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Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy

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A Correction to this article was published on 16 September 2020

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Abstract

Purpose

Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). Minimal evidence exists to support the use of these perceptual methods for judging HE. We investigated whether binary judgment of HE differentiates quantitative measures of hyoid movement, using frame-by-frame VFSS analysis to measure anatomically scaled peak hyoid positions.

Methods

Medical records of patients who received a CSE and VFSS within a 24-h period were reviewed. Clinician ratings of HE (‘reduced’ or ‘normal’) were collected from CSE and VFSS reports, along with rater experience. Five ml puree swallows were extracted from each VFSS for randomized, blinded analysis. Peak hyoid position from C4 was captured in anterior, superior, and hypotenuse positions and expressed relative to C2–C4 length. T-test comparisons of hyoid positions between patients judged to have reduced versus normal HE on palpation and VFSS were conducted.

Results

Eighty-seven patients (56 male, mean age 61) met criteria. Peak anterior hyoid position was significantly different between patients judged to have reduced (mean = 89.2% C2–C4) and normal (mean = 110.6% C2–C4) HE on palpation (p = 0.001). Further analysis revealed no effect of clinician experience on differentiation of objective measures based on palpation. No differences were found across any objective measures when compared to clinician VFSS ratings.

Conclusions

Clinicians appeared to be able to differentiate peak anterior hyoid movement but not superior or hypotenuse movement on palpation. On VFSS visualization, no significant differences were found between swallows judged to have reduced versus normal HE in any directional dimension. While perceptual methods may contribute to clinical decision-making, clinicians should remain cautious when making judgments about HE using these methods.

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Fig. 1

Reproduced with permission from Molfenter and Steele [24]

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Change history

  • 16 September 2020

    This letter notifies the readers of the Dysphagia journal of an error in the original published version of this manuscript, for which a previously available open source spreadsheet tool had been used to calculate the position of the hyoid bone or larynx on lateral view videofluoroscopic images. An error in the mathematical formula built into the spreadsheet resulted in a reversal of the results for the X and Y planes of measurement. This erratum provides corrections to the results and interpretations of the original manuscript.

References

  1. Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):953–63. https://doi.org/10.2214/ajr.154.5.2108569.

    Article  CAS  PubMed  Google Scholar 

  2. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19(4):691–707. https://doi.org/10.1016/j.pmr.2008.06.001.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Paik NJ, Kim SJ, Lee HJ, Jeon JY, Lim JY, Han TR. Movement of the hyoid bone and the epiglottis during swallowing in patients with dysphagia from different etiologies. J Electromyogr Kines. 2008;18(2):329–35. https://doi.org/10.1016/j.jelekin.2006.09.011.

    Article  Google Scholar 

  4. Logemann JA, Kahrilas PJ, Cheng J, Pauloski BR, Gibbons PJ, Rademaker AW, Lin S. Closure mechanisms of laryngeal vestibule during swallow. Am J Physiol. 1992;262(2 Pt 1):G338–44. https://doi.org/10.1152/ajpgi.1992.262.2.G338.

    Article  CAS  PubMed  Google Scholar 

  5. Jacob P, Kahrilas PJ, Logemann JA, Shah V, Ha T. Upper esophageal sphincter opening and modulation during swallowing. Gastroenterology. 1989;97(6):1469–78.

    Article  CAS  Google Scholar 

  6. McCullough GH, Rosenbek JC, Wertz RT, McCoy S, Mann G, McCullough K. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hear Res. 2005;48(6):1280–93. https://doi.org/10.1044/1092-4388(2005/089).

    Article  CAS  PubMed  Google Scholar 

  7. Ramsey DJC, Smithard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke. 2003;34(5):1252–7. https://doi.org/10.1161/01.Str.0000066309.06490.B8.

    Article  PubMed  Google Scholar 

  8. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin, TX: Pro-Ed; 1998.

    Google Scholar 

  9. McCullough GH, Martino R. Clinical evaluation of patients with dysphagia: importance of history taking and physical exam. In: Shaker EC, Belafsky PC, Postma GN, editors. Manual of diagnostic and therapeutic techniques for disorders of deglutition. New York: Springer; 2013. p. 11–30.

    Chapter  Google Scholar 

  10. Ishida R, Palmer JB, Hiiemae KM. Hyoid motion during swallowing: factors affecting forward and upward displacement. Dysphagia. 2002;17(4):262–72. https://doi.org/10.1007/s00455-002-0064-5.

    Article  PubMed  Google Scholar 

  11. Kim Y, McCullough GH. Maximum hyoid displacement in normal swallowing. Dysphagia. 2008;23(3):274–9. https://doi.org/10.1007/s00455-007-9135-y.

    Article  PubMed  Google Scholar 

  12. Chi-Fishman G, Sonies BC. Effects of systematic bolus viscosity and volume changes on hyoid movement kinematics. Dysphagia. 2002;17(4):278–87. https://doi.org/10.1007/s00455-002-0070-7.

    Article  PubMed  Google Scholar 

  13. Nagy A, Molfenter SM, Peladeau-Pigeon M, Stokely S, Steele CM. The effect of bolus volume on hyoid kinematics in healthy swallowing. Biomed Res Int. 2014;2014:738971. https://doi.org/10.1155/2014/738971.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rofes L, Arreola V, Martin A, Clave P. Natural capsaicinoids improve swallow response in older patients with oropharyngeal dysphagia. Gut. 2013;62(9):1280–7. https://doi.org/10.1136/gutjnl-2011-300753.

    Article  PubMed  Google Scholar 

  15. Leow LP, Huckabee ML, Sharma S, Tooley TP. The influence of taste on swallowing apnea, oral preparation time, and duration and amplitude of submental muscle contraction. Chem Senses. 2007;32(2):119–28. https://doi.org/10.1093/chemse/bjl037.

    Article  CAS  PubMed  Google Scholar 

  16. Leonard RJ, Kendall KA, McKenzie S, Goncalves MI, Walker A. Structural displacements in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15(3):146–52. https://doi.org/10.1007/s004550010017.

    Article  CAS  PubMed  Google Scholar 

  17. Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH. Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res. 2000;43(5):1264–74.

    Article  CAS  Google Scholar 

  18. Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26(1):67–74. https://doi.org/10.1007/s00455-010-9309-x.

    Article  PubMed  Google Scholar 

  19. McCullough GH, Wertz RT, Rosenbek JC, Dinneen C. Clinicians’ preferences and practices in conducting clinical-bedside and videofluoroscopic swallowing examinations in an adult, neurogenic population. Am J Speech Lang Pathol. 1999;8(2):149–63.

    Article  Google Scholar 

  20. Mann G. MASA: the Mann assessment of swallowing ability. Boston: Cengage Learning; 2002.

    Google Scholar 

  21. McCullough GH, Wertz RT, Rosenbek JC, Mills RH, Ross KB, Ashford JR. Inter- and intrajudge reliability of a clinical examination of swallowing in adults. Dysphagia. 2000;15(2):58–67. https://doi.org/10.1007/s004550010002.

    Article  CAS  PubMed  Google Scholar 

  22. Rangarathnam B, McCullough GH. Utility of a clinical swallowing exam for understanding swallowing physiology. Dysphagia. 2016;31(4):491–7. https://doi.org/10.1007/s00455-016-9702-1.

    Article  PubMed  Google Scholar 

  23. Lee JW, Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Subjective assessment of videofluoroscopic swallow studies. Otolaryngol Head Neck Surg. 2017;156(5):901–5. https://doi.org/10.1177/0194599817691276.

    Article  PubMed  Google Scholar 

  24. Schneider CA, Rasband WS, Eliceiri KW. NIH image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9(7):671–5.

    Article  CAS  Google Scholar 

  25. Molfenter SM, Steele CM. Use of an anatomical scalar to control for sex-based size differences in measures of hyoid excursion during swallowing. J Speech Lang Hear Res. 2014;57(3):768–78. https://doi.org/10.1044/2014_Jslhr-S-13-0152.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Perlman AL, VanDaele DJ, Otterbacher MS. Quantitative assessment of hyoid bone displacement from video images during swallowing. J Speech Hear Res. 1995;38(3):579–85.

    Article  CAS  Google Scholar 

  27. Thompson TZ, Obeidin F, Davidoff AA, Hightower CL, Johnson CZ, Rice SL, Sokolove RL, Taylor BK, Tuck JM, Pearson WG Jr. Coordinate mapping of hyolaryngeal mechanics in swallowing. J Vis Exp. 2014. https://doi.org/10.3791/51476.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fleiss JL. The design and analysis of clinical experiments. New York, NY: Wiley; 1986.

    Google Scholar 

  29. Steele CM, Bailey GL, Chau T, Molfenter SM, Oshalla M, Waito AA, Zoratto DC. The relationship between hyoid and laryngeal displacement and swallowing impairment. Clin Otolaryngol. 2011;36(1):30–6. https://doi.org/10.1111/j.1749-4486.2010.02219.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. World Health Organization. Physical status: the use and interpretation of anthropometry. Technical Report Series. Geneva: WHO; 1995.

    Google Scholar 

  31. Molfenter SM, Steele CM. Use of an anatomical scalar to control for sex-based size differences in measures of hyoid excursion during swallowing. J Speech Lang Hear Res. 2014;57(3):768–78. https://doi.org/10.1044/2014_JSLHR-S-13-0152.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Benoist M. Natural history of the aging spine. Eur Spine J. 2003;12(Suppl 2):S86–9. https://doi.org/10.1007/s00586-003-0593-0.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Malcolm GP. Surgical disorders of the cervical spine: presentation and management of common disorders. J Neurol Neurosurg Psychiatry. 2002;73(Suppl 1):i34–41.

    PubMed  PubMed Central  Google Scholar 

  34. Ezra D, Masharawi Y, Salame K, Slon V, Alperovitch-Najenson D, Hershkovitz I. Demographic aspects in cervical vertebral bodies’ size and shape (C3–C7): a skeletal study. Spine J. 2017;17(1):135–42. https://doi.org/10.1016/j.spinee.2016.08.022.

    Article  PubMed  Google Scholar 

  35. Palmer JB, Tanaka E, Ensrud E. Motions of the posterior pharyngeal wall in human swallowing: a quantitative videofluorographic study. Arch Phys Med Rehabil. 2000;81(11):1520–6. https://doi.org/10.1053/apmr.2000.17829.

    Article  CAS  PubMed  Google Scholar 

  36. Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405. https://doi.org/10.1007/s00455-008-9185-9.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank James C. Borders for his assistance during data collection, Glen Leverson and Sharon Weinberg for their assistance during data analysis, and the speech-language pathologists at UW-Madison Voice and Swallow clinics. Portions of this work were presented at the 2018 Dysphagia Research Society meeting.

Funding

Diane M. Bless Endowed Chair in Otolaryngology, University of Wisonsin-Madison.

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Authors and Affiliations

  1. Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA

    Danielle Brates & Sonja M. Molfenter

  2. Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI, 53705-2275, USA

    Danielle Brates & Susan L. Thibeault

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Correspondence to Susan L. Thibeault.

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Conflict of interest

The research conducted by the first author was supported by funding from the Diane M. Bless Endowed Chair in Otolaryngology. The authors declare no conflict of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was waived with IRB approval for retrospective medical chart review data collection.

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Brates, D., Molfenter, S.M. & Thibeault, S.L. Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy. Dysphagia 34, 298–307 (2019). https://doi.org/10.1007/s00455-018-9927-2

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