Longitudinal Kinematic Evaluation of Pharyngeal Swallowing Impairment in Thyroidectomy Patients.

The aim of this study was to assess pharyngeal swallowing impairments in thyroidectomy patients and to delineate the contributory kinematic components. Forty consecutive patients (mean age = 47.33 years) and fourteen age- and sex-matched heathy adult volunteers (mean age = 42.64 years) participated in this study. A videofluoroscopic swallowing study (VFSS) was performed 1 day prior to surgery, and at 1 week and 3 months post-surgery. VFSS images were evaluated using the Modified Barium Swallowing Impairment Profile (MBSImp). Kinematic and temporal aspects of swallowing were characterized by measurement of maximum hyoid and laryngeal excursion, pharyngeal transit duration, laryngeal response duration (LRD), and laryngeal closure duration at each three time-points. At 1 week post-surgery, only pharyngeal impairment was significantly deteriorated than pre-surgery (p = 0.001). However, at 3 months, a significant improvement was observed to pre-surgery level (p = 0.01). Post-surgery, maximum hyoid excursion was significantly reduced in patients compared controls (p = 0.001). Although the maximal distance of the hyoid and the laryngeal excursion was shorter than before surgery, laryngeal excursion at all three time-points was similar to that of controls. At all three time-points, LRD was significantly longer in patients than in controls (p = 0.01). Following thyroidectomy, pharyngeal aspects of swallowing as measured by the MBSImp and kinematic aspects of swallowing were reduced with incomplete recovery at 3 months. These exploratory data may guide decision regarding management of pharyngeal swallowing impairment with patients undergoing total thyroidectomy.

The effects of dynamic laryngeal movements on pitch control.

BACKGROUND AND OBJECTIVES: Extralaryngeal structures have been known to not only play an important role in swallowing, but also have a significant influence on the voice during phonation. The aim of this study is to evaluate the effect of dynamic laryngeal movements on pitch control. SUBJECTS AND METHODS: Videofluoroscopic examinations were analyzed. To accurately analyze the sequence of these movements, the recorded images were digitized using a computer program. The moving distances of the hyoid bone, thyroid cartilage, and cricoid cartilage were analyzed, and they were compared to the cricothyroid distance during pitch elevation. RESULTS: The vertical movements of the hyoid bone, and cricoid and thyroid cartilages had an impact on the increase in the pitch with a decrease in the cricothyroid distance. All Ad-R(2) values for distance of the hyoid bone, and cricoid and thyroid cartilages were above 0.9, which showed a higher explanatory power than the cricothyroid distance, showing an Ad-R(2) value of 0.4. CONCLUSIONS: Upward movements of the larynx had a more dominant effect on pitch elevation than the cricothyroid distance. We suspect that the pitch is more affected by the antero-vertical movements of the larynx than the horizontal movement by cricothyroid muscle in human study.

Swallowing outcomes in patients with subcortical stroke associated with lesions of the caudate nucleus and insula.

Objective The present study was performed to investigate the relationships between swallowing outcomes and lesion location, bolus characteristics, and age in patients with subcortical stroke. PATIENTS: Patients with subcortical and insular stroke (mean age, 57.38 ± 12.71 years) were investigated. All patients (n = 21) completed both brain magnetic resonance imaging studies and videofluoroscopic swallowing studies. Main Outcome Measures The oral transit duration, pharyngeal transit duration (PTD), laryngeal response duration, and Penetration-Aspiration Scale (PAS) score were applied to examine the efficiency of propulsion and airway protection in three swallowing tasks. Path analyses were performed to assess the relationships between swallowing outcomes and lesion location, age, bolus viscosity, and bolus volume. Results Caudate nucleus (CN) lesions were associated with higher PAS scores. Insular lesions were associated with a longer PTD. Advanced age was associated with a longer PTD. Bolus viscosity significantly moderated the association between CN lesions and higher PAS scores. Conclusions In the present cohort, CN lesions impacted airway protection and insular lesions impacted pharyngeal transit. An increased bolus viscosity reduced the aspiration severity. These results suggest that lesion location is an important indicator to predict subsequent dysphagia in patients with subcortical stroke.