High-Density Surface Electromyography for Swallowing Evaluation in Post-Radiation Dysphagia.

OBJECTIVES: Our study aimed to investigate the feasibility of using high-density surface electromyography (HD-sEMG) for swallowing assessment by comparing the quantitative parameters and topographic patterns of HD-sEMG between post-irradiated patients and healthy individuals. METHODS: Ten healthy volunteers and ten post-irradiated nasopharyngeal carcinoma patients were recruited. 96-channel HD-sEMG was recorded although each participant consumed different consistencies of food (thin and thick liquid, puree, congee, and soft rice). Dynamic topography was generated from the root mean square (RMS) of the HD-sEMG signals to illustrate the anterior neck muscle function in the swallowing process. The averaged power of muscles and the symmetry of swallowing patterns were assessed by objective parameters including average RMS, Left/Right Energy Ratio, and Left/Right Energy Difference. RESULTS: The study showed different swallowing patterns between patients with dysphagia and healthy individuals. The mean RMS values were higher in the patient group compared to the healthy group, but the difference was not statistically significant. Asymmetrical patterns were shown in patients with dysphagia. CONCLUSION: HD-sEMG is a promising technique that could be used to quantitatively evaluate the average power of neck muscles and the symmetry of swallowing activities in patients with swallowing difficulties. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 133:2920-2928, 2023.

Endoscopic and observational findings of swallowing of traditional and molded puree in healthy individuals.

Puree is commonly prescribed for patients with mastication and bolus formation difficulties, but its appearance might negatively impact appetite and intake. Molded puree is marketed to be an alternative to traditional puree, but the process of molding puree could alter the properties of the food significantly and lead to different swallowing physiology as compared to puree. The current study investigated the differences between traditional and molded puree in terms of swallowing physiology and perception in healthy individuals. Thirty two participants were included. Two outcomes were used to quantify the oral preparatory and oral phase. Fibreoptic endoscopic evaluation of swallowing was used to assess the pharyngeal phase as it could retain the purees in their original form. Six outcomes were collected. Perceptual rating of the purees were provided by participants in six domains. Molded puree required significantly more masticatory cycles (p < 0.001) and longer time for ingestion (p < 0.001). Molded puree had longer swallow reaction time (p = 0.001) and more inferior site of swallow initiation (p = 0.007) compared with traditional puree. Participants' satisfaction with the appearance, texture and overall of molded puree was significantly greater. Molded puree was perceived to be more difficult to chew and swallow. This study established that the two types of puree were different in various aspects. The study also provided important clinical implications regarding the use of molded puree as a form of texture modified diet (TMD) in patients with dysphagia. The results could serve as the foundation of larger cohort studies on the effect of various TMDs on patients with dysphagia.

Do Chinese speakers need a specialized cochlear implant system?

BACKGROUND: Cochlear implants are a standard treatment option for the profoundly deaf, but have only recently become a treatment option in China. Chinese is a tonal language, and a change in the lexical tone almost always changes the meaning of a word. METHODS: A critical review of the strategies for improving the outcome of cochlear implantation in Chinese speakers was made. RESULTS: The introduction of cochlear implantation in China has stimulated the development of new speech perception tests, which are specific to Chinese, for adults and children. Research undertaken over the last decade in Hong Kong has demonstrated the successful acquisition of tones in adults and children who have received cochlear implants. Surgical approaches have been developed to address specific issues, including post-irradiation and infected ears. New areas of research into the enhancement of speech understanding through signal processing have been established. CONCLUSIONS: The findings in these new areas will form the basis of a cochlear implant system for Chinese people in the near future.

Spoken word recognition in children with cochlear implants: a five-year study on speakers of a tonal language.

OBJECTIVES: To study the effects of age at implantation and duration of implant use on the performance of spoken word recognition of pediatric cochlear implantees in a tonal language setting over a period of 5 years. DESIGN: Sixty-four children, given implants between the ages 1:01 and 14:09 (years:months), were divided into three age groups. They were tested on open-set word recognition ability at seven time intervals from before surgery to 5 years after surgery. Analyses of variance with repeated measurements were used to examine the effect of their age at implantation and the duration of implant use. RESULTS: Duration of implant experience was significant in spoken word recognition across the three age groups (p < 0.01). Children given implants below the age of 3 years caught up with the performance of the older children at 12 months after implantation. The difference in score reached statistical significance at 2 and at 3 years after surgery (p = 0.03, p = 0.00). CONCLUSIONS: The performance of Cantonese-speaking children was similar to that of English-speaking children in that better outcomes were associated with longer implant experience as well as when implantation occurred at a younger age. The children implanted before the age of 3 and who had an implant experience of more than 2 years outperformed the children who were given implants after the age of 6 and also sustained these higher scores throughout 5 years of postimplant testing.

Tone perception ability of Cantonese-speaking children.

Studies have shown that while children acquire all Cantonese tones by age two, they are not able to label them reliably until approximately age 10. One possible explanation for the large age discrepancy may be the different methodologies used. This study aimed to (1) investigate a new research design for the collection of reliable tone perception data from young children; (2) compare lexical and nonlexical items for testing tone perception ability; and (3) identify the relative ease of perceiving the three basic tone contrasts in Cantonese, that is, high level/high rising (T1/T2), high level/low falling (T1/T4), and, high rising/low falling tones (T2/T4). The three tone pairs were presented to 31 children in the form of word and nonword stimuli. It was found that the research design could be used to assess the tone perception knowledge of children as young as 2;09. Significant differences were found between word and nonword stimuli and also in the identification of the T2/T4 contrast in comparison with the other two pairs. Children's overall tone perception abilities are discussed in detail with reference to the role of lexical knowledge and the potential for tone perception confusions arising from differences in fundamental frequencies for tone onset and offset.