Picone D, Cavella S. Temporal sweetness profile of MNEI protein in gelled model systems. J SENS STUD 2016. [DOI: 10.1111/joss.12222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rossella Di Monaco
- Department of Agricultural Sciences; University of Naples Federico II; Portici Italy
- CAISIAL-Center of Food Innovation and Development in the Food Industry, University of Naples Federico II, Via Università 133; Portici 80055 Italy
| | - Adriana Galiñanes Plaza
- UMR Ingénierie Procédés Aliments, AgroParisTech, INRA, Université Paris-Saclay; Massy 91300 France
- Center for Food and Hospitality Research, Institut Paul Bocuse; Chateau du Vivier, BP 25 69131 Ecully Cedex France
| | - Nicoletta A. Miele
- CAISIAL-Center of Food Innovation and Development in the Food Industry, University of Naples Federico II, Via Università 133; Portici 80055 Italy
| | - Delia Picone
- Department of Chemical Sciences; University of Naples Federico II; Naples Italy
| | - Silvana Cavella
- Department of Agricultural Sciences; University of Naples Federico II; Portici Italy
- CAISIAL-Center of Food Innovation and Development in the Food Industry, University of Naples Federico II, Via Università 133; Portici 80055 Italy
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