Jijakli Amr, Borders James C, Gottlieb Amy, Ramirez Emily, Leonard Rebecca, Langmore Susan E, Murray Joseph, Pisegna Jessica M
Boston University School of Public Health, Boston, MA, United States of America.
Department of Otolaryngology, Boston Medical Center, Boston, MA, United States of America.
Am J Otolaryngol. 2023 Mar-Apr;44(2):103757. doi: 10.1016/j.amjoto.2022.103757. Epub 2023 Jan 25.
Epiglottic inversion, which provides one layer of the requisite protection of the airway during swallowing, is dependent on a number of biomechanical forces. The aim of this study was to examine the association between swallowing mechanics, as visualized during a Modified Barium Swallow (MBS) exam, and the rating of epiglottic inversion as seen on Flexible Endoscopic Evaluation of Swallowing (FEES).
This study analyzed twenty-five adult outpatients referred for a simultaneous FEES/MBS exams. Each participant swallowed a 5 mL thin liquid bolus, which was the bolus size analyzed for this study's question. Epiglottic inversion, as seen on FEES, was rated by three independent raters. Additionally, twelve swallowing landmarks tracked the shape change of each participant's swallow on the MBS video using a MatLab-specific tracking tool. Analyses were run to determine mean differences in swallowing shape change between the swallows across 3 groups: complete, reduced, and absent epiglottic inversion, as seen on FEES. Using a Computerized Analysis of Swallowing Mechanics (CASM), canonical variate analyses and discriminant function testing were carried out. Other swallowing mechanics were also analyzed for kinematic movements to isolate the function of the hyoid and larynx. A two-sample t-test was conducted to compare mean hyolaryngeal movement between complete and incomplete epiglottic inversion groups.
Overall swallowing shape changes were statistically significantly different between the absent, reduced, and complete epiglottic inversion groups on FEES. Canonical variate analyses revealed a significant overall effect of shape change between the groups (eigenvalue = 2.46, p < 0.0001). However, no statistically significant differences were found on hyoid excursion (p = 0.37) and laryngeal elevation (p = 0.06) kinematic measurements between patients with complete and incomplete epiglottic inversion on FEES.
Epiglottic inversion on FEES is a valuable rating that infers reduced range of motion of structures that cannot be seen on FEES. This small sample of patients suggests that FEES ratings of absent epiglottic inversion may represent gestalt reduction in swallowing mechanics.
会厌反转在吞咽过程中为气道提供了一层必要的保护，它依赖于多种生物力学力量。本研究的目的是检查在改良钡餐吞咽（MBS）检查中可视化的吞咽力学与吞咽功能的纤维内镜评估（FEES）中所见的会厌反转评级之间的关联。
本研究分析了25名被转诊同时进行FEES/MBS检查的成年门诊患者。每位参与者吞咽了5毫升稀液体团块，这是本研究问题所分析的团块大小。FEES上所见的会厌反转由三名独立评估者进行评级。此外，使用特定于MatLab的跟踪工具，在MBS视频上通过12个吞咽标志点跟踪每位参与者吞咽时的形状变化。进行分析以确定在FEES上所见的三组吞咽形状变化的平均差异：完全会厌反转、会厌反转减少和会厌反转缺失。使用吞咽力学计算机分析（CASM）进行典型变量分析和判别函数测试。还分析了其他吞咽力学的运动学动作，以分离舌骨和喉部的功能。进行双样本t检验以比较完全会厌反转组和不完全会厌反转组之间的平均舌骨喉运动。
在FEES上，会厌反转缺失、减少和完全会厌反转组之间的总体吞咽形状变化在统计学上有显著差异。典型变量分析显示各组之间形状变化有显著总体效应（特征值 = 2.46，p < 0.0001）。然而，在FEES上完全会厌反转和不完全会厌反转患者之间的舌骨偏移（p = 0.37）和喉部抬高（p = 0.06）运动学测量上未发现统计学显著差异。
FEES上的会厌反转是一项有价值的评级，可推断在FEES上看不到的结构的运动范围减小。这一小部分患者表明，FEES上会厌反转缺失的评级可能代表吞咽力学的整体降低。
