European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 7, pp 2149–2156 | Cite as

Evaluation of an EMG bioimpedance measurement system for recording and analysing the pharyngeal phase of swallowing

  • Corinna SchultheissEmail author
  • Thomas Schauer
  • Holger Nahrstaedt
  • Rainer O. Seidl


A neuroprosthetic device for treating swallowing disorders requires an implantable measurement system capable to analysing the timing and quality of the swallowing process in real time. A combined EMG bioimpedance (EMBI) measurement system was developed and is evaluated here. The study was planned and performed as a case–control study. The studies were approved by the Charité Berlin ethics committee in votes EA1/160/09 and EA1/161/09. Investigations were carried out on healthy volunteers in order to examine the usefulness and reproducibility of measurements, the ability to distinguish between swallowing and head movements and the effect of different food consistencies. The correlation between bioimpedance and anatomical and functional changes occurring during the pharyngeal phase of swallowing in non-healthy patients was examined using videofluoroscopy (VFSS). 31 healthy subjects (15♂, 16♀) were tested over the course of 1350 swallows and 19 (17♂, 2♀) non-healthy patients over the course of 54 swallows. The signal curves obtained from both transcutaneous and subcutaneous measurement were similar, characteristic and reproducible (r > 0.5) and correlated with anatomical and functional changes during the pharyngeal phase of swallowing observed using VFSS. Statistically significant differences between head movements and swallowing movements, food volumes and consistencies were found. Neither the conductivity of the food, the sex of the test subject nor the position of the measurement electrodes exerted a statistically significant effect on the measured signal. EMBI is able to reproducibly map the pharyngeal phase of swallowing and changes associated with it both transcutaneously and subcutaneously. The procedure therefore appears to be suitable for use in performing automated evaluation of the swallowing process and for use as a component of an implant.


Dysphagia Diagnosis Pharyngeal phase of swallowing Bioimpedance EMG 



The authors would like to thank Dr. Arndt (Radiology Unit, ukb) and Dr. S. Wolter (ENT Unit, ukb) for their support in performing the radiology investigations.


  1. 1.
    Broniatowski M, Grundfest-Broniatowski S, Hadley AJ, Shah NS, Barbu AM, Phillipbar SA, Strohl KP, Tucker HM, Tyler DJ (2010) Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment. Laryngoscope 120:76–83PubMedCrossRefGoogle Scholar
  2. 2.
    Broniatowski M, Grundfest-Broniatowski S, Tyler DJ, Scolieri P, Abbass F, Tucker HM, Brodsky S (2001) Dynamic laryngotracheal closure for aspiration: a preliminary report. Laryngoscope 111:2032–2040PubMedCrossRefGoogle Scholar
  3. 3.
    Freed ML, Chatburn RL, Christian M (2001) Electrical stimulation for swallowing disorders caused by stroke. Respir Care 46:466–474PubMedGoogle Scholar
  4. 4.
    Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies C, Crujido L (2007) Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia 22:1–10PubMedCrossRefGoogle Scholar
  5. 5.
    Burnett TA, Mann EA, Cornell SA, Ludlow CL (2003) Laryngeal elevation achieved by neuromuscular stimulation at rest. J Appl Physiol 94:128–134PubMedGoogle Scholar
  6. 6.
    Burnett TA, Mann EA, Stoklosa JB, Ludlow CL (2005) Self-triggered functional electrical stimulation during swallowing. J Neurophysiol 94:4011–4018PubMedCrossRefGoogle Scholar
  7. 7.
    Leelamanit V, Limsakul C, Geater A (2002) Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope 112:2204–2210PubMedCrossRefGoogle Scholar
  8. 8.
    Park J-W, Oh J-C, Lee H, Park S-J, Yoon T-S, Kwon B (2009) Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing. Dysphagia 24(3):296–301. doi: 10.1007/s00455-008-9205-9 PubMedCrossRefGoogle Scholar
  9. 9.
    Yamamoto Y, Nakamura T, Seki Y, Utsuyama K, Akashi K, Jikuya K (2000) Neck electrical impedance for measurement of swallowing. Electr Eng Jpn 130:210–217CrossRefGoogle Scholar
  10. 10.
    Nahrstaedt H, Schauer T, Seidl RO (2010) Bioimpedance based measurement system for a controlled swallowing neuroprosthesis. In: Proccedings of 15th Annual International FES Society Conference and 10th Vienna Int. Workshop on FES, Wien, pp 40–51Google Scholar
  11. 11.
    Hunter JE, Schmidt FL (2000) Fixed effects vs. random effects meta-analysis models: implications for cumulative knowledge in psychology. Int J Sel Assess 8:275–292CrossRefGoogle Scholar
  12. 12.
    Lukaski HC, Bolonchuk WW, Hall CB, Siders WA (1986) Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol 60(4):1327–1332PubMedGoogle Scholar
  13. 13.
    Sia I, Carvajal P, Carnaby-Mann G, Crary M (2012) Measurement of hyoid and laryngeal displacement in video fluoroscopic swallowing studies: variability, reliability, and measurement error. Dysphagia 27(2):192–197. doi: 10.1007/s00455-011-9352-2 PubMedCrossRefGoogle Scholar
  14. 14.
    McCullough GH, Wertz RT, Rosenbek JC, Mills RH, Webb WG, Ross KB (2001) Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia 16:110–118PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly AM, Leslie P, Beale T, Payten C, Drinnan MJ (2006) Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity? Clin Otolaryngol 31(5):425–432PubMedCrossRefGoogle Scholar
  16. 16.
    Kendall KA, McKenzie S, Leonard RJ, Goncalves MI (2000) Timing of events in normal swallowing: a videofluoroscopic study. Dysphagia 15:74–83PubMedGoogle Scholar
  17. 17.
    Reimers-Neils L, Logemann JA, Larson C (1994) Viscosity effects on emg activity in normal swallow. Dysphagia 9:101–106PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Corinna Schultheiss
    • 1
    Email author
  • Thomas Schauer
    • 2
  • Holger Nahrstaedt
    • 2
  • Rainer O. Seidl
    • 1
  1. 1.Klinik für Hals, Nasen, Ohrenheilkunde Unfallkrankenhaus BerlinBerlinGermany
  2. 2.Control Systems Group (Prof. Dr.-Ing. J. Raisch)Technische Universität BerlinBerlinGermany

Personalised recommendations