Hearing Loss and Cognitive Function: Baseline Findings From the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil.

OBJECTIVE: Hearing loss (HL) has been associated with cognitive impairment in high-income countries. However, no study has investigated this association in low- and middle-income countries. Therefore, our aim was to investigate the association between cognitive function and HL in the Brazilian Longitudinal Study of Adult Health. DESIGN: Cross-sectional analysis of Longitudinal Study of Adult Health (ELSA-Brasil) with 802 individuals (35-74 years old). Hearing was measured using pure-tone audiometry. A pure-tone average (s) of thresholds at 500, 1000, 2000, and 4000 Hz was calculated. HL was defined as a PTA above 25 dB in the better ear or either ear, as a categorical variable. Cognitive performance was measured using the Consortium to Establish a Registry for Alzheimer's Disease word list memory test, the semantic and phonemic verbal fluency (VF) tests, and the Trail Making test version B. To investigate the association between cognitive performance and HL, we used linear regression models adjusted for sociodemographic and clinical variables. RESULTS: Of the total of participants, 7.6% had HL. After adjustment for sociodemographic and health confounding variables, only VF was associated with HL; a 10 dB increase in the PTA in the better ear was associated with worse performance in the phonemic VF test (ß = -0.115 [95% CI, -0.203 to -0.027], p = 0.01). We found a significant interaction between HL and age in the VF domain ( p = 0.01). HL was related to poor VF performance among older adults only. CONCLUSION: In a community-dwelling sample of most middle-aged adults, objectively measured HL was associated with lower VF. These results should be evaluated with caution, given the likelihood of residual confounding and the fact that only VF showed an association with HL.

Distúrbios da Comunicação em Pacientes Pediátricos ­ um Algoritmo da Avaliação Audiológica / Communication Disorders in Pediatric Patients - An Algorithm of Audiological Evaluation

Introdução: Foi instituído Teste de Triagem Auditiva Neonatal Universal (TANU). Crianças podem passar no teste e apresentar surdez tardia ou progressiva ou, ainda, serem portadoras de perdas leves e moderadas que não são observadas. Objetivo: Através deste relato de caso, discutir os exames auditivos pertinentes em cada situação e a orientação dos profissionais de saúde que primeiramente recebem estes pacientes. Descrição do Caso: O caso mostra a importância da avaliação da audição para auxílio no diagnóstico. Paciente foi encaminhado por quadro de atraso de linguagem e hipótese de perda auditiva. Apresentava dificuldades na interação social e alterações comportamentais. Avaliação audiológica foi normal, sendo feito diagnóstico de transtorno de espectro autista (TEA). Comentários: Pacientes com atraso e dificuldades na comunicação podem ser difíceis de avaliar, visto que muitos dos exames auditivos são subjetivos e dependem da interação do examinador com a criança. O caso relatado mostra uma das várias situações com que os profissionais podem se deparar e revela quais são os exames adequados para uma avaliação auditiva apropriada.

Introduction: Universal Newborn Hearing Screening (UNHS) Test was instituted to detect cases with higher probability of hearing loss. Children may pass the test and have late or progressive deafness or even mild and moderate losses that are not observed. Objective: To discuss, through this report of case, the pertinent auditory exams in each situation and the orientation of the health professionals who first receive these patients. Case Description: The case shows the importance of hearing evaluation for diagnostic assistance. Case 1 was referred for language delay and hypothesis of hearing loss. He presented difficulties in social interaction and behavioral changes. Audiological evaluation was normal, being diagnosed as Autistic Spectrum Disorder (ASD). Comments: Patients with delayed communication may be difficult to assess, since many of the auditory exams are subjective and depend on the interaction of the examiner with the child. The reported case presents one of the several situations that professionals may face and reveals what examinations are appropriate for an adequate auditory assessment.

Structure and variability in human tongue muscle anatomy.

The human tongue has a complex architecture, consistent with its complex roles in eating, speaking and breathing. Tongue muscle architecture has been depicted in drawings and photographs, but not quantified volumetrically. This paper aims to fill that gap by measuring the muscle architecture of the tongue for 14 people captured in high-resolution 3D MRI volumes. The results show the structure, relationships and variability among the muscles, as well as the effects of age, gender and weight on muscle volume. Since the tongue consists of partially interdigitated muscles, we consider the muscle volumes in two ways. The functional muscle volume encompasses the region of the tongue served by the muscle. The structural volume halves the volume of the muscle in regions where it interdigitates with other muscles. Results show similarity of scaling across subjects, and speculate on functional effects of the anatomical structure.

Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly.

OBJECTIVES: To investigate whether disclosed symptoms (coughing, choking and throat clearing) can be used as early predictors of swallowing disorders in non-hospitalized elderly population. In addition, to determine the presence of early findings of swallowing disorders through fiber optic endoscopic evaluation of swallowing (FEES). MATERIALS AND METHODS: One hundred subjects older than 60 years were recruited from local community social meetings for seniors, they fulfilled inclusion criteria, and were given an oral interview and underwent FEES, with findings classified as: (1) saliva stasis; (2) pharyngeal residue; (3) penetration; (4) aspiration; (5) laryngeal sensitivity. RESULTS: Twenty-one percent of subjects declared previous choking, 10% coughing, and 7% throat clearing, 39% had pharyngeal residue; 6% saliva stasis; 9% penetration; 2% aspiration; and 92% laryngeal sensitivity present. Thirty-three percent showed pharyngeal residue without saliva stasis, while only 6% showed positivity for both (p = 0.003). CONCLUSIONS: Our data suggest that health care professionals should be aware that among an apparently healthy population, some subjects may have swallowing disorders without clinical complaints and that a nasolaryngoscopy exam may not be enough to predict dysphagia. We suggest that FEES should be performed to look for surrogate of dysphagia such as pharyngeal residue, laryngeal penetration, and aspiration.

Vocal Tract Adjustments of Dysphonic and Non-Dysphonic Women Pre- and Post-Flexible Resonance Tube in Water Exercise: A Quantitative MRI Study.

OBJECTIVE: To compare vocal tract (VT) adjustments of dysphonic and non-dysphonic women before and after flexible resonance tube in water exercise (FRTWE) at rest and during phonation using magnetic resonance imaging. STUDY DESIGN: Prospective study. METHODS: Twenty women, aged 20-40 years, 10 dysphonic with vocal nodules (VNG) and 10 controls (CG), underwent four sets of sagittal VT MRI: two pre-FRTWE, at rest and during phonation, and two post-FRTWE, during phonation and at rest. The subjects performed 3 minutes of exercise. Nine parameters at rest and 21 during phonation were performed. RESULTS: Pre-FRTWE, eight significant differences were found, three at rest and five during phonation: at rest - laryngeal vestibule area, distance from epiglottis to pharyngeal posterior wall (PPW) and interarytenoid complex length were smaller in the VNG; during phonation - laryngeal vestibule area, angle between PPW and vocal fold (VF), epiglottis to PPW, and anterior commissure of the larynx to laryngeal posterior wall were smaller in the VNG; tongue area was larger in the VNG. Post-FRTWE, only three significant differences were found, two during phonation and one at rest: during phonation - angle between PPW and VF and the membranous portion of the VF length were smaller in the VNG; at rest - distance from epiglottis to PPW was smaller in the VNG. CONCLUSIONS: Results suggest that the habitual VT adjustments of dysphonic and non-dysphonic women are different at rest and during phonation. The FRTWE promoted positive VT changes in the VNG, reducing the intergroup differences.

Perturbation Measurements on the Degree of Naturalness of Synthesized Vowels.

OBJECTIVE: To determine the impact of jitter and shimmer on the degree of naturalness perception of synthesized vowels produced by acoustical simulation with glottal pulses (GP) and with solid model of the vocal tract (SMVT). STUDY DESIGN: Prospective study. METHODS: Synthesized vowels were produced in three steps: 1. Eighty GP were developed (20 with jitter, 20 with shimmer, 20 with jitter+shimmer, 20 without perturbation); 2. A SMVT was produced based on magnetic resonance imaging (MRI) from a woman during phonation-/ε/ and using rapid prototyping technology; 3. Acoustic simulations were performed to obtain eighty synthesized vowels-/ε /. Two experiments were performed. First Experiment: three judges rated 120 vowels (20 humans+80 synthesized+20% repetition) as "human" or "synthesized". Second Experiment: twenty PowerPoint slide sequences were created. Each slide had 4 synthesized vowels produced with the four perturbation condition. Evaluators were asked to rate the vowels from the most natural to the most artificial. RESULTS: First Experiment: all the human vowels were classified as human; 27 out of eighty synthesized vowels were rated as human, 15 of those were produced with jitter+shimmer, 10 with jitter, 2 without perturbation and none with shimmer. Second Experiment: Vowels produced with jitter+shimmer were considered as the most natural. Vowels with shimmer and without perturbation were considered as the most artificial. CONCLUSIONS: The association of jitter and shimmer increased the degree of naturalness of synthesized vowels. Acoustic simulations performed with GP and using SMVT demonstrated a possible method to test the effect of the perturbation measurements on synthesized voices.

Hypo-Vascular Liver Metastases Treated with Transarterial chemoembolization: Assessment of Early Response by Volumetric Contrast-Enhanced and Diffusion-Weighted Magnetic Resonance Imaging.

OBJECTIVE: To evaluate the value of anatomic and volumetric functional magnetic resonance imaging (MRI) in early assessment of response to trans-arterial chemoembolization (TACE) in hypovascular liver metastases. METHODS: This retrospective study included 52 metastatic lesions (42 targeted and 10 non-targeted) in 17 patients who underwent MRI before and early after TACE. Two reviewers reported response by anatomic criteria (Response Evaluation Criteria in Solid Tumor [RECIST], modified RECIST [mRECIST], and European Association for the Study of Liver Disease [EASL]) and functional criteria (volumetric apparent diffusion coefficient and contrast enhancement). Treatment endpoint was RECIST at 6 months. A 2-sample paired t test was used to compare the mean changes after intra-arterial therapy. P < .05 was considered statistically significant. RESULTS: Reduction in mRECIST and EASL at 1 month was significant in the whole cohort as well as in responders by RECIST at 6 months, and the changes fulfilled partial response criteria for both metrics in responders. Responders also had significant changes in volumetric apparent diffusion coefficient (P = .01 and P = .03) and contrast enhancement (P < .0001 and P < .0001) at 1 month for both readers, respectively. CONCLUSION: At 1 month post treatment, responders did not fulfill RECIST criteria but fulfilled mRECIST and EASL criteria. In addition, volumetric contrast-enhanced and diffusion-weighted MRI may be helpful in evaluating early treatment response after TACE in hypovascular liver metastases in patients who have failed to respond to initial chemotherapy.

Analysis of 3-D Tongue Motion From Tagged and Cine Magnetic Resonance Images.

PURPOSE: Measuring tongue deformation and internal muscle motion during speech has been a challenging task because the tongue deforms in 3 dimensions, contains interdigitated muscles, and is largely hidden within the vocal tract. In this article, a new method is proposed to analyze tagged and cine magnetic resonance images of the tongue during speech in order to estimate 3-dimensional tissue displacement and deformation over time. METHOD: The method involves computing 2-dimensional motion components using a standard tag-processing method called harmonic phase, constructing superresolution tongue volumes using cine magnetic resonance images, segmenting the tongue region using a random-walker algorithm, and estimating 3-dimensional tongue motion using an incompressible deformation estimation algorithm. RESULTS: Evaluation of the method is presented with a control group and a group of people who had received a glossectomy carrying out a speech task. A 2-step principal-components analysis is then used to reveal the unique motion patterns of the subjects. Azimuth motion angles and motion on the mirrored hemi-tongues are analyzed. CONCLUSION: Tests of the method with a various collection of subjects show its capability of capturing patient motion patterns and indicate its potential value in future speech studies.

Liver Malignancies Treated With Intra-Arterial Therapy: Assessment of Early Response as Quantified by Volumetric Enhancement Using Gadoxetate Disodium.

OBJECTIVE: The aim of the study was to evaluate the value of volumetric contrast-enhanced magnetic resonance imaging (MRI) using gadoxetate disodium in early assessment of treatment response after intra-arterial therapy (IAT). MATERIALS AND METHODS: This prospective study included 21 patients (32 malignant lesions) who underwent MRI using gadoxetate disodium before and early after IAT. Two reviewers reported response by anatomic criteria including Response Evaluation Criteria in Solid Tumor (RECIST), Modified RECIST (mRECIST), and European Association for the Study of Liver Disease and functional criteria including volumetric enhancement in hepatic arterial phase and portal venous phase. Treatment end point was RECIST at 6 months. A 2-sample paired t test was used to compare the mean changes after IAT. A P value of less than 0.05 was considered statistically significant. RESULTS: Responders by RECIST at 6 months did not fulfill partial response by conventional criteria at 1 month, except for mRECIST by reader 2. The mRECIST and European Association for the Study of Liver Disease could not be assessed in a total of 4 and 3 lesions for readers 1 and 2, respectively. However, volumetric measurements were obtained in all lesions and the changes were statistically significant at 1 month for hepatic arterial phase (P = 0.02 and P = 0.008) and portal venous phase (P < 0.0001 and P < 0.0001), as assessed by both readers, respectively. CONCLUSIONS: Volumetric contrast-enhanced MRI using gadoxetate disodium may be a helpful tool to evaluate early treatment response after IAT in malignant liver tumors.

A Bayesian approach to distinguishing interdigitated tongue muscles from limited diffusion magnetic resonance imaging.

The tongue is a critical organ for a variety of functions, including swallowing, respiration, and speech. It contains intrinsic and extrinsic muscles that play an important role in changing its shape and position. Diffusion tensor imaging (DTI) has been used to reconstruct tongue muscle fiber tracts. However, previous studies have been unable to reconstruct the crossing fibers that occur where the tongue muscles interdigitate, which is a large percentage of the tongue volume. To resolve crossing fibers, multi-tensor models on DTI and more advanced imaging modalities, such as high angular resolution diffusion imaging (HARDI) and diffusion spectrum imaging (DSI), have been proposed. However, because of the involuntary nature of swallowing, there is insufficient time to acquire a sufficient number of diffusion gradient directions to resolve crossing fibers while the in vivo tongue is in a fixed position. In this work, we address the challenge of distinguishing interdigitated tongue muscles from limited diffusion magnetic resonance imaging by using a multi-tensor model with a fixed tensor basis and incorporating prior directional knowledge. The prior directional knowledge provides information on likely fiber directions at each voxel, and is computed with anatomical knowledge of tongue muscles. The fiber directions are estimated within a maximum a posteriori (MAP) framework, and the resulting objective function is solved using a noise-aware weighted ℓ1-norm minimization algorithm. Experiments were performed on a digital crossing phantom and in vivo tongue diffusion data including three control subjects and four patients with glossectomies. On the digital phantom, effects of parameters, noise, and prior direction accuracy were studied, and parameter settings for real data were determined. The results on the in vivo data demonstrate that the proposed method is able to resolve interdigitated tongue muscles with limited gradient directions. The distributions of the computed fiber directions in both the controls and the patients were also compared, suggesting a potential clinical use for this imaging and image analysis methodology.

A High-resolution Atlas and Statistical Model of the Vocal Tract from Structural MRI.

Magnetic resonance imaging (MRI) is an essential tool in the study of muscle anatomy and functional activity in the tongue. Objective assessment of similarities and differences in tongue structure and function has been performed using unnormalized data, but this is biased by the differences in size, shape, and orientation of the structures. To remedy this, we propose a methodology to build a 3D vocal tract atlas based on structural MRI volumes from twenty normal subjects. We first constructed high-resolution volumes from three orthogonal stacks. We then removed extraneous data so that all 3D volumes contained the same anatomy. We used an unbiased diffeomorphic groupwise registration using a cross-correlation similarity metric. Principal component analysis was applied to the deformation fields to create a statistical model from the atlas. Various evaluations and applications were carried out to show the behaviour and utility of the atlas.

The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics.

Radiation oncologists have focused on the pharyngeal constrictors as the primary muscles of concern for dysphagia. However, our prior investigations have demonstrated that radiation dose to the geniohyoid rather than the constrictor muscles was more closely related to penetration aspiration scores (PAS). We examined the relationship between (1) radiation dose and swallowing temporal kinematics, and (2) between PAS and swallowing kinematics in these patients. Videofluoroscopic swallowing studies of 41 patients following radiation therapy for oropharyngeal cancer were analyzed for thin liquid boluses. Timing measures included duration of laryngeal vestibule closure (DLVC), duration to maximum hyoid elevation (DTMHE), duration to cricopharyngeal opening (DTCPO), and pharyngeal transit time (PTT). PAS was extracted for each swallow and considered normal if ≤ 2. As minimum and mean dose to the geniohyoid increased, DTMHE, DTCPO, and PTT increased. Worse PA scores were most strongly correlated with radiation dose received by geniohyoid (r = 0.445, p < 0.0001). Mean DLVC varied according to PAS group (normal PAS mean = 0.67 s, abnormal PAS mean = 0.13 s; p < 0.001). Similarly, DTCPO was significantly different based upon PAS (normal PAS mean = 0.22 s, abnormal PAS mean = 0.37 s, p = 0.016). As PAS increased, DTPCO and PTT increased (r = 0.208, p = 0.04; r = 0.204, p = 0.043). A negative correlation was noted between PAS and DLVC (r = -0.375, p = 0.001). Higher doses of radiation to the geniohyoid muscles are associated with increased severity of dysphagia as measured through both kinematics and PAS. Consideration of dose to the geniohyoid should be considered when planning radiation.

Segmentation of tongue muscles from super-resolution magnetic resonance images.

Imaging and quantification of tongue anatomy is helpful in surgical planning, post-operative rehabilitation of tongue cancer patients, and studying of how humans adapt and learn new strategies for breathing, swallowing and speaking to compensate for changes in function caused by disease, medical interventions or aging. In vivo acquisition of high-resolution three-dimensional (3D) magnetic resonance (MR) images with clearly visible tongue muscles is currently not feasible because of breathing and involuntary swallowing motions that occur over lengthy imaging times. However, recent advances in image reconstruction now allow the generation of super-resolution 3D MR images from sets of orthogonal images, acquired at a high in-plane resolution and combined using super-resolution techniques. This paper presents, to the best of our knowledge, the first attempt towards automatic tongue muscle segmentation from MR images. We devised a database of ten super-resolution 3D MR images, in which the genioglossus and inferior longitudinalis tongue muscles were manually segmented and annotated with landmarks. We demonstrate the feasibility of segmenting the muscles of interest automatically by applying the landmark-based game-theoretic framework (GTF), where a landmark detector based on Haar-like features and an optimal assignment-based shape representation were integrated. The obtained segmentation results were validated against an independent manual segmentation performed by a second observer, as well as against B-splines and demons atlasing approaches. The segmentation performance resulted in mean Dice coefficients of 85.3%, 81.8%, 78.8% and 75.8% for the second observer, GTF, B-splines atlasing and demons atlasing, respectively. The obtained level of segmentation accuracy indicates that computerized tongue muscle segmentation may be used in surgical planning and treatment outcome analysis of tongue cancer patients, and in studies of normal subjects and subjects with speech and swallowing problems.

Semi-automatic segmentation for 3D motion analysis of the tongue with dynamic MRI.

Dynamic MRI has been widely used to track the motion of the tongue and measure its internal deformation during speech and swallowing. Accurate segmentation of the tongue is a prerequisite step to define the target boundary and constrain the tracking to tissue points within the tongue. Segmentation of 2D slices or 3D volumes is challenging because of the large number of slices and time frames involved in the segmentation, as well as the incorporation of numerous local deformations that occur throughout the tongue during motion. In this paper, we propose a semi-automatic approach to segment 3D dynamic MRI of the tongue. The algorithm steps include seeding a few slices at one time frame, propagating seeds to the same slices at different time frames using deformable registration, and random walker segmentation based on these seed positions. This method was validated on the tongue of five normal subjects carrying out the same speech task with multi-slice 2D dynamic cine-MR images obtained at three orthogonal orientations and 26 time frames. The resulting semi-automatic segmentations of a total of 130 volumes showed an average dice similarity coefficient (DSC) score of 0.92 with less segmented volume variability between time frames than in manual segmentations.

Tissue-point motion tracking in the tongue from cine MRI and tagged MRI.

PURPOSE Accurate tissue motion tracking within the tongue can help professionals diagnose and treat vocal tract-related disorders, evaluate speech quality before and after surgery, and conduct various scientific studies. The authors compared tissue tracking results from 4 widely used deformable registration (DR) methods applied to cine magnetic resonance imaging (MRI) with harmonic phase (HARP)-based tracking applied to tagged MRI. METHOD Ten subjects repeated the phrase "a geese" multiple times while sagittal images of the head were collected at 26 Hz, first in a tagged MRI data set and then in a cine MRI data set. HARP tracked the motion of 8 specified tissue points in the tagged data set. Four DR methods including diffeomorphic demons and free-form deformations based on cubic B-spline with 3 different similarity measures were used to track the same 8 points in the cine MRI data set. Individual points were tracked and length changes of several muscles were calculated using the DR- and HARP-based tracking methods. RESULTS The results showed that the DR tracking errors were nonsystematic and varied in direction, amount, and timing across speakers and within speakers. Comparison of HARP and DR tracking with manual tracking showed better tracking results for HARP except at the tongue surface, where mistracking caused greater errors in HARP than DR. CONCLUSIONS Tissue point tracking using DR tracking methods contains nonsystematic tracking errors within and across subjects, making it less successful than tagged MRI tracking within the tongue. However, HARP sometimes mistracks points at the tongue surface of tagged MRI because of its limited bandpass filter and tag pattern fading, so that DR has better success measuring surface tissue points on cine MRI than HARP does. Therefore, a hybrid method is being explored.

Radiation dose to the floor of mouth muscles predicts swallowing complications following chemoradiation in oropharyngeal squamous cell carcinoma.

OBJECTIVES: While radiation dose to the larynx and pharyngeal constrictors has been the focus of swallowing complications, the suprahyoid muscles, or floor of mouth (FoM) muscles, are critical for hyoid and laryngeal elevation and effective bolus diversion, preventing penetration and aspiration. We hypothesize that radiation dose to these muscles may be important in the development of dysphagia. MATERIALS AND METHODS: We studied 46 patients with OPSCC treated with CRT and who underwent baseline swallowing evaluations and post-treatment videofluoroscopic swallowing studies (VFSS) from 2007 to 2010. Patients with abnormal penetration aspiration scores (PAS>2) served as the study population and patients with normal PAS scores (≤ 2) served as the control cohort. Three suprahyoid muscles and two extrinsic tongue muscles were individually delineated and collectively referred to as the FoM muscles. Radiation dose-volume relationships for these muscles were calculated. Univariate logistic regression analysis was used to determine parameters of significance between patients with normal or abnormal PAS scores. A multivariate regression analysis was subsequently performed to isolate the most statistically critical structures associated with abnormal PAS. RESULTS: Univariate analysis resulted in significance/borderline significance of multiple structures associated with abnormal PAS following irradiation. However, when a multivariate model was applied, only the mean dose to the floor of mouth and minimum dose to the geniohyoid were associated with post-radiation abnormal PAS. CONCLUSIONS: The dose and volume delivered to the collective FoM muscles may be associated with an increased risk of laryngeal penetration/aspiration to a greater degree than previously recognized organs at risk.

A Bayesian Approach to Distinguishing Interdigitated Muscles in the Tongue from Limited Diffusion Weighted Imaging.

Fiber tracking in crossing regions is a well known issue in diffusion tensor imaging (DTI). Multi-tensor models have been proposed to cope with the issue. However, in cases where only a limited number of gradient directions can be acquired, for example in the tongue, the multi-tensor models fail to resolve the crossing correctly due to insufficient information. In this work, we address this challenge by using a fixed tensor basis and incorporating prior directional knowledge. Within a maximum a posteriori (MAP) framework, sparsity of the basis and prior directional knowledge are incorporated in the prior distribution, and data fidelity is encoded in the likelihood term. An objective function can then be obtained and solved using a noise-aware weighted ℓ1-norm minimization. Experiments on a digital phantom and in vivo tongue diffusion data demonstrate that the proposed method is able to resolve crossing fibers with limited gradient directions.

MRI ANALYSIS OF 3D NORMAL AND POST-GLOSSECTOMY TONGUE MOTION IN SPEECH.

Measuring the internal muscular motion and deformation of the tongue during natural human speech is of high interest to head and neck surgeons and speech language pathologists. A pipeline for calculating 3D tongue motion from dynamic cine and tagged Magnetic Resonance (MR) images during speech has been developed. This paper presents the result of a complete analysis of eleven subjects' (seven normal controls and four glossectomy patients) global tongue motion during speech obtained through MR imaging and processed through the tongue motion analysis pipeline. The data is regularized into the same framework for comparison. A generalized two-step principal component analysis is used to show the major difference between patients' and controls' tongue motions. A test is performed to demonstrate the ability of this process to distinguish patient data from control data and to show the potential power of quantitative analysis that the tongue motion pipeline can achieve.