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

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Abstract

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.

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Acknowledgements

Thanks are due to Zhenwei Zhang MS, Shitong Mao, MS, Aliaa Sabry, MD/PhD, and Atsuko Kurosu, PhD for assistance with data collection and coding.

Funding

Research reported in this manuscript was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD092239 and National Science Foundation CAREER Award Number 1652203, while the data were collected under Award Number R01HD074819. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or National Science Foundation.

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Authors and Affiliations

  1. Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA

    Amanda S. Mahoney, Erin Lucatorto & James L. Coyle

  2. Department of Electrical and Computer Engineering, School of Computing and Information, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA

    Yassin Khalifa

  3. Department of Bioengineering, Swanson School of Engineering, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, 15260, USA

    Yassin Khalifa

  4. Department of Biomedical Informatics, School of Medicine Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, 15260, USA

    Yassin Khalifa

  5. The Edward S. Rogers Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada

    Ervin Sejdić

  6. North York General Hospital, Toronto, ON, Canada

    Ervin Sejdić

Authors
  1. Amanda S. Mahoney
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  2. Yassin Khalifa
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  3. Erin Lucatorto
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  4. Ervin Sejdić
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  5. James L. Coyle
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Coyle, Khalifa, Lucatorto, and Mahoney. The first draft of the manuscript was written by Mahoney with comments from all authors on all versions of the manuscript. The final version of the manuscript has been approved by all contributing authors.

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Correspondence to James L. Coyle.

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The authors do not have any conflicts of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mahoney, A.S., Khalifa, Y., Lucatorto, E. et al. Cervical Vertebral Height Approximates Hyoid Displacement in Videofluoroscopic Images of Healthy Adults. Dysphagia 37, 1689–1696 (2022). https://doi.org/10.1007/s00455-022-10414-8

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  • DOI: https://doi.org/10.1007/s00455-022-10414-8

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