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Culbert A, Fullerton A, Edwards K, Hitchcock K, Davenport P, Ku J, Silver NL. Effects of Tongue Strength Training on Quality of Life in Head and Neck Cancer Patients: Results From a Pilot Interventional Clinical Trial. Ann Otol Rhinol Laryngol 2024:34894241275463. [PMID: 39158476 DOI: 10.1177/00034894241275463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND Head and neck cancer (HNC) patients often have dysphagia following surgical and/or chemoradiation treatment, which can lead to reduced quality of life. Some patients suffer from decreased tongue strength and mobility that may cause discomfort and difficulty with swallowing. Our group has developed a patented genioglossus muscle strength trainer (GMST) to increase tongue protrusive force that has been used in patients with sleep apnea. We hypothesized that the GMST device would increase tongue strength in the HNC population. METHODS We conducted an IRB approved, non-randomized, interventional clinical trial of HNC patients with dysphagia to determine the effect of GMST on tongue strength. Our secondary objective was to assess dysphagia quality of life, as determined by questionnaires. Genioglossus muscle strength measurements (measured in Newtons, N) and dysphagia quality of life scores (SWAL-QoL questionnaire) were obtained from enrolled patients at baseline and following 4 weeks of intervention. Treatment was at-home GMST exercise regimen 3 times daily, 5 days per week. Compliance was assessed via review of training logs. Two-sided paired t-tests at significance level α = .05 were performed to assess difference in mean GG muscle strength pre- and post-treatment. RESULTS Out of 10 patients initially enrolled, 7 patients completed the trial. Eighty-six percent were male and the average age was 60. About 5 patients had surgery plus adjuvant radiation and 2 patients had primary radiation. All patients had baseline dysphagia as determined by patient complaint and/or objective measurement (prior modified barium swallow). No adverse events were reported. We observed a statistically significant increase in genioglossus muscle strength (mean change: 4.0 N, 95% CI 1.1-6.9, P = .015) after 4 weeks of treatment. Patients reported reduced swallowing burden and feeling of stigma around eating based on SWAL-QoL results. CONCLUSIONS Our data suggest that protrusive tongue-training exercises utilizing a novel tongue trainer device is well-tolerated and increases genioglossus muscle strength in treated HNC patients complaining of dysphagia. Patient-reported outcomes based on the SWAL-QoL survey indicate improvements in quality-of-life post-treatment, although our results are limited by small sample size. Larger studies are needed to see if this device could have clinically meaningful results for this difficult-to-treat patient population.
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Affiliation(s)
- August Culbert
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Amy Fullerton
- Department of Communication Sciences and Disorders, Jacksonville University, Jacksonville, FL, USA
| | - Kaitlyn Edwards
- Department of Otolaryngology/Head and Neck Surgery, University of Florida, Gainesville, FL, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Paul Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Jamie Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Natalie L Silver
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
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Ichikawa Y, Kikutani T, Sumi M, Iwata H, Takahashi N, Tohara T, Ozeki M, Tamura F. Intramuscular condition of swallowing-related muscles using shear-wave elastography: A preliminary study in healthy adults. J Oral Rehabil 2024. [PMID: 39152545 DOI: 10.1111/joor.13844] [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: 08/31/2023] [Revised: 06/13/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Assessing the internal condition of swallowing-related muscles and muscle strength and size is important because their deterioration may lead to dysphagia. However, there are few reports on stiffness of swallowing-related muscles measured using shear-wave elastography (SWE) and their qualitative characteristics. OBJECTIVES We measured stiffness of swallowing-related muscles using SWE to investigate the relationship between muscle stiffness and body composition as well as other relevant variables in healthy adults. METHODS Thirty healthy adults were included in this cross-sectional study. We evaluated stiffness of the genioglossus muscle (GGM) and geniohyoid muscle (GHM) using SWE. Skeletal muscle mass index, body mass index (BMI), handgrip strength, tongue pressure, and cross-sectional areas of the muscles were measured, and we determined their relationship with muscle stiffness. RESULTS For muscle stiffness, the mean value for the middle GGM was 7.08 ± 1.92 kPa, that for the posterior GGM was 9.31 ± 2.68 kPa, and that for the GHM was 8.84 ± 2.15 kPa. In multiple regression analysis, with stiffness of the posterior GGM as the dependent variable, BMI (β = -.473, p = .039) was a significant negative explanatory variable. However, with the GHM stiffness as the dependent variable, BMI (β = .419, p = .033) was a significant positive explanatory variable. CONCLUSION Stiffness of the posterior GGM was positively correlated with BMI and that of the GHM was negatively correlated with BMI. Stiffness, as measured using SWE, has the potential to capture the intramuscular characteristics of swallowing-related muscles, particularly the posterior GGM.
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Affiliation(s)
- Yoko Ichikawa
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tokyo, Japan
| | - Takeshi Kikutani
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tokyo, Japan
| | - Misa Sumi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Iwata
- Division of Diagnosis, Oral and Maxillofacial Radiology and Pathology Diagnostic Service, The Nippon Dental University, Tokyo, Japan
| | - Noriaki Takahashi
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tokyo, Japan
| | - Takashi Tohara
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tokyo, Japan
| | - Maiko Ozeki
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
| | - Fumiyo Tamura
- Tama Oral Rehabilitation Clinic, The Nippon Dental University, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tokyo, Japan
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Pauloski BR, Yahnke KM. Reliability of Measuring Geniohyoid Cross-Sectional Area with B-Mode Ultrasound. Dysphagia 2024:10.1007/s00455-024-10712-3. [PMID: 38789680 DOI: 10.1007/s00455-024-10712-3] [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: 08/26/2023] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique. This study examined three methods of transducer placement in the coronal plane by two examiners to determine the reliability of measurement of CSA of the geniohyoid muscle. Forty healthy adults participated in the study. Each participant's geniohyoid muscles were imaged using B-mode ultrasound under three transducer placement conditions in the coronal plane by two examiners. Geniohyoid CSA was measured from each ultrasound image. A three-way mixed-methods ANOVA was used to determine whether there were significant differences in geniohyoid CSA among transducer position conditions, trials, and examiners. There were significant differences among the transducer placement conditions, indicating that each condition was measuring a different portion of the muscle. There were no significant differences among repeated trials nor between examiners within each method of transducer placement. All three conditions of transducer placement were reliable at measuring geniohyoid CSA across trials and examiners. This study emphasizes the need for consistency of placement, whichever method is selected. It also highlights the need for researchers to provide a precise description of methods for positioning the transducer so that placement is reproducible.
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Affiliation(s)
- Barbara R Pauloski
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA.
| | - Kacey M Yahnke
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA
- Manhattan Star Academy, 180 Amsterdam Avenue, New York, NY, 10023, USA
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Sung JH, Baek SH, Park JW, Lee JH, Son MH, Kim BJ. Dynamic suprahyoid muscle ultrasound in assessing oropharyngeal dysphagia in neurological disorders. Eur J Phys Rehabil Med 2024; 60:233-244. [PMID: 38332698 PMCID: PMC11114157 DOI: 10.23736/s1973-9087.24.08216-9] [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: 09/05/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Appropriate evaluation and management of dysphagia are essential in neurological disorders. However, there is currently a lack of a simple yet reliable method for dysphagia evaluation. AIM This study aimed to investigate the usefulness of new dynamic M-mode ultrasonography (US) parameters of suprahyoid muscle (SHM) to evaluate dysphagia. DESIGN Prospective observational, cross-sectional study. SETTING Inpatient setting at neurology department of tertiary medical center. POPULATION A total of 89 patients with dysphagia and 175 healthy volunteers were enrolled in the study. Patients were subdivided into mild and severe dysphagia groups depending on the need for dietary changes and disease classification, which included amyotrophic lateral sclerosis, peripheral neuromuscular diseases, and stroke. METHODS Dynamic M-mode US was performed during swallowing to obtain the SHM thickness (the baseline thickness of the SHM), SHM displacement (peak-to-peak amplitude of SHM movement), SHM difference (SHM displacement - SHM thickness), SHM ratio (SHM displacement/SHM thickness), peak-to-peak time, and total duration. A videofluoroscopic swallowing study (VFSS) was performed. RESULTS Significant differences were found in SHM displacement and SHM difference according to dysphagia severity (P<0.001). The SHM ratio, total duration (P<0.001), and peak-to-peak time (P=0.001) differed significantly according to the patients' underlying diseases. The pharyngeal delay time and penetration-aspiration scale from the VFSS demonstrated significant negative correlations with SHM displacement and difference (P<0.001). By combining SHM difference and total duration, patients with dysphagia could be distinguished from healthy controls, with the highest negative predictive value of 95.6%. CONCLUSIONS Dynamic M-mode US of the SHM provided added value in evaluating the severity of dysphagia and differentiating swallowing mechanics of dysphagia related to underlying neurological disorders. CLINICAL REHABILITATION IMPACT Dynamic M-mode US of the SHM can serve as a supportive tool for rapid screening and repetitive follow-up of patients with dysphagia, which would contribute to dysphagia rehabilitation in patients with various neurological disorders.
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Affiliation(s)
- Joo Hye Sung
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jin-Woo Park
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jung Hun Lee
- Neurophysiology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Myeong Hun Son
- Neurophysiology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea -
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
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Ogawa N, Ohno T, Kunieda K, Watanabe M, Fujishima I. A Novel Exercise to Improve Suprahyoid Muscle Area and Intensity as Evaluated by Ultrasonography. Dysphagia 2024:10.1007/s00455-024-10667-5. [PMID: 38324169 DOI: 10.1007/s00455-024-10667-5] [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: 08/14/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
Insufficient suprahyoid muscle strength with poor opening of the upper esophageal sphincter can cause dysphagia. This study investigated whether an exercise of the suprahyoid muscle, named forehead exercise for suprahyoid muscles (FESM, "Enge-Odeko-Taiso" in Japanese), improves the geniohyoid muscle area and intensity using ultrasonography. Sixty-four participants (15 men and 49 women, 82.8 ± 6.0 years) living independently with no symptoms of swallowing difficulties were enrolled. The participants were divided into the FESM and the control group. The FESM is an isometric exercise involving repetitions of looking into the navel as if the chin is pulled back with little neck motion using a hand pushed against the forehead for resistance. This exercise is performed five times in 10 courses a day (total 50 times) for 8 weeks. Participants in the control group did not conduct any exercises. Body mass index, hand grip strength, gait speed, calf circumference, Mini Nutritional Assessment short-form, eating assessment tool, repetitive saliva swallowing test (RSST), and Food Intake LEVEL Scale scores were examined. The ultrasonographic geniohyoid muscle area, intensity, and RSST were investigated before and after the program. In the FESM group, the geniohyoid muscle area increased from 2.24 to 2.52 cm2 (P < 0.05), intensity decreased from 34.6 to 32.0 (P < 0.05), and the median RSST increased from 5 to 6 (P < 0.05) significantly. Conversely, no significant differences were observed in the control group. The FESM was effective to increase the area and decrease the intensity of the geniohyoid muscle and may improve swallowing function.
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Affiliation(s)
- Nami Ogawa
- Department of Dentistry, Sakaue Dental Office, 3F-3-14-8, Tamagawa, Setagaya-Ku, Tokyo, 158-0094, Japan.
| | - Tomohisa Ohno
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu-City, Gifu, 501-1194, Japan
| | - Masato Watanabe
- Department of Internal Medicine and Respiratory Medicine, Ohisamagenki Clinic, 2F-5-2-5, Futako, Takatsu-Ku, Kawasaki-Shi, Kanagawa, 213-0002, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
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Kitagawa T, Nakamura M, Fukumoto Y. Usefulness of muscle echo intensity for evaluating functional performance in the older population: A scoping review. Exp Gerontol 2023; 182:112301. [PMID: 37776985 DOI: 10.1016/j.exger.2023.112301] [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: 04/16/2022] [Revised: 06/16/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
Muscle echo intensity, as measured by ultrasonography, could be used as a new marker of functional performance in older populations. This scoping review aimed to present evidence on the utility of muscle echo intensity as determined by ultrasonography for assessing functional performance in older adults. The eligibility criterion included observational studies that investigated the associations between muscle echo intensity and functional performance in older adults. Terms, such as "echo intensity" and "older adults", were searched for in databases, such as PubMed, Web of Science, the Cochrane database of systematic reviews, and the Cumulative Index of Nursing and Allied Health Literature, in April 2021. Two independent reviewers screened and extracted the data; 46 papers, of which almost one-third were Japanese, were subsequently identified for inclusion. The representative functional performances included in this review were muscle strength, gait speed, sit-to-stand test results, and timed up-and-go test results. Poor to moderate associations were found between muscle echo intensity and functional performance; however, heterogeneities were observed in the characteristics of study participants. Moreover, the accurate effect size and causal inferences between muscle echo intensity and functional performance remained unclear. Further longitudinal studies are needed to determine these causal inferences.
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Affiliation(s)
- Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, 4490-9 Ozaki, Kanzaki 842-8585, Japan.
| | - Yoshihiro Fukumoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Japan.
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Yamaguchi K, Nakagawa K, Yoshimi K, Ariya C, Nakane A, Okumura T, Tohara H. The Cross-Sectional Area of the Middle and Base of the Tongue is Associated with Swallowing-Related Muscle Strength. Dysphagia 2022; 37:1723-1731. [PMID: 35278127 DOI: 10.1007/s00455-022-10431-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
Muscle strength and function are generally positively correlated with muscle quantity and negatively correlated with muscle quality; however, the tongue shows a unique tendency, different from limb muscles. The relationship between the characteristics of each part of the tongue, muscle strength and function, and systemic factors has been unclear. The aim of the study was to investigate the relationship between cross-sectional area (CSA) and echo intensity (EI) of the middle and base of the tongue and swallowing, articulation function, and body composition. Eighty-nine healthy individuals were included in this cross-sectional study. Swallowing was assessed using tongue pressure (TP) and jaw opening force (JOF) as they indicate swallowing-related muscle strength. Articulation function was evaluated through oral diadochokinesis (ODK). Bioelectrical impedance analysis was performed for body composition. CSAs and EIs of the middle and base of the tongue were measured using ultrasound. Multiple regression analysis was used to examine the relationship between the characteristics of the tongue, swallowing-related muscle strength, and ODK. In multiple regression analysis with TP as the dependent variable, age (β = - 0.22, P < 0.01) and CSA of the middle part (β = 0.02, P < 0.01) were significant explanatory variables. In multiple regression analysis with JOF as the dependent variable, sex (β = - 2.76, P < 0.01) and CSA of the base (β = - 0.004, P < 0.05) were significant explanatory variables. Multiple regression analysis with articulation function as the dependent variable did not yield significant results. The CSA of the tongue is a better indicator of swallowing-related muscle strength than EI. Ultrasonography may be used for assessing swallowing-related muscle strength.
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Affiliation(s)
- Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Chantaramanee Ariya
- Department of Preventive Dentistry, Naresuan University, 99 Moo 9, Phitsanulok-Nakhon Sawan Road, Tha Pho, Mueang Phitsanlok, Phitsanulok, 65000, Thailand
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takuma Okumura
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Exploring the Age Effects on European Portuguese Vowel Production: An Ultrasound Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For aging speech, there is limited knowledge regarding the articulatory adjustments underlying the acoustic findings observed in previous studies. In order to investigate the age-related articulatory differences in European Portuguese (EP) vowels, the present study analyzes the tongue configuration of the nine EP oral vowels (isolated context and pseudoword context) produced by 10 female speakers of two different age groups (young and old). From the tongue contours automatically segmented from the US images and manually revised, the parameters (tongue height and tongue advancement) were extracted. The results suggest that the tongue tends to be higher and more advanced for the older females compared to the younger ones for almost all vowels. Thus, the vowel articulatory space tends to be higher, advanced, and bigger with age. For older females, unlike younger females that presented a sharp reduction in the articulatory vowel space in disyllabic sequences, the vowel space tends to be more advanced for isolated vowels compared with vowels produced in disyllabic sequences. This study extends our pilot research by reporting articulatory data from more speakers based on an improved automatic method of tongue contours tracing, and it performs an inter-speaker comparison through the application of a novel normalization procedure.
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Comparison of Tongue Characteristics Classified According to Ultrasonographic Features Using a K-Means Clustering Algorithm. Diagnostics (Basel) 2022; 12:diagnostics12020264. [PMID: 35204355 PMCID: PMC8870935 DOI: 10.3390/diagnostics12020264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
The precise correlations among tongue function and characteristics remain unknown, and no previous studies have attempted machine learning-based classification of tongue ultrasonography findings. This cross-sectional observational study aimed to investigate relationships among tongue characteristics and function by classifying ultrasound images of the tongue using a K-means clustering algorithm. During 2017–2018, 236 healthy older participants (mean age 70.8 ± 5.4 years) were enrolled. The optimal number of clusters determined by the elbow method was 3. After analysis of tongue thickness and echo intensity plots, tongues were classified into three groups. One-way ANOVA was used to compare tongue function, tongue pressure, and oral diadochokinesis for /ta/ and /ka/ in each group. There were significant differences in all tongue functions among the three groups. The worst function was observed in patients with the lowest values for tongue thickness and echo intensity (tongue pressure [P = 0.023], /ta/ [P = 0.007], and /ka/ [P = 0.038]). Our results indicate that ultrasonographic classification of tongue characteristics using K-means clustering may aid clinicians in selecting the appropriate treatment strategy. Indeed, ultrasonography is advantageous in that it provides real-time imaging that is non-invasive, which can improve patient follow-up both in the clinic and at home.
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Tagami Y, Fujimoto K, Goto T, Suito H, Nagao K, Ichikawa T. Measurement of ultrasonic echo intensity predicts the mass and strength of the tongue muscles in the elderly. J Oral Sci 2021; 64:44-48. [PMID: 34880146 DOI: 10.2334/josnusd.21-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between the echo intensity (EI) on ultrasound images of the tongue, tongue thickness, and tongue pressure to examine the effectiveness of EI measurement for assessing the tongue function. METHODS A total of 100 elderly outpatients were enrolled. Tongue thickness and EI were measured using ultrasonography. The distance from mylohyoid muscle surface to dorsal surface of the tongue was measured for tongue thickness. Subsequently, this area was vertically divided into four areas: top of tongue dorsal side (DT), bottom of tongue dorsal side (DB), top of basal tongue side (BT), and bottom of basal tongue side (BB), and the EI was measured in each area. RESULTS The mean EIs of DT and DB were lower than those of BT and BB. In the three areas apart from BB, the EI decreased with an increase in tongue thickness. In particular, a significant correlation between the EI in DB and tongue thickness was found. In all areas, the EI decreased with an increase in tongue pressure. CONCLUSION The results of this study suggested that the measurement of EI could be an important indicator for assessing the tongue function in the elderly.
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Affiliation(s)
- Yoshihiro Tagami
- Department of Prosthodontics and Oral Rehabilitation, Tokushima University, Graduate School of Biomedical Sciences
| | - Keiko Fujimoto
- Department of Prosthodontics and Oral Rehabilitation, Tokushima University, Graduate School of Biomedical Sciences
| | - Takaharu Goto
- Department of Prosthodontics and Oral Rehabilitation, Tokushima University, Graduate School of Biomedical Sciences
| | - Hideki Suito
- Department of Oral and Maxillofacial Radiology, Tokushima University, Graduate School of Biomedical Sciences
| | - Kan Nagao
- Department of Prosthodontics and Oral Rehabilitation, Tokushima University, Graduate School of Biomedical Sciences
| | - Tetsuo Ichikawa
- Department of Prosthodontics and Oral Rehabilitation, Tokushima University, Graduate School of Biomedical Sciences
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Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med 2021; 12:45-59. [PMID: 33387359 DOI: 10.1007/s41999-020-00433-9] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE In 2018, the SARCUS working group published a first article on the standardization of the use of ultrasound to assess muscle. Recommendations were made for patient positioning, system settings and components to be measured. Also, shortcomings in knowledge were mentioned. An important issue that still required standardization was the definition of anatomical landmarks for many muscles. METHODS A systematic search was performed in Medline, SCOPUS and Web of Sciences looking for all articles describing the use of ultrasound in the assessment of muscle not described in the first recommendations, published from 01/01/2018 until 31/01/2020. All relevant terms used for older people, ultrasound and muscles were used. RESULTS For 39 muscles, different approaches for ultrasound assessment were found that likely impact the values measured. Standardized anatomical landmarks and measuring points were proposed for all muscles/muscle groups. Besides the five already known muscle parameters (muscle thickness, cross-section area, pennation angle, fascicle length and echo-intensity), four new parameters are discussed (muscle volume, stiffness, contraction potential and microcirculation). The former SARCUS article recommendations are updated with this new information that includes new muscle groups. CONCLUSIONS The emerging field of ultrasound assessment of muscle mass only highlights the need for a standardization of measurement technique. In this article, guidelines are updated and broadened to provide standardization instructions for a large number of muscles.
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Arakawa I, Igarashi K, Imamura Y, Müller F, Abou-Ayash S, Schimmel M. Variability in tongue pressure among elderly and young healthy cohorts: A systematic review and meta-analysis. J Oral Rehabil 2020; 48:430-448. [PMID: 32799377 DOI: 10.1111/joor.13076] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Tongue pressure (TP) is used for the diagnosis of oral hypofunction; however, the impact of several variables on TP is unclear. Therefore, the current systematic review and meta-analysis aimed to analyse the variability in tongue pressure among healthy individuals aged ≥60 years vs <60 years. Secondary outcomes were the influence of gender and the type of measuring device (Iowa Oral Performance Instrument (IOPI) vs JMS tongue pressure measurement device (JMS)). METHODS PubMed and the Japanese database Ichushi-Web were searched systematically by two independent reviewers for studies reporting TP values in healthy populations. Clinical studies published between 1959 and June 2020 with more than 10 participants, written in English, German or Japanese, were included. A random-effects meta-regression for aggregate-level data was applied (α < 0.05). RESULTS Sixty-eight studies reported TP for a total of 13 773 subjects aged <60 years (n = 3265) and ≥60 years (n = 10 508). TP was significantly higher in subjects <60 years (estimated weighted mean (EWM) ± standard error = 51.9 ± 1.28 kPa; 95% CI = 49.4-54.4) relative to those ≥60 (EWM = 34.7 ± 0.94 kPa; 95% CI = 32.8-36.5) (P < .001), men (EWM = 45.9 ± 2.09 kPa; 95% CI = 41.8-50.0) relative to women (EWM = 39.3 ± 1.68 kPa; 95% CI = 36.0-42.6) (P = .015) and when assessed with the IOPI (EWM = 51.9 ± 1.32 kPa; 95% CI = 49.3-54.5) compared to the JMS (EWM = 33.5 ± 0.63 kPa; 95% CI = 32.2-34.7) (P < .001). In terms of gender, there was no significant difference in TP among subjects ≥60 years (P = .282). However, in subjects younger than 60, a significant difference was observed (P = .004). CONCLUSIONS Healthy populations aged <60 years showed significantly higher TP than those aged ≥60 years. TP values ascertained by the IOPI are significantly higher than those obtained with the JMS.
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Affiliation(s)
- Itsuka Arakawa
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Comprehensive Dental Care, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Kensuke Igarashi
- Department of Dental Materials Science, School of Life Dentistry at Niigata, The Nippon Dental University, Niigata, Japan
| | - Yoshiki Imamura
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Geriatric Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Samir Abou-Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Yamaguchi K, Tohara H, Hara K, Chantaramanee A, Nakagawa K, Yoshimi K, Nakane A, Minakuchi S. Tongue thickness is associated with masticatory performance of perioral muscles: Ultrasonographic study of perioral muscle characteristics in healthy young subjects. J Oral Rehabil 2019; 47:325-331. [DOI: 10.1111/joor.12909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/14/2019] [Accepted: 11/07/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Kohei Yamaguchi
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
| | - Haruka Tohara
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
| | - Koji Hara
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
| | - Ariya Chantaramanee
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
| | - Kazuharu Nakagawa
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
| | - Kanako Yoshimi
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
| | - Ayako Nakane
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation Tokyo Medical and Dental University Bunkyo‐ku Japan
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