The Prediction of Risk of Penetration–Aspiration Via Hyoid Bone Displacement Features
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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.
KeywordsHyoid 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.
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 was obtained from all individual participants included in the study.
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