Videofluoroscopy of the aerodigestive tract in Phoca vitulina: reshaping perspectives on translational medicine.

Thousands of rescued harbor seals (Phoca vitulina) require rehabilitation worldwide. Many require resource intensive gavage feeding due to abandonment soon after birth. Little is known about seal swallowing, therefore, our primary objective was to determine the feasibility of conducting videofluoroscopic swallowing studies (VFS) on seal pups prior to their release. Secondarily, we propose swallowing phase descriptions. We adapted a VFS approach used in humans and our feasibility parameters included: bolus detection and consumption, and number of analyzable swallowing events. Unrestrained seals were imaged in a dry environment using a Siemens mobile c-arm fluoroscopy unit. Oral boluses were thawed herring injected with liquid barium suspension (105% w/v). Two independent raters described swallows using a standardized approach with results summarized descriptively. We successfully completed freely-behaving VFS with two infant seals (1 male: 8 wks, 3 d; 1 female: 5 wks, 3 d). Both consumed five boluses with six fully analyzable swallowing events. We describe four swallow phases: preparatory, prehension, oropharyngeal and esophageal. Airway protection likely occurs in two ways: (1) during the preparatory phase through modified corniculate cartilage contact with the glottis and (2) with soft palate contact to the base of tongue prior to swallow initiation. We have conducted a unique VFS approach on rehabilitated seals, prior to their release. We have described airway protection and suggest that swallowing is initiated earlier in the feeding process than described previously. This protocol success will afford: (1) collection of normative swallowing data, and (2) future knowledge translation from humans to seals.

Reliability and Validity of the Chinese Mandarin Version of the Dysphagia Handicap Index.

This study aimed to develop the Dysphagia Handicap Index-Chinese Mandarin (DHI-CM) and to assess its reliability and validity. This prospective study was conducted in China with individuals who speak Mandarin. The DHI-CM was developed according to a five-stage process. 264 patients with oropharyngeal dysphagia (OD) and 187 healthy individuals completed the study. Reliability was assessed using Cronbach's α and test-retest reliability. Differences between healthy participants and patients with OD were analyzed for instrument validity. Convergent and concurrent validity were assessed using the Swallowing Quality of Life Questionnaire (SWAL-QoL) and Functional Oral Intake Scale (FOIS), respectively. The Content Validity Index (CVI) was used to assess content validity. Exploratory and Confirmatory Factor Analyses (EFA and CFA, respectively) were used to assess structural validity. The Cronbach's alpha was > 0.9 for the total score and every individual subscale. The Pearson and intraclass correlation coefficients were both > 0.8. The patients with OD showed significantly higher scores in the DHI-CM and its subscales than the healthy individuals. Significant correlations were found between most subscales of the DHI-CM and both the SWAL-QoL and FOIS. The CVI of the DHI-CM was 0.892 and ranged between 0.878 and 1.000 for the subscales. The EFA identified three components that explained 24.33%, 23.99%, and 22.73% of the variance, respectively. The scale showed good structural validity through CFA. Conclusions. The DHI-CM demonstrated good reliability and validity among Mandarin-speaking Chinese adults.

Indication and efficacy of injection laryngoplasty for laryngeal clefts - A retrospective cohort study.

PURPOSE: Laryngeal cleft (LC) is an anatomical defect of the larynx, where there is a gap (or cleft) between the arytenoids. Milder types can be treated with injection laryngoplasty (IL), involving injection with a filler, resulting in a decreased depth of the cleft and thereby reducing tracheal penetration or aspiration. The effect, however, is temporary. The aim of this study was to investigate the possible indications and the efficacy of IL for LC. METHODS: Patients who underwent IL for LC between March 2018 and June 2023 were retrospectively evaluated. The following parameters were studied: incidence of LC symptoms and objective swallowing evaluations before and after IL, the duration of possible symptom improvement, complications, and the number of subsequent suture repairs. RESULTS: Eighty-five patients were included. Before IL, 81 (96 %) patients had symptoms of aspiration during feeding, compared to 41 (54 %) patients after IL (p ≤ 0.001). In 42 (49 %) patients, temporary symptom relief occurred, in 22 (26 %) patients symptoms persisted, in 16 (19 %) patients symptoms decreased permanently. Mild complications such as cough and desaturations in the direct postoperative period occurred. CONCLUSION: This study shows a statistically significant decrease in the number of parents/caretakers reporting swallowing symptoms after injection laryngoplasty, and a decrease in the average percentage of parents/caretakers reporting various other symptoms. Based on our results, injection laryngoplasty can be recommended as a diagnostic tool in the treatment of laryngeal cleft. Furthermore, it can be used as bridge therapy (i.e. until patients outgrow their symptoms, or until suture repair).

Reliability, validity and normative data of the timed water swallow test accompanied by sEMG.

PURPOSE: Swallowing disorders are highly interrelated with increased morbidity and mortality rates; therefore, early detection is crucial. Most screening tools rely on subjective observation, thus making objective assessment tools more vital. Timed Water Swallowing Test (TWST) is a screening tool used in the field providing quantitative data. This study aimed to investigate the swallowing parameters in a wide age range by using TWST and to expand the already existing normative data pool accordingly. It is also aimed to examine the reliability of the TWST and assess its validity in stroke survivors. MATERIALS AND METHODS: This study had a cross-sectional design. TWST carried out simultaneously along with surface EMG and laryngeal sensor on 196 healthy subjects aged 10 to 80 for normative data. Also, TWST carried out 30 patients having a history of recent stroke. Test-retest and inter-rater scoring analysis were used for reliability purposes, while Gugging Swallowing Screen (GUSS) test was used for validity purposes. Additionally, the correlations between the participants' TWST scores and GUSS scores were examined using the Spearman correlation coefficient. RESULTS: The normative TWST data of healthy participants are tabulated and presented and their average swallowing capacity was found 13.73 ml/s. Furthermore, the mean swallowing capacity of stroke survivors was found 4.61 ml/s. As a result of validity analyses, a statistically strong and significant relationship was found between GUSS and TWST parameters (r = 0.775, p < 0.001). Intraclass correlation coefficient (ICC) and correlation values were found between moderate to good agreement between test-retest measurement (ICC = 0.563 to 0.891, p < 0.05). Also, the agreement between the raters was found to be significant (ICC = 0.949 to 0.995, p < 0.05). CONCLUSION: TWST is a valid and reliable screening tool to evaluate dysphagia on given population. Although the test's performance on healthy individuals is adequate, more research is still needed to confirm that it can be used as a screening tool for stroke.

Cervical Auscultation for Detecting Oropharyngeal Aspiration in Paediatric and Adult Populations: A Systematic Review and Meta-Analysis.

BACKGROUND: Cervical auscultation (CA) involves listening to swallowing and respiratory sounds and/or vibrations to detect oropharyngeal aspiration (OPA). CA has shown promising diagnostic test accuracy when used with the clinical swallowing examination and is gaining popularity in clinical practise. There has not been a review to date analysing the accuracy of CA in paediatric and adult populations with meta-analyses. OBJECTIVES: To determine the accuracy of CA in detecting OPA in paediatric and adult populations, when compared to instrumental assessments. SEARCH METHODS: Databases searched included MEDLINE, PubMed, Embase, CINAHL, AustHealth, Cochrane and Web of Science. The search was restricted between 01 October 2012 and 01 October 2022. SELECTION CRITERIA: Inclusion criteria included (a) all clinical populations of all ages, (b) who have had an instrumental assessment and (c) CA. All study types were included. DATA COLLECTION AND ANALYSIS: Studies were reviewed independently by two authors. The methodological quality of the studies was analysed using the QUADAS-2. MAIN RESULTS: Ten studies met the inclusion criteria for this review and meta-analyses. The pooled diagnostic performance of CA in detecting OPA was 0.91 for sensitivity and 0.79 for specificity. The area under the curve summary receiver operating curve (sROC) was estimated to be 0.86, thereby indicating good discrimination of OPA. Most studies scored high for risk of bias in at least one domain in the QUADAS-2, likely attributed to a lack of high-quality prospectively designed studies. CONCLUSIONS: There are promising diagnostic test accuracies for the use of CA in detection of OPA. Future research could include using CA in specific clinical populations and settings, and identifying standardised criteria for CA.

Hyoid displacement during swallowing function for completely edentulous subjects rehabilitated with mandibular implant retained overdenture.

BACKGROUND: Hyoid bone is attached to the mandible, tongue, larynx, temporal bone, and cervical spine via different types of muscles or ligaments. The tongue, mandible, and hyoid system play a crucial role in swallowing function. This within subject study aimed to evaluate the impact of mandibular implant overdentures on the displacement of the hyoid bones during the swallowing process. METHODS: Twenty five healthy edentulous subjects were selected for participating in the study. New complete dentures were constructed for all the participants. Subsequently two dental implants were inserted in the canine regions of the participant's mandibular arch. In order to retain the mandibular prosthesis in place, ball attachments were incorporated into the mandibular dentures to convert them into implant overdentures. Using 10 ml of thin liquid bolus, videofluoroscopy swallowing examination was performed in three different oral conditions: without complete dentures (WCD), with complete denture (CDs), and with a mandibular implant overdenture (IODs). ANOVA with Bonferroni test was used to analyze the data in order to determine how the hyoid displacement varied throughout different oral conditions. RESULTS: Compared to complete dentures, mandibular implant overdentures showed a significant decrease (P < 0.05) in both anterior hyoid displacement and duration of hyoid maximum anterior excursion (DOHMAE). However, there was a non-significant difference (P > 0.05) between the two oral circumstances in terms of superior hyoid displacement or duration for hyoid maximum elevation (DOHME). There is no penetration or aspiration for both complete denture and implant overdenture oral conditions. CONCLUSION: Implant retained overdentures have a positive effect on hyoid displacement during swallowing of thin liquid bolus consistency relative to conventional complete dentures. TRIAL REGISTRATION: Retrospectively registered (NCT06187181) 02/1/2024.

The discriminant ability of the Eating Assessment tool-10 to detect swallowing efficiency in neurogenic dysphagia.

PURPOSE: Neurogenic dysphagia causes complications such as malnutrition, dehydration, and aspiration pneumonia. Therefore, early detection with clinically valid tools is essential. This study aimed to investigate the Eating Assessment Tool-10 (EAT-10) ability to detect swallowing efficiency at three different consistencies in neurogenic dysphagia. METHODS: One hundred twelve patients with neurogenic dysphagia (74 males and 38 females, mean ± SD age 61.83 ± 9.72 years) were included in the study. A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed in the clinic following EAT-10 to assess swallowing efficacy at International Dysphagia Diet Standardization Initiative (IDDSI) consistencies of 0, 3, and 7. The swallowing efficiency of the patients was assessed using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Area under the curve, sensitivity, and specificity values were calculated to evaluate the ability of EAT-10 to discriminate between participants with and without residue and between participants with and without moderate-to-severe residue. RESULTS: The EAT-10 significantly detected participants with and without residues for three IDDSI consistent: for IDDSI 0 residue in the vallecula and pyriform sinus (cutoff score ≥ 14, p < 0.001), for IDDSI 3 residue in the vallecula and pyriform sinus (cutoff score ≥ 13, p < 0.001), for IDDSI 7 residue in the vallecula and pyriform sinus (respectively, cutoff score ≥ 13, cutoff score ≥ 14, p < 0.001). Additionally, the EAT-10 significantly detected those with and without moderate-to-severe residue. CONCLUSIONS: The EAT-10, frequently used in swallowing clinics, can determine swallowing efficiency in individuals with neurogenic dysphagia. Additionally, it has the power to detect moderate-to-severe pharyngeal residue.

Preparation and characterization of fish-derived protein gel as a potential dysphagia food: Co-mingling effects of inulin and konjac glucomannan mixtures.

The study aimed to create a fish-derived protein gel with inulin/konjac glucomannan (KGM) mixture for dysphagia. The inulin/KGM complex improved the swallowing properties of myofibrillar protein (MP) emulsion gel. Interactions, physicochemical, and flavor properties were analyzed. Inulin/KGM mixture inhibited hydrophobic groups exposure, and maintained MP structure during thermal induction. Inulin/KGM-protein gels exhibited shear-thinning behavior, low deformation resistance and hardness. IDDSI test also indicated inulin/KGM gels is suitable for dysphagia. Inulin/KGM mixture improved flavor by increasing ethanol and 2-octen-ol while decreasing ichthyological substances such as hexanal and nonanal, enhancing the sensory experience of patients with dysphagia. An 8% inulin/KGM mixture effectively modulated mechanical, swallowing, and sensory properties of MP emulsion gels, offering insights for future marine-derived dysphagia foods development.

Screening for dysphagia in older people with dementia: Evidence of validity based on internal structure and reliability of the Caregiver Questionnaire - RaDID-QC.

OBJECTIVE: To identify internal structure validity evidence of a dysphagia screening questionnaire for caregivers of older adults with Alzheimer's disease dementia and/or vascular dementia. METHODS: The 24-question Dysphagia Screening in Older Adults with Dementia - Caregiver Questionnaire (RaDID-QC) was administered by interviewing 170 caregivers of older people with dementia, selected by convenience at the Outpatient Reference Center for Older People. Exploratory Factor Analysis (EFA) was used to assess the internal structure validity of the questionnaire, and Cronbach's alpha was used to analyze reliability. Questions with factor loadings lower than 0.45 in magnitude were removed from the final questionnaire. Multivariate multiple linear regression was used to assess the percentage of variance explained by the remaining questions. RESULTS: Kayser-Meyer-Olkin (KMO) and Bartlett's tests suggested that the questionnaire was adequate for EFA. Principal Component Analysis (PCA) suggested that 12 components captured at least 75 % of the total variance. The corresponding 12-factor EFA model showed a statistically significant fit, and 15 out of the 24 questions had factor loadings greater than 0.45. Cronbach's alpha was 0.74 for the 15 questions, which explained 71 % of the total variance in the complete dataset. The questionnaire has adequate internal structure validity and good reliability. Based on EFA, RaDID-QC decreased from 24 to 15 questions. Other internal validity and reliability parameters will be obtained by administering the questionnaire to larger target populations. CONCLUSION: The RaDID-QC applied to caregivers of older adults with dementia due to Alzheimer's disease and/or vascular dementia produced valid and reliable responses to screen dysphagia signs and symptoms.

Bedside Clinical Swallow Test and the Fiberoptic Endoscopic Evaluation of Swallow - Level of Agreement.

Introduction: Bedside test are important tool for evaluating aspiration during swallowing. FEES that is functional endoscopic evaluation of swallowing is a gold standard method used in evaluation of dysphagia patients. Through this study we aim to assess the sensitivity and specificity of Bedside Clinical swallow evaluation in comparison with Fiberoptic Endoscopic Evaluation of Swallowing. Objective: To analyze which physiological examination amongst oro motor labial examination, lingual examination, gag reflex, coughs during or post swallow, change in voice quality and hyo-laryngeal excursion during swallow with semisolid and thin liquid consistency in the Bedside Clinical swallow evaluation is better indicator for presence or absence of aspiration. Methodology: 38 patients with different diagnostic entities were presented& included in the study for the assessment of swallowing difficulties as presence or absence of aspiration and possibility of weaning from nasogastric or Nasojejunal tube between March 2016 to October 2016. They were 32 (86%) males and 6 (14%) females. Aspiration correlates were assessed using bedside test (labial movement, lingual movement, gag reflex, strength of productive cough, hyo-laryngeal excursion, And post swallow changes in the quality of voice). FEES was then performed and sensitivity and specificity was compared. Result: Bedside test showed 84.62% sensitivity and 100% specificity in comparison to FEES. Gag and voice quality were noted to have significant difference with value of 0.009 and 0.033 respectively. Conclusion: Bedside tests can be considered as an important, easy, sensitive, and specific for the detection of aspiration. Combination of gag reflex and change of voice as parameters of aspiration compared with FEES showed high sensitivity and specificity.

Physiological analyses of swallowing changes due to chronic obstructive pulmonary disease in anesthetized male rats.

Chronic obstructive pulmonary disease (COPD) was previously known as chronic bronchitis and emphysema. It has various main symptoms, such as dyspnea, chronic cough, and sputum, and is often accompanied by dysphagia. Although many published clinical reports have described COPD-related dysphagia, the physiological mechanisms underlying swallowing changes due to COPD remain unclear. Therefore, we analyzed how COPD affects the swallowing reflex using COPD model rats. We performed an electrophysiological study of respiration and swallowing using COPD model induced by intratracheal administration of porcine pancreatic elastase and lipopolysaccharide in Sprague-Dawley male rats. To identify the respiration and swallowing responses, electromyographic activity was recorded from the diaphragm, digastric (Dig), and thyrohyoid (TH) muscles. We confirmed COPD using micro-computed tomography analysis and hematoxylin and eosin staining of the lungs. The duty cycle was defined as the ratio of the inspiration duration to the total respiratory duration. In COPD model rats, the duty cycle was significantly higher than that in control rats. The frequency of the swallowing reflex evoked by electrical stimulation of the superior laryngeal nerve during the inspiration phase was higher in COPD model rats than in control rats. Furthermore, long-term COPD altered Dig and TH muscle activity without pathological muscle change. Our results suggest that COPD increases the frequency of swallowing initiation during the inspiration phase. Furthermore, long-term COPD affects swallowing-related muscle activity without pathological muscle changes. These physiological changes may increase the risk of developing dysphagia. Further studies are necessary to clarify the mechanisms contributing to the functional changes in respiration and swallowing in COPD.

Advancing stroke patient care: a network meta-analysis of dysphagia screening efficacy and personalization.

Introduction: The increasing incidence of stroke globally has led to dysphagia becoming one of the most common complications in stroke patients, with significant impacts on patient outcomes. Accurate early screening for dysphagia is crucial to avoid complications and improve patient quality of life. Methods: Included studies involved stroke-diagnosed patients assessed for dysphagia using bedside screening tools. Data was sourced from Embase, PubMed, Web of Science, Scopus, and CINAHL, including publications up to 10 December 2023. The study employed both fixed-effect and random-effects models to analyze sensitivity, specificity, positive predictive value (PPV), and Negative Predictive Value (NPV), each with 95% confidence intervals. The random-effects model was particularly utilized due to observed heterogeneity in study data. Results: From 6,979 records, 21 studies met the inclusion criteria, involving 3,314 participants from 10 countries. The analysis included six assessment tools: GUSS, MASA, V-VST, BSST, WST, and DNTA, compared against gold-standard methods VFSS and FEES. GUSS, MASA, and V-VST showed the highest reliability, with sensitivity and specificity rates of 92% and 85% for GUSS, 89% and 83% for MASA, respectively. Heterogeneity among studies was minimal, and publication bias was low, enhancing the credibility of the findings. Conclusion: Our network meta-analysis underscores the effectiveness of GUSS, MASA, and V-VST in dysphagia screening for stroke patients, with high sensitivity and specificity making them suitable for diverse clinical settings. BSST and WST, with lower diagnostic accuracy, require more selective use. Future research should integrate patient-specific outcomes and standardize methodologies to enhance dysphagia screening tools, ultimately improving patient care and reducing complications. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Temporal recovery and prognostic factors for dysphagia following cardiovascular surgery: Retrospective analysis and development of predictive score.

OBJECTIVE: Dysphagia is a common complication associated with cardiovascular surgery (CVS). This study sought to better understand recovery timelines, identify risk factors, and create a prognostic model for oral intake restoration. METHODS: This retrospective study included 134 patients who had CVS between April 2022 and March 2024. We assessed swallowing ability through fiberoptic endoscopic evaluation of swallowing (FEES). We randomly divided the patients' data into a training dataset and a test dataset in a ratio of 70/30 and Kaplan-Meier analyses and Cox regression were used to assess predictors of total oral intake. We also created a scoring system using the estimated regression coefficients. RESULTS: Most patients with CVS achieved total oral intake in 7-11 days after extubation. Over 168 h of intubation, the presence of penetration or aspiration, a poor FEES score (score > 6), and perioperative complications were significant risk factors for delayed total oral intake. The predicting score was calculated by adding the scores for each individual factor, including FEES score, penetration/aspiration, and preoperative complications. Scores ranged 0-8, categorizing patients into 0-2, 3-5, and 6-8 groups, clearly demonstrating that the higher the predicting score, the longer the time to total oral intake in both the training and the test dataset. CONCLUSIONS: All risk factors for unsuccessful or delayed total oral intake were intubation for more than a week, poor swallowing ability, and the presence of perioperative complications. The scoring system accurately predicts the restoration of oral intake following CVS.

Cortical compensation mechanism for swallowing recovery in patients with medullary infarction-induced dysphagia.

Introduction: This study aims to examine brain activity during different swallowing actions in patients with dysphagia caused by medullary infarction (MI) before and after treatment using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Methods: Fifteen patients were enrolled in this study. Brain activation during saliva swallowing and effortful saliva swallowing was observed using BOLD imaging in the acute phase of stroke and after 4 weeks of rehabilitation training. Differences in the activation of brain regions during saliva swallowing before and after treatment, during effortful saliva swallowing before and after treatment, and between the two swallowing actions before and after treatment were compared. Results: In the acute phase of stroke, only the bilateral precentral and left lingual gyrus were partially activated during saliva swallowing, and there was no obvious activation in the insula. Effortful saliva swallowing activated more brain regions than saliva swallowing before treatment, including the bilateral supplementary motor area (SMA), postcentral gyrus, and right insular cortex. The number of brain regions activated during saliva swallowing increased after treatment, including the bilateral precentral gyrus, postcentral gyrus, insula, thalamus, and SMA. Discussion: Cortical activation increases after recovery from dysphagia, and the increased activation of the postcentral gyrus might play a functional compensatory role. Effortful saliva swallowing is a more effective rehabilitation training method for patients with dysphagia caused by MI.

A deep learning approach to dysphagia-aspiration detecting algorithm through pre- and post-swallowing voice changes.

Introduction: This study aimed to identify differences in voice characteristics and changes between patients with dysphagia-aspiration and healthy individuals using a deep learning model, with a focus on under-researched areas of pre- and post-swallowing voice changes in patients with dysphagia. We hypothesized that these variations may be due to weakened muscles and blocked airways in patients with dysphagia. Methods: A prospective cohort study was conducted on 198 participants aged >40 years at the Seoul National University Bundang Hospital from October 2021 to February 2023. Pre- and post-swallowing voice data of the participants were converted to a 64-kbps mp3 format, and all voice data were trimmed to a length of 2 s. The data were divided for 10-fold cross-validation and stored in HDF5 format with anonymized IDs and labels for the normal and aspiration groups. During preprocessing, the data were converted to Mel spectrograms, and the EfficientAT model was modified using the final layer of MobileNetV3 to effectively detect voice changes and analyze pre- and post-swallowing voices. This enabled the model to probabilistically categorize new patient voices as normal or aspirated. Results: In a study of the machine-learning model for aspiration detection, area under the receiver operating characteristic curve (AUC) values were analyzed across sexes under different configurations. The average AUC values for males ranged from 0.8117 to 0.8319, with the best performance achieved at a learning rate of 3.00e-5 and a batch size of 16. The average AUC values for females improved from 0.6975 to 0.7331, with the best performance observed at a learning rate of 5.00e-5 and a batch size of 32. As there were fewer female participants, a combined model was developed to maintain the sex balance. In the combined model, the average AUC values ranged from 0.7746 to 0.7997, and optimal performance was achieved at a learning rate of 3.00e-5 and a batch size of 16. Conclusion: This study evaluated a voice analysis-based program to detect pre- and post-swallowing changes in patients with dysphagia, potentially aiding in real-time monitoring. Such a system can provide healthcare professionals with daily insights into the conditions of patients, allowing for personalized interventions. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05149976.

Intramuscular condition of swallowing-related muscles using shear-wave elastography: A preliminary study in healthy adults.

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 (ß = -.473, p = .039) was a significant negative explanatory variable. However, with the GHM stiffness as the dependent variable, BMI (ß = .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.

Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance.

Rehabilitative exercises require precise movement coordination and target accuracy for optimal effectiveness. This paper explores the impact of tongue strength exercises (TSE) performance accuracy on exercise outcomes, adherence, and participant confidence and motivation. An 8-week randomized clinical trial included 84 typically aging participants divided into four groups defined by access to biofeedback (present/absent) and TSE intensity dosing (maximal/submaximal) during a home exercise program (HEP). Retention, training, and HEP accuracy were tracked at biweekly visits and during HEP for participants with access to a biofeedback device. Associations with tongue strength outcomes, participant factors, biofeedback, and intensity dosing were analyzed. Exercise accuracy measures did not contribute to tongue strength outcomes at the end of 8 weeks. Increased training accuracy (less practice required to achieve competency) was associated with higher participant confidence and better adherence to the HEP. The presence of biofeedback was associated with reduced adherence but better retention accuracy, while maximal intensity was associated with improvements in all accuracy measures compared to submaximal intensity exercise. These findings in typically aging participants suggest the need for tailored approaches in swallowing-related exercise programs, given the effects of biofeedback and exercise intensity on motor learning and exercise retention. Accuracy performance and its effect on clinical outcomes warrants study in clinical populations with dysphagia and with various rehabilitative approaches.Trial Registration Clincialtrials.gov: NCT04809558.

Early-onset dysphagia predicts short survival in multiple system atrophy.

BACKGROUND: The prognostic impact of dysphagia in multiple system atrophy (MSA) remains controversial. This study aimed to investigate the relationship between dysphagia severity and survival in MSA and to elucidate whether this impact differs between MSA-cerebellar ataxia (MSA-C) and MSA-parkinsonism (MSA-P). METHODS: This retrospective study included 297 patients with MSA: 251 met criteria for clinically established MSA and 46 for clinically probable MSA. Among them, 171 had MSA-C and 126 had MSA-P. We evaluated symptomatic dysphagia within 3 years of onset and quantified dysphagia severity using the Hyodo score (0 to 12) through fibreoptic endoscopic evaluation of swallowing (FEES) and clinical features, including autonomic dysfunction and vocal cord paralysis. Patients were followed up until death or tracheostomy, and survival factors were analysed using the log-rank test and multivariate Cox proportional hazards model. RESULTS: Ninety patients developed symptomatic dysphagia within 3 years of onset, and 75 were evaluated for dysphagia severity using FEES. Survival from onset was shorter in patients with dysphagia within 3 years compared to those without (median: 4.2 years vs. 7.3 years; p < 0.001). Symptomatic dysphagia within 3 years of onset was an independent predictor of shorter survival in the multivariate Cox analysis. While the Hyodo score was higher in MSA-P than in MSA-C patients (p = 0.048), the Hyodo score was associated with survival in both MSA-C and MSA-P patients (log-rank p < 0.001 and p = 0.046, respectively). CONCLUSION: Symptomatic dysphagia within 3 years of onset predicts shorter survival in MSA-C and MSA-P patients.

An Unusual Case of Contralateral Hypoglossal and Recurrent Laryngeal Nerve Palsies Following Endotracheal Intubation.

We present an unusual case of a 62-year-old male presenting with contralateral hypoglossal and recurrent laryngeal nerve palsies following endotracheal intubation for emergency cardiac surgery. Postoperative, the patient was referred to Speech and Language Therapy due to concerns regarding the safety of his swallow. Oromotor assessment revealed left-sided tongue weakness and aphonia. Flexible endoscopic evaluation of swallowing (FEES) revealed a right vocal cord palsy and severe oropharyngeal dysphagia. There were no other focal neurological signs. An MRI head did not demonstrate a medial medullary stroke or other intracranial lesion. CT neck showed no abnormality identified in relation to the course of the right vagus nerve or recurrent laryngeal nerve at the skull base or through the neck respectively. The patient required a gastrostomy for nutrition and hydration. He continued to be assessed at several month intervals over the course of a year using FEES to obtain a range of voice, secretion and swallowing outcome measures. The patient commenced intensive dysphagia therapy targeting pharyngeal drive, hyolaryngeal excursion and laryngeal sensation. Swallow manoeuvres were trialled during FEES and a head-turn to the side of the vocal cord palsy during deglutition reduced aspiration risk which expedited return to oral intake. The patient had partial recovery over twelve months. Hypoglossal nerve palsy completely resolved. The right vocal cord remained paralysed however the left vocal cord compensated enabling the patient to produce a normal voice. The patient was able to take thin fluids and regular diet and the gastrostomy was removed.

Validation of a Low-Cost Manometer to Assess of Tongue, Lip, Cheek, and Respiratory Strength: A Laboratory-Based Study.

OBJECTIVE(S): The objective of this study was to characterize the level of agreement between three manometers: (1) Iowa Oral Performance Instrument (IOPI)-the reference standard for tongue, lip, and cheek strength assessments; (2) MicroRPM Respiratory Pressure Meter (MicroRPM)-the reference standard for respiratory strength assessments; and (3) Digital Pressure Manometer (DPM)-an alternative, low-cost pressure testing manometer. METHODS: Manual pressures were simultaneously applied to the IOPI and DPM, and to the MicroRPM and DPM, within a controlled laboratory setting. Agreement in pressure readings were analyzed using descriptive statistics, Lin's concordance correlation, and Bland-Altman Plots. Agreement was interpreted as "poor" if ρc < 0.90, "moderate" if ρc = 0.90 - < 0.95, "substantial" if ρc = 0.95 - < 0.99, and "excellent" if ρc ≥ 0.99. RESULTS: Differences in pressure readings between the DPM and clinical reference standards were consistently present yet highly predictable. There was a median absolute difference of 2.0-3.9 kPa between the IOPI and DPM, and 4.5-9.8 cm H2O between the MicroRPM and DPM. Lin's concordance revealed "substantial" agreement between the IOPI and DPM (ρc = 0.98) and the MicroRPM and DPM (ρc = 0.99). CONCLUSION: The DPM revealed higher pressure readings when compared to the IOPI and MicroRPM. However, differences in pressure readings were relatively small, highly predictable, and yielded substantial overall agreement. These findings suggest the DPM may be a valid, lower-cost alternative for objective assessments of tongue, lip, cheek, and respiratory muscle strength. Future research should expand on the present findings in clinical patient populations. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.