Changes in Pharyngeal Width Over Time as an Indicator of Dysphagia in Stroke Patients.

OBJECTIVE: To verify the pharyngeal width at rest as a measurement that could be used to assess changes in the degree of dysphagia over time in stroke patients. METHODS: In a cohort of stroke patients, we performed serial measurements of the pharyngeal width at the midpoints of the second (C2) and third (C3) cervical vertebral bodies using lateral neck X-rays while the patients were at rest. The JOSCYL width, a parameter named after the first initial of each developers' surname and defined as the average value of the upper and lower pharyngeal widths, was used to formulate the JOSCYL scale, which was calculated as the JOSCYL width × 100/neck circumference. All patients also underwent serial videofluoroscopic swallowing studies (VFSSs). The Spearman correlation analysis was used to detect correlations between the serial VFSS results, JOSCYL widths, and JOSCYL scale values. RESULTS: Over time, we observed significant positive and negative correlations of change in the JOSCYL width and scale with changes in the Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale scores, respectively. CONCLUSION: The JOSCYL width and JOSCYL scale clearly reflected changes in dysphagia in stroke patients over time. These parameters may provide an easier method for evaluating whether post-stroke dysphagia has been alleviated.

Predictive Value of Pharyngeal Width at Rest (JOSCYL Width) for Aspiration in Elderly People.

OBJECTIVE: To develop a new tool for aspiration risk prediction based on pharyngeal width at rest in older adults with symptoms of aspiration. METHODS: Lateral cervical spine roentgenograms were obtained from 33 older adult patients who complained of dysphagia and from 33 healthy, age-matched controls. Pharyngeal width at rest was measured at two points. We named the average of these two pharyngeal widths 'JOSCYL Width', calculated 'JOSCYL Scale', and compared these parameters between dysphagia and control groups. Correlations of individual JOSCYL Width and JOSCYL Scale, with Penetration Aspiration Scale (PAS) and Dysphagia Outcome and Severity Scale (DOSS) scores were analyzed for the dysphagia group. To determine optimal cutoff points for predicting aspiration, a receiver operating characteristic curve analysis was performed on JOSCYL Width and JOSCYL Scale. RESULTS: Both JOSCYL Width and JOSCYL Scale of the dysphagia group were larger than those of the control group (p<0.001). The correlation between JOSCYL Width and severity of dysphagia was significant for the dysphagia group (PAS p=0.007; DOSS p=0.012). The correlation between JOSCYL Scale and the severity of dysphagia was also significant for the dysphagia group (PAS p=0.009; DOSS p=0.011). Optimal cutoffs for JOSCYL Width and JOSCYL Scale for predicting aspiration were 20.0 mm and 5.9, respectively. CONCLUSION: JOSCYL Width and JOSCYL Scale can be new indicators for predicting aspiration in older adults. They are both precise and easy to use.

Pharyngeal width and aspiration after stroke.

It is important to assess aspiration in stroke patients. The aim of this study was to develop a new additional tool to predict aspiration based on the pharyngeal width at rest in stroke patients with aspiration symptoms. The pharyngeal width was measured at the middle level of the second and third cervical vertebral bodies using a lateral neck roentgenogram in stroke patients and healthy controls. We named the average of the two pharyngeal widths as the JOSCYL width and calculated the 'JOSCYL width × 100 / neck circumference' as the JOSCYL scale. The correlation between the individual JOSCYL width, JOSCYL scale, and severity of dysphagia was analyzed in the stroke group using Spearman correlation analysis. The optimal cutoff point for predicting aspiration was determined by receiver-operating characteristic curve analysis of the JOSCYL width and JOSCYL scale. The JOSCYL width and JOSCYL scale of the stroke group were larger than those of the control group (P < 0.05). The correlation between the JOSCYL width, JOSCYL scale, and the severity of dysphagia was significant for the whole stroke group and the chronic stroke group (P < 0.05). The optimal cutoffs of the JOSCYL width and JOSCYL scale for predicting aspiration were approximately 18 mm and 50 in the stroke group. The JOSCYL width and JOSCYL scale are new indicators for predicting aspiration in stroke patients and are precise and easy to use. The accuracy of the JOSCYL width and JOSCYL scale for predicting aspiration was shown to be higher in the chronic stroke stage.