Toronto Rehabilitation Institute, University of Toronto, Toronto, ON, Canada.
Clin Otolaryngol. 2011 Feb;36(1):30-6. doi: 10.1111/j.1749-4486.2010.02219.x.
Reduced range of hyoid and laryngeal movement is thought to contribute to aspiration risk and pharyngeal residues in dysphagia. Our aim was to determine the extent to which movements of the hyoid and larynx are correlated in the superior and anterior directions in swallowing, and whether movement range is predictive of penetration-aspiration or pharyngeal residue.
Prospective, single-blind study of penetration-aspiration and pharyngeal residue with objective frame-by-frame measures of hyoid and laryngeal excursion from videofluoroscopy.
Tertiary hospital and rehabilitation teaching hospital.
Twenty-eight participants referred for videofluoroscopy: 13 women, aged 57-77; 15 men, aged 54-70. Individuals with known neurodegenerative diseases or prior surgery to the neck were excluded. Each swallowed three boluses of 40% w/v thin liquid barium suspension.
Two speech-language pathologists independently rated penetration-aspiration, vallecular and pyriform sinus residue. Cervical spine length, hyoid and laryngeal displacement were traced frame-by-frame. Predictive power was calculated.
Cervical spine length was significantly greater in men. Hyoid displacement ranged from 34-63% of the C2-4 distance. Arytenoid displacement ranged from 18-66%, with significantly smaller anterior displacement in men. Positive hyoid-laryngeal movement correlations in both axes were the most common pattern observed. Participants with reduced displacement ranges (≤ first quartile) and with abnormal correlation patterns were more likely to display penetration-aspiration. Those with reduced anterior hyoid displacement and abnormal correlation patterns had a greater risk of post-swallow pharyngeal residues.
It is difficult for clinicians to make on-line appraisals of the extent to which hyoid and laryngeal movement may be contributing to functional swallowing consequences during videofluoroscopy. This study suggests that it is most important for clinicians to discern whether reduced anterior displacement of these structures is contributing to a patient's swallowing impairment. Measures of structural displacement in thin liquid swallowing should be corrected for variations in participant height. Reductions in anterior hyoid and laryngeal movement below the first-quartile boundaries are statistically associated with increased risk for penetration-aspiration and post-swallow residues.
人们认为，会厌和喉的运动范围减小会增加吞咽时的吸入风险和咽部残留物。本研究旨在确定在吞咽过程中，会厌和喉在向上和向前方向上的运动程度是否相关，以及运动范围是否可以预测渗透-吸入或咽部残留物。
前瞻性、单盲研究，使用视频透视法对会厌和喉的运动进行客观的逐帧测量，以确定渗透-吸入和咽部残留物。
三级医院和康复教学医院。
28 名参与者接受了视频透视检查：13 名女性，年龄 57-77 岁；15 名男性，年龄 54-70 岁。排除已知患有神经退行性疾病或颈部先前手术的个体。每个人吞咽 3 次 40%w/v 稀薄钡悬浮液。
两名言语病理学家独立评估了渗透-吸入、梨状窦和下咽残留物。颈椎长度、会厌和喉的位移被逐帧追踪。计算了预测能力。
男性的颈椎长度显著更大。会厌位移范围为 C2-4 距离的 34-63%。杓状软骨位移范围为 18-66%，男性的前向位移明显较小。在两个轴上，阳性的会厌-喉运动相关性是最常见的观察到的模式。运动范围减小（≤第一四分位数）和异常相关模式的参与者更有可能显示渗透-吸入。那些有减少的前会厌位移和异常相关模式的人，有更大的风险在吞咽后有咽部残留物。
在视频透视检查期间，临床医生很难在线评估会厌和喉的运动程度可能对功能吞咽结果的影响。本研究表明，对于临床医生来说，最重要的是要辨别这些结构的前向位移是否对患者的吞咽障碍有影响。在稀薄液体吞咽中，结构位移的测量应该根据参与者身高的变化进行校正。前会厌和喉运动的减少低于第一四分位数的界限与渗透-吸入和吞咽后残留物的风险增加有统计学上的关联。
