pp 1–7 | Cite as

The Prediction of Risk of Penetration–Aspiration Via Hyoid Bone Displacement Features

  • Zhenwei Zhang
  • Subashan Perera
  • Cara Donohue
  • Atsuko Kurosu
  • Amanda S. Mahoney
  • James L. Coyle
  • Ervin SejdićEmail author
Original Article


Videofluoroscopic swallow studies are widely used in clinical and research settings to assess swallow function and to determine physiological impairments, diet recommendations, and treatment goals for people with dysphagia. Videofluoroscopy can be used to analyze biomechanical events of swallowing, including hyoid bone displacement, to differentiate between normal and disordered swallow functions. Previous research has found significant associations between hyoid bone displacement and penetration/aspiration during swallowing, but the predictive value of hyoid bone displacement during swallowing has not been explored. The primary objective of this study was to build a model based on aspects of hyoid bone displacement during swallowing to predict the extent of airway penetration or aspiration during swallowing. Aspects of hyoid bone displacement from 1433 swallows from patients referred for videofluoroscopy were analyzed to determine which aspects predicted risk of penetration and aspiration according to the Penetration–Aspiration Scale. A generalized estimating equation incorporating components of hyoid bone displacement and variables shown to impact penetration and aspiration (such as age, bolus volume, and viscosity) was used to evaluate penetration and aspiration risk. Results indicated that anterior-horizontal hyoid bone displacement was the only aspect of hyoid bone displacement predictive of penetration and aspiration risk. Further research should focus on improving the model performance by identifying additional physiological swallowing events that predict penetration and aspiration risk. The model built for this study, and future modified models, will be beneficial for clinicians to use in the assessment and treatment of people with dysphagia, and for potentially tracking improvement in hyolaryngeal excursion resulting from dysphagia treatment, thus mitigating adverse outcomes that can occur secondary to dysphagia.


Hyoid bone Penetration/aspiration Deglutition Generalized estimation equation Deglutition disorders 



The authors acknowledge Dr. Aliaa Elbahnasy Sabry for her critical review and suggestions on the final manuscript.


This study was funded by two grants from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD092239, while the data was 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.

Compliance with Ethical Standards

Conflict of interest

We have no conflict of interest to declare.

Ethical Approval

All procedures performed in studies 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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259–70.CrossRefPubMedGoogle Scholar
  2. 2.
    Dudik JM, Coyle JL, El-Jaroudi A, Sun M, Sejdić E. A matched dual-tree wavelet denoising for tri-axial swallowing vibrations. Biomed Signal Process Control. 2016;27:112–21.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Miller AJ. The neurobiology of swallowing and dysphagia. Dev Disabil Res Rev. 2008;14(2):77–86.CrossRefPubMedGoogle Scholar
  4. 4.
    Movahedi F, Kurosu A, Coyle JL, Perera S, Sejdić E. Anatomical directional dissimilarities in tri-axial swallowing accelerometry signals. IEEE Trans Neural Syst Rehabilit Eng. 2017;25(5):447–58.CrossRefGoogle Scholar
  5. 5.
    Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Murray J. Manual of dysphagia assessment in adults. Boston: Cengage Learning; 1999.Google Scholar
  7. 7.
    Lazarus C, Logemann A. Swallowing disorders in closed head trauma patients. Arch Phys Med Rehabil. 1987;68(2):79–84.PubMedGoogle Scholar
  8. 8.
    Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116(2):455–78.CrossRefPubMedGoogle Scholar
  9. 9.
    Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke. Br Med J. 1987;295(6595):411–4.CrossRefGoogle Scholar
  10. 10.
    Humbert IA, Robbins J. Dysphagia in the elderly. Phys Med Rehabil Clin N Am. 2008;19(4):853–66.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gorell JM, Johnson CC, Rybicki BA. Parkinson’s disease and its comorbid disorders An analysis of Michigan mortality data, 1970 to 1990. Neurology. 1994;44(10):1865–1865.CrossRefPubMedGoogle Scholar
  12. 12.
    Coyle JL, Davis LA, Easterling C, Graner DE, Langmore S, Leder SB, Lefton-Greif MA, Leslie P, Logemann JA, Mackay L, Martin-Harris B, Murray JT, Sonies B, Steele CM. Oropharyngeal dysphagia assessment and treatment efficacy: setting the record straight (response to Campbell–Taylor). J Am Med Directors Assoc. 2009;10(1):62–6.CrossRefGoogle Scholar
  13. 13.
    Rugiu M. Role of videofluoroscopy in evaluation of neurologic dysphagia. Acta Otorhinolaryngol Ital. 2007;27(6):306.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26(1):67–74.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim Y, McCullough GH. Maximum hyoid displacement in normal swallowing. Dysphagia. 2008;23(3):274–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Kang B-S, Oh B-M, Kim IS, Chung SG, Kim SJ, Han TR. Influence of aging on movement of the hyoid bone and epiglottis during normal swallowing: a motion analysis. Gerontology. 2010;56(5):474–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19(4):769–85.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Zhang Z, Kurosu A, Coyle J, Perera S, Sejdić E. Hyoid displacement during swallowing is related to penetration–aspiration scores. Under Review.Google Scholar
  19. 19.
    Kendall KA, Leonard RJ. Hyoid movement during swallowing in older patients with dysphagia. Arch Otolaryngol Head Neck Surg. 2001;127(10):1224–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Perlman AL, Booth B, Grayhack J. Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia. 1994;9(2):90–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Su J, Yuan C, Shu K. Hyoid bone displacement during swallowing have no association with penetration/aspiration severity in dysphagic stroke patients. Arch Phys Med Rehabil. 2014;95(10):e16.Google Scholar
  22. 22.
    Molfenter SM, Steele CM. Kinematic and temporal factors associated with penetration–aspiration in swallowing liquids. Dysphagia. 2014;29(2):269–76.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Seo HG, Oh B-M, Han TR. Swallowing kinematics and factors associated with laryngeal penetration and aspiration in stroke survivors with dysphagia. Dysphagia. 2016;31(2):160–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration–aspiration scale. Dysphagia. 1996;11(2):93–8.CrossRefGoogle Scholar
  25. 25.
    Lof GL, Robbins J. Test–retest variability in normal swallowing. Dysphagia. 1990;4(4):236–42.CrossRefPubMedGoogle Scholar
  26. 26.
    Wang M. Generalized estimating equations in longitudinal data analysis: a review and recent developments. Adv Stat. 2014. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Zhenwei Zhang
    • 1
  • Subashan Perera
    • 2
  • Cara Donohue
    • 3
  • Atsuko Kurosu
    • 3
  • Amanda S. Mahoney
    • 3
  • James L. Coyle
    • 3
  • Ervin Sejdić
    • 1
    Email author
  1. 1.Department of Electrical and Computer Engineering, Swanson School of EngineeringUniversity of PittsburghPittsburghUSA
  2. 2.Division of Geriatrics, Department of MedicineUniversity of PittsburghPittsburghUSA
  3. 3.Department of Communication Science and DisordersUniversity of PittsburghPittsburghUSA

Personalised recommendations