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Impact of Thickened Liquids on Laryngeal Movement Velocity in Patients with Dysphagia

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Abstract

Considering that thickened liquids are frequently used for patients with dysphagia, elucidating their impact on laryngeal dynamics is important. Although studies have investigated the impact of thickened liquids on laryngeal movement velocity among healthy young adults, no study has examined the same among patients with dysphagia. We aimed to elucidate the influence of bolus consistency on laryngeal movement velocity and surface electromyographic activity of the suprahyoid muscles in patients with dysphagia. Participants included 18 male, poststroke patients with dysphagia, whereas patients with true bulbar paralysis, head and neck cancer, neuromuscular disease, or recurrent nerve paralysis were excluded. A video fluoroscopic swallowing study (VFSS) was performed while swallowing 3 mL of moderately thick and thin liquids. Quantitative VFSS analysis, including factors such as laryngeal peak velocity, laryngeal mean velocity, laryngeal movement distance, duration of the laryngeal elevation movement, and the temporal location of laryngeal vestibule closure within the laryngeal elevation movement was performed. Muscle activity was evaluated using integrated muscles activity values obtained from electromyography (iEMG) of the suprahyoid muscle during swallowing. VFSS analysis showed that laryngeal peak velocity and laryngeal mean velocity were significantly faster while swallowing moderately thick than while swallowing thin liquids. Laryngeal movement distance was significantly greater while swallowing moderately thick than while swallowing thin liquids. iEMG was significantly higher while swallowing moderately thick liquids than while swallowing thin liquids. Compared to thin liquids, moderately thick induced an increase in laryngeal movement velocity and in suprahyoid muscle activity among patients with dysphagia, a finding consistent with that of a previous study among healthy adults.

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References

  1. Robbins J, Nicosia M, Hind JA, Gill GD, Blanco R, Logemann J. Defining physical properties of fluids for dysphagia evaluation and treatment. Perspect Swallow Swallow Disorders (Dysphagia). 2002;11(2):16–9. https://doi.org/10.1044/sasd11.2.16.

    Article  Google Scholar 

  2. Cichero JA. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12:54. https://doi.org/10.1186/1475-2891-12-54.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Hear Res. 1994;37(5):1041–59. https://doi.org/10.1044/jshr.3705.1041.

    Article  CAS  PubMed  Google Scholar 

  4. Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258(5 Pt 1):G675-681. https://doi.org/10.1152/ajpgi.1990.258.5.G675.

    Article  CAS  PubMed  Google Scholar 

  5. Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16(2):119–22. https://doi.org/10.1007/s004550011003.

    Article  CAS  PubMed  Google Scholar 

  6. Trent A, Park T, Oommen E, Kim Y. The effects of bolus consistencies on the swallowing safety in poststroke patients. Commun Sci Disorders. 2014;19(2):249–55. https://doi.org/10.12963/csd.14129.

    Article  Google Scholar 

  7. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98. https://doi.org/10.2147/CIA.S23404.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zu Y, Yang Z, Perlman AL. Hyoid displacement in post-treatment cancer patients: preliminary findings. J Speech, Language, and Hear Res. 2011;54(3):813–20. https://doi.org/10.1044/1092-4388(2010/10-0077).

    Article  Google Scholar 

  9. 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 

  10. Rofes L, Arreola V, Mukherjee R, Swanson J, Clave P. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment Pharmacol Ther. 2014;39(10):1169–79. https://doi.org/10.1111/apt.12696.

    Article  CAS  PubMed  Google Scholar 

  11. Oommen ER, Kim Y, McCullough G. Stage transition and laryngeal closure in poststroke patients with dysphagia. Dysphagia. 2011;26(3):318–23. https://doi.org/10.1007/s00455-010-9314-0.

    Article  PubMed  Google Scholar 

  12. Lee SI, Yoo JY, Kim M, Ryu JS. Changes of timing variables in swallowing of boluses with different viscosities in patients with dysphagia. Arch Phys Med Rehabil. 2013;94(1):120–6. https://doi.org/10.1016/j.apmr.2012.07.016.

    Article  PubMed  Google Scholar 

  13. Lin PH, Hsiao TY, Chang YC, Ting LL, Chen WS, Chen SC, Wang TG. Effects of functional electrical stimulation on dysphagia caused by radiation therapy in patients with nasopharyngeal carcinoma. Support Care Cancer. 2011;19(1):91–9. https://doi.org/10.1007/s00520-009-0792-2.

    Article  PubMed  Google Scholar 

  14. Nagy A, Molfenter SM, Peladeau-Pigeon M, Stokely S, Steele CM. The effect of bolus consistency on hyoid velocity in healthy swallowing. Dysphagia. 2015;30(4):445–51. https://doi.org/10.1007/s00455-015-9621-6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nakao Y, Onishi H, Haji T, Shiromoto O, Fukuoka T, Saito S, Tabe Y, Kodama N, Domen K. A quantitative analysis of the laryngeal moving velocity during swallowing: the effect of bolus viscosity on laryngeal movement in healthy males. Deglutit: Off J Soc Swallow Dysphagia Japan. 2017;6(1):79–85.

    Google Scholar 

  16. Park J, Yoo W, Yoo B. Standard recipes for the preparation of thickened barium liquids used in the diagnosis of Dysphagia. Clin Nutr Res. 2019;8(4):265–71. https://doi.org/10.7762/cnr.2019.8.4.265.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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  Google Scholar 

  18. Ueda N, Nohara K, Kotani Y, Tanaka N, Okuno K, Sakai T. Effects of the bolus volume on hyoid movements in normal individuals. J Oral Rehabil. 2013;40(7):491–9. https://doi.org/10.1111/joor.12060.

    Article  CAS  PubMed  Google Scholar 

  19. 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 

  20. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. https://doi.org/10.1007/BF00417897.

    Article  CAS  PubMed  Google Scholar 

  21. Pearson WG Jr, Molfenter SM, Smith ZM, Steele CM. Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia. 2013;28(2):167–77. https://doi.org/10.1007/s00455-012-9426-9.

    Article  PubMed  Google Scholar 

  22. Inamoto Y, Saitoh E, Okada S, Kagaya H, Shibata S, Ota K, Baba M, Fujii N, Katada K, Wattanapan P, Palmer JB. The effect of bolus viscosity on laryngeal closure in swallowing: kinematic analysis using 320-row area detector CT. Dysphagia. 2013;28(1):33–42. https://doi.org/10.1007/s00455-012-9410-4.

    Article  PubMed  Google Scholar 

  23. Raut VV, McKee GJ, Johnston BT. Effect of bolus consistency on swallowing–does altering consistency help? Eur Arch Otorhinolaryngol. 2001;258(1):49–53. https://doi.org/10.1007/s004050000301.

    Article  CAS  PubMed  Google Scholar 

  24. Sia I, Crary MA, Kairalla J, Carnaby GD, Sheplak M, McCulloch T. Bolus volume and viscosity effects on pharyngeal swallowing power-How physiological bolus accommodation affects bolus dynamics. Neurogastroenterol Motil. 2018;30(12):e13481. https://doi.org/10.1111/nmo.13481.

    Article  PubMed  Google Scholar 

  25. Reimers-Neils L, Logemann J, Larson C. Viscosity effects on EMG activity in normal swallow. Dysphagia. 1994;9(2):101–6. https://doi.org/10.1007/bf00714596.

    Article  CAS  PubMed  Google Scholar 

  26. Taniguchi H, Tsukada T, Ootaki S, Yamada Y. Inoue M (2008) Correspondence between food consistency and suprahyoid muscle activity, tongue pressure, and bolus transit times during the oropharyngeal phase of swallowing. J Appl Physiol. 1985;105(3):791–9. https://doi.org/10.1152/japplphysiol.90485.2008.

    Article  Google Scholar 

  27. Zhu M, Yu B, Yang W, Jiang Y, Lu L, Huang Z, Chen S, Li G. Evaluation of normal swallowing functions by using dynamic high-density surface electromyography maps. Biomed Eng Online. 2017;16(1):133. https://doi.org/10.1186/s12938-017-0424-x.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wu S, Chu L, Liu CF, Zhang Q, Zhang YF, Zhou TF, Wang ZT, Ni RH, Li Y. Effect of Changes in Bolus Viscosity on Swallowing Muscles in Patients with Dysphagia after Stroke. Chin Med J (Engl). 2018;131(23):2868–70. https://doi.org/10.4103/0366-6999.246071.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pearson WG Jr, Davidoff AA, Smith ZM, Adams DE, Langmore SE. Impaired swallowing mechanics of post radiation therapy head and neck cancer patients: A retrospective videofluoroscopic study. World J Radiol. 2016;8(2):192–9. https://doi.org/10.4329/wjr.v8.i2.192.

    Article  PubMed  Google Scholar 

  30. Steele CM, Alsanei WA, Ayanikalath S, Barbon CE, Chen J, Cichero JA, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B, Lam P, Lecko C, Leigh C, Nagy A, Namasivayam AM, Nascimento WV, Odendaal I, Smith CH, Wang H. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015;30(1):2–26. https://doi.org/10.1007/s00455-014-9578-x.

    Article  PubMed  Google Scholar 

  31. Steele CM, Peladeau-Pigeon M, Barbon CAE, Guida BT, Namasivayam-MacDonald AM, Nascimento WV, Smaoui S, Tapson MS, Valenzano TJ, Waito AA, Wolkin TS. Reference Values for Healthy Swallowing Across the Range From Thin to Extremely Thick Liquids. J Speech Lang Hear Res. 2019;62(5):1338–63. https://doi.org/10.1044/2019_JSLHR-S-18-0448.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We gratefully acknowledge the work of past and present staffs of the Department of Rehabilitation, Hyogo College of Medicine College Hospital. This study was partly supported by the Japan Society for the Promotion of Science [KAKENHI (19H00462)].

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Authors and Affiliations

  1. Department of Rehabilitation, Hyogo College of Medicine College Hospital, 1-1 MukoGawa-cho, Nishinomiya City, Hyogo, 663-8501, Japan

    Yuta Nakao, Shota Saito & Tomoki Nanto

  2. Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan

    Hideo Onishi

  3. Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Okayama, Japan

    Tomoyuki Haji

  4. Department of Communication Science and Disorders, Prefectural University of Hiroshima, Hiroshima, Japan

    Osamu Shiromoto

  5. Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan

    Yuki Uchiyama & Kazuhisa Domen

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  1. Yuta Nakao
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Contributions

Conceptualization—YN, HO, TH, OS, and KD. Data curation—YN, SS, TN, and YU. Formal analysis—YN. Funding acquisition—YN. Investigation; Methodology—YN, HO, TH, and OS. Roles/Writing—original draft—YN. Writing—review & editing—YN, HO, TH, OS, YU, and KD.

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Correspondence to Yuta Nakao.

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The authors have no conflicts of interest to disclose.

Ethical Approval

This study was approved by the institutional ethics committee of Hyogo College of Medicine. All patients provided their written informed consent before VFSS.

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Nakao, Y., Onishi, H., Haji, T. et al. Impact of Thickened Liquids on Laryngeal Movement Velocity in Patients with Dysphagia. Dysphagia 37, 207–215 (2022). https://doi.org/10.1007/s00455-021-10267-7

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  • DOI: https://doi.org/10.1007/s00455-021-10267-7

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