Aging and Sex Effects on Mastication Performance in Healthy, Nondysphagic, Community-Dwelling Adults

Features of Swallowing Function in Sporadic Inclusion Body Myositis: Preliminary Evidence Using Well-Tested Assessment Frameworks

PURPOSE

Evidence surrounding swallowing impairment in sporadic inclusion body myositis (IBM) is based on nonstandardized and nonvalidated assessment methods. We investigated (a) IBM's impact on swallowing function and oral intake status using well-tested assessment frameworks; (b) changes in swallowing over time; and (c) age, sex, and swallowing impairment severity's influence on oral intake status.

METHOD

We conducted a secondary analysis of Modified Barium Swallow Impairment Profile (MBSImP) and Functional Oral Intake Scale (FOIS) data from 13 patients with IBM (seven females; Mage = 60.2 [±13.6] years) and 13 age- and sex-matched healthy controls. We compared MBSImP Overall Impression (OI), Oral Total (OT), Pharyngeal Total (PT), and FOIS scores between groups. Specific to the IBM cohort, we analyzed repeated OT and PT scores and calculated whether age, sex, and OT and PT scores predicted FOIS scores.

RESULTS

The IBM cohort demonstrated poorer OI scores across six swallowing components than healthy controls (each p < .05). Unlike OT scores (p = .84), PT (p = .033) and FOIS (p < .001) scores were worse in the IBM cohort. Repeated OI scores revealed changes in three swallowing components (each p < .05), but repeated OT (p = .16) and PT (p = .30) scores did not significantly change. Age, sex, and OT and PT scores did not influence FOIS scores (each p > .05).

CONCLUSIONS

Pharyngeal impairments were most prominent in the IBM cohort, and their oral intake status was adversely affected. Our preliminary data showcase the application of robust assessment methods to investigate swallowing function in IBM, enhancing standardization and comparability across studies.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27165450.

The effects of endoscope placement in the hypopharynx on swallowing-related measures in healthy adults

PURPOSE

The purpose of this study was to determine whether transnasal passage of a flexible endoscope results in changes in salivary flow rate (SFR), spontaneous swallow frequency (SSF), and masticatory efficiency (ME) in healthy adults.

METHODS

Data were collected from 15 healthy adults, 20-63 years of age. SFR and SSF were measured at baseline, after endoscope insertion, and after endoscope removal. The Test of Masticating and Swallowing Solids was administered at baseline and while the endoscope was in the hypopharynx. A repeated measures ANOVA was used to determine the effect of endoscope insertion on SFR and SSF. A paired samples t-test was used to determine the effect of endoscope insertion on total mastication time and number of masticatory cycles required with a cracker bolus. Statistical significance was set at α = 0.05.

RESULTS

SFR was found to be significantly increased during endoscope placement in the hypopharynx (M = 0.471 g/min, SD = 0.175, p = 0.002) as well as following endoscope removal (M = 0.481 g/min, SD = 0.231, p = 0.004), as compared to baseline (M = 0.310 g/min, SD = 0.130). Total mastication time and number of masticatory cycles required with a cracker bolus were significantly decreased when the endoscope was present in the hypopharynx, as compared to baseline t(14) = 3.054, p = 0.009; t(14) = 3.250, p = 0.006, respectively.

CONCLUSIONS

Visualization of swallowing during FEES is an important method for objectively evaluating several anatomical and functional parameters of the pharynx and larynx. Insertion of the endoscope into the hypopharynx during FEES may stimulate salivary secretion and improve ME, which could influence interpretation of FEES and resulting clinical recommendations.

Hyolaryngeal Movement During Normal and Effortful Swallows Determined During Ultrasonography

PURPOSE

This study investigated (a) the effects of the effortful swallow under two different instructions (tongue emphasis vs. pharyngeal squeezing) on hyoid displacement and hyoid-larynx approximation, (b) the association between tongue pressure and hyolaryngeal movement during normal swallowing and the effortful swallow produced with tongue emphasis, and (c) age-related differences in hyolaryngeal movement during normal and effortful swallows (tongue emphasis vs. pharyngeal squeezing) in healthy individuals.

METHOD

Forty healthy adults (20 younger and 20 older) swallowed their saliva as they normally do (normal swallow) and performed the effortful swallow with tongue emphasis and pharyngeal squeezing. Tongue-to-palate pressure during swallowing was measured using the Iowa Oral Performance Instrument, hyolaryngeal movement was measured using ultrasonography, and submental surface electromyography was used to track swallows.

RESULTS

Results revealed differences in hyolaryngeal movement across swallowing types. Both types of effortful swallows showed greater hyolaryngeal movement than normal swallows. Additionally, hyolaryngeal movement was greater during the effortful swallow with tongue emphasis than the effortful swallow with pharyngeal squeezing. Age-related differences were found only in hyoid-larynx approximation during the effortful swallow with tongue emphasis (younger > older adults). Furthermore, moderate positive correlations were identified between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis.

CONCLUSIONS

The findings show that varying instructions of the effortful swallow affect hyolaryngeal movement differently, suggesting that clinicians may need to individualize the effortful swallow instruction according to the physiological impairments of each patient. Additionally, natural age-related changes in swallowing physiology do not seem to affect an individual's ability to perform the effortful swallow or to impact hyolaryngeal movement. Finally, the association between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis suggests that the tongue plays a critical role in swallowing, priming subsequent swallowing events.

Comparison of Oropharyngeal Efficiency Between Two Popular Brands of Marie Biscuits

OBJECTIVE

The main objective of the study was to compare four measures of TOMASS (number of bites, number of masticatory cycles, number of swallowing and total time taken) across brands of Marie biscuits and gender.

METHODOLOGY

The study employed a cross-sectional design with nonrandomized convenience sampling. A total of 60 participants (30 females and 30 males) were recruited for the study in the age range of 18 to 26 years. Prior to enrolment in the study, the participants were screened for potential speech and swallowing issues. Two commercially available crackers (biscuits) in India, Sunfeast Marie Light and Britannia Marie Gold were used. Video recordings of the participants eating the biscuits were analyzed to document four measures of TOMASS.

RESULTS

The mean values obtained on all the measures for males were lesser than mean values for females for both the biscuits. Mann-Whitney U test revealed a statistically significant difference across number of swallows and total time taken across gender. There were no significant differences across biscuits on the four TOMASS measures.

CONCLUSION

It can be concluded that the TOMASS measures were near similar for both brands of Marie biscuits. Thus, any of these two brands of Marie could be used for clinical swallow evaluation. However, gender needs to be kept in mind, while interpreting the results of TOMASS. Future studies need to be conducted with other brands of Marie biscuit and in other age groups.

Effects of Presbyphagia on Oropharyngeal Swallowing Observed during Modified Barium Swallow Studies

OBJECTIVES

Understanding how aging impacts swallowing can help differentiate typical from atypical behaviors. This study aimed to quantify age-related swallowing alterations observed during a modified barium swallow study.

DESIGN

Cross-sectional study.

SETTING

Adult fluoroscopy suite in a metropolitan hospital at an academic center.

PARTICIPANTS

195 healthy adults distributed across 3 age categories: 21-39; 40-59; 60+ years.

MEASUREMENTS

17 physiologic components of swallowing across three functional domains (oral, pharyngeal, esophageal), including summed composite scores (Oral Total [OT] and Pharyngeal Total [PT]), from the validated and standardized Modified Barium Swallow Impairment Profile.

RESULTS

Most components (65%) demonstrated no impairment (scores of "0"). The odds of a worse (higher) score increased significantly with age for: Tongue Control during Bolus Hold, Hyolaryngeal Movement, Laryngeal Closure, Pharyngeal Contraction, and Pharyngoesophageal Segment Opening. OT and PT scores for 40-59-year-olds were worse than the youngest group (p=.01 and p <.001, respectively). Adults 60+ years had significantly worse PT scores among all groups (p-values <.01).

CONCLUSION

Oropharyngeal swallowing physiology evolves as healthy adults age and should be considered during clinical decision-making.

Diagnostic accuracy of the Dysphagia Trained Nurse Assessment tool in acute stroke

BACKGROUND AND PURPOSE

Comprehensive swallow screening assessments to identify dysphagia and make early eating and drinking recommendations can be used by trained nurses. This study aimed to validate the Dysphagia Trained Nurse Assessment (DTNAx) tool in acute stroke patients.

METHODS

Participants with diagnosed stroke were prospectively and consecutively recruited from an acute stroke unit. Following a baseline DTNAx on admission, participants underwent a speech and language therapist (SLT) bedside assessment of swallowing (speech and language therapist assessment [SLTAx]), videofluoroscopy (VFS) and a further DTNAx by the same or a different nurse.

RESULTS

Forty-seven participants were recruited, of whom 22 had dysphagia. Compared to SLTAx in the identification of dysphagia, DTNAx had a sensitivity of 96.9% (95% confidence interval [CI] 83.8-99.9) and specificity of 89.5% (95% CI 75.2-97.1). Compared to VFS in the identification of aspiration, DTNAx had a sensitivity of 77.8% (95% CI 40.0-97.2) and a specificity of 81.6% (95% CI 65.7-92.3). Over 81% of the diet and fluid recommendations made by the dysphagia trained nurses were in absolute agreement compared to SLTAx. Both DTNAx and SLTAx had low diagnostic accuracy compared to the VFS-based definition of dysphagia.

CONCLUSIONS

Nurses trained in DTNAx showed good diagnostic accuracy in identifying dysphagia compared to SLTAx and in identifying aspiration compared to VFS. They made appropriate diet and fluid recommendations in line with SLTs in the early management of dysphagia.