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Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome

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Abstract

To assess the severity and timing of penetration and aspiration (PA) of severe dysphagia after lateral medullary syndrome (LMS) and its association with temporal characteristics. We performed videofluoroscopic swallowing studies (VFSS) in 48 patients with LMS and severe dysphagia and 26 sex- and age-matched healthy subjects. The following temporal measures were compared between groups: velopharyngeal closure duration (VCD); hyoid bone movement duration (HMD); laryngeal vestibular closure duration (LCD); upper esophageal sphincter (UES) opening duration (UOD); stage transition duration (STD) and the interval between laryngeal vestibular closure and UES opening (LC-UESop). The association between temporal measures and Penetration–Aspiration Scale (PAS) scores was analyzed. Differences in timing measures were compared between subgroups (safe swallows, and swallows with PA events during and after the swallow). PAS scores ≥ 3 were seen in 48% of swallows (4% occuring before, 35% occurred during and 61% after the swallow) from the LMS patients. Significantly longer STD and LC-UESop were found in the patients compared to the healthy subjects (p < 0.05). Significant negative correlations with PA severity were found for HMD, LCD, and UOD. Short UOD was the strongest predictor with an area under the receiver-operating-characteristic curve of 0.66. UOD was also significantly shorter in cases of PA after the swallow (p < 0.01). Patients with LMS involving severe dysphagia exhibit a high frequency of PA (mostly during and after swallowing). PA events were associated with shorter UOD, HMD, and LCD. Notably, shortened UOD appears to be strongly associated with PA.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon request.

Abbreviations

PA:

Penetration and aspiration

LMS:

Lateral medullary syndrome

VCD:

Velopharyngeal closure duration

HMD:

Hyoid bone movement duration

LCD:

Laryngeal vestibular closure duration

UES:

Upper esophageal sphincter

UOD:

UES opening duration

STD:

Stage transition duration

LC-UESop:

Interval between laryngeal vestibular closure and UES opening

PAS:

Penetration–aspiration scale score

VFSS:

Videofluoroscopic swallowing study

FOIS:

Functional oral intake scale

MRI:

Magnetic resonance imaging

CT:

Computer tomography

mRS:

Modified Rankin scale

CPG:

Central pattern generator

PSD:

Post-stroke dysphagia

NTS:

Nucleus Tractus Solitarius

NA:

Nucleus ambiguus

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Funding

The author(s) disclose receipt of the following financial support for the research, authorship, and/or publication of this article: This work was sponsored by the Natural Science Foundation of China [NSFC, No. 81972159].

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Author notes

  1. Meng Dai and Jiao Qiao have contributed equally to this work.

Authors and Affiliations

  1. Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, Guangdong, China

    Meng Dai, Jiao Qiao, Huayu Chen, Zhonghui Shi & Zu-Lin Dou

  2. Mingxin Rehabilitation Center, No. 1, Wushan Road, Tianhe District, Guangzhou, 510630, Guangdong, China

    Binbin Liu

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Contributions

MD: Conceptualization, Methodology, Software, Writing—Original draft preparation, Writing—Review and editing, Project administration. JQ: Validation, Data curation. XW: Writing—Review and editing, Supervision. HC: Software, Investigation. ZS: Visualization, Investigation, YL: Writing—Review and editing. ZD: Supervision, Funding-acquisition.

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Dai, M., Qiao, J., Chen, H. et al. Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome. Dysphagia 39, 255–266 (2024). https://doi.org/10.1007/s00455-023-10607-9

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