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Relationship Between Tongue Pressure and Pharyngeal Function Assessed Using High-Resolution Manometry in Older Dysphagia Patients with Sarcopenia: A Pilot Study

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Abstract

Tongue pressure is often used to evaluate swallowing muscle strength in dysphagia patients with sarcopenia. However, the amount of tongue pressure that reflects pharyngeal swallowing function is unclear. The aims of this descriptive study were (1) to assess the association between tongue pressure and swallowing function using high-resolution manometry (HRM), (2) to evaluate whether manometric parameters were related to maximum tongue pressure (MTP) and other sarcopenia-related factors, and (3) to evaluate the manometric characteristics of pharyngeal swallowing in sarcopenic dysphagia. Sixteen patients with dysphagia (13 men; mean age 85.0 ± 6.6) who were diagnosed with sarcopenia and sixteen healthy subjects (10 men; mean age 33.6 ± 7.2) were included. Evaluation of HRM parameters including velopharyngeal contractile integral (VPCI), mesohypopharyngeal contractile integral (MHPCI), upper esophageal sphincter (UES) relaxation duration, and UES nadir pressure was performed. HRM parameters of patients were compared with MTP, sarcopenia factors, and manometric parameters of healthy subjects. The VPCI showed no statistically significant differences between patient and healthy groups. In the patient group, the MHPCI was significantly lower (126.1 ± 76.6 vs 193.2 ± 34.1 mmHg cm s; p = 0.003), UES nadir pressure was significantly higher (10.5 ± 27.5 vs − 11.2 ± 6.7 mmHg; p < 0.001), and UES relaxation duration (318.0 ± 152.4 vs 520.6 ± 60.0 ms; p = 0.007) was significantly shorter than those in the healthy group. HRM parameters were not significantly correlated with MTP and sarcopenia factors. Older dysphagia patients with sarcopenia had weaker pharyngeal contractility and UES dysfunction. Manometric evaluation of pharyngeal function may not be significantly associated with MTP and sarcopenia-related factors. Further study is needed to clinically apply tongue pressure for evaluating sarcopenic dysphagia.

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References

  1. Delmonico MJ, Harris TB, Lee JS, Visser M, Nevitt M, Kritchevsky SB, Tylavsky FA, Newman AB. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc. 2007;55:769–74.

    Article  Google Scholar 

  2. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A. 2006;61:1059–64.

    Article  Google Scholar 

  3. Fujishima I, Fujiu Kurachi M, Arai H, Hyodo M, Kagaya H, Maeda K, Mori T, Nishioka S, Oshima F, Ogawa S, Ueda K, Umezaki T, Wakabayashi H, Yamawaki M, Yoshimura Y. Sarcopenia and dysphagia: position paper by four professional organizations. Geriatr Gerontol Int. 2019;19:91–7.

    Article  Google Scholar 

  4. Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle. 2014;5:269–77.

    Article  Google Scholar 

  5. Maeda K, Akagi J. Treatment of sarcopenic dysphagia with rehabilitation and nutritional support: a comprehensive approach. J Acad Nutr Diet. 2016;116:573–7.

    Article  Google Scholar 

  6. Wakabayashi H. Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders. J Frailty Aging. 2014;3:97–103.

    CAS  PubMed  Google Scholar 

  7. Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12:259–70.

    Article  Google Scholar 

  8. Takashi M, Ichiro F, Hidetaka W, Masataka I, Kenjiro K, Jun K, Shinta N, Akiko S, Yoshitoshi K, Minoru Y, Sumito O. Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia. JCSM Clin Rep. 2017;2:e00017.

    Google Scholar 

  9. Maeda K, Takaki M, Akagi J. Decreased skeletal muscle mass and risk factors of sarcopenic dysphagia: a prospective observational cohort study. J Gerontol A. 2017;72:1290–4.

    Google Scholar 

  10. Bonilha HS, Simpson AN, Ellis C. The one-year attributable cost of post-stroke dysphagia. Dysphagia. 2014;29:545–52.

    Article  Google Scholar 

  11. Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;136:784–9.

    Article  Google Scholar 

  12. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–23.

    Article  Google Scholar 

  13. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JS, Lee WJ, Lee Y, Liang CK, Limpawattana P, Lin CS, Peng LN, Satake S, Suzuki T, Won CW, Wu CH, Wu SN, Zhang T, Zeng P, Akishita M, Arai H. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15:95–101.

    Article  Google Scholar 

  14. Maeda K, Akagi J. Sarcopenia is an independent risk factor of dysphagia in hospitalized older people. Geriatr Gerontol Int. 2016;16:515–21.

    Article  Google Scholar 

  15. Yoshida M, Kikutani T, Tsuga K, Utanohara Y, Hayashi R, Akagawa Y. Decreased tongue pressure reflects symptom of dysphagia. Dysphagia. 2006;21:61–5.

    Article  Google Scholar 

  16. Ball S, Idel O, Cotton SM, Perry A. Comparison of two methods for measuring tongue pressure during swallowing in people with head and neck cancer. Dysphagia. 2006;21:28–37.

    Article  Google Scholar 

  17. Utanohara Y, Hayashi R, Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y. Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia. 2008;23:286–90.

    Article  Google Scholar 

  18. Hirota N, Konaka K, Ono T, Tamine K, Kondo J, Hori K, Yoshimuta Y, Maeda Y, Sakoda S, Naritomi H. Reduced tongue pressure against the hard palate on the paralyzed side during swallowing predicts Dysphagia in patients with acute stroke. Stroke. 2010;41:2982–4.

    Article  Google Scholar 

  19. Knigge MA, Thibeault S. Relationship between tongue base region pressures and vallecular clearance. Dysphagia. 2016;31:391–7.

    Article  Google Scholar 

  20. Minagi Y, Ono T, Hori K, Fujiwara S, Tokuda Y, Murakami K, Maeda Y, Sakoda S, Yokoe M, Mihara M, Mochizuki H. Relationships between dysphagia and tongue pressure during swallowing in Parkinson's disease patients. J Oral Rehabil. 2018;45:459–66.

    Article  CAS  Google Scholar 

  21. Sakai K, Nakayama E, Tohara H, Takahashi O, Ohnishi S, Tsuzuki H, Hayata M, Takehisa T, Takehisa Y, Ueda K. Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: a cross-sectional observational study. Clin Nutr. 2018;38:303–9.

    Article  Google Scholar 

  22. Butler SG, Stuart A, Wilhelm E, Rees C, Williamson J, Kritchevsky S. The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphagia. 2011;26:225–31.

    Article  Google Scholar 

  23. Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia. 2015;30:80–7.

    Article  Google Scholar 

  24. Nativ-Zeltzer N, Kahrilas PJ, Logemann JA. Manofluorography in the evaluation of oropharyngeal dysphagia. Dysphagia. 2012;27:151–61.

    Article  Google Scholar 

  25. Granger CV, Hamilton BB, Zielezny M, Sherwin FS. Advances in functional assessment in medical rehabilitation. Top Geriatr Rehabil. 1986;1:59–74.

    Article  Google Scholar 

  26. Kunieda K, Ohno T, Fujishima I, Hojo K, Morita T. Reliability and validity of a tool to measure the severity of dysphagia: the food intake LEVEL scale. J Pain Symptom Manag. 2013;46:201–6.

    Article  Google Scholar 

  27. Tohara H, Saitoh E, Mays KA, Kuhlemeier K, Palmer JB. Three tests for predicting aspiration without videofluorography. Dysphagia. 2003;18:126–34.

    Article  Google Scholar 

  28. O'Rourke A, Humphries K, Lazar A. The pharyngeal contractile integral is a useful indicator of pharyngeal swallowing impairment. Neurogastroenterol Motil. 2017;29:e13144.

    Article  Google Scholar 

  29. Omari TI, Miki K, Davidson G, Fraser R, Haslam R, Goldsworthy W, Bakewell M, Dent J. Characterisation of relaxation of the lower oesophageal sphincter in healthy premature infants. Gut. 1997;40:370–5.

    Article  CAS  Google Scholar 

  30. Robbins J, Humpal NS, Banaszynski K, Hind J, Rogus-Pulia N. Age-related differences in pressures generated during isometric presses and swallows by healthy adults. Dysphagia. 2016;31:90–6.

    Article  Google Scholar 

  31. Nativ-Zeltzer N, Logemann JA, Zecker SG, Kahrilas PJ. Pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography-a normative study of younger and older adults. Neurogastroenterol Motil. 2016;28:721–31.

    Article  CAS  Google Scholar 

  32. Cock C, Omari T. Systematic review of pharyngeal and esophageal manometry in healthy or dysphagic older persons (%3e60 years). Geriatrics. 2018;3:E67.

    Article  Google Scholar 

  33. Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154:953–63.

    Article  CAS  Google Scholar 

  34. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122:1314–21.

    Article  Google Scholar 

  35. Roubenoff R, Hughes VA. Sarcopenia: current concepts. J Gerontol A Biol Sci Med Sci. 2000;55:M716–M724724.

    Article  CAS  Google Scholar 

  36. Carmeli E, Coleman R, Reznick AZ. The biochemistry of aging muscle. Exp Gerontol. 2002;37:477–89.

    Article  CAS  Google Scholar 

  37. Grelot L, Barillot JC, Bianchi AL. Pharyngeal motoneurones: respiratory-related activity and responses to laryngeal afferents in the decerebrate cat. Exp Brain Res. 1989;78:336–44.

    CAS  PubMed  Google Scholar 

  38. Szczesniak MM, Wu PI, Maclean J, Omari TI, Cook IJ. The critical importance of pharyngeal contractile forces on the validity of intrabolus pressure as a predictor of impaired pharyngo-esophageal junction compliance. Neurogastroenterol Motil. 2018;30:e13374.

    Article  CAS  Google Scholar 

Download references

Acknowledgement

Thanks to Jun Kayashita who kindly measured the viscosity of the thickened liquid.

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Authors and Affiliations

  1. Department of Neurology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu-City, Gifu, 501-1194, Japan

    Kenjiro Kunieda

  2. Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan

    Kenjiro Kunieda, Ichiro Fujishima & Tomohisa Ohno

  3. Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Japan

    Hidetaka Wakabayashi

  4. Department of Rehabilitation Medicine, Seirei Awaji Hospital, Awaji, Japan

    Takashi Shigematsu

  5. Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan

    Masataka Itoda

  6. Department of Rehabilitation, Japanese Red Cross Society Suwa Hospital, Suwa, Japan

    Fumiko Oshima

  7. Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Koriyama, Japan

    Takashi Mori

  8. Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Nami Ogawa

  9. Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Sumito Ogawa

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  1. Kenjiro Kunieda
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Correspondence to Kenjiro Kunieda.

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Kunieda, K., Fujishima, I., Wakabayashi, H. et al. Relationship Between Tongue Pressure and Pharyngeal Function Assessed Using High-Resolution Manometry in Older Dysphagia Patients with Sarcopenia: A Pilot Study. Dysphagia 36, 33–40 (2021). https://doi.org/10.1007/s00455-020-10095-1

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  • DOI: https://doi.org/10.1007/s00455-020-10095-1

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