Development of a Subjective Symptom Rating Scale for Postoperative Oral Dysfunction in Patients with Oral Cancer: Reliability and Validity of the Postoperative Oral Dysfunction Scale-10.

Currently, there is no scale to subjectively assess postoperative oral dysfunction in patients with oral cancer. The purpose of this study was to evaluate the reliability and validity of the Postoperative Oral Dysfunction Scale (POD-10) that we developed. Between September 2019 and August 2021, 62 eligible oral cancer patients (median age, 72 years; 42 men and 20 women) were enrolled in the study. The Cronbach's alpha coefficient, which indicates the internal consistency of the scale, was 0.94, and the intraclass correlation coefficient, which indicates reproducibility, was 0.85 (95% confidential interval: 0.40-0.96, p < 0.05). Concurrent validity testing showed a statistically significant correlation between POD-10 and Eating Assessment Tool (EAT-10) (r = 0.89, p < 0.05). To test discriminant validity, statistically significant differences were found between early-stage cancer (stage I and II) and advanced-stage cancer (stage III and IV) (p < 0.05). Twenty-four points were calculated as the cutoff value for POD-10 using receiver operating characteristic analysis to calculate the cutoff value. The POD-10 was shown to be a clinically reliable and valid scale that can be used to subjectively assess postoperative oral dysfunction in patients with oral cancer and is expected to be used as a simple diagnostic tool.

Effects of Tongue-Strengthening Exercise on the Geniohyoid Muscle in Young Healthy Adults.

The activities of the suprahyoid muscles have been reported to be induced by tongue muscle contraction. The purpose of this research was to investigate whether tongue-strengthening exercises using a device cause hypertrophy of the geniohyoid muscle in healthy adults. Seven healthy young adults (3 men and 4 women, 21.0 ± 1.3 years old) received 8-week tongue muscle training with the JMS Tongue Pressure Measuring Device. The participants were instructed to press the anterior tongue against the hard palate 30 times in each session, three sessions a day, and 3 days a week. The exercise intensity was set to 60% of maximum tongue pressure in the first week, and to 80% of maximum tongue pressure for the remaining period. The training effect was evaluated by measuring (1) maximum tongue pressure value with the JMS Tongue Pressure Measuring Device, and (2) the area at rest, shortening amount, and contraction ratio of the geniohyoid muscle using ultrasonic imaging. After the 8-week training program, the maximum tongue pressure increased significantly from 44.9 to 61.6 kPa. The area of the geniohyoid muscle at rest also increased significantly from 2.3 to 2.6 cm2 after the program. There were no significant differences in the shortening amounts and the contraction ratios of the geniohyoid muscle between the values before and after the program. The tongue-strengthening exercise was useful to increase the muscle power of the geniohyoid, as well as the tongue muscles, in healthy young adults.

Effects of anterior tongue strengthening exercises on posterior tongue strength in healthy young adults.

OBJECTIVE: The aim of the present study was to investigate whether anterior tongue muscle strengthening exercises can affect the strength of posterior tongue muscles. DESIGN: Eleven healthy subjects (20.6 ± 1.2 years) were included. The subjects exercised by pushing the anterior tongue to the palate 30 times, three times a day, 3 days a week for 8 weeks. The exercise intensity was set at 60% of maximum tongue pressure (MTP) in the first week and 80% of MTP for the remainder of training. After the completion of training, MTP measurements were continued every month for another 3 months to evaluate whether training effects were sustained. RESULTS: MTP was significantly increased after 8 weeks of training compared with before training. No significant differences were seen between MTP immediately after completion of training and MTP 1-3 months after completion of training. However, MTP was significantly higher 1-3 months after completion of training than before training. CONCLUSIONS: The present study showed significant increases in both anterior and posterior MTPs by anterior tongue muscle strengthening exercises. In the future, a database on tongue muscle strengthening exercises in elderly persons, patients with dysphagia, etc. will need to be generated, with the aim of preventing frailty.

Effect of bolus volume and flow time on temporospatial coordination in oropharyngeal pressure production in healthy subjects.

The effects of bolus volume and flow time on the sequential coordination of tongue pressure (TP) and pharyngeal pressure (PP), which are important in the biomechanics of swallowing, are unclear. In this study, we measured TP and PP simultaneously in 10 healthy adults at multiple points during dry swallowing and the swallowing of 5 ml and 15 ml of liquids with different viscosities, and investigated changes in the timing of the onset, peak, and offset of these pressures. TP was measured using a sensor sheet system with five measuring points on the hard palate, and PP was measured using a manometry catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. We found that the differences between the TP and PP onset times decreased when the bolus volume was larger. The change in bolus volume had very little effect on peak time or offset time. The flow time of the bolus affected the appearance of onset and peak time for both TP and PP. A time difference between TP and PP emerged as the flow time increased, with TP starting to appear before PP. This may be the first detailed analysis of pressure-flow dynamics that treats the mouth and pharynx as a single functional unit. We believe that our analysis is an important step toward extending future research to include a wider range of age groups and dysphagia patients.

Sequential coordination between lingual and pharyngeal pressures produced during dry swallowing.

The aim of this study was to investigate oropharyngeal pressure flow dynamics during dry swallowing in ten healthy subjects. Tongue pressure (TP) was measured using a sensor sheet system with five measuring points on the hard palate, and pharyngeal pressure (PP) was measured using a manometric catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. Onset of TP was earlier than that of PP. The peak of TP did not show significant differences with the onset of PP, and it was earlier than that of PP. There was no significant difference between the offset of TP and PP. The onset of PP was temporally time-locked to the peak of TP, and there was an especially strong correlation between the onset of PP and TP at the posterior-median part on the hard palate. The offset of PP was temporally time-locked to that of TP. These results could be interpreted as providing an explanation for the generation of oropharyngeal pressure flow to ensure efficient bolus transport and safe swallowing.

[Study on aspiration and swallowing exercise in stroke patients].

We investigated factors for aspiration by videofluoroscopy (VF) and swallowing exercises in stroke patients. Subjects were 102 stroke patients aged 34-101 years (mean 72.8+/-13.8 years) including 72 males and 30 females and for whom VF was performed because of suspected swallowing difficulty. They consisted of 64 patients with cerebral infarction, 33 patients with cerebral hemorrhage, and 5 patients with subarachnoid hemorrhage. Aspiration was classified into aspiration with choking and silent aspiration (SA) by the presence of a cough reflex. Eating instructions such as foodstuffs and intake methods and outcome were investigated. On VF, aspiration with foodstuffs was found in 59 of 102 (57.8%) patients and SA was found in 44 of them (44.1%). Some patients ate food on the ward in spite of SA in VF. Such patients were given eating instructions by the judgment of the attending physician, but foodstuffs and intake methods based on the results of VF could be changed in most cases. As for swallowing training, direct training was conducted only in a few patients in the group that presented overt aspiration in this study. On the other hand direct training was possible in the majority of patients if foodstuffs and intake methods were handled appropriately in SA. If these strok patients were approached with attention paid to the forms of foodstuffs and intake method on the basis of detailed evaluation on VF using mimic foodstuffs, eating was possible without aspiration in many cases.

Influence of bite force and tongue pressure on oro-pharyngeal residue in the elderly.

OBJECTIVE: To investigate the influence of maximal bite force, maximal tongue pressure, number of mastications and swallowing on the oro-pharyngeal residue in the elderly. BACKGROUND: Oro-pharyngeal residue in the elderly is an indication of dysphagia. Pharyngeal residue is especially critical as it may cause aspiration pneumonia, which is one of the major causes of death in elderly. MATERIALS AND METHODS: Videofluorographic recordings were performed on 14 elderly volunteers (six males, eight females, age range 65-93 years) without any history or symptoms of dysphagia. The subjects were instructed to consume 9 g of barium containing bread in two manners; free mastication and swallow (FMS: masticate and swallow freely), and limited mastication and swallow (LMS: swallow once after 30 chewing actions). The amount of oral and pharyngeal residue was evaluated using a 4-point rating scale. Maximal occlusal force was measured by a pressure sensitive sheet, and maximal tongue pressure using a handy probe. Multiple regression analysis was performed to examine the influence of these items on the amount of oral and pharyngeal residue in FMS and LMS. RESULTS: In FMS, age was found to be a factor which increased oral residue (p = 0.053), and the number of swallowing (p = 0.017) and the state of the prosthesis (p = 0.030) reduced the pharyngeal residue. In LMS, tongue pressure was a factor which reduced oral residue (p = 0.015) and increased pharyngeal residue (p = 0.008). CONCLUSION: It is suggested that in the elderly tongue pressure contributed to propulsion of the food bolus from oral cavity into the pharynx, and multiple swallowing contributed to the reduction in the amount of pharyngeal residue.

[A comparison study of aspiration with clinical manifestions in stroke patients].

This study was investigated clinical factors for aspiration in stroke patients by videofluoroscopy (VF). Subjects were 102 patients with strokes aged between 34 and 101 years including 72 males and 30 females and for whom VF was performed for swallowing difficulty or suspected swallowing difficulty. They consisted of 64 patients with cerebral infarction, 33 patients with cerebral hemorrhage, and 5 patients with subarachnoid hemorrhage. Before VF, pharyngeal reflex, physical status, and cognitive function were evaluated as bedside clinical assessment. As for swallowing evaluation at bedside, the repetitive saliva swallowing test (RSST) and water swallowing test were performed. Aspiration was classified into aspiration with choking and silent aspiration (SA) by presence of a cough reflex. As results, aspiration with foodstuffs on VF was found in 59 of 102 (57.8%) patients and SA was found in 44 of them (43.1%). In patients with not only pharyngeal reflex but also cervical and maintaining a position stability, and those who were decreased in cognitive function, aspiration should always be supposed and the observation for eating behavior against aspiration should be needed. We divided patients into three groups; no aspiration, SA and aspiration with choking. Significant difference was observed between the groups in Mini-Mental State Examination, Barthel Index, and RSST. Although in the water-swallowing test, swallowing was possible without choking, SA was observed on VF in most cases. Therefore, in cases with serious disability and cognitive dysfunction with advanced age, RSST and water swallowing test should not be overestimated, it is worth conducting VF when aspiration is suspected from neurological assessment.

Tongue pressure against hard palate during swallowing in post-stroke patients.

OBJECTIVES: The tongue plays an important role in swallowing by contacting the palate. The aim of the present study was to investigate the characteristics of tongue pressure production during swallowing in post-stroke patients using a newly developed sensor sheet. MATERIALS AND METHODS: Ten post-stroke inpatients with hemiplegia and five healthy volunteers participated in this study. Magnitude of tongue pressure during a dry swallow was measured using a newly developed sensor sheet comprising five sensors applied directly to the palate or to the palatal surface of a maxillary denture using denture adhesive. Swallowing ability was evaluated by measuring the time taken to swallow 30 ml of water. The magnitude of tongue pressure was compared between the post-stroke patients and healthy subjects as well as between each measuring point in both groups. The relationship between tongue pressure and swallowing ability and that between tongue pressure and state of occlusal support were also examined. RESULTS: The magnitude of tongue pressure in the post-stroke patients was smaller than that of the healthy subjects at the measuring points along the median line (Welch test, p < 0.05), larger in the non-paralysed side than in the paralysed side (two-way ANOVA, p < 0.05), and was influenced by swallowing ability and occlusal support (Welch test, p < 0.05). CONCLUSIONS: Measurement of the magnitude of tongue pressure shows promise as a simple, non-invasive and quantitative method by which tongue activity in post-stroke patients, in whom swallowing ability is a concern, could be evaluated.

Factors influencing eating ability of old in-patients in a rehabilitation hospital in Japan.

OBJECTIVES: This study was designed to determine the factors influencing eating ability of old in-patients in a rehabilitation hospital. DESIGN: Cross-sectional investigation. SETTING: Forty-six in-patients in the rehabilitation ward of Hashimoto Hospital in Kagawa Prefecture in Japan were investigated using a multidisciplinary approach. MAIN OUTCOME MEASURES: Age, gender, state of dentition, muscle activity of lip, cheek and tongue, biting force, salivary flow rate per a minute (SFR), masticatory ability for gummy jelly, swallowing ability, texture of meal, independency of walking (Functional Independence Measure = FIM) and ability to communicate. RESULTS: Bivariate analysis for the relationship between surveyed items and masticatory ability (chi-square test) identified that better masticatory ability for gummy jelly was associated with age (< 85years), gender (male),state of dentition (dentate), SFR (high), activity of lip (good), biting force (high), swallowing ability (good) and activity of communication (high). Among these items, SFR (p = 0.001), gender (p = 0.004), ability to communicate (p = 0.005) and age (p = 0.012) were found having an influence on the masticatory ability (logistic regression analysis). On the other hand, age (< 85years), gender (male), SFR (high), activity of lip (good), activity of cheek (good), biting force (high), masticatory ability (good) and swallowing ability (good) had a relationship with normal texture of meal. In regression analysis, only two items, activity of lip (p = 0.003) and swallowing ability (p = 0.024) emerged as factors on texture of meal. CONCLUSIONS: Masticatory ability for gummy jelly was influenced by cognitive function and was excluded from the factors on the state of meal. These results suggested the limitation of evaluation using test food, so dentists should observe eating behaviour of in-patients. In addition, dentists should pay attention to the activity of the lip and swallowing ability as well as dentition and prostheses in the rehabilitation of eating ability. As SFR was the most significant factor on masticatory ability, this emphasizes the necessity of care for dry mouth caused by side effects of multi-medication.