Cervical Vertebral Height Approximates Hyoid Displacement in Videofluoroscopic Images of Healthy Adults

Clinicians and researchers commonly judge the completeness of hyoid displacement from videofluoroscopic swallow study (VFSS) videos. Judgments made during the clinical exam are often subjective, and post-examination analysis reduces the measure's immediate value. This study aimed to determine the validity and feasibility of a visual, anatomically scaled benchmark for judging complete hyoid displacement during a VFSS. The third and fourth cervical vertebral bodies (C3 and C4) lie at roughly the same vertical position as the hyoid body and are strongly correlated with patient height. We hypothesized that anterior and superior displacement of the hyoid bone would approximate the height of one C3 or C4 body during safe swallows. Trained raters marked points of interest on C3, C4, and the hyoid body on 1414 swallows of adult patients with suspected dysphagia (n = 195) and 50 swallows of age-matched healthy participants (n = 17), and rated Penetration Aspiration Scale scores. Results indicated that the mean displacements of the hyoid bone were greater than one C3 unit in the superior direction for all swallows from patient and healthy participants, though significantly and clinically greater in healthy participant swallows (p < .001, d > .8). The mean anterior and superior displacements from patient and healthy participant swallows were greater than one C4 unit. Results show preliminary evidence that use of the C3 and/or C4 anatomic scalars can add interpretive value to the immediate judgment of hyoid displacement during the conduct of a clinical VFSS examination.

Swallowing beyond six years post (chemo)radiotherapy for head and neck cancer; a cohort study

OBJECTIVE

The objective of this prospective study is to report on long-term swallowing outcomes in a group of head and neck cancer patients following (chemo) radiotherapy treatment, assess for changes over time and identify any predictor variables of outcome.

MATERIALS AND METHODS

42 survivors were assessed on four swallowing measures and followed up from pre-treatment to six years post 3D (chemo) radiotherapy. Measures included a swallowing specific QOL questionnaire, penetration-aspiration scale, dietary restrictions and a timed water swallow test.

RESULTS

At six years, 71% reported swallowing difficulties on the questionnaire. One fifth of patients had aspiration, with a raised risk of chest infection. Seven percent required a laryngectomy for a dysfunctional larynx. Despite this, half the group reported having a normal diet. There was variation in the pattern of change between one and six years. A significant deterioration was only observed in the timed water swallow test (p < 0.0001). Larger radiotherapy volume predicted this outcome. None of the variables tested predicted outcome for the other three swallow measures.

CONCLUSION

Patients continue to report swallowing difficulties at six years, with a proportion having persistent aspiration. Further work on identifying the risk factors associated with aspiration tolerance, aspiration pneumonia, prevention and management is warranted. Long-term dysphagia remains a significant and serious concern following (chemo) radiotherapy for HNC and swallowing outcomes should continue to be monitored over time.