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Kuuskoski J, Vanhatalo J, Hirvonen J, Rekola J, Aaltonen L, Järvenpää P. Inter-rater reliability and clinical relevance of subjective and objective interpretation of videofluoroscopy findings. Laryngoscope Investig Otolaryngol 2024; 9:e1298. [PMID: 38974605 PMCID: PMC11222653 DOI: 10.1002/lio2.1298] [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: 05/26/2024] [Accepted: 06/09/2024] [Indexed: 07/09/2024] Open
Abstract
Background Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal-abnormal ratings, objective measurements have been developed. We compared the inter-rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Methods Two blinded raters analyzed the subjective normal-abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter-rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. Results In the pharyngeal findings, the subjective analysis inter-rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter-rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. Conclusions The subjective analysis had moderate to strong inter-rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter-observer reproducibility and could thus improve the reliability of VFS diagnostics. Level of evidence 4.
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Affiliation(s)
- Jonna Kuuskoski
- Department of Otorhinolaryngology—Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Jaakko Vanhatalo
- Department of RadiologyTurku University Hospital and University of TurkuTurkuFinland
| | - Jussi Hirvonen
- Department of RadiologyTurku University Hospital and University of TurkuTurkuFinland
- Faculty of Medicine and Health TechnologyTampere University Hospital and Tampere UniversityTampereFinland
| | - Jami Rekola
- Department of Otorhinolaryngology—Head and Neck SurgeryTurku University Hospital and University of TurkuTurkuFinland
| | - Leena‐Maija Aaltonen
- Department of Otorhinolaryngology—Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Pia Järvenpää
- Department of Otorhinolaryngology—Head and Neck SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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Gao M, Inamoto Y, Saitoh E, Aihara K, Shibata S, Gonzalez-Fernandez M, Otaka Y. Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT. J Oral Rehabil 2024; 51:1193-1201. [PMID: 38570928 DOI: 10.1111/joor.13686] [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: 07/15/2023] [Revised: 12/21/2023] [Accepted: 03/09/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Upper oesophageal sphincter (UES) serves as an important anatomical and functional landmark during swallowing. However, the precise UES location before and during swallowing has not been well established. OBJECTIVE This study aimed to determine upper oesophageal sphincter (UES) location and displacement during swallowing accounting for sex, age, and height in healthy adults using 320-row area detector computed tomography (320-ADCT). METHODS Ninety-four healthy adults (43 males; 22-90 years) underwent 320-ADCT scanning while swallowing one trial of 10 mL honey thick barium. UES location at bolus hold and at maximum displacement and vertical displacement during swallowing were identified using the coordinates and the section classification of vertebrae (VERT scale). The differences and correlations of UES location and distance in terms of sex, age, and height were analysed using Mann-Whitney U test and Spearman's correlation coefficient. RESULTS UES locations at bolus hold and at maximum displacement were significantly lower and UES vertical displacement was significantly larger in males than in females (p < .001). UES location at bolus hold became lower with increasing age (r = -.312, p = .002), but the negative correlation was low at maximum displacement (r = -.230, p = .026), resulting in larger vertical distance with ageing. UES locations showed high negative correlation at bolus hold with height (r = -.715, p < .001), and showed moderate negative correlation at maximum displacement with height (r = -.555, p < .001), although this effect was unclear when analysed by sex. CONCLUSION Males showed lower UES location and larger displacement than females. The impact of age was evident with lower location before swallowing and larger displacement during swallowing. Differences observed by sex were not completely explained by using the VERT scale to adjust for height.
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Affiliation(s)
- Minxing Gao
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Marlis Gonzalez-Fernandez
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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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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Wu S, Chu L, Liu CF, Zhang Q, Zhang YF, Zhou TF, Wang ZT, Ni RH, Li Y. Effect of Changes in Bolus Viscosity on Swallowing Muscles in Patients with Dysphagia after Stroke. Chin Med J (Engl) 2019; 131:2868-2870. [PMID: 30511693 PMCID: PMC6278180 DOI: 10.4103/0366-6999.246071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Shuang Wu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Lan Chu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004; Institute of Neuroscience of Soochow University, Suzhou, Jiangsu 215004, China
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University; Institute of Neuroscience of Soochow University, Suzhou, Jiangsu 215004, China
| | - Qian Zhang
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Yi-Fan Zhang
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Teng-Fei Zhou
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Zhi-Tao Wang
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Rui-Han Ni
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Yuan Li
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
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Regueiro MRB, Parreira LC, Nascimento WV, Dantas RO. Influence of Body Height on Oral and Pharyngeal Transit Time of a Liquid Bolus in Healthy Volunteers. Gastroenterology Res 2018; 11:411-415. [PMID: 30627264 PMCID: PMC6306106 DOI: 10.14740/gr1063w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Swallowing duration may be influenced by several factors. The effect of body height on oral-pharyngeal bolus transit has not been clearly elucidated. The hypothesis of this investigation was that height has influence on oral-pharyngeal transit time of a liquid bolus. METHODS Videofluoroscopic assessment of swallowing was performed on 40 healthy volunteers: 20 "tall" (171 cm to 207 cm) and 20 "short" (152 cm to 170 cm) subjects, 10 men and 10 women in each group. Each subject performed three swallows of 10 mL of liquid barium bolus. The following parameters were measured: oral transit time (OTT): time from the beginning of tongue tip movement at incisors to arrival of the bolus tail at the fauces; pharyngeal transit time (PTT): time between the arrival of the bolus tail at fauces and complete passage of the bolus tail through the upper esophageal sphincter (UES); pharyngeal clearance (PC): time between the arrival of the bolus head at fauces to complete passage of the bolus tail through the UES; UES opening (UESO): time between the arrival of the bolus head at the UES to complete passage of the bolus tail through the UES; duration of hyoid movement (HM): time interval between the onset and the end of hyoid movement; oral-pharyngeal transit time (OPTT): time from the beginning of tongue tip movement at incisors until complete passage of the bolus tail through the UES. The statistical analysis was done by a linear model with mixed effects. Correlation between height and swallowing events duration was assessed by Spearman's correlation coefficient (r). RESULTS In women OTT, PC, HM and OPTT were longer in tall than in short subjects, what was not seen in men. In women there was a positive correlation between OTT, PTT and OPTT and height. Men (mean height: 177 cm) had longer PTT and PC than women (mean height: 166 cm). CONCLUSIONS In women, oral and pharyngeal transit time of a 10 mL liquid bolus were influenced by height and was longer in taller subjects.
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Affiliation(s)
- Marcia R.K. Bernardi Regueiro
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
| | - Luana Casari Parreira
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
| | - Weslania Viviane Nascimento
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataro, Universitat Autonoma de Barcelona, Spain
| | - Roberto Oliveira Dantas
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
- Department of Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
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