Reliability of Measuring Geniohyoid Cross-Sectional Area with B-Mode Ultrasound.

B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique.

Association of Tongue Strength and Maximum Incisal Opening with Oral Intake in Persons with Head and Neck Cancer Treated with Radiotherapy: A Retrospective Study.

Persons treated with radiotherapy (RT) for cancer of the head and neck (HNC) may experience limited oral intake at treatment completion. The purpose of this retrospective study was to examine the contributions of tongue strength and maximum incisal opening (MIO) to oral intake in a cohort of veterans treated for HNC. Medical records of veterans diagnosed with HNC treated with RT who were seen by the Speech Pathology Service prior to and throughout treatment per usual care were reviewed for this study; eighty-two records met the inclusion criteria for analysis.

Ultrasonography as Biofeedback to Increase Muscle Activation During the Mendelsohn Maneuver in Healthy Adults.

The Mendelsohn Maneuver (MM) is a therapeutic strategy that targets reduced laryngeal elevation. Both clinicians and clients identify the MM as one of the more difficult interventions to teach and learn. The purpose of this study was to examine the effect of applying real-time ultrasound as visual feedback in teaching the MM to healthy adults.

Using Ultrasound to Document the Effects of Expiratory Muscle Strength Training (EMST) on the Geniohyoid Muscle.

Expiratory muscle strength training (EMST) is an exercise program designed to strengthen the muscles of expiration by increasing expiratory load during breathing exercises using either resistive or pressure threshold devices. Previous research has shown that EMST may increase submental suprahyoid muscle activity as measured with surface electromyography. The impact of EMST on submental muscles is of interest to those who treat dysphagia.

Swallowing Patterns in the HNC Population: Timing of Penetration-Aspiration Events and Residue.

Objective: This study described swallowing patterns in a large head/neck cancer (HNC) cohort.

Study Design: In a retrospective review of data from a randomized controlled trial, we studied timing of penetration events as they related to aspiration and oral/pharyngeal residue.

Setting: Retrospective review of a multicenter randomized controlled trial.

Dose-volume relationship for laryngeal substructures and aspiration in patients with locally advanced head-and-neck cancer.

Background: Literature has shown a significant relationship between radiation dose to the larynx and swallowing disorders. We prospectively studied the dose-volume relationship for larynx substructures and aspiration.

Methods: Forty nine patients with stage III/IV head-and-neck (H&N) squamous cell carcinoma were prospectively enrolled in this IRB-approved, federally funded study.

The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program.

Background: Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes.

Methods: Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes.

Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors.

Objectives/hypothesis: Dysphagia is one of the most significant side effects of the treatment of head and neck cancer. Residue and aspiration are two indicators of dysphagia, but aspiration is historically the only indicator of interest, because it may impact health outcomes. Clinicians have anecdotally used residue as another marker of swallowing dysfunction, but it is understudied.

Impact of Compliance on Dysphagia Rehabilitation in Head and Neck Cancer Patients: Results from a Multi-center Clinical Trial.

A 5-year, 16-site, randomized controlled trial enrolled 170 HNC survivors into active (estim + swallow exercise) or control (sham estim + swallowing exercise) arms. Primary analyses showed that estim did not enhance swallowing exercises. This secondary analysis determined if/how patient compliance impacted outcomes.

Orosensory contributions to dysphagia: a link between perception of sweet and sour taste and pharyngeal delay time.

Pharyngeal delay is a significant swallowing disorder often resulting in aspiration. It is suspected that pharyngeal delay originates from sensory impairment, but a direct demonstration of a link between oral sensation and pharyngeal delay is lacking. In this study involving six patients with complaints of dysphagia, taste sensation of the oral tongue was measured and subsequently related to swallowing kinematics.

Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial.

Background: Neuromuscular electrical stimulation (NMES) is a highly sought after but poorly studied treatment for dysphagia among patients with head and neck cancer with dysphagia. This study investigated the efficacy of NMES in this patient population.

Methods: In this double-blinded, randomized controlled trial, 170 patients with head and neck cancer experiencing posttreatment dysphagia were randomized into active NMES + swallow exercise versus sham NMES + swallow exercise groups.

Comparison of swallowing function after intensity-modulated radiation therapy and conventional radiotherapy for head and neck cancer.

Background: Intensity-modulated radiotherapy (IMRT) is hoped to protect structures important for swallow function. We compared posttreatment swallow function in 7 pairs of patients with head and neck cancer treated with either IMRT or conventional radiotherapy (RT).

Methods: Patients were matched on tumor characteristics.

Effect of induction chemotherapy on swallow physiology and saliva production in patients with head and neck cancer: a pilot study.

Background: No objective data are available to assess the potential damage induction chemotherapy alone contributes to swallowing physiology and salivary production in patients with locally and regionally confined head and neck cancer.

Methods: Thirteen patients with head and neck cancer were evaluated preinduction and postinduction chemotherapy. Assessment included: (1) percentage of nutrition taken orally and food consistencies in diet; (2) videofluorographic swallow evaluation; (3) whole mouth saliva collection; (4) quality-of-life questionnaire; and (5) pain and oral mucositis scores.

Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer.

Background: Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients.

Methods: Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects.

Verbal communication for the ventilator-dependent patient requiring an inflated tracheotomy tube cuff: A prospective, multicenter study on the Blom tracheotomy tube with speech inner cannula.

Background: The purpose of this study was to present our findings on the impact of the Blom tracheotomy tube with speech inner cannula on voice production abilities and speech intelligibility scores of ventilator-dependent patients requiring a fully inflated tracheotomy tube cuff.

Methods: Prospective single group case-series design permitted consecutive accrual of 23 adult inpatients from acute care and rehabilitation settings. Maximum ambient room noise, voice intensity, phonation duration of vowel /a/, and speech intelligibility scores were determined over 3 sessions.

Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer.

Background: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing.

Methods: Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment.

A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study.

Seven institutions participated in this small clinical trial that included 19 patients who exhibited oropharyngeal dysphagia on videofluorography (VFG) involving the upper esophageal sphincter (UES) and who had a 3-month history of aspiration. All patients were randomized to either traditional swallowing therapy or the Shaker exercise for 6 weeks. Each patient received a modified barium swallow pre- and post-therapy, including two swallows each of 3 ml and 5 ml liquid barium and 3 ml barium pudding.

The Feasibility of Establishing Agreement Between Laboratories for Measures of Oropharyngeal Structural Movements.

Kinematic analysis, also commonly referred to as biomechanical analysis, of the swallow is used to measure movement of oropharyngeal structures over time. Two laboratory directors who have used kinematic analysis in their research collaborated to determine the feasibility of establishing agreement between two separate laboratories on measures of structural movements of the swallow. This report describes the process that was followed toward the goal of establishing measurement agreement.

Relationship between manometric and videofluoroscopic measures of swallow function in healthy adults and patients treated for head and neck cancer with various modalities.

Pharyngeal manometry complements the modified barium swallow with videofluoroscopy (VFS) in diagnosing pressure-related causes of dysphagia. When manometric analysis is not feasible, it would be ideal if pressure information about the swallow could be inferred accurately from the VFS evaluation. Swallowing function was examined using VFS and concurrent manometry in 18 subjects (11 head and neck patients treated with various modalities and 7 healthy adults).

Rehabilitation of dysphagia following head and neck cancer.

Patients who have cancers of the oral cavity, pharynx, or larynx may be treated with surgery, radiotherapy, chemotherapy, or a combination of these modalities. Each treatment type may have a negative impact on posttreatment swallowing function; these effects are presented in this article. A number of rehabilitative procedures are available to the clinician to reduce or eliminate swallowing disorders in patients treated for cancer of the head and neck.

Augmentation of deglutitive thyrohyoid muscle shortening by the Shaker Exercise.

Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown.

What information do clinicians use in recommending oral versus nonoral feeding in oropharyngeal dysphagic patients?

There is little evidence regarding the type(s) of information clinicians use to make the recommendation for oral or nonoral feeding in patients with oropharyngeal dysphagia. This study represents a first step toward identifying data used by clinicians to make this recommendation and how clinical experience may affect the recommendation. Thirteen variables were considered critical in making the oral vs.

Swallowing disorders in the first year after radiation and chemoradiation.

Background: Radiation alone or concurrent chemoradiation can result in severe swallowing disorders. This manuscript defines the swallowing disorders occurring at pretreatment and 3 and 12 months after completion of radiation or chemoradiation.

Methods: Forty-eight patients (10 women and 38 men) participated in this study involving videofluorographic evaluation of oropharyngeal swallow at the 3 time points.

Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer.

Background: Oral tongue strength and swallowing ability are reduced in patients treated with chemoradiotherapy for oral and oropharyngeal cancer.

Methods: Patients with oral or oropharyngeal cancer treated with high-dose chemoradiotherapy underwent tongue strength, swallowing, and dietary assessments at pretreatment and 1, 3, 6, and 12 months posttreatment. Tongue strength was assessed using the Iowa Oral Performance Instrument (IOPI).

Laryngeal penetration during deglutition in normal subjects of various ages.

This study examined the frequency of penetration of liquid, paste, and masticated materials into the airway during videofluoroscopic studies of normal swallow in 98 normal subjects who were from 20 to 94 years of age. The purposes of the study were to define frequency and level of penetration using the penetration-aspiration scale as a result of age, bolus volume, viscosity, and gender, and to describe the body's sensorimotor response to the penetration based on audible coughs or throat clearing on the audio channel of each videotaped fluoroscopic study. Frequencies of penetration were defined in relation to bolus volume, age, gender, and bolus viscosity from swallows of 1, 3, 5, and 10 ml and cup-drinking of thin liquids; 3 ml of pudding; (1/4) of a Lorna Doone cookie; and a bite of an apple.