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Lee E, Kim GJ, Ryu H, Jung KI, Yoo WK, Ohn SH. Pharyngeal Structure and Dysphagia in Patients with Parkinson's Disease and Related Disorders. Dysphagia 2024; 39:468-475. [PMID: 37902836 DOI: 10.1007/s00455-023-10631-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/15/2023] [Indexed: 11/01/2023]
Abstract
Pharyngeal muscle changes occur in patients with Parkinson's disease and related disorders (PRD); however, the association between the structural alterations in the pharynx and the symptoms of dysphagia remains unclear. We assessed structural changes and contractile forces by measuring pharyngeal wall thickness and width. We aimed to define the pharyngeal measurements and determine their value as diagnostic tools for dysphagia. The pharyngeal wall thickness (PWT), pharyngeal width at rest (PWR), and shortest pharyngeal width at swallowing (PWS) were measured using lateral neck roentgenograms and videofluoroscopic swallowing study. We compared the PWR and PWT between the PRD and control groups using an independent t-test. The Kendall correlation test was performed on the radiological data of the pharynx (PWT, PWR and PWS), dysphagia scales (Penetration-Aspiration scale [PAS] and Dysphagia Outcome and Severity Scale [DOSS]), and Hoehn and Yahr scale (HY scale). The PWT was smaller and the PWR greater in the PRD than in the control group (p < 0.05). The dysphagia scales (PAS and DOSS) were correlated with the radiological data (PWT and PWS) and the HY scale (p < 0.05). The HY scale score also correlated with the PWT (p < 0.05). The optimal cutoff points of the PWT and PWR for predicting aspiration were 4.05 and 16.05 mm in the PRD group, respectively. Using the PWT, PWR and PWS, muscle atrophy and contractile strength of the pharynx can be estimated. The combination of the PWT and PWR can be a simple indicator for predicting swallowing disorders at the bedside.
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Affiliation(s)
- Eunjee Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Gyu Jin Kim
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Hyewon Ryu
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea.
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Bayona HHG, Inamoto Y, Saitoh E, Aihara K, Kobayashi M, Otaka Y. Prediction of Pharyngeal 3D Volume Using 2D Lateral Area Measurements During Swallowing. Dysphagia 2024:10.1007/s00455-023-10659-x. [PMID: 38245902 DOI: 10.1007/s00455-023-10659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3 years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10 mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior-posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT.
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Affiliation(s)
- Howell Henrian G Bayona
- Graduate School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Eichii Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masanao Kobayashi
- Faculty of Radiology, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Kang W, Chung J, Lee J, Jung KI, Yoo WK, Ohn SH. The influence of pharyngeal width on post-stroke laryngeal aspiration. NeuroRehabilitation 2021; 49:435-444. [PMID: 34308916 DOI: 10.3233/nre-210120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laryngeal penetration, which is a less serious form of aspiration, should be considered in patients with stroke to ensure early detection of risk of laryngeal aspiration and prevention of pneumonia. OBJECTIVE As a follow-up to a previous study that demonstrated the association of pharyngeal width to laryngeal aspiration, the present study sought to determine whether the pharyngeal width was related to not only laryngeal aspiration but also laryngeal penetration in patients with deglutition disorder following stroke. METHODS The pharyngeal width on the roentgenogram was measured and compared based on the severity of aspiration. Moreover, the optimal cut-off points were determined for predicting the penetration and aspiration so that the difference between the penetration and the aspiration could be elucidated. RESULTS The pharyngeal width of the patients was wider than the controls. The increase of the pharyngeal width by aspiration severity was more evident in the patients with chronic and right cerebral stroke. The optimal cut-off point of the pharyngeal width was approximately 1 mm lesser for the prediction of penetration than for aspiration. CONCLUSIONS The pharyngeal width could be an ancillary method for detecting penetration and aspiration in stroke patients.
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Affiliation(s)
- Wonil Kang
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Jane Chung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Jeongeun Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
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