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Yang QL, Chen Y, Wang XJ, Qiu HY, Chen MT, Zhou XH, Jian CY, Zhao SF. Correlation between lesion location and dysphagia characteristics in post-stroke patients. J Stroke Cerebrovasc Dis 2024; 33:107682. [PMID: 38522758 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107682] [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: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To assess the correlation between lesion location and swallowing function characteristics in post-stroke dysphagia (PSD) patients. MATERIALS AND METHODS We enrolled 133 PSD. The patients were divided into supratentorial and infratentorial stroke groups. We compared the measurements in the videofluoroscopic swallowing study (VFSS) with 3ml and 5 ml of diluted and thickened barium liquid data between supratentorial and brainstem stroke groups. We further compared the difference of VFSS measurements between patients with left hemispheric or right hemispheric lesions (further divided into unilateral hemispheric cortical and subcortical subgroups) and brianstem leison stroke group.To explore the lesion location's effect on different bolus volume, the VFSS measurements of 3ml and 5ml in each subgroups were compared respectively. The measurements of VFSS included the oral transit time, soft palate elevation duration, hyoid bone movement duration (HMD), UES opening duration, pharyngeal transit duration (PTD), stage of ansition duration, and laryngeal closure duration (LCD), the upper esophageal sphincter opening (UESO), hyoid bone superior horizontal displacement, and hyoid bone anterior horizontal displacement. General swallowing function was assessed using the Penetration Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). We performed the paired t-test, Spearman's correlation, and Kruskal-Wallis test analysis to characterize the parameters among the groups. RESULTS Fifty-eight patients were assessed in the final analysis. The HMD (p = 0.019), PTD (p = 0.048) and LCD (p = 0.013) were significantly different between the supratentorial and brainstem lesion groups in 5ml volume. The HMD was significantly different (p = 0.045) between the left cortical and brainstem lesion groups. Significant differences in the HMD (p = 0.037) and LCD (p = 0.032) between the left subcortical and brainstem lesion groups were found in 5ml volume bolus. There was no group different when taking the 3ml volume bolus. Regarding the relationship between food bolus volume and swallowing functions, only the UESO demonstrated a significant difference in the subcortical lesion of the right hemisphere (p = 0.0032) compared the 3 ml and 5 ml volume bolus. The PTD demonstrated a moderate correlation with the PAS scores (r = 0.38, p = 0.0044). The HMD (r = 0.32, p = 0.018) and LCD (r = 0.29, p = 0.039) demonstrated weak correlations with the PAS scores. We did not identify any correlation between the VFSS parameters and FOIS scores in each subgroup level. CONCLUSION The PSD with brainstem lesion shows more sever dysfunction in the pharyngeal phases. The left hemisphere was engaged in both the oral and pharyngeal phases. Lesions in the bilateral cortical, subcortical, and brainstem regions may impair sensory input.
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Affiliation(s)
- Qing-Lu Yang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yang Chen
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Xue-Jie Wang
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hui-Ying Qiu
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Meng-Ting Chen
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Xu-Hui Zhou
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Chu-Yao Jian
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shao-Feng Zhao
- Department of Rehabilitation Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
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Inamoto Y, González-Fernández M, Saitoh E. Timing of True Vocal Cords Closure for Safe Swallowing: A Review of 5 Studies Using 3D Analysis Using Computerized Tomography (CT). Dysphagia 2024; 39:313-320. [PMID: 37804445 DOI: 10.1007/s00455-023-10620-y] [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: 07/25/2022] [Accepted: 08/28/2023] [Indexed: 10/09/2023]
Abstract
Timely and complete laryngeal closure is critical for a successful swallow. Researchers have studied laryngeal closure, including true vocal cords (TVC) closure, closure of the arytenoids to the epiglottis base (laryngeal vestibule closure), and epiglottic inversion, but the most commonly available imaging tools have limitations that do not allow the study of these components individually. Swallowing computerized tomography (CT) has enabled three-dimensional dynamic visualization and quantitative evaluation of swallowing events providing a unique view of swallowing-related structures and their motion. Using CT, TVC closure can be visualized and evaluated on any plane or cross-section without being obscured by of laryngeal vestibule closure or epiglottis inversion. The current review summarizes the results of five papers evaluating the effects of bolus consistency and volume, posture, and age on TVC closure. The combined results of these studies suggest that TVC closure is responsive to oral sensory input based on bolus consistency and size and can be modulated in response to conditions perceived to increase the risk of airway invasion. These results are meaningful for dysphagia rehabilitation as it suggests that interventions to improve TVC closure are likely to enhance airway protection.
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Affiliation(s)
- Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
| | - Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation and Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Kochi K, Sei H, Tanabe Y, Yasuda K, Kido T, Yamada H, Taguchi A, Hato N. The dynamics of deglutition during head rotation using dynamic 320-row area detector computed tomography. Laryngoscope Investig Otolaryngol 2023; 8:746-753. [PMID: 37342115 PMCID: PMC10278121 DOI: 10.1002/lio2.1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
Objective We aimed to elucidate the dynamics of deglutition during head rotation by acquiring 320-row area detector computed tomography (320-ADCT) images and analyzing deglutition during head rotation. Methods This study included 11 patients experiencing globus pharyngeus. A 320-ADCT was used to acquire images in two types of viscosity (thin and thick), with the head rotated to the left. We measured the movement time of deglutition-related organs (soft palate, epiglottis, upper esophageal sphincter [UES], and true vocal cords) and pharyngeal volume (bolus ratio at the start of UES opening [Bolus ratio], pharyngeal volume contraction ratio [PVCR], and pharyngeal volume before swallowing [PVBS]). A two-way analysis of variance was performed for statistical analysis, and all items were compared for significant differences in terms of head rotation and viscosity. EZR was used for all statistical analyses (p-value <.05). Results Head rotation significantly accelerated the onset of epiglottis inversion and UES opening compared with no head rotation. The duration of epiglottis inversion with the thin viscosity fluid was significantly longer. The bolus ratio increased significantly with thick viscosity. There was no significant difference in viscosity and head rotation in terms of PVCR. PVBS increased significantly with head rotation. Conclusion The significantly earlier start of epiglottis inversion and UES opening due to head rotation could be caused by: (1) swallowing center; (2) pharyngeal volume; and (3) pharyngeal contraction force. Thus, we plan to further analyze swallowing with head rotation by combining swallowing CT with manometry and examine its relationship with pharyngeal contraction force. Level of Evidence 3b.
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Affiliation(s)
- Kazutaka Kochi
- Department of Otolaryngology, Head and Neck SurgeryEhime University School of MedicineToon CityJapan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck SurgeryEhime Prefectural Central HospitalMatsuyamaEhimeJapan
- Department of Mechanical Systems Engineering, Graduate School of Science and EngineeringYamagata UniversityYonezawa CityJapan
| | - Yuki Tanabe
- Department of RadiologyEhime University Graduate School of MedicineToon CityJapan
| | - Kazunori Yasuda
- Department of Mechanical Engineering, Graduate School of Science and EngineeringEhime UniversityMatsuyama CityJapan
| | - Teruhito Kido
- Department of RadiologyEhime University Graduate School of MedicineToon CityJapan
| | - Hiroyuki Yamada
- Department of Otolaryngology, Head and Neck SurgeryEhime University School of MedicineToon CityJapan
| | - Aki Taguchi
- Faculty of Health and WelfarePrefectural University of HiroshimaMiharaJapan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck SurgeryEhime University School of MedicineToon CityJapan
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Santoyo-Zedillo M, Andriot I, Lucchi G, Pacheco-Lopez G, Escalona-Buendía H, Thomas-Danguin T, Sinding C. Dedicated odor-taste stimulation design for fMRI flavor studies. J Neurosci Methods 2023; 393:109881. [PMID: 37172913 DOI: 10.1016/j.jneumeth.2023.109881] [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: 03/23/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Flavor is a mental representation that results from the brain's integration of at least odor and taste, and fMRI can highlight brain-related areas. However, delivering stimuli during fMRI can be challenging especially when administrating liquid stimuli in supine position. It remains unclear how and when odorants are released in the nose and how to improve odorant release. NEW METHOD We used a proton transfer reaction mass spectrometer (PTR-MS) to monitor the in vivo release of odorants via the retronasal pathway during retronasal odor-taste stimulation in a supine position. We tested techniques to improve odorant release, including avoiding or delaying swallowing and velum open training (VOT). RESULTS Odorant release was observed during retronasal stimulation, before swallowing, and in a supine position. VOT did not improve odorant release. Odorant release during stimulation had a latency more optimal for fitting with BOLD timing than after swallowing. COMPARISON WITH EXISTING METHOD(S) Previous in vivo measurements of odorant release under fMRI-like conditions showed that odorant release occurred only after swallowing. On the contrary, a second study found that aroma release could occur before swallowing, but participants were sitting. CONCLUSION Our method shows optimal odorant release during the stimulation phase, meeting the criteria for high-quality brain imaging of flavor processing without swallowing-related motion artifacts. These findings provide an important advancement in understanding the mechanisms underlying flavor processing in the brain.
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Affiliation(s)
- Marianela Santoyo-Zedillo
- Centre des Sciences du Goût et de l'Alimentation, INRAE, CNRS, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France; Doctorado en Ciencias Biológicas y de la Salud - Universidad Autónoma Metropolitana (UAM); Health Sciences Department Metropolitan Autonomous University (UAM), Campus Lerma, Mexico
| | - Isabelle Andriot
- Centre des Sciences du Goût et de l'Alimentation, INRAE, CNRS, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France; ChemoSens, CNRS, INRAE, PROBE research infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - Géraldine Lucchi
- Centre des Sciences du Goût et de l'Alimentation, INRAE, CNRS, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France; ChemoSens, CNRS, INRAE, PROBE research infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - Gustavo Pacheco-Lopez
- Health Sciences Department Metropolitan Autonomous University (UAM), Campus Lerma, Mexico
| | - Héctor Escalona-Buendía
- Biotechnology Department Metropolitan Autonomous University (UAM), Campus Iztapalapa, Mexico
| | - Thierry Thomas-Danguin
- Centre des Sciences du Goût et de l'Alimentation, INRAE, CNRS, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Charlotte Sinding
- Centre des Sciences du Goût et de l'Alimentation, INRAE, CNRS, Institut Agro, Université de Bourgogne Franche-Comté, F-21000 Dijon, France.
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Pongpipatpaiboon K, Inamoto Y, Aihara K, Kagaya H, Shibata S, Mukaino M, Saitoh E, Gonzalez-Fernandez M. Thin Liquid Bolus Volume Alters Pharyngeal Swallowing: Kinematic Analysis Using 3D Dynamic CT. Dysphagia 2022; 37:1423-1430. [PMID: 34981256 DOI: 10.1007/s00455-021-10397-y] [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: 07/17/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
The previous studies reported that different volumes of thick liquid had an impact on spatiotemporal characteristics and pharyngeal response of swallowing. However, the bolus flow and swallowing motion pattern were different between thick and thin liquids. The effects of thin bolus volume on pharyngeal swallowing, especially true vocal cord (TVC) closure is still unclear. This study assessed the temporal characteristics when swallowing different volumes of thin liquid to determine the mechanical adaptation using 320-row area detector computed tomography (320-ADCT) and investigated a change of swallowing physiology including laryngeal closure, particularly TVC closure. Fourteen healthy women (28-45 years) underwent 320-ADCT while swallowing of 3, 10, and 20 ml of thin liquid barium in 45° semi-reclining position. Kinematic analysis was performed for each swallow including temporal characteristic, structural movements while swallowing, and maximal cross-sectional area of the upper esophageal sphincter (UES) opening. Bolus head reached to pharynx and esophagus earlier in larger volume significantly, indicating faster bolus transport as volume increased. There were significant effects on swallowing mechanism revealing earlier TVC closure and UES opening with increasing volume. Maximum cross-sectional area of the UES opening was increased to accommodate a larger bolus. Differences in mechanical adaptation through bolus transit and motion of swallowing structures were detected across increasing volumes. These volume-dependent adaptations potentially reduce the risk of aspiration. Understanding the swallowing physiological changes as volume increased is helpful for diagnosis and treatment of dysphagia patients as well as outcomes of swallowing rehabilitation in clinical practice.
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Affiliation(s)
- Kannit Pongpipatpaiboon
- Department of Rehabilitation Medicine, Samitivej Srinakarin Hospital, Bangkok, Thailand.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoko Inamoto
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan. .,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.
| | - Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
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6
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Noninvasive Evaluation of the Biomechanical Accommodations to Bolus Volume during Human Swallowing. Appl Bionics Biomech 2022; 2022:7146947. [DOI: 10.1155/2022/7146947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
Bolus volume is very important in the biomechanics of swallowing. By noninvasively characterizing swallow responses to volume challenges, we can gain more knowledge on swallowing and evaluate swallowing behavior easily. This study aimed to evaluate the impact of bolus volume on the biomechanical characteristics of oropharyngeal swallowing events with a noninvasive sensing system. Fifteen healthy male subjects were recruited and instructed to swallow 5, 10, and 15 ml of water. The sensing system consisted of a tongue pressure sensor sheet, bend sensor, surface electrodes, and a microphone. They were used to monitor tongue pressure, hyoid activity, surface EMG of swallowing-related muscles, and swallowing sound, respectively. In addition to the onset, the peak time and offset of the above four structures, certain characteristics, such as the duration, peak value, and interval of the structure motions, were measured during the different drinking tasks. The coordination between the hyoid movement and tongue pressure was also assessed. Although no sequence of the structural events changed with volume, most of the timings of the structural events were significantly delayed, except for certain hyoid activities. The swallowing volume did not affect the active durations of the monitored structures, the peak values, or intervals of tongue pressure and supra- and infrahyoid muscle activity, but certain hyoid kinetic phases were prolonged when a larger volume was swallowed. Additionally, sequential coordination between hyoid movement and tongue pressure was confirmed among the three volumes. These findings suggest that oropharyngeal structural movements change in response to bolus volume to facilitate safe swallowing. The noninvasive and quantitative measurements taken with the sensing system provide essential information for understanding normal oropharyngeal swallowing.
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7
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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8
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3D-CT Evaluation of Swallowing: Metrics of the Swallowing Response Using Swallowing CT. Dysphagia 2021; 37:237-249. [PMID: 33818630 PMCID: PMC8948108 DOI: 10.1007/s00455-021-10288-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 10/28/2022]
Abstract
Videofluoroscopy and videoendoscopy dramatically changed the evaluation and management of swallowing disorders. Later advancements in techniques for the instrumental evaluation of swallowing were limited by technique and positioning. The advent of 320-row area detector CT solved previous challenges and allowed for the study of swallowing physiology and dysphagia in greater detail. In this summary, we describe the history and evolution of CT technology and describe research and clinical applications for the evaluation of swallowing physiology and pathophysiology.
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9
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King SN, Hurley J, Carter Z, Bonomo N, Wang B, Dunlap N, Petruska J. Swallowing dysfunction following radiation to the rat mylohyoid muscle is associated with sensory neuron injury. J Appl Physiol (1985) 2021; 130:1274-1285. [PMID: 33600281 DOI: 10.1152/japplphysiol.00664.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Radiation-based treatments for oropharyngeal and hypopharyngeal cancers result in impairments in swallowing mobility, but the mechanisms behind the dysfunction are not clear. The purpose of this study was to determine if we could establish an animal model of radiation-induced dysphagia in which mechanisms could be examined. We hypothesized that 1) radiation focused at the depth of the mylohyoid muscle would alter normal bolus transport and bolus size and 2) radiation to the mylohyoid muscle will induce an injury/stress-like response in trigeminal sensory neurons whose input might modulate swallow. Rats were exposed to 48 or 64 Gy of radiation to the mylohyoid given 8 Gy in 6 or 8 fractions. Swallowing function was evaluated by videofluoroscopy 2 and 4 wk following treatment. Neuronal injury/stress was analyzed in trigeminal ganglion by assessing activating transcription factor (ATF)3 and GAP-43 mRNAs at 2, 4, and 8 wk post treatment. Irradiated rats exhibited decreases in bolus movement through the pharynx and alterations in bolus clearance. In addition, ATF3 and GAP-43 mRNAs were upregulated in trigeminal ganglion in irradiated rats, suggesting that radiation to mylohyoid muscle induced an injury/stress response in neurons with cell bodies that are remote from the irradiated tissue. These results suggest that radiation-induced dysphagia can be assessed in the rat and radiation induces injury/stress-like responses in sensory neurons.NEW & NOTEWORTHY Radiation-based treatments for head and neck cancer can cause significant impairments in swallowing mobility. This study provides new evidence supporting the possibility of a neural contribution to the mechanisms of swallowing dysfunction in postradiation dysphagia. Our data demonstrated that radiation to the mylohyoid muscle, which induces functional deficits in swallowing, also provokes an injury/stress-like response in the ganglion, innervating the irradiated muscle.
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Affiliation(s)
- Suzanne N King
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky
| | - Justin Hurley
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Zachary Carter
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Nicholas Bonomo
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Brian Wang
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Jeffrey Petruska
- Department of Anatomical Sciences & Neurobiology, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
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10
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Mao S, Sabry A, Khalifa Y, Coyle JL, Sejdic E. Estimation of laryngeal closure duration during swallowing without invasive X-rays. FUTURE GENERATIONS COMPUTER SYSTEMS : FGCS 2021; 115:610-618. [PMID: 33100445 PMCID: PMC7584133 DOI: 10.1016/j.future.2020.09.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Laryngeal vestibule (LV) closure is a critical physiologic event during swallowing, since it is the first line of defense against food bolus entering the airway. Identifying the laryngeal vestibule status, including closure, reopening and closure duration, provides indispensable references for assessing the risk of dysphagia and neuromuscular function. However, commonly used radiographic examinations, known as videofluoroscopy swallowing studies, are highly constrained by their radiation exposure and cost. Here, we introduce a non-invasive sensor-based system, that acquires high-resolution cervical auscultation signals from neck and accommodates advanced deep learning techniques for the detection of LV behaviors. The deep learning algorithm, which combined convolutional and recurrent neural networks, was developed with a dataset of 588 swallows from 120 patients with suspected dysphagia and further clinically tested on 45 samples from 16 healthy participants. For classifying the LV closure and opening statuses, our method achieved 78.94% and 74.89% accuracies for these two datasets, suggesting the feasibility of implementing sensor signals for LV prediction without traditional videofluoroscopy screening methods. The sensor supported system offers a broadly applicable computational approach for clinical diagnosis and biofeedback purposes in patients with swallowing disorders without the use of radiographic examination.
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Affiliation(s)
- Shitong Mao
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - Aliaa Sabry
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260 USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260 USA
- Department of Bioengineering, Swanson School of Engineering Department of Biomedical Informatics, School of Medicine Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA 15260 USA
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11
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Tsuzuki H, Inamoto Y, Saitoh E, Aihara K, Shibata S, Kagaya H, Onogi K, Nakayama E, Sato M, Ueda K. Effects of bolus consistency and reclining position on kinematic swallowing events in analysis using 320-row area detector computed tomography. J Oral Sci 2020; 62:18-22. [PMID: 31996517 DOI: 10.2334/josnusd.18-0377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study used 320-row area detector computed tomography (320-ADCT) to determine whether kinematic swallowing events and bolus movement through the oropharynx are affected by bolus consistency and angle of recline. Fourteen healthy adults (4 men, 10 women; age, 22-90 years) underwent 320-ADCT assessment during three 10-mL barium swallow tests, with honey-thick liquid at 60° recline (60°thick), thin liquid at 60° recline (60°thin), and thin liquid at 45° recline (45°thin). The times of swallowing events were measured and compared among the different tests. Bolus propulsion, onset time of true vocal cord (TVC) closure, and upper esophageal sphincter opening were significantly earlier for 60°thin than for 60°thick. Onset time did not significantly differ between 60°thin and 45°thin; however, greater variability was noted for onset of TVC closure with 45°thin, as the TVC started to close before onset of swallowing in 30% of participants. Modulation of TVC closure depends on bolus transport in different reclining positions. The 45° reclining position elicited pre-swallow TVC closure in some participants, which suggests that excessive recline can increase perceived risk of airway invasion during swallowing.
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Affiliation(s)
- Hidetaka Tsuzuki
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University
| | - Keiko Aihara
- Department of Rehabilitation, Fujita Health University Hospital
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University
| | - Keiko Onogi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University
| | - Enri Nakayama
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry
| | - Mitsuyasu Sato
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry
| | - Koichiro Ueda
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry
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12
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Gould FDH, Lammers AR, Mayerl CJ, German RZ. Specific Vagus Nerve Lesion Have Distinctive Physiologic Mechanisms of Dysphagia. Front Neurol 2019; 10:1301. [PMID: 31920925 PMCID: PMC6920241 DOI: 10.3389/fneur.2019.01301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/26/2019] [Indexed: 01/17/2023] Open
Abstract
Swallowing is complex at anatomical, functional, and neurological levels. The connections among these levels are poorly understood, yet they underpin mechanisms of swallowing pathology. The complexity of swallowing physiology means that multiple failure points may exist that lead to the same clinical diagnosis (e.g., aspiration). The superior laryngeal nerve (SLN) and the recurrent laryngeal nerve (RLN) are branches of the vagus that innervate different structures involved in swallowing. Although they have distinct sensory fields, lesion of either nerve is associated clinically with increased aspiration. We tested the hypothesis that despite increased aspiration in both case, oropharyngeal kinematic changes and their relationship to aspiration would be different in RLN and SLN lesioned infant pigs. We compared movements of the tongue and epiglottis in swallows before and after either RLN or SLN lesion. We rated swallows for airway protection. Posterior tongue ratio of safe swallows changed in RLN (p = 0.01) but not SLN lesioned animals. Unsafe swallows post lesion had different posterior tongue ratios in RLN and SLN lesioned animals. Duration of epiglottal inversion shortened after lesion in SLN animals (p = 0.02) but remained unchanged in RLN animals. Thus, although SLN and RLN lesion lead to the same clinical outcome (increased aspiration), the mechanisms of failure of airway protection are different, which suggests that effective therapies may be different with each injury. Understanding the specific pathophysiology of swallowing associated with specific neural insults will help develop targeted, disease appropriate treatments.
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Affiliation(s)
- François D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States
| | - Andrew R Lammers
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
| | | | - Rebecca Z German
- Department of Anatomy and Neurobiology, NEOMED, Rootstown, OH, United States
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13
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Ohta J, Ishida S, Kawase T, Katori Y, Imai Y. A computational fluid dynamics simulation of liquid swallowing by impaired pharyngeal motion: bolus pathway and pharyngeal residue. Am J Physiol Gastrointest Liver Physiol 2019; 317:G784-G792. [PMID: 31566413 DOI: 10.1152/ajpgi.00082.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Common practices to improve the ability to swallow include modifying physical properties of foods and changing the posture of patients. Here, we quantified the effects of the viscosity of a liquid bolus and patient posture on the bolus pathway and pharyngeal residue using a computational fluid dynamics simulation. We developed a computational model of an impaired pharyngeal motion with a low pharyngeal pressure and no pharyngeal adaptation. We varied viscosities from 0.002 to 1 Pa·s and postures from -15° to 30° (from nearly vertical to forward leaning). In the absence of pharyngeal adaptation, a honey-like liquid bolus caused pharyngeal residue, particularly in the case of forward-leaning postures. Although the bolus speed was different among viscosities, the final pathway was only slightly different. The shape, location, and tilting of the epiglottis effectively invited a bolus to two lateral pathways, suggesting a high robustness of the swallowing process.NEW & NOTEWORTHY Thickening agents are often used for patients with dysphagia. An increase in bolus viscosity not only reduces the risk of aspiration but also can cause a residual volume in the pharynx. Because information obtained from videofluoroscopic swallowing studies is only two-dimensional, measurement of pharyngeal residue is experimentally difficult. We successfully quantified the three-dimensional bolus pathway and the pharyngeal residual volume using computational modeling and simulation.
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Affiliation(s)
- Jun Ohta
- Department of Otorhinolaryngology and Head and Neck Surgery, Tohoku University, Sendai, Japan
| | - Shunichi Ishida
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Tetsuaki Kawase
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Department of Audiology, Tohoku University, Sendai, Japan
| | - Yukio Katori
- Department of Otorhinolaryngology and Head and Neck Surgery, Tohoku University, Sendai, Japan
| | - Yohsuke Imai
- Graduate School of Engineering, Kobe University, Kobe, Japan
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14
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Joujima T, Oda M, Sasaguri M, Habu M, Kataoka S, Miyamura Y, Wakasugi-Sato N, Matsumoto-Takeda S, Takahashi O, Kokuryo S, Sago T, Yoshiga D, Tanaka T, Morimoto Y. Evaluation of velopharyngeal function using high-speed cine-magnetic resonance imaging based on T2-weighted sequences: a preliminary study. Int J Oral Maxillofac Surg 2019; 49:432-441. [PMID: 31451304 DOI: 10.1016/j.ijom.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
The objective was to introduce a new technique for visualizing the three-dimensional (3D) movements of velopharyngeal-related muscles using high-speed cine-magnetic resonance imaging (MRI) based on T2-weighted sequences. The evaluation of phonation- and water swallowing-related events was performed in 11 healthy subjects. Specifically, whether cine-MRI could precisely visualize normal velopharyngeal function during these two events was examined. The 3D movements of the soft palate, superior pharyngeal constrictor muscles, and levator veli palatini muscles were visualized in all 11 subjects. A noteworthy finding was that the magnetic resonance signals of the superior constrictor pharyngeal muscles and the levator veli palatini muscles were significantly higher during phonation and during water swallowing than at rest. This initial study suggests that the 3D movements of velopharyngeal-related muscles can be successfully and precisely visualized without side effects. The magnetic resonance signal changes seen in the superior pharyngeal constrictor and levator veli palatini muscles using the technique described here should be useful to develop better methods of evaluation of velopharyngeal function.
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Affiliation(s)
- T Joujima
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - M Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kataoka
- Division of Anatomy, Kyushu Dental University, Kitakyushu, Japan
| | - Y Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - N Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - S Matsumoto-Takeda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - O Takahashi
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Sago
- Division of Dental Anaesthesiology, Kyushu Dental University, Kitakyushu, Japan
| | - D Yoshiga
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Y Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan.
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15
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Inamoto Y, Saitoh E. Morphologic and Kinematic Analysis of Swallowing Using Multislice CT. Dysphagia 2017. [DOI: 10.1007/174_2017_123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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