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Murray KL, Wong SM, Kamarunas E. Short-term cortical activation changes associated with postural compensation in swallowing. Exp Brain Res 2024:10.1007/s00221-024-06928-2. [PMID: 39320437 DOI: 10.1007/s00221-024-06928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024]
Abstract
Compensatory strategies used to treat dysphagia, like the chin-down and chin-up positions, are often employed by speech-language pathologists to enhance swallowing safety. However, their effects on cortical neural responses remain unclear. This study aimed to investigate the cortical hemodynamic responses to swallowing across three head positions -chin-down, chin-neutral, and chin-up - using functional near-infrared spectroscopy (fNIRS) in the bilateral precentral and postcentral gyrus regions of interest. Twenty-six healthy adults completed 32 swallows of 5 ml water in each head position. Results revealed short-term cortical activation increases for chin-up swallows compared to both chin-neutral (mean difference = 1.2, SE = 0.18, p = .048) and chin-down swallows (mean difference = 0.76, SE = 0.18, p = .009). These findings suggest that postural changes during swallowing induce immediate neural adaptations in people without swallowing difficulty. These modifications likely reflect the necessary sensory and neuromuscular adaptations required for safe swallowing in different head positions, with less hyolaryngeal movement needed for a chin-down swallow and more movement needed for a chin-up swallow. While challenging swallow conditions, like the chin-up, may offer promising therapeutic potential, caution is warranted considering the associated safety risk, and further investigation is needed. This study provides insights into the immediate effects of head positions on cortical activity during swallowing and highlights avenues for future research in dysphagia rehabilitation.
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Affiliation(s)
- Kelsey L Murray
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA.
| | - Seng Mun Wong
- Speech Therapy Department, Singapore General Hospital, Singapore, Singapore
| | - Erin Kamarunas
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
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Kim CW, Lee TS, Byun CS, Park YC. Association Between Masticatory Difficulty and Chronic Cough in a Korean Population. Int Dent J 2024:S0020-6539(24)00192-8. [PMID: 39068122 DOI: 10.1016/j.identj.2024.07.003] [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: 04/02/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE Chronic cough, a common outpatient symptom, has various aetiologies, including upper airway cough syndrome, asthma, and gastroesophagoeal reflux. The potential link between dental issues and respiratory diseases has recently garnered attention. This study aims to investigate the association between masticatory difficulty and chronic cough using data from the 2011-2015 Korean National Health and Nutrition Examination Survey (KNHANES). METHODS Analysis included 9706 individuals from KNHANES. Participants self-reported masticatory function and chronic cough. Covariates included age, sex, underlying diseases, socioeconomic status, lifestyle factors, and laboratory markers. Binary logistic regression analysed odds ratios for chronic cough covariates. Multiple logistic regression assessed adjusted odds ratios for masticatory difficulty. RESULTS Masticatory difficulty prevalence was 32.2%, with chronic cough higher in this group (4.8%) than in the group without masticatory difficulty (3.0%). After adjusting for socioeconomic status, lifestyle factors, and laboratory markers, masticatory difficulty was significantly associated with greater chronic cough prevalence (odds ratio, 1.137; 95% confidence interval, 1.134-1.140). CONCLUSIONS Masticatory difficulty was linked with an elevated chronic cough risk in Korean healthy adults. Further research, including prospective studies and detailed investigations into gastroesophagoeal reflux disease and microbiological studies, is warranted to elucidate the impact of mastication on respiratory health. As masticatory difficulty may serve as a clinical indicator for chronic cough interdisciplinary collaboration between dental and respiratory health professionals can facilitate early intervention and enhance patient care.
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Affiliation(s)
- Chang Wan Kim
- Department of Cardiovascular and Thoracic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Tae Sic Lee
- Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chun Sung Byun
- Department of Cardiovascular and Thoracic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yon Chul Park
- Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
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Verma H, Kumar S, Sharma A, Mishra R, Nagamani B. Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM). Geriatr Nurs 2024; 56:64-73. [PMID: 38301436 DOI: 10.1016/j.gerinurse.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions. METHOD One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM. RESULTS The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10. CONCLUSION Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life.
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Affiliation(s)
- Himanshu Verma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Kumar
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshani Mishra
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Banumathy Nagamani
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Chen YC, Ku EN, Lin CW, Tsai PF, Wang JL, Yen YF, Ko NY, Ko WC, Lee NY. Tongue pressure during swallowing is an independent risk factor for aspiration pneumonia in middle-aged and older hospitalized patients: An observational study. Geriatr Gerontol Int 2024; 24 Suppl 1:351-357. [PMID: 38111274 DOI: 10.1111/ggi.14769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/29/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023]
Abstract
AIM To evaluate oral frailty features present in hospitalized older patients with aspiration pneumonia. METHODS We enrolled hospitalized patients aged ≥50 years and classified them into three groups: the community-acquired, aspiration, and non-community-acquired pneumonia groups. Oral frailty was defined as meeting three or more criteria from the following: choking, and decreased occlusal force, masticatory function, tongue-lip motor function, tongue pressure, and tongue pressure during swallowing. RESULTS Of 168 patients enrolled, the incidence of aspiration pneumonia was 23.9% (17/71) in patients admitted with pneumonia as the primary diagnosis. The occlusal force and masticatory function were significantly poorer and tongue pressure and tongue pressure during swallowing were significantly lower in the aspiration pneumonia group than in the other two groups. A higher number of chronic comorbidities, poor oral health, and lower tongue pressure during swallowing were significantly associated with aspiration pneumonia. A tongue pressure during swallowing of <10.32 kPa might be a cutoff point for predicting the risk of aspiration pneumonia. CONCLUSIONS Hospitalized patients aged ≥50 years with multiple comorbidities, poor oral hygiene, and oral frailty during swallowing are at a higher risk of developing aspiration pneumonia, especially when their tongue pressure during swallowing is <10.32 kPa. Aspiration pneumonia is a preventable disease. Healthcare professionals should incorporate tongue pressure measurements or other screening tools into routine clinical practice to facilitate the early detection of this condition and intervention. Geriatr Gerontol Int 2024; 24: 351-357.
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Affiliation(s)
- Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - En-Ni Ku
- Department of Nursing, Taipei Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Che-Wei Lin
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Fen Yen
- Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chieh Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Quantitative prediction of aspiration risk in head and neck cancer patients treated with radiation therapy. Oral Oncol 2023; 136:106247. [PMID: 36410204 DOI: 10.1016/j.oraloncology.2022.106247] [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: 07/18/2022] [Revised: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine characteristics most strongly associated with risk for aspiration events among head and neck cancer (HNC) patients undergoing curative intent treatment. MATERIALS AND METHODS This was a retrospective, cross-sectional study of 106 patients with previously untreated HNC who received definitive or postoperative radiation therapy (RT) +/- systemic therapy with curative intent. Patients who received post-treatment videofluoroscopic swallow study (VFSS) between 2018-2021 were included. Using ordinal multivariable logistic regression, we modeled the effects of age (>60 years vs. ≤60 years), sex, body mass index (BMI) (>20 kg/m2 vs. ≤20 kg/m2), American Joint Committee on Cancer 8th edition stage (I-II vs. III-IVB), treatment with cisplatin (vs. other or no systemic therapy), post-operative status, primary site (oral cavity vs. P16+ oropharynx vs. P16- Mucosal Site vs. other), and quantitative VFSS measures on Penetration-Aspiration Scale (PAS) score. RESULTS AND CONCLUSION On ordinal multivariable logistic regression, age >60 years (odds ratio (OR): 3.91, 95% confidence interval (CI): 1.29, 11.9), advanced stage (stage III-IVB) (OR: 3.13, 95% CI: 1.23, 7.79), pharyngeal constriction ratio (PCR) >0.25 (OR: 3.65, 95% CI: 1.14, 11.7), and bolus clearance ratio (BCR) > 0.10 (OR: 3.42, 95% CI: 1.20, 9.75) were found to be significant risk factors for higher PAS scores. Patients with ≥ 2 pre-treatment risk factors had statistically significant increased risk for post-treatment aspiration (OR 2.52, 95% CI: 1.31, 4.86) on ordinal logistic regression. This model could be useful to direct high-risk patients toward interventions designed to reduce risk of aspiration events.
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Moulaei NA, Ramroodi N, Tabatabaie SMNA, Danesh HA, Khazaie HA. Aspiration pneumonia after cerebrovascular stroke: a comparison between patients with and without dysphagia. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Morishita M, Okubo M, Sekine T. Effects of Carbonated Thickened Drinks on Pharyngeal Swallowing with a Flexible Endoscopic Evaluation of Swallowing in Older Patients with Oropharyngeal Dysphagia. Healthcare (Basel) 2022; 10:healthcare10091769. [PMID: 36141382 PMCID: PMC9498686 DOI: 10.3390/healthcare10091769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to determine the efficacy of carbonated and sweetened drinks added to thickened liquids, which are routinely used for patients with dysphagia to improve dysphagia. Patients swallowed thin liquid (Thin), thickened liquid (Thick), carbonated thin drink (C-Thin), and carbonated thickened drink (C-Thick) in random order. Penetration and/or aspiration were scored using the Penetration−Aspiration Scale (PAS). The residue was scored using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). Swallowing reflex initiation was scored using the Hyodo score. The subjective difficulty of swallowing was scored on a face scale. We analyzed 13 patients with a mean age of 79.6 ± 9.6 years. PAS was significantly lower in the C-Thick group than the Thin group (p < 0.05). Swallowing reflex initiation was significantly different between the Thin and Thick (p < 0.01) groups; moreover, post hoc analysis revealed that it was significantly lower in the C-Thick group than the Thin group (p < 0.01). The subjective difficulty of swallowing in the C-Thick was significantly lower than the Thick group (p < 0.05). C-Thick was easier to swallow than Thick and may improve penetration and/or aspiration in older patients with dysphagia with complex diseases.
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Affiliation(s)
- Motoyoshi Morishita
- Department of Physical Therapy, Kibi International University, 8, Iga-machi, Takahashi 716-8508, Okayama, Japan
- Correspondence: (M.M.); (M.O.)
| | - Masahiko Okubo
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi 350-0475, Saitama, Japan
- Department of Dentistry, Yokohama Izumidai Hospital, 7838, Izumi-cho, Izumi-ku, Yokohama 245-0016, Kanagawa, Japan
- Correspondence: (M.M.); (M.O.)
| | - Tatsuro Sekine
- Department of Otolaryngology, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi 350-0475, Saitama, Japan
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